UNMC Orthopaedic Surgery

1. Department of Orthopaedic Surgery and Rehabilitation UNMC Orthopaedic Surgery Rotating Medical Student Orientation

2. Introduction • This presentation will give you an introduction to your rotation at UNMC. • You should use it as a reference both before and during your rotation as it contains important information regarding your month with us.

3. Welcome • Welcome to the orthopaedic surgery experience at the University of Nebraska Medical Center. We hope you find this rotation both challenging and rewarding. This rotation should allow you to expand your knowledge of basic orthopaedics as well as participate in diagnosis, treatment, and care of various orthopaedic patients.

4. WELCOME • We are here to teach you about the basic foundations of and help you gain a feel for a career in Orthopaedic Surgery

5. UNMC Orthopaedics

6. About our hospital • Nebraska Medical Center • This is the combination of two hospitals that merged in 1997 including • Clarkson (Private) • Univ of Nebraska Medical Center (Academic) • The Nebraska Medical Center is one of the region's premier health systems. • 735 bed state of the art hospital • Recent addition of new clinical center that includes nearly 30 new operating rooms, radiology suites, and a brand new emergency department. • To learn more about our hospital and medical school • www.unmc.edu • www.nebraskamed.com

7. About our program • UNMC Department of Orthopaedics • A full description of our program is available on the department website. This includes a list of current and past residents, information about applying for a residency position, information regarding salaries, benefits and call, and finally information about our faculty • http://www.unmcphysicians.com/ttg-ortho/new/index.cfm

8. About our program • 4 residents per year (20 total) • Divided among: • Interns (4) • Children’s Hospital (2) • VA Hospital (3) • UNMC Sports (1) • Private Sports / Foot&Ankle (2) • Adult Reconstruction (2) • Trauma / Foot&Ankle / Tumor (3) • Hand & Upper Extremity (2) • Spine (1)

9. Rotation Schedule • There are generally many medical students on the main orthopaedic service each month • In order to expose each of you to a broad experience and to expose you to several of the faculty and residents we generally provide you four one week blocks on different services. • This is the only fair way to accommodate all of the students rotating and allow the staff and residents to get to know you. • Requests for different services will be taken, but keep in mind that we have to make it fair for everyone.

10. Rotation Schedule • Students will or may be assigned to the following services: • ADULT RECONSTRUCTION (UNMC) • The GOLD service with Dr. Garvin • TRAUMA / FOOT & ANKLE (UNMC) • The GREEN service with Drs. Mormino, Reed • ONCOLOGY (UNMC) • The GREEN service with Dr. Mcgarry • UPPER EXTREMITY (UNMC) • The BLACK service with Drs. Fehringer, Lauder, Nystrom • PEDIATRICS (Children’s Hospital and UNMC) • With Drs. Esposito, Scherl, Hasley, Ginsburg • SPORTS MEDICINE (UNMC) • With Drs. Dietrich, Daccarett • VA HOSPITAL

11. Rotation Schedule • An example of a typical month for a student would be: • Week 1 • Gold Service with Dr. Garvin and a 5th and 2nd year resident • Week 2 • Green Service with Drs. Mormino, Reed, McGarry, and a 4th, 3rd, and 2nd year resident • Week 3 • Pediatric Service with Drs. Esposito, Ginsburg, Hasley, Scherl, and a 5th and 3rd year resident • Week 4 • Sports with Drs. Dietrich, Daccarett, and a 5th year resident

12. Expectations • Each of you is interested in an orthopaedic residency and a career in orthopaedics. • You will be rotating with us not only to learn about our residency program, but also to allow us to evaluate you as a potential resident. • Please read through the following expectations carefully and try to use them as a guide for what we are looking for in a potential resident.

13. Expectations: General • We expect you to: • Show up on time, be available, and work hard • Read before surgical cases (anatomy and surgical plan) • Be helpful, be inquisitive, ask questions • Learn basic management of common musculoskeletal problems • Participate actively in rounds, clinics, conference, and general discussions about Orthopaedic problems

14. The best medical students: • Work hard and ask appropriate questions at appropriate times • Take initiative and do things without being asked • Help write notes including chart notes, post op notes, and post op orders • Have labs ready for rounds in the morning • Update patient list with current patient rooms • Are sure case notes and x-rays are available for the current day and next day cases • Are prepared for daily conferences, clinics, and cases by reading beforehand • Function at an intern level

15. Clinical functioning at the level of an intern • Think about the patient care plan: • Pre-op planning • Medical workup before surgery • Antibiotics • Pain control • DVT prophylaxis • Therapy goals & restrictions • Dressing changes / drain output • Discharge planning & clinic follow-up • Read other consult service notes for their plan

16. Note writing • We expect you to be able to write chart notes, post op notes, and assist with post- op order writing • Several examples follow. Use them as a guide for what we are looking for in notes.

17. Chart note example • Subjective • Pt was comfortable overnight, no pain issues, no nausea/vomiting. Good PO intake and had a bowel movement • Objective • Hgb 11 • Inr 2.1 • Walked 110’ with PT • Afebrile • Alert/oriented • Wound is clean and dry • Neurovascular exam is intact • Assessment • S/P Right Total Hip • Plan • Continue pain mgt • Increase activity • DVT prophylaxis • Discharge planning

18. Post op Note • We write standard post op notes for each surgery • Pre-op Diagnosis • Post-op Diagnosis • Procedure • Surgeon • Assistant • Anesthesia • EBL • Fluids • Complications • Post op status

19. Post op note example • Pre-op • Left Closed Femur Fracture • Post op • Same • Procedure • Closed reduction IM fixation • Surgeon • Dr. Mormino • Assistant • Dr. Buck HOV and Dr. Johnston HOIII • Anesthesia • GETA • EBL • 50cc • Fluids • 1000cc crystalloid • Complications • None • Status • Return to floor in stable condition

20. Post Op Orders • Most of the staff have standard post op orders. The residents will help you to figure out where these are and what they specifically want. We do not expect you to know what each staff wants, but we do expect you to have an understanding of typical post op orders for specific surgeries.

21. CALL

22. Divide call on trauma nights between the students such that you average no more frequently than q4 during your month. • Be sure to get at least one full weekend off. We’d like you to be able to both have a life and also get to know a little about our city. • The actual schedule is left up to the students to arrange. Be fair to each other.

23. Carry the on-call pager and notify the junior resident on-call that you will be taking call with them that evening. • The best opportunity to learn how to suture, splint, cast, and possibly do reductions as a medical student takes place on-call and in the ER/trauma bay.

24. CONFERENCES

25. Conference Schedules • Three rules • Read assigned material before conference, if you are unsure, ask the junior resident on your service. • No scrubs in conference, dress appropriately. • Be on time. Tardiness to conference will be looked upon very poorly.

26. Conference Schedules

27. Lectures

28. Lectures • Each week the rotating medical students will participate in a lecture given by one or more of the residents in the orthopaedic library. • These lectures are interactive meaning that we expect you to read about the topic beforehand and be able to answer questions. • Weekly Educational Topics (1700 Wednesday) • Week 1: Trauma / Radiographs / Splinting • Week 2: Lower Extremity Injuries • Week 3: Upper Extremity Injuries • Week 4: Case Conference

29. Library

30. Orthopaedic Library • We have an extensive collection of current and past textbooks and journals in our departmental library. It is a resource for everyone. Please take advantage of it. We only ask that you do not remove any of the books or journals. • There is no excuse for not being prepared for a procedure, lecture, or clinic. The resources are available to you.

31. Commonly used books and websites • Useful textbooks • Hoppenfeld’s Surgical exposures • Hoppenfeld’s Physical Examination of the Spine and Extremities • Netter’s Anatomy • Miller’s Review of Orthopaedics Textbook • The Handbook of Fractures • Campbell’s Operative Orthopaedics • Browner and Jupiter and Rockwood and Green Trauma Textbooks • Useful websites • http://www.wheelessonline.com/ • http://www.aaos.org/ • http://www.ota.org/ • http://osrr.orthosurg.net/

32. Miscellaneous Information

33. Contact person • Geri Miller is the contact person rotating medical students. • Email • gmiller@unmc.edu • Phone • 1-402-559-2258

34. Key Phone Numbers • Geri Miller 559-2258 • Ortho Clinic 559-5360 • Resident Room 559-5614 • Radiology File Room 559-1001 • Emergency Room 559-6637 • Univ OR Pre-Op 559-5859 • Univ OR Recovery 559-4133

35. Nuts & Bolts • Accessing computers • The computers in the resident room are password protected. You will need to get access to these. • Accessing electronic x-rays (Magic Web) • All of our x-rays are digital. Students are not given a password for magic web, but should be able to view x-rays with an available resident. • Accessing medical record (Last Word) • Last word is for patient information including labs, notes, and other reports. You will get access to this. • Scrub valet codes • Scrub codes will be given for the scrub valet. This is done at the OR front desk on your first day. You will be allotted 3 sets of scrubs while you are here.