Goals and Objectives for the Orthopaedic Surgery Resident
McGill Arthroplasty
At the completion of the rotation, the resident will have acquired the following competencies and will function effectively as:
1. Medical Expert/Clinical Decision-Maker
General Requirement for R2-R5s:
- Demonstrate diagnostic and therapeutic skills for ethical and effective patient care.
- Access and apply relevant information and therapeutic options to clinical practice.
- Demonstrate effective consultation services with respect to patient care, education and legal opinions.
- Recognise personal limits of expertise.
Specific Requirements:
PGY-3 Level
Appreciate the normal anatomy and physiology of diathrodial joints. Understand the pathophysiology of inflammatory, degenerative and infectious joint processes. Understand treatment modalities and investigative techniques as they relate to joint reconstruction. Recognize the importance of postoperative complications. Understand the role of physiotherapy and occupational therapy. Understand the indications, contradictions and complications associated with non-steroidal and anti-inflammatories. Understand the principles of surgery as they relate to intra-articular and extra-articular reconstructive procedures of the lower extremity.
PGY-4 Level
Acquire as detailed knowledge of joint biomechanics reconstructive procedures for the lower extremity. Develop detailed knowledge of osteotomy, athrodesis and jonit arthroplasty: indications, contraindications, complications as well as prosthetic options. Recognize and manage postoperative complications. Recognize and evaluate septic arthroplasties.
Hip Surgery:
Hemiarthroplasty (unipolar, bipolar).
Core decompression.
Arthrotomy.
Knee Surgery:
Patellar alignment procedures.
Arthrotomy.
Arthroscopy (sepsis).
Synovectomy.
High tibial osteotomy.
Ankle/Foot Surgery:
Arthrotomy.
Synovectomy.
Osteotomy/implant arthroplasty.
Arthrodesis: (Simple, triple, subtalar, ankle).
PGY-5
Diplay a detailed knowledge of complex hip and knee arthroplasty and understand prosthetic options as well as technical considerations required to achieve the desired surgical goal.
Display a detailed knowledge of the principles of revision surgery with bone loss, and the principles of autograft/allograft reconstruction.
Display the ability to manage complex postoperative complications. Understand the principles of management of septic arthroplasties.
Hip Surgery:
Arthrodesis.
Osteotomies: femoral and pelvic.
Arthroplasty: primary and simple revision
Arthroscopy
Knee Surgery:
Arthrodesis.
Osteotomy: femoral and tibial
Arthroplasty: primary
Ankle/Foot Surgery:
Arthrodesis: Complex (subtalar, triple, ankle).
Arthroscopy.
2. Communicator
General Requirement for R2-R5s:
- Establish therapeutic relationships with patients/families.
- Obtain and synthesise relevant history from patients/families/communities.
- Listen effectively.
- Discuss appropriate information with patients/families and the health care team.
Specific Requirements:
- Understand that effective patient-physician communication can foster patient satisfaction and compliance as well as influence the manifestations and outcome of a patient's illness and surgical intervention.
- Establish relationships with the patient that are characterized by understanding, trust, respect, empathy and confidentiality.
- Recognize the emotional stress for patients and families faced with orthopedic conditions and their associated surgical management, a stress especially accentuated in the treatment of children.
- Gather information not only about the disease but also about the patient's beliefs, concerns and expectations about the illness, while considering the influence of factors such as the patient's age, gender, ethnic, cultural and socioeconomic background, and spiritual values on that illness and on any proposed surgical intervention. (R4-5)
- Deliver information to the patient and family in a humane manner and in such a way that it is understandable; encourage discussion and promote patient's participation in decision-making to the degree that they wish.
- Obtain informed consent; appreciate alternative means of achieving consent if the patient is incompetent to provide consent, be it on the grounds of age or mental status, or other disqualifier.
- Understand and demonstrate the importance of cooperation and communication among health professionals involved in the care of individual patients such that the roles of these professionals are delineated and consistent messages are delivered to patients and their families.
- Maintain clear, accurate and appropriate written records.
- Write well-organized and legible orders and progress notes.
- Complete concise hospital discharge summaries promptly.
- Write well-organized letters, providing clear direction to the referring physician and other physician and allied personnel, where indicated.
3. Collaborator
General Requirement for R2-R5s:
- Consult effectively with other physicians and health care professionals.
- Contribute effectively to other interdisciplinary team activities.
Specific Requirements:
- Identify and describe the role, expertise and limitations of all members of an interdisciplinary team required to optimally achieve a goal related to patient care, a research problem, an educational task, or an administrative responsibility. (R4-5)
- Develop a care plan for a mutual-interest patient, that includes investigation, treatment and continuing care, whether preoperatively or postoperatively, as well as in both hospital and community settings. (R3-R5)
- Participate in an interdisciplinary team, demonstrating the ability to accept, consider and respect the opinions of other team members, while contributing specialty-specific expertise.
4. Manager
General Requirement for R2-R5s:
a. Utilize resources effectively to balance patient care, learning needs, and outside activities.
b.Allocate finite health care resources wisely.
c. Work effectively and efficiently in a health care organisation.
d. Utilize information technology to optimise patient care, life-long learning and other activities.
Specific Requirements:
- Have basic knowledge of how to function effectively in health care organizations, ranging from an individual clinical practice to organizations at the local, regional and national level. (R4-5)
- Have basic knowledge of the structure, financing, and operation of the Canadian health system and its facilities; and function effectively within it. (R4-5)
- Have ability to access and apply a broad base of information to the care of patients in ambulatory care, hospitals and other health care settings.
- Make clinical decisions and judgments based on sound evidence for the benefit of individual patients and the population served. This allows for an advocacy role primarily for the individual but in the context of societal needs when monitoring and allocating needed resources. (R3-5)
- Be open to working effectively as a member of a team or a partnership and to accomplish tasks whether one is a team leader or a team member.
- Have basic knowledge of population-based approaches to health care services and their implication for medical practice.
5. Health Advocate
General Requirement for R2-R5s:
- Identify the important determinants of health affecting patients.
- Contribute effectively to improved health of patients and communities.
- Recognise and respond to those issues where advocacy is appropriate.
Specific Requirements:
- Demonstrate knowledge of determinants of health by identifying the most important determinants of health (i.e., poverty, unemployment, early childhood education, social support systems), being familiar with the underlying research evidence, and applying this understanding to common problems and conditions in orthopedics. (R4-5)
- Demonstrate knowledge of public policy for health by describing how public policy is developed; identifying current policies that affect health, either positively or negatively (i.e., communicable diseases, tobacco, substance abuse); and citing examples of how policy was changed as a result of actions by physicians. (R3-5)
- Demonstrate knowledge of the management of individual patients, by identifying the patient's status with respect to one or more of the determinants of health (e.g., unemployment); adapting the assessment and management accordingly (e.g. the medical history to the patient's social circumstances); and assessing the patient's ability to access various services in the health and social system. (R4-5)
- Demonstrate knowledge of the key issues currently under debate regarding changes in the Canadian health care system, indicating how these changes might affect societal health outcomes and advocating to decrease the burden of illness (at a community or societal level) of a condition or problem relevant to orthopedics through a relevant orthopedic society, community-based advocacy group, other public education bodies, or private organizations. (R4-5)
6. Scholar
General Requirement for R2-R5s:
- Develop, implement and monitor a personal continuing education strategy.
- Critically appraise sources of medical information.
- Facilitate learning of patients, house staff/students and other health professionals.
- Contribute to development of new knowledge.
Specific Requirements:
1. Demonstrate the following clinical skills:
- Pose a clinical question.
- Recognize and identify gaps in knowledge and expertise around the clinical question.
- Formulate a plan to fill the gap including to:
- conduct an appropriate literature search based on the clinical question;
- assimilate and appraise the literature;
- develop a system to store and retrieve relevant literature;
- consult others (physicians and other health professionals) in a collegial manner.
- Propose a solution to the clinical question.
- Implement the solution in practice. Evaluate the outcome and reassess the solution (re-enter the loop at a) or b).
- Identify practice areas for research.
2. Demonstrate the following research skills:
- Pose a research question (clinical, basic or population health).
- Develop a proposal to solve the research question including to:
- conduct an appropriate literature search based on the research question;
- identify, consult and collaborate with appropriate content experts to conduct the research; and to
- propose a methodological approach to solve the question.
- Carry out the research outlined in the proposal.
- Defend and disseminate the results of the research.
- Identify areas for further research that flow from the results.
3. Acquire the following educational experience:
- Demonstrate knowledge of, and the ability to apply, the principles of adult learning, with respect to oneself and others.
- Demonstrate knowledge of preferred learning methods in dealing with students, residents, and colleagues.
7. Professional
General Requirement for R2-R5s:
- Deliver highest quality care with integrity, honesty and compassion.
- Exhibit appropriate personal and interpersonal professional behaviours.
- Practise medicine ethically consistent with obligations of a physician.
Specific Requirements:
1. Achieve the following discipline-based objectives:
- Display attitudes commonly accepted as essential to professionalism.
- Use appropriate strategies to maintain and advance professional competence.
- Continually evaluate his/her abilities, knowledge and skills and know his/her limitations of professional competence.
2. Achieve the following personal/professional boundary objectives:
- Adopt specific strategies to heighten personal and professional awareness and explore and resolve interpersonal difficulties in professional relationships.
- Consciously strive to balance personal and professional roles and responsibilities and to demonstrate ways of attempting to resolve conflicts and role strain.
3. Achieve the following objectives related to ethics and professional bodies:
- Know and understand the professional, legal and ethical codes to which physicians are bound.
- Recognize, analyze and attempt to resolve in clinical practice ethical issues such as truth-telling, consent, advanced directives, confidentiality, end-of-life care, conflict of interest, resource allocation, research ethics, etc.
- Have basic knowledge of and be able to apply relevant legislation that relates to the health care system in order to guide one's clinical practice. (R4-R5).
- Recognize, analyze and know how to deal with unprofessional behaviors in clinical practice, taking into account local and provincial regulations.
Revised into CanMEDS format
Objectives of Clinical Fellowship in Hip and Knee Arthroplasty
Sir Mortimer B. Davis – Jewish General Hospital – McGill University
Introduction:
The Department of Orthopaedic Surgery at the Sir Mortimer B. Davis – Jewish General Hospital is an active service specializing primarily in hip and knee arthroplasty, foot and ankle surgery, spine surgery and level 2-3 trauma care.
The Sir Mortimer B. Davis – Jewish General Hospital is a McGill University associated teaching hospital with 637 beds. The Arthroplasty service performs the highest volume of hip and knee arthroplasties in Quebec..
There are 50 in-patients beds available for orthopaedic patients primarily on the 8 West ward. There are 12 operating theatres available weekly consisting of 3 trauma days, 7 arthroplasty theatres with the remainder being utilized for foot and ankle and spine surgery.
The out-patient department is busy consisting of many fracture clinics, specialized orthopaedic clinics and offices. It is well staffed with receptionist and clerical staff. The arthroplasty service has a full-time coordinator to facilitate patient visits, ensure data collection. All data relating to arthroplasty patients is gathered prospectively.
The attending staff consists of 5 geographic full-time surgeons including Dr. Ruth Chaytor foot and ankle surgery, Dr. Monika Volesky foot and ankle surgery, Dr. John Antoniou arthroplasty surgery, Dr. Olga Huk arthroplasty surgery, Dr. Leonard Rosen arthroplasty surgery and Dr. David Zukor arthroplasty surgery.
Arthroplasty surgeons have 1.5 elective days per week each (for arthroplasty) and share trauma time averaging 2-4 trauma days per month.
Objectives:
Objectives of a Clinical Fellowship in arthroplasty surgery at the Sir Mortimer B. Davis – Jewish General Hospital will be tailored to meet the individual needs of each particular clinical Fellow.
Generally, the main objective is to expose the Fellow to the full spectrum of hip and knee arthroplasty issues including preoperative care, patient and implant selection, operative care ( the latest in primary and revision arthroplasty suregry utilizing cemented and cementless fixation, various articulating surfaces and surgical approaches) and postoperative care. Specialized techniques such as resurfacing arthroplasty are also routinely performed.
Clinical Duties:
In order to maximize exposure of the practices of the attending staff to the Fellow (and to minimize any conflict with resident teaching) the Fellow will be assigned on a rotating basis to each attending staff.
The means that the Fellow will adopt the schedule of that particular staff including OR attendance, clinic attendance and call. Rotations will be scheduled to allow the Fellow to spend equal time with each of the staff.
Thus it is expected that the Fellow would spend approximately 1.5 days a week in the clinic with the staff and 3 days in the Operating Room (with the staff).
With regard to surgical cases, the Fellow will first assist or perform the case under the supervision of the attending staff that he/she is rotating with. The exact role of the Fellow in the Operating Room will be discussed before the surgery with the staff, resident and the Fellow.
Teaching Duties:
The Fellow will be expected to attend all Rounds including Fracture Rounds, Orthopaedic Rounds, McGill Combined Grand Rounds and Arthroplasty Rounds. The Fellow will present at least 1 topic per month to the general group of staff and residents at the usual Orthopaedic Rounds.
Research Duties:
The Clinical Fellow will be expected to complete at least 1 clinical or basic science research project during his/her tenure. It is expected that the results of this project will be presented at a National or International Meeting and will be submitted for publication. There are many opportunities to perform many more such projects throughout the year with invited papers, clinical research nurses gathering and recording all arthroplasty data prospectively on a yearly basis and work performed at the orthopaedic research lab of the lady Davis institute under the supervision of Dr. John Antoniou.
Send request and C.V. to Fellowship Director:
John Antoniou MD, PhD, FRCSC
3755 Cote-St. Catherine road
Room E-003
Montreal QC H3T 1E2
Canada
Or Email: malevisatos [at] jgh.mcgill.ca
Fellowships run for 1 year and begin from July1st to June 30th
Deadline for submission is September 1st of the year prior to beginning the fellowship