Curriculum

Orthopedic Surgery Residency Program

Resident Schedule

Our program is designed to address the growth and development of each resident with progressive responsibility delegated as accumulated knowledge and skills warrant. The small size of the program permits a more individualized approach to resident needs.

The teaching staff is attuned to the needs for appropriate supervision at all levels of the residency and work closely with the program director in ongoing evaluation of residents.

PGY-1 - This preliminary year of training is structured to provide the resident as broad an exposure to areas in general surgery and internal medicine as are essential to building a good foundation for orthopaedic surgery. With this preliminary year incorporated into the orthopaedic residency, the program director can structure an ideal experience tailored to each resident. There is enough flexibility in this year to accommodate individual resident needs. The General Surgery residency program has been a long-standing fully accredited program at Monmouth Medical Center with a total of 20 residents. Medical students from Drexel University School of Medicine have clinical rotations in the surgery department as well. The surgical department staff is comprised of Board certified multi-specialty faculty including general, plastics, vascular, pediatric and neurosurgery. The six months assigned to General Surgery include exposure to vascular, pediatric, urologic, plastic, neurosurgical and otolaryngologic surgery. The resident is also assigned to the Surgical ICU and the Emergency Department for multi-system trauma for two months during this block. There are excellent opportunities for electives in infectious disease, rheumatology, neurology, rehabilitation medicine and other medical disciplines for the three-month block. Each resident is assigned to the orthopaedic service for three months. The program director in orthopaedic surgery works with his counterparts in surgery and medicine to assure that our resident is fully incorporated into all patient care activities and relevant conferences during each rotation, including the on-call schedules of departments and sections to which he is assigned. Timely evaluations are submitted to the program director.

The program is designed to provide increasing responsibility for patient care, teaching and research. The responsibilities are delineated as per year in training with flexibility and recognition of specific needs and abilities of each resident. A description by year is as follows:

PGY-1	1	2	3	4	5	6
	ICU/ED	ICU/ED	Vasc Surg	Ortho Surg	Ortho Surg	Ortho Surg
	7	8	9	10	11	12
	Neurology	Pain Mgmt	Rehab	Gen Surg	Gen Surg	Gen Surg

PGY-2 - This second year introduces a resident into the management of orthopaedic patients. The interviewing and physical examination skills, general patient management and competence with acute medical emergencies gained in the medical rotations provide the resident an excellent clinical foundation. The essentials of a proper orthopaedic evaluation are now added. The PGY-5 resident closely supervises the PGY-2 in developing this competence. Residents are encouraged to seek appropriate consultations from other services where needed in the pre-operative evaluation of orthopaedic patients and management of significant illnesses through surgery and post-operatively. The resident is assigned to assist in the operating room with progressive responsibility as demonstrated confidence warrants. Collateral experience with ambulatory orthopaedic patients is obtained during assignment to community orthopaedic clinics. Supervision by more senior residents and residents and attendings is present in all clinic assignments and daily rounds on the orthopaedic floor are made by PGY-2 residents withchief resident, intern and students.

PGY-2	1	2	3	4	5	6
	Adult Ortho/ Foot-Ankle	Adult Ortho/ Foot-Ankle	Adult Ortho/ Foot-Ankle	Adult Ortho/ Foot-Ankle	Adult Ortho/ Foot-Ankle	Adult Ortho/ Foot- Ankle
	7	8	9	10	11	12
	Sports Med	Sports Med	Sports Med	Sports Med	Sports Med	Sports Med

PGY-3 - The PGY-3 resident further develops his skills in the evaluation and management of ambulatory orthopaedic patients through a primary responsibility to the emergency room during the first six months of this year. He gains further experience in appropriate investigational studies needed to assess emergency orthopaedic situations, management of acute orthopaedic problems, and how to triage patients for admission. In all this, he is always supervised by a member of the teaching staff in a consultative role. He becomes intimately involved with the trauma team in the management of patients with multiple injuries. It is his responsibility to manage the orthopaedic patients who are in the intensive care units, adolescent medicine and diabetic wards and whatever patients are on other floors and consults that are in the hospital, under the direct supervision of the attending physician.

Surgical judgment and skills are further developed through an increasingly responsible role in patient management. His role in the operating room evolves from assistant to surgeon, as appropriate, and, he is increasingly involved in procedures that are more complex.

Also during this year, the PGY-3 resident is encouraged to attend the private office practice of selected members of the teaching staff. On Friday afternoons he is assigned to the pediatric orthopaedist. There are other private office experiences designed by the resident and program director, in some instances to permit follow up of hospital patients and in order to satisfy individual interests or needs.

A trauma / hand / research rotation has been established at Morristown Memorial Hospital, which is a Level II Trauma Center located in Morristown, NJ. The rotation is for six months during the third year, where the resident is primarily responsible for the initial evaluation and management of all trauma cases admitted through the hospital. The faculty consists of three full-time attendings who are all fellowship trained. The orthopaedic resident is under direct supervision of the attending who is treating each patient. The department is also supplemented with several physician assistants to assist in management. The operative experience includes clinics such as rehabilitation and orthotics, along with journal review and didactic lectures.

PGY-3	1	2	3	4	5	6
	Trauma	Trauma	Trauma	Trauma	Trauma	Trauma
	7	8	9	10	11	12
	Spine	Spine	Spine	Spine	Spine	Spine

PGY-4 - The cognitive knowledge and surgical skills developed during the first three years of residency and required for advancement to the PGY-4 year have produced a mature resident ready for augmented responsibilities in patient care, surgery, teaching and supervision. The PGY-4 resident is responsible for the children's orthopaedic service during this entire year. Also, the PGY-4 resident is away on pediatric rotation at the Children's Hospital of Philadelphia for a five month period during this year. CHOP provides the resident with the plethora of unusual cases one expects in a large urban referral center along with laboratory bench time, an important ingredient in teaching residents.

A one month elective in orthopaedic oncology is required.

Responsibilities as a supervisory and teaching member of the team significantly increase, as does involvement in outpatient programs and surgery. The PGY-4 resident is increasingly involved as operator in surgical procedures with teaching staff assisting and supervising as is appropriate.

PGY-4	1	2	3	4	5	6
	Ped Ortho	Ped Ortho	Ped Ortho	Ped Ortho	Ortho Surg	Tumor Elective*
	7	8	9	10	11	12
	Sports/ Shoulder/ Elbow	Sports/ Shoulder/ Elbow	Sports/ Shoulder/ Elbow	Sports/ Shoulder/ Elbow	Sports/ Shoulder/ Elbow	Sports/ Shoulder/ Elbow

PGY-5 - The Chief Resident has major supervisory responsibility over all aspects of the program, including resident assignments to surgery and outpatient clinics, conference scheduling and the administrative details of a residency. Some can be delegated to more junior residents, making work management a hands-on learning experience as well. The Chief Resident has a significant role in resident evaluations. In surgery, the Chief Resident performs most of the major reconstructive cases and sophisticated hand, spine, and trauma cases under supervision.

The Chief Resident becomes preceptor to the PGY-1 resident assigned to orthopaedics from general surgery. He is responsible for third-year medical students rotating to orthopaedics while on general surgery clerkships at Monmouth Medical Center, and for fourth-year students taking electives at MMC. He is responsible for orthopaedic consultations to service cases of all departments. He does, as well as all other residents, work under the direction and supervision of the attending physician.

PGY-5	1	2	3	4	5	6
	Sports/ Hand	Sports/ Hand	Sports/ Hand	Recons truction	Recons truction	Recons truction
	7	8	9	10	11	12
	Sports/ Hand	Sports/ Hand	Sports/ Hand	Recons truction	Recons truction	Recons truction