General Educational Goals
The general goal of this residency program is to produce a clinically competent Orthopaedic surgeon who provides high quality patient care and who realizes the importance of ongoing critical evaluation of surgical procedures and continuing appreciation of current trends in Orthopaedic practice. The stimulation of young minds to pursue the accumulation of knowledge and apply such to the practice of Orthopaedic surgery is of utmost importance. Throughout this residency program, residents are given the opportunity for primary patient management, as well as ever increasing responsibility for the performance of surgical procedures. Graded resident responsibility is of paramount importance in the development of a responsible surgeon and is an expected sequence throughout the training program. There are also rotation-specific educational goals for each level of training.
Specific Educational Objectives
What follows reflects the expectations for each of training. It is important that a graduation of responsibility occur throughout the residency training period.
PGY-1 & PGY-2
Understand the general principles of general surgery. Introduction to pathology and radiology, as it relates to Orthopaedic Surgery. Prepare for the Surgical Foundations Exam (POS). The first two years encourage the development of understanding of basic disease processes through contact with basic pathology and radiology. These first two years provide the framework of knowledge and surgical skills required to enter orthopaedic surgery and to pass the Principles of Surgery, Royal College examination. The R1 year is relegated to the evaluation development of clinical skills as they apply to surgery as a generic specialty. R2 rotations consist of orthopaedic training to acquire orthopaedic knowledge at a fundamental level – in particular, with regards to disease classification, surgical indication, and potential surgical complications. In both instances, the junior residents are under the direct supervision of the senior residents and appropriate attending staff. It is important that they attend outpatient clinics and assist in the operating room, as well as day surgery procedures. Patient assessment and clinical judgement along with the understanding of disease process are the goals during the first two years of training.
Progressive development of surgical and clinical skills with greater responsibility in areas of decision making and patient management are essential during this year of training. R3 level residents must show adequate and improving clinical skills with regards to diagnostic ability, improving and expanding disease classifications and surgical indications for both traumatic and non-traumatic orthopaedic conditions. Indications for surgical intervention as well as appreciation of potential complications as expected to progressive expand throughout this year. He/she is also introduced to simple surgical procedures under direct supervision of senior residents and attending staff.
Understand and manage preoperative and postoperative care of both elective and trauma cases. Understand the principles skeletal and skin traction (Buck’s, Russell’s and Bryant’s). Be adept at the insertion of skeletal traction pins (Kirschner, Steinman) and understand the principles of their management. Understand the management of open wounds, including long bone fractures and dislocations. Understand the principles of management of tendon and peripheral nerve injuries. Be capable of diagnosing (clinical evaluation/radiographic assessment) and discussing common long bone fractures in adults and children as well as understand principles of management of injuries to the musculoskeletal system and recommend appropriate treatment. Be adept at joint aspiration. Learn to adequately assist in operative procedures and prepare the patient for the appropriate surgical intervention (draping, site preparation). Learn to carry out post-surgical skin closure and write appropriate postoperative orders.
Even more progressive development of surgical and clinical skills with greater responsibility in areas of decision making and patient management are essential during this year of training.
R4s should show ability to reach appropriate surgical decisions and becoming increasingly proficient in the technical aspect of surgical procedures. They are expected to assist in educating the more junior residents and medical students.
Understand the preoperative and postoperative management of total joint arthroplasty, spinal surgery and acute trauma cases. This involves in the ordering of special investigative procedures where appropriate, assessment of such investigations and presentation of concise management protocols to his/her immediate superior. Be able to evaluate and manage acute fractures of the extremities utilizing appropriate open and closed reductions methods. Be able to evaluate and manage, surgically or conservatively, soft tissue injuries around joints and repair traumatic injuries. Be capable of assessing spinal and pelvic trauma, as well as suggest appropriate treatment. Be capable of evaluating neurovascular injuries of the extremities and suggest management protocols. Be capable of diagnosing and assessing congenital and accord non-traumatic abnormalities of the musculoskeletal system. Be familiar with diagnostic modalities related to non-traumatic spinal disorders and suggest appropriate treatment options. Be capable of diagnosing and assessing primary and secondary tumors of the musculoskeletal system. Appreciate the multidisciplinary approach in their management.
Residents at this level must assume a major administrative role in organizing day-to-day ward activities as well as be responsible for orthopaedic teaching rounds and general service organization. They must be proficient in the administrative aspects of the service and organize the on-call schedule and surgical scheduling. They must show significant interest in teaching junior residents, medical students and paramedical personnel. As expected, R5 residents will act with a certain amount of autonomy in assessing consultations, in traumatic and non-traumatic orthopaedic patients. Surgical procedures must be conducted with confidence and residents are expected to reach a competent level in diagnosis, patient management, awareness and treatment of post-surgical complications. .
Be capable of managing post-traumatic complications (early and late), such as infection, instability, non-union and post-traumatic arthritis. Be capable of assessing and managing traumatic and non-traumatic disorders of the spine: disc protrusions, scoliosis, spondylolisthesis
and fractures. Be able to assess and surgically manage soft tissue injuries of the musculoskeletal system. Be capable of performing joint reconstructive procedures - arthroplasty, osteotomy and arthrodesis. Be capable of surgically managing simple musculoskeletal tumors of the extremities. Be capable of diagnosing and managing congenital and acquired pediatric disorders. Be capable of diagnosing and managing major pediatric trauma to the axial and appendicular skeleton. Be capable of passing the condensed examination of the Royal College of Physicians and Surgeons of Canada. Be capable of passing the American Board of Orthopaedic Surgery examination.
The following rounds are compulsory for all residents rotating through the specific hospital or subspecialty:
- Department of Orthopaedic Surgery, Montreal General Hospital:
- Orthopaedic Trauma Rounds, from 7:00 to 7:15 a.m., daily
- MGH Orthopaedic Rounds, from 7:00 to 8:30 a.m., every other Thursday
- MGH Trauma Rounds, from 4:00 to 6:00 p.m., every Wednesday
- MGH Orthopaedic Oncology Rounds, from 6:45 to 7:15 a.m., every other Friday
- MGH Sarcoma Tumour Board, from 7:30 to 8:30 a.m., every Friday
- MGH Sports Rounds, from 3:30pm to 5:00pm., every other Tuesday
- MGH Spine Rounds, from 7:00am to 8:30am., every Wednesday
- Department of Orthopaedic Surgery, Jewish General Hospital:
- JGH Fracture Rounds, from 4:00 to 6:00 p.m., every Tuesday
- JGH Orthopaedic Grand Rounds from 7:00 to 8:30 a.m., every other Thursday
- JGH up-to-date teaching schedule
- Montreal Children’s Hospital and Shriners Hospital:
- MCH Fracture Rounds, from 7:30 to 8:30 a.m., every Monday
- Shriners Bedside Rounds, from 7:30 to 8:30 a.m., every Tuesday
- MCH Indication Rounds, from 4:00 to 6:00 p.m., every Thursday
- Shriners Grand Rounds, from 7:15 to 8:30 a.m., every other Thursday
- Shriners Teaching Rounds, from 7:15 to 8:30 a.m., every Wednesday and Friday
- Department of Orthopaedic Surgery, St. Mary’s Hospital:
- SMH Orthopaedic Grand Rounds, from 7:30 to 9:00 a.m., every Wednesday
- Subspecialty Rounds:
- Arthroplasty Rounds, from 4:00 to 6:00 p.m, every Thursday
- Spine Rounds, from 7:00 to 8:30 a.m. (MGH), every Wednesday
- Sports Medicine Rounds, from 3:30 to 5:00 p.m., every other Tuesday