Rotating Medical Student

Orientation

UNMC Orthopaedic Surgery

Department of Orthopaedic Surgeryand Rehabilitation

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.

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.

WELCOME

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

UNMC Orthopaedics

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 emergency department.

To learn more about our hospital and medical school– www.unmc.edu– www.nebraskamed.com

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

– www.unmc.edu/orthosurgery

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)

Rotation Schedule There are generally many medical

students on rotation at UNMC each month Requests for different services will be

taken, but keep in mind that we have to make it fair for everyone

Generally speaking, each student is on one ‘team’ for the duration of the 4 week rotation

There are frequent opportunities to participate in clinics or cases with attendings from other teams

Rotation Schedule Students will or may be assigned to the following

services:– ADULT RECONSTRUCTION (UNMC)

The GOLD service with Drs. Garvin, Konigsberg, Hartman– TRAUMA / FOOT & ANKLE/SPINE (UNMC)

The GREEN service with Drs. Mormino, Reed, Cornett– ONCOLOGY (UNMC)

The GREEN service with Dr. McGarry– UPPER EXTREMITY (UNMC)

The BLACK service with Drs. Fehringer, Ferlic, Thompson, Crabb and Bruggeman

– SPORTS MEDICINE (UNMC) The RED service with Drs. Dietrich, Daccarett

– PEDIATRICS (Children’s Hospital and UNMC) With Drs. Esposito, Scherl, Hasley, Jenson

– VA HOSPITAL

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.

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

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

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

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.

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

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

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

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.

CALL

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.

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.

CONFERENCES

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

Conference SchedulesMon Tues Wed Thurs Fri

600amTextbookConference

630amGrand Rounds

600amGold JointConference

600amPediatricOrthoConference

600amTraumaConference

600amHand/Upper extremity/ SpineConference

Sorrell Center Room 1005

UNMC OrthoLibrary

Children’sHospitalGlow Aud.3rd Floor

UNMC Ortho Library

UNMC OrthoLibrary

Lectures

Lectures Each week the rotating medical students will

participate in a lecture given by one or more of the residents in the ortho 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 (Time and place determined on a week to week basis)– Week 1: Trauma / Radiographs / Splinting– Week 2: Lower Extremity Injuries– Week 3: Upper Extremity Injuries– Week 4: Case Conference

Library

Orthopaedic Library

We have an extensive collection of current and past textbooks and journals in our department library. It is a resource for everyone. Please take advantage of it.

If you are not sure what to read, ask the residents. We can help you find appropriate reading material.

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/

Miscellaneous Information

Contact person

Geri Miller is the contact person for rotating medical students. – Email

gmiller@unmc.edu– Phone

402-559-2258

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 Recovery559-4133

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.

Final Thoughts

If you have questions, please ask the residents. We want you to have a great experience during your month with us at UNMC.

Most of all… HAVE FUN!