Transcript M4 Orientation

UNMC Orthopaedic Surgery
Rotating Medical
Student
Orientation
Department of Orthopaedic Surgery
and 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 postop 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
Plan
 S/P Right Total Hip




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
–
Same
–
Closed reduction IM fixation
–
Dr. Mormino
–
Dr. Buck HOV and Dr. Johnston HOIII
–
GETA
–
50cc
–
1000cc crystalloid
–
None
–
Return to floor in stable condition
Post op
Procedure
Surgeon
Assistant
Anesthesia
EBL
Fluids
Complications
Status
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 Schedules
Mon
600am
Textbook
Conference
Tues
600am
Gold Joint
Conference
Wed
600am
Pediatric
Ortho
Conference
630am
Grand
Rounds
Sorrell
Center
Room 1005
UNMC Ortho Children’s
Library
Hospital
Glow Aud.
3rd Floor
Thurs
600am
Trauma
Conference
Fri
600am
Hand/Upper
extremity/
Spine
Conference
UNMC Ortho UNMC Ortho
Library
Library
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
Week
Week
Week
1:
2:
3:
4:
Trauma / Radiographs / Splinting
Lower Extremity Injuries
Upper Extremity Injuries
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
 [email protected]
– Phone
 402-559-2258
Key Phone Numbers
Geri Miller
 Ortho Clinic
 Resident Room
 Radiology File Room
 Emergency Room
 Univ OR Pre-Op
 Univ OR Recovery

559-2258
559-5360
559-5614
559-1001
559-6637
559-5859
559-4133
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!
