Trauma Fellowship Guidelines
Vision and Mission:
To train and foster the growth of competent, compassionate and critical thinking orthopaedic trauma surgeons who will serve their patients, local health systems, national organizations and society as a whole.Educational Goals Trauma Fellowship:
The fellowship is designed to provide a complete experience in the management of orthopedic trauma. At the completion of the fellowship, the participants should be competent to treat orthopaedic trauma in either a private practice trauma center or academic setting. Fellowship goals include:
1) To develop clinical expertise in the diagnosis and management of complex and multi-system orthopedic trauma.
2) To refine clinical skills in such a way that new problems can be addressed based upon pathophysiologic and patient-oriented information allowing an appropriate treatment plan to be initiated in patient care.
3) To attain technical and surgical expertise in complex orthopedic trauma, to all orthopaedic body parts.
4) To gain exposure to research including clinical reviews, clinical outcome studies, and basic science research.
These goals are obtained through the following educational methods: 1) clinical preceptorship, 2) didactic lectures, 3) Socratic conferences, and 4) formal research experience. The clinical preceptorship includes experience in the offices of the attendings as well as a fellow-directed clinic, and operating room coverage. New patients are followed from diagnosis through the selection of treatment plan, pre-operative planning, operative intervention, and post-operative management. Outpatient clinic time allows the fellow to observe directly the recovery process and to observe long-term results following surgical procedures. The didactic portion of the education process includes lectures by the faculty during a weekly trauma conference, weekly resident core conference, a weekly fellow specific lecture series and guest lectureships. The Socratic conferences include pre-operative conferences, case presentations at Trauma Conference, one-on-one discussions and interchanges during rounds, and direct evaluation of patients in the office. Care Responsibility:
The fellows assist and contribute to inpatient care by 1) performing a complete orthopaedic exam as indicated on patients admitted through the emergency room when on call or patients admitted from the outpatient or private offices in which the fellows participate in their surgical management, 2) serve as a source of experience and knowledge to the resident staff, 3) evaluate consults and aid the resident and attending staff with patient care. The presence of the fellows will augment, not supplant, resident responsibility. The clinical care of in-patients is the primary responsibility of the attending and resident staff.
The inpatient orthopedic trauma service is comprised of three attendings, a chief resident (PGY-5), a PGY-4 resident, and one or two PGY-1 residents from General Surgery, Emergency Medicine, or anesthesia. There is also a midlevel provided dedicated to the orthopaedic trauma service. The fellow provides information regarding patient care, and advises the resident staff and the trauma team as a whole. Team administration is directed by the chief resident who utilizes the fellows as a clinical resource and a source of expertise. Final decisions regarding patient care are at the attending level.Call:
The fellow’s call is selected by the fellow with assistance from the trauma service coordinator. The fellow should notify the coordinator at least 4 weeks ahead of individual need in changes to the schedule. The final schedule is submitted to the administrative scheduler, by the 1st of the month (the month prior to the official call schedule). The fellow will be responsible for 4 weekday call nights and for one weekend call night per month. The fellow is always on call with orthopedic faculty. A majority of these call nights are taken with faculty on the orthopedic trauma service.Emergency Room Coverage:
Emergency room consultations are handled by the residents on call. The fellow on call is notified of orthopaedic trauma via the orthopedic attending on call. Fellow involvement is triaged by the on call physician taking onto account the potential educational value of the case in question. Currently, all emergency room patients are reviewed by the attending staff before final dispositions. The fellow has the opportunity to evaluate complex orthopaedic trauma problems in the emergency room and to formulate a treatment plan with an attending. Emphasis is placed on resuscitation and the orthopaedic trauma surgeon’s role in the management of the unstable patient and fellows are strongly encouraged to be actively engaged in the care of these patients. In addition to the formal emergency room consultation (written by the resident) the fellows are expected to document their involvement. Supervision will be provided by the attending staff. Trauma fellows do not admit patients to hospital or independently staff OR cases. Travel/Away Dates:
All away dates are approved by the chief of trauma. Once approved, the administrative assistant will communicate as appropriate. The fellow will be given three weeks of vacation. In addition, ten professional days may be utilized for meetings and job interviews. No vacation may be taken during the final week of fellowship. The fellow is expected to attend the annual OTA (orthopedic trauma meeting) meeting, the OTA fellow’s course, and the AO fellow’s course. Other educationally beneficial meetings can be attended with the fellowship director’s approval.Pages:
It is the fellow’s responsibility to answer and resolve pages in a timely manner. The fellow will be provided a pager by the department at the beginning of the fellowship.Outpatient Clinics (Resident/Fellow Continuity Clinics):
The Trauma fellow will have 1 half day of clinic per week (see typical week below). This clinic time will allow for long term follow-up and for evaluation and work-up of referred malunion and non-union cases. The half day will be part of the orthopedic trauma clinic on Friday mornings. This clinic consists of an attending, fellow, senior resident a midlevel and serves as the main follow-up for multi-trauma patients and referred trauma. This clinic allows the fellow the opportunity to follow multitrauma patients in the immediate post-operative period and to guide the rehabilitation process. The second half day will be with faculty on the orthopedic trauma service.Operating Room:
The trauma fellow will be assigned to the orthopedic trauma room (fracture room) on Monday, Tuesday, Wednesday and Thursdays. He/she may also spend time in the operating room with faculty not on the trauma service should the fellow wish to gain more specific experience a specific area. All operative procedures in are supervised directly by an attending who is physically present in the operating theater.
The fellowship is committed to critical evaluation and continued improvement. As such a 360 degree program evaluation will take place bi-annually. In this process fellows will evaluate the fellowship, all trauma faculty and residents whom have rotated on the trauma service via an online, semi-confidential (to all but program director) computer generated survey. This is the same evaluation program and scheme used for evaluation of our residency.
In a similar manner all faculty and residents will evaluate the fellow. The nursing and ancillary staff interfacing with the fellow in the clinic and in the operating room will also have the opportunity to evaluate the fellow. The program director will have bi-annual meetings with the fellow to discuss the results of these evaluations. In addition the fellow will complete a final evaluation of the fellowship and individual faculty prior to graduation. These evaluations will be a necessary part of successful program completion.
Evaluation will target patient centeredness, clinical decision making, aptitude in the operating room, as well as the ability to work constructively with others and as part of a multidisciplinary care team. Particular emphasis will be placed on professionalism and its importance to long term career success.
The faculty involved in fellow education will meet in a bi-annual fashion to discuss the results of the fellow evaluations and make adjustments and changes as necessary. The results of the year end program evaluation will be used to make continued refinements and improvements to the trauma fellowship as a whole. Annually, soon after fellow graduation, the trauma faculty as a whole reviews the fellow’s evaluation of the program to debrief, address problems or shortcomings and to generate an action plan to continue to improve fulfillment of our mission and vision.Conferences:
Formal training in orthopaedic trauma is an integral component of the current orthopaedic training program. The weekly trauma conference takes place on Monday mornings. It involves the presentation of the cases from the previous week's trauma schedule. Discussion focuses on pre-operative workup, indications, critique of post-operative x-rays and discussion of rehabilitation and expected outcomes. In addition to the existing weekly trauma conference schedule, the trauma fellow participates in department wide grand rounds conference on Wednesday mornings.
The first Wednesday of each month there will be a department wide morbidity and mortality conference. The orthopaedic trauma service is participative in this conference. Every other month an orthopaedic trauma case will be selected for discussion as part of this continued process improvement and review conference.
In addition the trauma fellow meets each morning at 5:45 am to discuss and triage the trauma from the previous evenings call team. Present at this meeting are the on call senior from the previous night, the orthopedic trauma attending who is staffing the trauma room that day, the fellow, research staff and our orthopedic trauma nurse coordinator. At this conference decision making regarding prioritization of cases for the day and indications will be emphasized.
There is also a didactic lecture series for the orthopedic house staff. Topics cover core curriculum topics specific to orthopedic trauma. The fellow will be expected to attend these conference times and to present 2-3 topics per year to the residents. Lastly there is a weekly fellow specific lecture given by an attending. This takes place on Friday mornings prior to orthopedic trauma clinic. This lecture is geared directly to the trauma fellow and involves higher level and more complex topics with emphasis on complex decision making. Research – Fellowship:
The trauma fellow will be encouraged to develop and pursue independent projects and/or may participate in other on-going research. Support includes time, space, computer/statistical aid, equipment, supplies, trained orthopaedic technicians to facilitate projects, with the support of two full time PhD’s and two full-time research assistants dedicated primarily to orthopaedic trauma. Fellows may be expected to engage actively in, 1) anatomic dissections, 2) clinical research or basic science research. The fellowship will require one completed manuscript ready for submission prior to graduation. Journal Club:
The orthopaedic trauma service hosts a quarterly journal club. This journal club includes all trauma faculty and the entirety of the orthopaedic residency. Topic focus and article specifics are chosen by the fellow with mentorship from the trauma faculty. Topics include both classic articles in orthopaedic trauma as well as contemporary debates or topics in our field. The format involves a resident or fellow presenting a paper with subsequent question, answer and discussion regarding the specific merits and pertinence of the presented research. Focus is on the methodology and quality of the presented work.Administrative/Work Space Support:
The orthopaedic trauma fellowship has an administrative coordinator dedicated to our program. The fellowship coordinator will assist the fellow with credentialing, travel arrangements, journal club organization. This person will also serve as a point of contact regarding vacation, call, mandatory training and data and case log entry. Moreover this individual will serve as first resources for questions as they arise during the course of the year. The fellow will have an office with a computer able to access all inpatient records, x-rays and library resources provided by the department.Grievance and Dismissal Policy
The fellow will have opportunity to make formal complaints regarding the structure, personnel, or educational value of the fellowship to the fellowship director, any trauma faculty or the fellowship coordinator. The fellow will have a meeting with the fellowship director once a month to provide a structured and formal opportunity for any complaints or problems to be addressed. In the same manner this monthly meeting will afford the fellowship director the opportunity to address fellow deficiencies.
The fellowship will adhere to the departmental and institutional formal grievance procedures.