Orthopaedic Surgery Residency Program: COMPETENCY BASED STREAM
Phase 3: Module 17: Complex Trauma
Learning
Context
This module will build on the trainees’ basic fracture knowledge to acquire the ability to manage complex trauma and its complications
CanMEDS
Role (s)
Learning
Outcomes:
Goals/Objectives
Medical Expert Know:
Demonstrate knowledge of Initial
ATLS management
Demonstrate knowledge of the principles of the management of: all extremity and axial fractures, dislocations and fracture-dislocation
(excluding the cervical, thoracic and lumbar spine)
Dr. Markku Nousiainen
Source Doc(s)
ATLS manual
ATLS course in first year of residency
Thomas P.
Rüedi, Thomas
P. Ruedi, Richard
Buckley,
Christopher G.
Moran. Principle of Fracture
Management Vol.
1 & 2
Specific
Competencies
Be able to manage a trauma patient following the
ATLS protocol
DO:
Provide appropriate initial and definitive management of fractures and dislocations
Be able to devise an appropriate pre-operative plan and execute the plan during
Learning/Teaching
Strategies
Review of source documentation and website materials
Management of patients with fractures with trauma team, emergency medicine team, and orthopaedic team (including allied health professionals) in emergency room, operating room, clinic and ward
Resident to be prepared to ask and answer impromptu questions from supervisor during observation and oneon-one teaching as they relate to the readings
Resident observation of staff surgeon performing all of the specific competencies, with the opportunity for questions and discussion afterwards
Resident opportunity to perform assessments under supervision of
07Jan15 Version
Evaluation Method or
Tools
Before start of rotation:
1) completion of ATLS course
2) completion of AO Basic course
3) completion of AO
Advanced course (can be done concurrently during the module)
During first 1-2 weeks of rotation:
1) Surgical Skills Lab
(MSH): a) retention tests on ORIF of tibia with fasciotomy and wound closure (on cadaver), ORIF hip fracture with sliding hip screw b) pre-test, teaching session, and post-test on
(i) ORIF AO C2 distal humerus fracture with olecranon osteotomy; (ii) ex fix application with conversion to ORIF for
Schatzker 5 tibial plateau fracture; (iii) ORIF trimalleolar ankle fracture with syndesmosis screw insertion (all on sawbones models)
2) Sunnybrook Health
1

Orthopaedic Surgery Residency Program: COMPETENCY BASED STREAM
Phase 3: Module 17: Complex Trauma
Learning
Context
CanMEDS
Role (s)
Learning
Outcomes:
Goals/Objectives
Dr. Markku Nousiainen
Source Doc(s) Specific
Competencies
Prioritize injuries in trauma patients
Demonstrate knowledge of the principles of open fracture management
Recognize the dysvascular limb and compartment syndrome
Chapter 4.1 in
Thomas P.
Rüedi, Thomas
P. Ruedi, Richard
Buckley,
Christopher G.
Moran. Principle of Fracture
Management Vol.
1 & 2
Chapter 4.2 in
Thomas P.
Rüedi, Thomas
P. Ruedi, Richard
Buckley,
Christopher G.
Moran. Principle of Fracture
Management Vol.
1 & 2
Chapter 1.6 in
Thomas P.
Rüedi, Thomas
P. Ruedi, Richard
Buckley,
Christopher G.
Moran. Principle of Fracture surgery
Demonstrate skill in the essential techniques of fracture fixation and soft tissue management
Demonstrate knowledge of the concepts of
“damage control orthopedics” vs.
“early total care”
DO:
Provide appropriate initial and definitive management of open fractures and dislocations
Provide initial and definitive management of a dysvascular limb and compartment syndrome
Learning/Teaching
Strategies supervisor
07Jan15 Version
Evaluation Method or
Tools
Sciences Centre: review of AO videos plus sawbones work on long bone nailing, ex fix placement of pelvis and lower extremity, tibial plateau, ankle fractures
(to be arranged with assistance of Synthes,
Canada)
During rotation:
1) Rotation through both
Sunnybrook HSC and/or
Thunder Bay Regional
Hospital (for 6-week rotation) taking mandatory call (as per PAIRO guidelines); resident should be responsible for being lead resident for each hospital’s trauma room on a q weekly basis, to be shared with other residents on rotation at each hospital. As lead resident, will be responsible for organizing room, doing pre-op planning, etc. with staff supervision
2) Resident to fulfill checklist of cases (both seen and performed) off list of mandatory cases to know for trauma module
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Orthopaedic Surgery Residency Program: COMPETENCY BASED STREAM
Phase 3: Module 17: Complex Trauma
Learning
Context
CanMEDS
Role (s)
Learning
Outcomes:
Goals/Objectives
Dr. Markku Nousiainen
Source Doc(s) Specific
Competencies
Medical Expert Demonstrate knowledge of the principles of the management of complications and issues in fracture care, including:
• Acute and chronic infection
• Malunion and nonunion
• Segmental bone loss
Management Vol.
1 & 2
Relevant chapters in
Thomas P.
Rüedi, Thomas
P. Ruedi, Richard
Buckley,
Christopher G.
Moran. Principle of Fracture
Management Vol.
1
DeCoster T,
Gehlert R, et al.
Management of
Posttraumatic
Segmental Bone
Defects, JAAOS
Jan 2004; 28-38
Masquelet AC,
Fitoussi F, et al.
Reconstruction des os longs par membrane induite et autogreffe spongieuse. Ann
Chir Plast Estet
2000;45:346-53.
Provide initial and definitive management of these complications/ issues
Be able to devise an appropriate pre-operative plan and execute the plan during surgery
Demonstrate competence in the essential surgical techniques to manage such complications
Learning/Teaching
Strategies
07Jan15 Version
Evaluation Method or
Tools by Royal College standards
3) List of special cases to see by resident to be provided
4) Three one-on-one teaching sessions reviewing the management of upper extremity, pelvis and acetabulum, and lower extremity fractures
5) Feedback to be informally provided from supervisory surgeons on on-going basis
6) Determination to complete rotation to be provided by supervising surgeon during midmodule evaluation – review of checklist of cases, feedback from other surgeons
Mid-module evaluation
1) written exam – multiple choice OITE trauma questions
2) 3 oral exam questions
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Orthopaedic Surgery Residency Program: COMPETENCY BASED STREAM
Phase 3: Module 17: Complex Trauma
Learning
Context
CanMEDS
Role (s)
Learning
Outcomes:
Goals/Objectives
Medical Expert Demonstrate an understanding of the management of associated conditions in patients sustaining musculoskeletal trauma, including:
• Adult respiratory distress syndrome
• DVT
• Fat and pulmonary embolism
• Multiple organ system failure
• Chronic regional pain syndrome
• Osteoporosis
Demonstrate awareness and recognition of: non-accidental trauma issues related to geriatric fractures and pathologic fractures
Dr. Markku Nousiainen
Source Doc(s)
Chapters 4.6, 4.7, and 4.8 inThomas P.
Rüedi, Thomas
P. Ruedi, Richard
Buckley,
Christopher G.
Moran. Principle of Fracture
Management Vol.
1 & 2
Chapter 3,
Complications of
Fractures: Acute in Orthopaedics ,
RH Fitzgerald, H
Kaufer, and AL
Malkani eds
Chapter 13,
Surgical
Management of
Bone Metastases in Bone
Metastases: A translational and clinical approach ,
D Kardamakis, V
Vassiliou, and E
Chow eds.
Bhandari M,
Sprague S, et al.
The prevalence of intimate partner violence across
Specific
Competencies
Learning/Teaching
Strategies
07Jan15 Version
Evaluation Method or
Tools
End of module evaluation
1) 360 evaluation
2) written exam
– multiple choice OITE trauma questions
3) 3 oral exam questions
4) Final examination in
Surgical Skills lab: OSATS on aforementioned sawbones cases
5) STACER for periarticular fracture or
ORIF for fracture nonunion
6) ITER from supervising surgeon evaluating all
CanMEDS roles
4

Orthopaedic Surgery Residency Program: COMPETENCY BASED STREAM
Phase 3: Module 17: Complex Trauma
Learning
Context
CanMEDS
Role (s)
Learning
Outcomes:
Goals/Objectives
Dr. Markku Nousiainen
Source Doc(s) Specific
Competencies orthopaedic fracture clinics in
Ontario. J Bone
Joint Surg Am.
2011 Jan
19;93(2):132-41.
Communicator Demonstrate skill in communicating with other members of the trauma team and other health care personnel involved in the care of the traumatized patients.
Demonstrate skills in working with patients and families who present with communication challenges such as anger, confusion, and issues related to gender, ethnicity, cultural and religious background. This would also involve communication with those with traumatic brain injury and critical injuries.
See appended ref’s for COM
Be able to perform a surgical check list/time out in real-time OR – this would involve clear communication of all necessary points of interest for surgical team on patient
Communicate effectively with appropriate consultants and synthesize their input into the care plan.
Be able to verbally present the findings and care plan for the patient.
Clearly document the patient encounter
Learning/Teaching
Strategies
Review of source documentation
On-going application in clinical scenarios, especially with regards to performing the surgical checklist/time out
07Jan15 Version
Evaluation Method or
Tools
Review of Surgical Record to assess the frequency of surgical check list/time out
Real time assessment
Summary review of communicator skills on end-of-rotation ITER
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Orthopaedic Surgery Residency Program: COMPETENCY BASED STREAM
Phase 3: Module 17: Complex Trauma
Learning
Context
CanMEDS
Role (s)
Learning
Outcomes:
Goals/Objectives
Dr. Markku Nousiainen
Source Doc(s) Specific
Competencies
Manager
Deliver information, including options of care, possible complications and long term prognosis, in a humane and understandable way. Encourage discussion and participation in developing a treatment plan.
This will lead to obtaining informed consent
Demonstrate an understanding the importance of allocation of resources for the trauma patient and prioritize care.
Demonstrate an understanding of
Informed Consent
Tips and
Resources
Document http://www.cpso.o
n.ca/CPSO/medi a/uploadedfiles/p olicies/policies/po licyitems/Consent
.pdf?ext=.pdf
including trauma records, progress notes, operative notes and discharge summaries.
Be able to verbally present the findings and care plan for the patient.
Obtain an appropriate informed consent for patients undergoing interventions
Deliver bad news in a humane and compassionate manner.
Triage patients on surgical emergency surgery waitlist at Sunnybrook
Learning/Teaching
Strategies
-Review of source documents
-Work with surgical team on triaging patients on surgical waitlist
07Jan15 Version
Evaluation Method or
Tools
Real time assessment
Summary review of communicator skills on end-of-rotation ITER
6

Orthopaedic Surgery Residency Program: COMPETENCY BASED STREAM
Phase 3: Module 17: Complex Trauma
Learning
Context
CanMEDS
Role (s)
Learning
Outcomes:
Goals/Objectives health care funding as it relates to trauma care and the principle of cost appropriate care.
Dr. Markku Nousiainen
Source Doc(s) Specific
Competencies
Learning/Teaching
Strategies
07Jan15 Version
Evaluation Method or
Tools
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Orthopaedic Surgery Residency Program: COMPETENCY BASED STREAM
Phase 3: Module 17: Complex Trauma
Dr. Markku Nousiainen
Medical Expert Reference Documents:
07Jan15 Version
Thomas P. Rüedi, Richard E Buckely, Christopher G. Moran. AO Principles of Fracture Management Vols. 1 & 2 , 2007 AO Publishing
DeCoster T, Gehlert R, Mikola E, et al. Management of Posttraumatic Segmental Bone Defects, JAAOS Jan 2004;28-38
Masquelet AC, Fitoussi F, et al. Reconstruction des os longs par membrane induite et autogreffe spongieuse. Ann Chir Plast Estet 2000;45:346-53.
M Nousiainen, CM Whyne, AJM Yee, J Finkelstein, and M Ford in: Chapter 13, Surgical Management of Bone Metastases in Bone Metastases: A translational and clinical approach , D Kardamakis, V Vassiliou, and E Chow eds.
Bhandari M, Sprague S, et al. The prevalence of intimate partner violence across orthopaedic fracture clinics in Ontario. J Bone Joint Surg Am.
2011 Jan 19;93(2):132-41.
Taylor BC, French BG, Fowler T, et al. Induced membrane technique for reconstruction to manage bone loss. JAAOS Mar 2012; 20(3):142-150.
Communicator Articles:
Kurtz, S., Silverman, J., & Draper, J. (Eds.) (2005). Teaching and Learning Communication Skills in Medicine.
San Francisco: Radcliffe
Publishing.
Makoul, G. (2001). Essential Elements of Communication in Medical Encounters: The Kalamazoo Consensus Statement. Academic Medicine. 76 ,
370-393.
Silverman, J. Kurtz, S., & Draper, J. (Eds.) (2005) Skills for communicating with Patients, 2 nd Edition. San Francisco: Radcliffe Publishing.
Simpson, M. Buckman, R., Stewart, M., McGuire, P., Lipkin, M., & Novack, D. (1991). Doctor-patient communication: the Toronto consensus statement.
British Medical Journal, 303, 1385-1387.
Stewart, M., Brown, J.B., Weston, W., McWinney, I., McWilliam, C., & Freeman, T. (2003). Patient-Centred medicine: transforming the clinical method.
Radcliffe Medical Press: Oxford.
Stewart, M., Belle Brown, J., Donner, A., McWhinney, I. R., Oates, J., Weston, W. W., & Jordan, J. (2000). The Impact of Patient-Centered Care on
Outcomes. The Journal of Family Practice , 49, 796-804
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