RIVERSIDE UNIVERSITY HEALTH SYSTEM - MEDICAL CENTER ORTHOPAEDIC SURGERY RESIDENCY PROGRAM. Hand/Upper Extremity (PGY-3) (Duration: Two Months)

Transcription

1 RIVERSIDE UNIVERSITY HEALTH SYSTEM - MEDICAL CENTER ORTHOPAEDIC SURGERY RESIDENCY PROGRAM Supervising Faculty: Dr. Ry Caput Hand/Upper Extremity (PGY-3) (Duratin: Tw Mnths) The verall gal f the PGY-3 Hand/Upper Extremity rtatin is t develp a basic understanding f the functinal anatmy f the upper extremity as well as t gain skills fr evaluating and treating patients with disrders f the upper extremity Gals Patient Care The rthpaedic resident must be able t prvide patient care that is cmpassinate, apprpriate, and effective fr the treatment f health prgrams and the prmtin f health. Demnstrate cmpetence in the pre-admissin care, hspital care, perative care and fllw up care (including rehabilitatin) f patients. Demnstrate cmpetence in their ability t gather essential and accurate infrmatin abut their patients Demnstrate cmpetence in their ability t make infrmed decisins abut diagnstic and therapeutic interventins based n patient infrmatin and preferences, up-t-date rthpaedic scientific evidence, and clinical judgment. Demnstrate cmpetence in their ability t develp and carry ut patient management plans Demnstrate cmpetence in their ability t prvide health care services aimed at preventing health prblems r maintaining health. Demnstrate cmpetence in the diagnsis and management f adult and pediatric rthpaedic disrders Variety f adult and pediatric hand surgery patients Graduated and prgressive patient care respnsibilities Develpment f a treatment plan t manage patients with traumatic, cngenital and develpmental, infectius, metablic, degenerative, neurlgic and rheumatlgic disrders Recuperative and rehabilitatin techniques, including the use f physical and ccupatinal therapy Judgment and technical capability t achieve satisfactry surgical and nnsurgical results in the fllwing areas Skin repair including grafts and flaps Fingertip injuries Tendn repair Nerve Decmpressin Nerve repair, including majr and digital, graft, neurlysis, surgical treatment f neurma, transpsitins and decmpressins Management f fractures and dislcatins, including phalangeal r metacarpal with and withut internal fixatin; wrist, radius and ulna with and withut internal fixatin, and injuries t jint ligaments

2 Bne grafts Tumrs, benign Dupuytrens cntracture Amputatins Fascitmy, deep incisin and drainage fr infectin, and wund debridement Freign bdy, implant remval Thermal injuries Arthrscpy Upper extremity pain management Example: Carpal Tunnel, Patient Care Gals/: Obtains fcused histry, including identifying night pain, paresthesias Perfrms median nerve mtr/ sensry evaluatin (e.g., MN numbness, thumb abductin) Perfrms prvcative maneuvers (e.g., Tinel, Phalen, MN cmpressin test) Apprpriately cnsiders electrdiagnstic test Prescribes nn-perative treatments (e.g., night splints, sterid injectin when apprpriate) Capable f diagnsing surgical cmplicatins (e.g., injury t the median nerve r its branches and vascular injury) Prvides simple pst-perative management and rehabilitatin Medical Knwledge Gals The rthpaedic resident must gain medical knwledge f established and evlving bimedical, clinical, epidemilgical and scial-behaviral sciences, as well as the applicatin f this knwledge t patient care. Demnstrate expertise in the knwledge f thse areas apprpriate fr an rthpaedic surgen Demnstrate investigatry and analytical thinking apprach t clinical situatins Educatin in surgical design, surgical diagnsis, embrylgy, surgical and artistic anatmy, surgical physilgy and pathlgy, pharmaclgy, wund healing, micrbilgy, adjunctive nclgic therapy, bimechanics, rehabilitatin, and surgical instrumentatin. An understanding f prsthetics and rthtics pertaining t disrders f the upper extremity and amputatin. Pssess an understanding f the scientific basis f evaluatin, diagnsis and treatment f cmmnly encuntered hand surgical cnditins including: carpal tunnel syndrme trigger finger, tendnitis de Quervain s, ECU, FCR tendinitis thumb basal jint arthritis (describe the basic management f stearthritis f the hand and the radigraphic findings, and understand the pathphysilgy f arthritis in the hand including stearthritis, rheumatid arthritis, and psttraumatic arthritis) animal and human bites

3 flexr and extensr injuries (classify and describe treatment fr tendn laceratins, describe suture techniques fr flexr tendn repair, and describe the basic steps f tendn healing) infectins f the fingertip, tendn sheaths and deep spaces, recgnize and list the classic signs f acute suppurative tensynvitis fingertip injuries and amputatins nail bed injuries phalangeal and metacarpal fractures (describe an algrithm fr management, and understand cmplicatins and risks assciated with treatment) ganglia f the hand and wrist mallet finger injuries sprains and dislcatins f the CMC, MCP and PIP jints (classify and describe treatment fr jint injuries, static carpal instability, and be familiar with the classificatin and radigraphic findings) cubital tunnel syndrme, chrnic carpal tunnel syndrme including tendn transfers and indicatin fr arthrdesis (understand the principles f tendn transfer, and describe cmmnly utilized ppnensplasty prcedures) describe a classificatin f flaps (randm pattern, axial pattern, island, free. lcal reginal, distant) and cite cmmn examples f each Develp and discuss a differential diagnsis f hand pathlgy Example: Carpal Tunnel, Medical Knwledge Gals/: Understands the anatmy f carpal tunnel/median nerve Understands the nrmal physilgy f the median nerve Demnstrates knwledge f the differential diagnsis f neurpathic surgery (e.g., prnatr syndrme, cubital tunnel, thracic utlet, cervical radiculpathy, peripheral neurpathy) Understands risk factrs assciated with Carpal Tunnel Syndrme (CTS) (e.g., diabetes, inflammatry arthritis, pregnancy, hypthyridism) Demnstrates knwledge f median nerve mtr/ sensry distributin, thumb abductin, thenar numbness, anterir intersseus nerve (AIN) weakness, cervical radiculpathy Understands natural histry f CTS Understands the pathphysilgy f nerve cmpressin (e.g., increased carpal tunnel pressure, nerve ischemia) Understands surgical ptins (e.g., pen, endscpic) Practice-based Learning and Imprvement Gals The rthpaedic resident must demnstrate the ability t investigate and evaluate his/her care f rthpaedic patients, t appraise and assimilate scientific evidence, and t cntinuusly imprve patient care based n cnstant self-evaluatin and life-lng learning Identify strengths, deficiencies, and limits in ne s knwledge and expertise Set learning and imprvement gals Identify and perfrm apprpriate learning activities

4 Systematically analyze practice using quality imprvement methds, and implement changes with the gal f practice imprvement Lcate, appraise, and assimilate evidence frm scientific studies related t their patients health prblems. Use infrmatin technlgy t ptimize learning Participate in the educatin f patients, families, students, residents and ther health prfessinals Apply knwledge f study designs and statistical methds t the appraisal f clinical studies and ther infrmatin n diagnstic and therapeutic effectiveness Acknwledges gaps in persnal knwledge and expertise, and frequently asks fr feedback frm teachers and clleagues Demnstrates cmputer literacy and basic cmputer skills in clinical practice Describes basic cncepts in clinical epidemilgy, bistatistics, and clinical reasning Categrizes the study design f a research study Cntinually assesses perfrmance by evaluating feedback and assessments Develps a learning plan based n feedback with sme external assistance Demnstrates use f published review articles r guidelines t review cmmn tpics in practice Uses patient care experiences t direct learning Ranks study designs by their level f evidence Identifies bias affecting study validity Frmulates a searchable questin frm a clinical questin Cmplete the persnal learning prject in the practice based learning and imprvement curriculum fr the rtatin Interpersnal and Cmmunicatin Skills Gals The rthpaedic resident must demnstrate interpersnal and cmmunicatin skills that result in the effective exchange f infrmatin and cllabratin with patients, their families, and ther health prfessinals. Cmmunicate effectively with patients, families, and the public, as apprpriate, acrss a brad range f sciecnmic and cultural backgrunds Cmmunicate effectively with physicians, ther health prfessinals, and health related agencies Act as a cnsultative rle t ther physicians and health prfessinals Maintain cmprehensive, timely, and legible medical recrds Use effective listening skills and elicit and prvide infrmatin using effective nnverbal, explanatry, questining, and writing skills, if applicable. Cmmunicates with patients abut rutine care (e.g., actively seeks and understands the patient s/family s perspective; Able t fcus in n the patient s chief cmplaint and ask pertinent questins related t that cmplaint) Recgnizes and cmmunicates rle as a team member t patients and staff Respnds t requests fr infrmatin Cmmunicates cmpetently within systems and ther care prviders, and prvides detailed infrmatin abut patient care (e.g., demnstrates sensitivity t patient and family related infrmatin gathering/sharing t scial cultural cntext;

5 Begins t engage patient in patient-based decisin making, based n the patient s understanding and ability t carry ut the prpsed plan; demnstrates empathic respnse t patient s and family s needs; actively seeks infrmatin frm multiple surces, including cnsultatins; avids being a surce f cnflict; able t btain infrmed cnsent [risks, benefits, alternatives, and expectatins]); actively participates in team-based care; Supprts activities f ther team members, cmmunicates their rll t the patient and family Prfessinalism Gals The rthpaedic resident must demnstrate a cmmitment t carrying ut prfessinal respnsibilities and an adherence t ethical principles Demnstrate respect, integrity and cmpassin fr thers Demnstrate respnsiveness t patient needs that supersedes self interest Demnstrate accuntability t patients, sciety and the prfessin Demnstrate a cmmitment t ethical principles pertaining t prvisin r withhlding f clinical care, cnfidentiality f patient infrmatin, infrmed cnsent, and business practices. Demnstrate sensitivity and respnsiveness t a diverse patient ppulatin, including but nt limited t diversity in culture, age, gender, disabilities and sexual rientatin Demnstrate cmmitment t ethical principles pertaining t prvisin r withhlding f clinical care, cnfidentiality f patient infrmatin, infrmed cnsent and business practice Cnsistently demnstrates behavir that cnveys caring, hnesty, and genuine interest in patients and families Recgnizes the diversity f patient ppulatins with respect t gender, age, culture, race, religin, disabilities, sexual rientatin, and sciecnmic status Recgnizes the imprtance and pririty f patient care, with an emphasis n the care that the patient wants and needs; demnstrates a cmmitment t this value Understands when assistance is needed and willing t ask fr help Exhibits basic prfessinal respnsibilities, such as timely reprting fr duty, being rested and ready t wrk, displaying apprpriate attire and grming, and delivering patient care as a functinal physician Aware f the basic principles and aspects f the general maintenance f emtinal, physical, mental health, and issues related t fatigue/sleep deprivatin Demnstrates an understanding f the imprtance f cmpassin, integrity, respect, sensitivity, and respnsiveness while exhibiting these attitudes cnsistently in cmmn and uncmplicated situatins Cnsistently recgnizes ethical issues in practice; discusses, analyzes, and manages in cmmn and frequent clinical situatins including sciecnmic variances in patient care Recgnizes limits f knwledge in cmmn clinical situatins and asks fr assistance Recgnizes value f humility and respect twards patients and assciate staff Demnstrates adequate management f persnal, emtinal, physical, mental health, and fatigue

6 Systems-Based Practice Gals The rthpaedic resident must demnstrate an awareness f and respnsiveness t the larger cntext and system f health care, as well as the ability t call effectively n ther resurces in the system t prvide ptimal health care. Wrk effectively in varius health care delivery settings and systems relevant t rthpaedics Crdinate patient care within the health care system relevant t their rthpaedics Practice cst-effective health care and resurces allcatin that des nt cmprmise quality f care. Advcate fr quality patient care and ptimal patient care systems Wrk in interprfessinal teams t enhance patient safety and imprve patient care quality Participate in identifying system errrs and implementing ptential system slutins Describes basic levels f systems f care (e.g., self-management t scietal) Understands the ecnmic challenges f patient care in the health care system Recgnizes imprtance f cmplete and timely dcumentatin in teamwrk and patient safety Explains the rle f the Electrnic Health Recrd (EHR) and Cmputerized Physician Order Entry (CPOE) in preventin f medical errrs Gives examples f cst and value implicatins f care he r she prvides (e.g., gives examples f alternate sites f care resulting in different csts fr individual patients) Uses checklists and briefings t prevent adverse events in health care Apprpriately and accurately enters patient data in EHR Effectively uses electrnic medical recrds in patient care Participate in ne medical staff cmmittee as a nn-vting member, prvide a frmal presentatin at the Orthpaedic Surgery educatinal grand runds, and write a self-assessment f cmmittee experience with relevant learning pints articulated and dcumented. ASSESSMENT METHOD: Direct and indirect bservatin by faculty with assessment n frmal end f rtatin evaluatin frm. DIDACTIC CURRICULUM REQUIRED ATTENDANCE: RUHS Mnday Pre-Op Cnference (Mnday AM) RUHS Wednesday Cnference (Wednesday AM) RUHS Friday Pst-Op Cnference (Friday AM) RUHS Orth Mnthly Research Meeting RUHS Orth Mnthly Department Meeting/Educatinal Grand Runds RUHS Orth Bi-Mnthly M&M Cnference