SUB-INTERNSHIP IN ORTHOPAEDICS
ORT 827
Course Department, Number & Title: ORT 827, Sub-Internship In Orthopaedic
Course credit or length: 4 Weeks
Course director and contact information (office phone and e-mail):
Dr. Felix Cheung; 304.691.1262, cheungf@marshall.edu
Course coordinator and contact information (office phone and e-mail):
Ashley Taliaferro, 304.691.1149; Roach33@marshall.edu , Department of Orthopaedics
Course location: Cabell Huntington Hospital, Cabell Huntington Surgery Center and the Marshall
University Medical Center.
Brief Course Description: A 4th year subinternship in orthopaedic surgery is offered, providing
experience in office and hospital management of diseases of the musculoskeletal system. Preference is
given to those considering matching in orthopaedic surgery. Visiting Medical Students are allowed
enrollment, but preference will be given to Marshall students. For those looking for an outpatient
musculoskeletal experience only, please consider ORT 808.
Goals: The student will be introduced to office and hospital management of diseases of the
musculoskeletal system. The goals of the course are to: 1) introduce the student to common
musculoskeletal conditions as encountered by the orthopaedic department; 2) develop procedural,
outpatient, and inpatient clinical skills relevant to orthopaedic surgery, 3) develop a solid knowledge
base of musculoskeletal conditions, and 4) develop the skills needed to succeed as an intern on a busy
orthopaedic service. The student will take up to four 1 week rotations through the available services at
the time of his or her rotation, including Joint Replacement, Sports Medicine, Spine, Trauma, Hand, Foot
and Ankle, and Tumor. Reasonable requests made at least one week prior to arrival will be honored on
a “first come, first served” and basis.
Institutional Objective
Patient Care - Students must demonstrate the ability to provide patient care that is compassionate,
appropriate, and effective for the treatment of health problems and the promotion of health.
Course Objective
The student will provide care that is compassionate, appropriate, and effective for the following:
1.
Development of procedural skills, including but not limited to casting techniques,
reductions, suturing, and assisting with orthopaedic surgeries.
2.
Development of outpatient clinical skills, including but not limited to performance of a
thorough orthopaedic history and physical, joint specific orthopaedic exams,
interpretation of medical images, and injections of joints.
3.
Development of inpatient clinical skills, including but not limited to post-surgical
management of orthopaedic patients, inpatient consultations, and communications
with ancillary staff and other services.
Outcome Measure
Faculty members and residents will observe and evaluate the student’s ability to: 1) assist in the
care of inpatients assigned by faculty, including surgical and postoperative care, 2) provide on
call coverage as assigned by the faculty and senior resident staff; 3) provide care of outpatients
assigned by faculty, including initial visits, treatment plan formation, and postoperative visits;
and 4) participate in assigned conferences by the faculty of the Department of Orthopaedic
Surgery. The student will be observed by faculty taking at least three orthopaedic patient
histories, examining and evaluating the patients, offering differential diagnosis, management
plans, and interpretation of laboratory results and imagining studies.
Institutional Objective
Medical Knowledge- Students must demonstrate knowledge of established and evolving biomedical,
clinical, epidemiological and social-behavioral sciences, as well as the application of this knowledge to
patient care.
Course Objective
The student will develop a solid knowledge base of orthopaedic problems including the
evaluation and workup for a trauma patient, issues involved with total joint replacements,
evaluation of sports injuries, and other common orthopaedic problems.
Outcome Measure
The student’s solid knowledge base of orthopaedic problems including the evaluation and
workup for a trauma patient, issues involved with total joint replacements, evaluation of sports
injuries, and other common orthopaedic problems. The patient cases may come from the
following list, with at least one case being selected by the faculty member:
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Bone health problems, including osteoporosis and other metabolic bone diseases, bone
and soft tissue tumors, osteomyelitis
Foot problems including posterior tibial tendonitis, pes planus, bunions, plantar fascitiis
Fractures and dislocations
Hand problems including carpal tunnel syndrome and other nerve compression issues,
trigger finger, carpometacarpal arthritis, fractures of the hand.
Osteoarthritis
Pediatric problems including growth plate abnormalities, pediatric fractures, scoliosis,
tumors.
Sports Injuries including meniscal tears, rotator cuff pathology, ligamental injuries,
bursitis, osteochondral defects
Spinal problems including ruptured disks, sciatica, low back pain, spondylosis
The student’s knowledge shall also be tested by the orthopaedic examination to be administered at the
end of the rotation.
Institutional Objective
Practice-based Learning and Improvement - Students must demonstrate the ability to investigate and
evaluate their care of patients, to appraise and assimilate scientific evidence, and to continuously
improve patient care based on constant self-evaluation and life-long learning.
Course Objectives
At the end of this course, students will be able to:
1.
Identify areas for personal and practice improvement and implement strategies to
enhance knowledge, skills, attitudes, and process of care.
2.
Use information technology to manage information, access online medical information,
and support own education.
3.
Facilitate the learning of students and other health care professionals.
Outcome Measures
The faculty and residents will observe and evaluate the student’s ability to read and access
current medical literature electronically to gain information about specific patient conditions
encountered in the care of patients. The student’s will also be observed and evaluated on
participation in the education of others, including patients, medical students and health care
professionals.
Institutional Objective
Interpersonal and Communication Skills- Students must demonstrate interpersonal and communication
skills that result in the effective exchange of information and collaboration with patients, their families,
and health professionals.
Course Objective
At the end of this course, students will be able to:
1.
Demonstrate interpersonal and communication skills that assist in effective information
exchange and be able to team with patients, patients’ families, and professional
associates.
2.
Elicit and provide information using effective listening, non-verbal, explanatory,
questioning, and writing skills.
3.
Maintain comprehensive, timely, and legible medical records.
Outcome Measure
Faculty and residents will directly observe the students:
1.
Communicating patient information to assist in the transition of care to and from the
orthopaedic on-call teams.
2.
Communicating patient information to faculty.
3.
Documenting patient information in the form of history and physical examinations,
progress notes, operative notes, discharge summaries, and other documentation as
assigned.
4.
Obtaining patient histories in the ambulatory and inpatient setting
5.
Communicating findings and plans of care with patients and families.
The student’s performance will also be accessed via the evaluation form.
Institutional Objective
Professionalism- Students must demonstrate a commitment to carrying out professional responsibilities
and an adherence to ethical principles.
Course Objective
Students will demonstrate professionalism by:
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4.
5.
Maintaining confidentiality of patient information.
Demonstrating punctuality in completing assignments.
Maintaining positive attitude and good work ethic.
Demonstrating respect, compassion, integrity, and responsiveness to the needs of
patients.
Promptly responding to the needs of nursing and support staff.
Outcome Measure
The faculty and residents of the Department of Orthopaedic Surgery will evaluate the student’s
abilities of the above professionalism standards and Institutional Objective.
Systems-based Practice - Students must demonstrate an awareness of and responsiveness to the larger
context and system of health care, as well as the ability to call effectively on other resources in the
system to provide optimal health care.
Course Objective
Students will demonstrate to the faculty a:
1.
Basic understanding of methods to practice cost-effective health care and resource
allocation that do not compromise quality of care.
2.
Basic ability to demonstrate knowledge that patient safety is always the first concern of
the physician.
3.
Basic ability to describe how types of medical practice and delivery systems differ from
one another.
4.
Basic understanding of the coordination of long term care with social services, physical
therapy, families, and other concerned parties.
5.
Basic understanding of the principles of patient safety in a hospitalized setting.
6.
Basic understanding of the universal precautions and how health care workers may
decrease the risk of acquiring blood borne illness.
7.
Basic understanding of the billing system in the United States, including the use of CPT,
ICD9, and RVUs.
Outcome Measure
The faculty and residents of the Department of Orthopaedic Surgery will evaluate the student’s
ability to justify the rationale for laboratory or imaging studies ordered during rotation and
ability to help coordinate the care of the patient with ancillary services.
Basic Science Objectives
The student will demonstrate understanding of the basic principles of orthopaedic surgery
including:
 Molecular and Cell Biology in Orthopaedics
 Genetic Basis of Disorders with Orthopaedic Manifestations
 Biomechanics
 Biomaterials
 Evidence-Based Orthopaedics
The student will demonstrate understanding of the physiology of musculoskeletal tissues
including:
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Thromboembolism
Growth and Development of the Skeleton
Form and Function of Bone
Articular Cartilage and Osteoarthritis
Form and Function of the Meniscus
Form and Function of Tendon and Ligaments
Form and Function of Skeletal Muscle
Form and Function of Peripheral Nerves and Spinal Cord
Form and Function of the Intervertebral Disk
Kinesiology
The student will demonstrate understanding of the basic principles and treatment of
musculoskeletal disease, including:
 Infections in Orthopaedics
 Orthopaedic Pharmacology and Therapeutics
 Bone Injury and Repair
 Articular Cartilage Repair
 The Biologic Response to Orthopaedic Implants
 Molecular Basis of Cancer
 Osteoarthritis and Rheumatoid Arthritis
 Metabolic Bone Disease
 Neuromuscular Diseases
Process
Reference Orthopaedic Basic Science, 3rd Edition 2007 textbook
Attend and take notes on all morning didactics
Attend and take notes on all Orthopaedic Grand Rounds
Participation on clinical rounds, outpatient clinics and surgeries
Independent reading on patient care
Outcome Measure for all Basic Science Objectives
Evaluation by faculty and residents of the Department of Orthopaedic Surgery at completion of
rotation.
Orthopaedic examination at end of rotation.
Self-Directed Learning
As a medical student, you are encouraged to use any unstructured time as a time to read about your
patients, research questions that arise during the day, prepare for case conferences, and prepare for
student-faculty rounds. Preceptors have been specifically asked to look for evidence that you have read
articles and books between clinic sessions. Use this time to build your knowledge of medicine and learn
from your patients.
Required References: Hoppenfeld’s Surgical Exposures in Orthopaedics; Essentials of Musculoskeletal
Care 3rd Ed; A pocket guide to orthopaedics (choice).
Additional Responsibilities of The Student
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The student will contact the Orthopaedic Course Director 1 week prior to arrival for
assignments.
The student will act and dress in a professional manner in compliance with the requirements
and customs of his or her attending.
The student will share call duties alongside the residents at an average of every fourth night. He
or she must take trauma and non-trauma calls during the rotation. Call requests must be
submitted to the administrative resident within 2 days after the start of the rotation.
The student will be an active participant in all aspects of patient care and didactic sessions.
ASSESSMENT METHODS
Mid Point Evaluation
In accordance with LCME standard ED-30, the Course Director will evaluate student performance at midpoint to review the student’s professional, clinical and academic performance up to that point. The
formative evaluation must be reviewed with the student and the student will have an opportunity to
discuss with the Course Director. The form must be signed by the student and returned to the Course
Director. The Course Director shall then forward a copy of the form to the Office of Academic Affairs.
The form will NOT however be included in the student’s official academic record. For two week
electives, oral feedback will be provided at the end of the first week.
Written Final Examination-25%
A written exam will be given at the end of the rotation. Study material and readings will be assigned at
the beginning of the rotation and students are encouraged to read the material early in the course.
Students must pass the examination (score at least the 70%) in order to pass the course. Students will
be able to retest one time. An unsuccessful second attempt will result in failure of the course. The
exam will be 50 questions and will be schedule for the last Friday of the rotation from 1-3 pm in the
Lewis Technology Center.
Case Presentation- 25%
The student will be required to give a 10-15 minute case presentation at a pre-arranged time during
their clinical rotation. The presentation will be given to the course director and medical students.
Students will be notified of the date and time of their presentation one week in advance. The course
director will assess the presentation and assign a percentage score. (See Case Presentation Form at the
end of this document for grading details.)
Preceptor Evaluation- 50%
Grading
A= 90-100%
B= 80-89%
C= 70-79%
F= below 70%
Each component must be passed in order to pass the course. The preceptors’ evaluation will be based,
but are not limited to, upon the following factors:
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Attendance and participation in tutorials
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Conference attendance
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Demonstration of basic knowledge of patient care during clinic
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Maturity and Professionalism
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Oral Case presentation/patient workup
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Participation in call
Participation in clinic and OR Hours
Evaluation of Course and Faculty Requirement
Completion of evaluations of Course and Faculty members by students is a required component of this
course. Students will be issued an “Incomplete” until the course and faculty evaluations have been
submitted.
MUJCESOM Policies: All medical students taking this course will comply with School of
Medicine policies given at http://musom.marshall.edu/students/policies. Individual policies can
be found at the following websites:
Student Infectious Material Exposure:
http://musom.marshall.edu/ups/postexposure.asp
MS-IV Attendance:
https://musom.marshall.edu/students/documents/policies/Yr4attendence.pdf
Academic Dishonesty Policy:
https://musom.marshall.edu/students/documents/policies/Standards-of-Professionalism-andHonor-Code.pdf
Academic Standards Policy:
https://musom.marshall.edu/students/documents/Policies/ASC-FINAL-POLICY.pdf
Policy for Students with Disabilities:
https://musom.marshall.edu/students/documents/Guidelines.pdf
University Computing Services’ Acceptable Use Policy:
http://www.marshall.edu/ucs/CS/accptuse.asp
Affirmative Action Policy:
pp. 16-17
http://www.marshall.edu/catalog/Graduate/S2008/gr_sp08.pdf
Inclement Weather Policy:
https://musom.marshall.edu/students/documents/policies/MUSOM-Inclement-WeatherPolicy.pdf
Notification of delays and cancellations of classes are posted on the Medical Education Home
Page when Marshall University Main Campus is not in session
https://musom.marshall.edu/weather