Residency Curriculum Years 3,4,5
During the last three years the resident will rotate through seven orthopaedic services
PGY – 3
PGY – 4 (Elective 3 months)
PGY – 5
Services Each service that the resident will rotate through is described below. This is meant as a general guide to each service and is not meant to describe the objectives, which can be fond in a different section of this manual. In each case two surgeons are paired up together and for each of these services, the fracture clinic has been allocated to the same day of the week for optimal resident learning. Where there are some services that list two different subspecialties, each has been selected to complement the other and to fit into the work schedule efficiently.
Dr. C.P. Coles
Dr. R.K. Leighton
Description: The Trauma Service will expose the resident to a wide variety of traumatic soft-tissue, articular and osseous injuries of the extremities and pelvis. This is a busy service, involving the care of many patients with often complex injuries. Many of these patients will have multiple systems involved, requiring communication and collaboration with other surgical and nonsurgical disciplines.
The resident will be expected to be an active participant and develop proficiency in the ATLS assessment, investigation and triage of the polytraumatized patient. The resident will learn to recognize and treat urgent life and limb threatening conditions including hemorrhage, compartment syndrome, open fractures, and vascular injuries. Most of the trauma patients will be encountered through the busy emergency department, and will require organization and efficiency in providing initial assessment and care. This will include reductions and casting/splinting of a variety of fractures and dislocations local anesthetic or intravenous sedation administered by the resident with nursing/paramedic assistance. Many of these patients will require admission to the trauma service for further investigations, monitoring, and often surgical treatment. The residents are also encouraged to attend the trauma clinic on Wednesdays, for an opportunity to follow the natural course of operatively and non-operatively managed patients over time, as well as the private office for the assessment of new patients with post-traumatic conditions.
This rotation will expose the resident to the surgical management of both simple and complex fractures and soft-tissue injuries, as well as the management of the long-term complications such as malunion, nonunion, and post-traumatic arthrosis. The resident will be expected to demonstrate competency in the surgical management of common orthopaedic injuries consistent with the level of training, progressing to more complex cases in the senior years. Often more important than the surgical management is the postoperative care of these multiply injured patients, as well as the isolated injury in the frail elderly. This will continually challenge the medical knowledge and diagnostic skills of the resident seeking to prevent and treat perioperative complications. The resident will have the opportunity to interact closely with the patient and families throughout this experience, and be expected to develop appropriate communication and counseling skills. Overall, a busy, challenging, and rewarding experience awaits the resident of the Trauma Service!
Pediatric Surgery Faculty: Dr. Ron El-Hawary Dr. Jason Howard Dr. Karl Logan Dr. Ben Orlik Description: The pediatric rotation at Dalhousie is located at the IWK Health Center. It is a busy tertiary care service that operated on over 1000 pediatric patients annually and has a thriving clinic as well. The Orthopedic resident will be exposed to a wide variety of pediatric problems. The resident will gain insight into the assessment, investigation of, non-operative and operative management of many conditions that include cerebral palsy, club feet, scoliosis, etc. Teaching: The teaching on the service is largely through interaction with the staff. Formal teaching sessions are integrated into the academic half-day throughout the year. There are also Friday morning case oriented teaching rounds in which a variety of interesting cases from the week are presented. In addition, Dr. Cook traditional hosts an evening series of case discussions at his home for the senior residents to prepare them for the examinations. Service: There will be one or two residents on the service during each rotation. Resident’s duties include covering the emergency during the daytime as well as a rotating night call. They resident will also be expected to participate in clinic as well as in the surgical and post-surgical management of the inpatients.
Dr. David Alexander
Dr. Bill Oxner
Content: The adult spinal service is based entirely at the New Halifax Infirmary. The service sees approximately 4,000 patients per year with spinal pathology and performs over 400 operations annually. The majority of the conditions are of a degenerative nature and includes degenerative conditions that affect the cervical through lumbar spines. The resident will become proficient in treating other conditions affecting the spine such as deformity, infection, tumor, fracture, etc. Teaching: There is a strong emphasis on learning on a case-by-case basis. The resident will be expected to review the operative cases for the following week in order to prepare for each case. The secretaries of the staff make the office charts available. Every patient treated in the operating theatre should have a history and physical done by the resident so that discussion around the case can lead to optimal learning. There will be a graded level of responsibility given in the operating room depending on prior exposure and level of training. In addition, follow-up of patients in the fracture clinic can help the resident see rare conditions such as primary spinal tumors that they may not have had exposure to on the service rotation. Formal teaching occurs during the spine block of the academic half-day and there is also a combined Neurosurgery and Orthopaedic spine rounds to be held on Wednesdays once per month. Service: The resident will be expected to round on the patient’s daily while in hospital and should attend the follow-up clinics. In the event that there is conflict in the schedule, the resident is expected to attend the operating room or clinic that holds the most educational value to them for their level of training. Evaluation: Evaluations are to be carried out face to face with both Dr. Oxner and Dr. Alexander near the end of the rotation and they will be done in the CanMeds 2005 format.
Upper Extremity Faculty: Dr. David Johnston – Upper Extremity
Dr. Andrew Trenholm – Upper Extremity Content: This is a busy service with two fellowship trained upper-extremity surgeon. The upper extremity service has a strong emphasis on treating conditions that affect the shoulder, elbow, wrist and hand. A wide experience is to be gained in the clinic, office, and operating theatre and in the ambulatory care setting. Service: Whenever possible the resident should attend the outpatient fracture clinic. When conflict arises the resident will be encouraged to attend the session that has the most educational merit for their level of training. Evaluation: Evaluation is carried out near the end of the rotation and is organized in the CanMeds 2005 format.
Foot and Ankle Faculty:
Dr. Mark Glazebrook – Foot and Ankle
Content: This is a busy service with a fellowship trained foot and ankle surgeons. A wide experience is to be gained in the clinic, office, and operating theatre and in the ambulatory care setting. The foot and ankle service is lead by Dr. Glazebrook who dedicated 40% of his time to basic science and clinical research. There is a wide variety of exposure to simple and complex tertiary care foot and ankle problems and their management Service: The resident will spend the rotation working with one surgeon. The resident will be expected to round on the patients daily and attend outpatient office on a weekly basis. The resident will be expected to prepare for cases the week before and should feel free to discuss the pre-operative planning with either surgeon. Whenever possible the resident should attend the outpatient fracture clinic. When conflict arises the resident will be encouraged to attend the session that has the most educational merit for their level of training. Evaluation: Evaluation is carried out near the end of the rotation and is organized in the CanMeds 2005 format.
Arthroplasty/tumor Faculty: Dr. M.J. Dunbar – Arthroplasty Dr. G. Richardson– Arthoplasty Description: Dr. Dunbar and Dr. Richardson are fellowship trained arthroplasty surgeons and Dr. Dunbar has a post-doctorate degree in Orthopaedic outcomes research. mainly a complex primary and revision arthroplasty practice in which the resident will gain a vast experience in everything from resurfacing arthroplasty to allograft revisions of total hips. Service: The resident will spend the rotation working with both surgeons. The clinic schedule is such that both surgeons are in their follow-up clinic on the same day but at different times. The resident will be expected to round on the patients daily and attend outpatient office on a weekly basis. The resident will be expected to prepare for cases the week before and should feel free to discuss the pre-operative planning with either surgeon. Teaching: Teaching is largely on a case-by-case basis. The academic sessions on the half-day incorporated sessions on arthritis and arthroplasty as well as Orthopaedic Oncology. There are intermittent Thursday afternoon planning arthroplasty rounds as well.
Tumor Faculty: Dr. M Biddulph – Tumour / Arthroplasty Dr. M. Gross – Tumour / Arthroplasty
Description:This is a combined rotation in which the resident will gain considerable exposure to musculoskeletal oncology as well as to the treatment of patients with arthritis, primary joint replacement, and revisions surgery. Dr. Gross is a fellowship trained Orthopedic Oncologist who serves the entire province as well as New Brunswick and Prince Edward Island for both adult and Pediatric musculoskeletal oncology. The resident will gain wide exposure to the diagnosis, imaging, and treatment of a wide variety of both benign and malignant soft tissue and bone neoplasms. There is an emphasis on multi-disciplinary care and the resident will be expected to attend joint musculoskeletal oncology rounds in the cancer center. The resident will gain considerable experience with the operative management and particularly in the details of the appropriate workup and biopsy of suspected lesions. In addition, Dr. Gross has a very busy practice in primary and revision hip and knee arthroplasty, which complements the arthroplasty component of the rotation nicely.
Service: The resident will spend the rotation working with both surgeons. The clinic schedule is such that both surgeons are in their follow-up clinic on the same day but at different times. The resident will be expected to round on the patients daily and attend outpatient office on a weekly basis. The resident will be expected to prepare for cases the week before and should feel free to discuss the pre-operative planning with either surgeon. Teaching: Teaching is largely on a case-by-case basis. The academic sessions on the half-day incorporated sessions on arthritis and arthroplasty as well as Orthopaedic Oncology. There are intermittent Thursday afternoon planning arthroplasty rounds as well.
General Faculty: Dr. J. D. Amirault Dr. G.P. Reardon Content: The general orthopaedic rotation covers a wide range of orthopaedic problems. The resident would be expected to obtain a grasp of the following issues as they pertain to a general orthopaedic practice. 1. Trauma Both staff take regular wait list for trauma as well as weekend call for trauma. This would involve the management of all fractures related to the axial skeleton except for spinal trauma and complex pelvic trauma. The resident is expected to obtain a grasp of the indications for non-operative as well as operative treatment of these fractures. As well, the resident is expected to be comfortable with the various options for operative treatment of the individual fractures.
2. Knee Reconstruction The resident will be exposed to Sports Medicine Injuries and their management. They will be expected to become skilled at arthroscopy as well as Arthroscopic knee ligament reconstruction. They will be exposed to and expected to become familiar with osteotomy about the knee including distal femur and proximal tibia. Total knee replacement will be the most common knee reconstructive procedure on this service. As well, they will be expected to be comfortable with revision total knee replacement.
3. Hip Reconstruction The residents will be expected to become facile with diagnosis and management of problems about the hip. This will include hip arthroscopy as well as osteotomy about the hip. Osteotomy about the hip will include femoral osteotomy and pelvic osteotomy such as the Ganz and Chiari osteotomies. Total hip replacement is one of the more common procedures. They will be expected to develop a plan for hip replacement in both the young and the elderly. This will include cemented as well as cementless total hip replacement. The residents will also be exposed to revision total hip replacement.
4. Shoulder Reconstruction This rotation will provide a broad exposure to rotator cuff disease. Again, the resident will be expected to become familiar with the non-operative as well as the operative approach in rotator cuff pathology. Shoulder instability is another common problem dealt with on this rotation. The resident will be expected to become familiar with both the open and arthroscopic technique correction of shoulder instability. Complex reconstruction of the AC joint is also a feature of this rotation. Finally shoulder replacement is performed on a regular basis on this rotation, as well.
5. Foot and Ankle Reconstruction The resident will become familiar with all problems of the forefoot dealing with hallux valgus and hallux rigidus. Deformities of the minor toes will also be addressed. There will be exposure to ankle ligament reconstruction as well as tendon transfers about the ankle. Arthritis of the ankle and the hindfoot will be addressed and the resident will be expected to become familiar with ankle arthrodesis and subtalar arthrodesis. No ankle arthroplasty will be performed on this service.
There is no exposure to spinal surgery on this service. There is also no exposure to complex wrist and forearm reconstruction. There is ample opportunity for collaborative research in projects related to hip and knee reconstruction that are ongoing with the Division of Orthopaedic Surgery. Residents will attend a clinic on a regular basis with the attending staff to assess follow-up of surgical cases. New consultations are evaluated in an office setting in the hospital. Residents have ample opportunity to attend these sessions to develop an approach to the elective orthopaedic patient.
Faculty: Dr. C. Coady Dr. I. Wong THE AIM The objective is to expose the orthopaedic resident in training to the full spectrum of disorders within the realm of Sport Medicine.
THE CONTENT The trainee will obtain experience with pathology unique to the active individual. These pathologies include disorders of the lower and upper extremities (as well as the axial skeleton) commonly seen in an orthopaedic/sport medicine practice. Overuse injuries of the knee and shoulder prevail, as do acute traumatic insults to the ligaments and tendons.
FORUM The orthopaedic trainee will participate in a multi-disciplinary sport medicine team at the Orthopaedic and Sport Medicine Clinic of Nova Scotia. Furthermore, surgical techniques will be assimilated within the operating room facilities at the QEII Health Sciences Center, Infirmary Site. Clinical interactions will also be conducted within that same university hospital.
TEACHING EXPOSURE The trainee will be mentored constantly on the proper techniques on the extracting of a medical history and the physical examination of the musculoskeletal system. Such teaching will be augmented with direct one-on-one supervision. Experience in operating techniques will be developed whilst in the operating room suite at the QEII Health Sciences Center. Trainees will be given responsibility in a progressive fashion, with the ultimate objective of performing surgery independently. (With supervision constantly available.)
OTHER RESOURCES Trainees will be encouraged to develop research initiatives. Assistance and support within this quest are available from established collaborators within the School of Biomedical Engineering, Kinesiology, Department of Psychology and the School of Physiotherapy.
THE TEAM The trainees will be exposed to the Orthopaedic Sport Medicine Fellows who come to our Program from all over the world. Elective Medical Students and PhD Students are constantly present, which augments the total experience.