Orthopaedic Surgery Residency Program: COMPETENCY BASED STREAM
Phase 2: Module 12: Foot and Ankle Dr. Tim Daniels
Learning
CanMEDS
Learning
Source Doc(s)
Context
Role (s)
Outcomes:
Goals/Objectives
In this module the Medical Expert
KNOW:
1. Chapter 1 in
trainee will learn
Demonstrates an
Surgery of the Foot
how to diagnose
understanding of
and Ankle: Edited by
and treat foot and
normal and abnormal M Coughlin and R
ankle conditions
gait.
Mann
non-operatively
and operatively.
2. Gait video
provided by Dr.
Daniels
Specific
Competencies
To be able to
assess, discuss,
and manage
normal and
abnormal gait
patterns
20January15 Version
Learning/
Evaluation Method
Teaching
or Tools
Strategies
Review of source Staff surgeons’
documents/video assessment of the
resident’s
Assessment of
performance on
patients in clinic
module will occur on
with staff
an on-going basis
supervision
with summative and
formative feedback
being given
3 Chapter 2 in
Disorders of the
Foot and Ankle:
Edited by M Jahss
A mid-module
evaluation will be
comprised of:
1) a written exam
2) an observed
history and physical
examination with
subsequent diagnosis
and treatment plan
3) a meeting with the
supervisor and
resident, where
summative and
formative feedback
will be given on the
resident’s progress
Medical Expert
KNOW:
Demonstrates an
understanding and
assessment of
deformities of
forefoot, midfoot,
hindfoot and ankle
1. Chapter 2 in
Surgery of the Foot
and Ankle: Edited by
M Coughlin and R
Mann
2. Guyton GP,
Saltzman CL. Ankle
To be able to
assess and
discuss the
management of
deformities of
the fore-, mid-,
and hindfoot
and ankle
Review of source
documents
Assessment of
patients in clinic
with staff
supervision
During the latter half
of the module, the
resident will be
assessed by one or
more STACERs on
the performance of an
ankle fusion, ankle
arthroscopy, or a
1
Orthopaedic Surgery Residency Program: COMPETENCY BASED STREAM
Phase 2: Module 12: Foot and Ankle Dr. Tim Daniels
Learning
CanMEDS
Learning
Source Doc(s)
Context
Role (s)
Outcomes:
Goals/Objectives
arthritis. J Bone
Joint Surg Am. 2003
May;85-A(5):923-36.
Specific
Competencies
20January15 Version
Learning/
Evaluation Method
Teaching
or Tools
Strategies
hallux valgus
correction or an
equivalent surgical
procedure.
3. Chapters 9, 27,
38, 41, 42, and 43 in
Foot and Ankle
Disorders: Edited by
M Myerson
Medical Expert
KNOW:
Demonstrates an
understanding and
recognition of feet at
high risk for
ulceration and the
presence of ulcers
1. Chapter 2 and 3
in Surgery of the
Foot and Ankle:
Edited by M
Coughlin and R
Mann
2. The diabetic foot:
basic mechanisms
of disease. Instr
Course Lect.
2002;51:169-81
3. The Diabetic
Foot: Edited by M
Levine, L O'Neal, J
Bowker
Medical Expert
KNOW:
Uses the most
appropriate
diagnostic imaging
and tests for the
assessment of foot
and ankle pain and
1. Chapter 3 in
Surgery of the Foot
and Ankle: Edited by
M Coughlin and R
Mann
To be able to
assess and
discuss the
management of
ulcers and feet
at high risk of
developing
ulcers
Review of source
documents
Assessment of
patients in clinic
with staff
supervision
Initial
management of
the diabetic/
Charcot foot
Initial
management of
the ischemic/
gangrenous foot
To be able to
assess and
discuss the
appropriate use
of tests for
patients with
foot and ankle
The end of the
module evaluation will
be comprised of:
1) a written exam
2) an observed
history and physical
examination with
subsequent diagnosis
and treatment plan
3) a meeting with the
supervisor and
resident, where
summative and
formative feedback
on the resident’s
progress will be
given. The ITER will
be completed at this
time.
Review of source
documents
Assessment of
patients in clinic
with staff
supervision
2
Orthopaedic Surgery Residency Program: COMPETENCY BASED STREAM
Phase 2: Module 12: Foot and Ankle Dr. Tim Daniels
Learning
CanMEDS
Learning
Source Doc(s)
Context
Role (s)
Outcomes:
Goals/Objectives
deformity
Medical Expert
Medical Expert
KNOW:
Demonstrate an
understanding of
non-operative
management of
common foot and
ankle pathology
1. Chapter 4 in
Surgery of the Foot
and Ankle: Edited by
M Coughlin and R
Mann
KNOW:
Assess and provide
a differential
diagnosis and
operative
management plan for
common foot and
ankle pathologies
(soft tissue and
bone)
1. Chapters 26 and
36-41 in Surgery of
the Foot and Ankle:
Edited by M
Coughlin and R
Mann
2. Coetzee JC, Ly
TV.
Fractures of the
tibial plafond. Instr
Course Lect.
2007;56:331-52
3. Haddad SL,
Specific
Competencies
20January15 Version
Learning/
Evaluation Method
Teaching
or Tools
Strategies
pain and
deformity
To be able to
assess and
discuss the
appropriate nonoperative
modalities in the
management of
patients with
pathologies due
to degenerative,
post-traumatic,
and
inflammatory
arthropathies
involving the
ankle, subtalar,
midfoot and
forefoot joints
The resident will
be expected to
have a clear
understanding,
assessment and
treatment for:
• Foot and ankle
tendinopathies
• Complex foot
and ankle
fractures
• Complex
forefoot
reconstruction
Review of source
documents
Assessment of
patients in clinic
with staff
supervision
Review of source
documents
Assessment of
patients in clinic
with staff
supervision
Supervising surgeon
to assess residents’
pre-operative plan
and intra-operative
management for
surgical cases
involving the foot and
ankle.
3
Orthopaedic Surgery Residency Program: COMPETENCY BASED STREAM
Phase 2: Module 12: Foot and Ankle Dr. Tim Daniels
Learning
CanMEDS
Learning
Source Doc(s)
Context
Role (s)
Outcomes:
Goals/Objectives
Coetzee JC, Estok
R, Fahrbach K,
Banel D, Nalysnyk
L.
Treatment of
primarily
ligamentous Lisfranc
joint injuries: primary
arthrodesis
compared with open
reduction and
internal fixation.
Surgical technique.
J Bone Joint Surg
Am. 2007 Mar;89
Suppl 2 Pt.1:122-7.
Specific
Competencies
20January15 Version
Learning/
Evaluation Method
Teaching
or Tools
Strategies
• Diagnostic and
operative ankle
arthroscopy
• Complications
of foot and ankle
surgery
• Definitive
management of
the
ischemic/gangre
nous foot
• Definitive
management of
the
diabetic/Charcot
foot
4. Robinson AH,
Limbers JP.
Talar neck fractures:
results and
outcomes. J Bone
Joint Surg Am. 2004
Aug;86-A(8):161624.
5. Operative
compared with
nonoperative
treatment of
displaced intraarticular calcaneal
fractures: a
prospective,
randomized,
controlled
multicenter trial. J
Bone Joint Surg Am.
4
Orthopaedic Surgery Residency Program: COMPETENCY BASED STREAM
Phase 2: Module 12: Foot and Ankle Dr. Tim Daniels
Learning
CanMEDS
Learning
Source Doc(s)
Context
Role (s)
Outcomes:
Goals/Objectives
2002 Oct;84A(10):1733-44.
Specific
Competencies
20January15 Version
Learning/
Evaluation Method
Teaching
or Tools
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6. Thomas RH,
Daniels TR. What's
new in foot and
ankle surgery. J
Bone Joint Surg Am.
2006 Apr;88(4):90922.
7. Marsh JL, Borrelli
J Jr, Dirschl DR,
Sirkin MS.
Rheumatoid forefoot
deformity: A
comparsion study of
two functional
methods of
reconstruction.
Journal of
Rheumatology 2003:
30, No. 7: pp 14401450
8. Vallier HA, Nork
SE, Barei DP,
Benirschke SK,
Sangeorzan BJ.
Intermediate and
long-term outcomes
of total ankle
arthroplasty and
ankle arthrodesis. A
systematic review of
the literature. J
Bone Joint Surg Am.
2007
5
Orthopaedic Surgery Residency Program: COMPETENCY BASED STREAM
Phase 2: Module 12: Foot and Ankle Dr. Tim Daniels
Learning
CanMEDS
Learning
Source Doc(s)
Context
Role (s)
Outcomes:
Goals/Objectives
Sep;89(9):1899-905
Medical Expert
Medical Expert
Medical Expert
Medical Expert
Specific
Competencies
KNOW:
Prescribe
appropriate
rehabilitation and
non-operative
management of
common foot and
ankle pathologies
Chapter 4 in Surgery
of the Foot and
Ankle: Edited by M
Coughlin and R
Mann
To be able to
assess and
discuss the
appropriate
rehabilitation
and nonoperative
management of
common foot
and ankle
pathologies
To be able to
perform local
anaesthetic
blocks in the
foot and ankle
DO:
Perform local
anaesthetic blocks
for foot and ankle
surgery
1. Chapter 5 in
Surgery of the Foot
and Ankle: Edited by
M Coughlin and R
Mann
Perform diagnostic
and therapeutic
injections of foot and
ankle joints
1. Chapter 5 in
Surgery of the Foot
and Ankle: Edited by
M Coughlin and R
Mann and Saltzman
To be able to
perform
diagnostic and
therapeutic
injections of the
foot and ankle
joints
DO:
• Complete a simple
forefoot
reconstruction
• Complete an
appropriate
Chapters 6, 7, and 9
in Surgery of the
Foot and Ankle:
Edited by M
Coughlin, R Mann
and Saltzman
To be able to
perform a
simple forefoot
reconstruction
and operative
repair of simple
20January15 Version
Learning/
Evaluation Method
Teaching
or Tools
Strategies
Review of source
documents
Assessment of
patients in clinic
with staff
supervision
Review of source
documents
Assessment of
ability to perform
blocks by staff
supervision
Review of source
documents
Assessment of ability
to perform blocks by
staff supervisor
Assessment of ability
to perform injections
by staff supervisor
Assessment of
ability to perform
injections by staff
supervision
Review of source
documents
Assessment of
ability to perform
injections by staff
Assessment of ability
to perform simple
surgical forefoot
reconstruction and
operative repair of
ankle and foot
6
Orthopaedic Surgery Residency Program: COMPETENCY BASED STREAM
Phase 2: Module 12: Foot and Ankle Dr. Tim Daniels
Learning
CanMEDS
Learning
Source Doc(s)
Context
Role (s)
Outcomes:
Goals/Objectives
procedure for simple
foot and ankle
fractures
Collaborator
Consult effectively
with other physicians
and health care
professionals in the
management of
patients with
fragility/insufficiency
fractures/metabolic
bone disorders.
1. Departmental
POS lectures
2. any other expert
sources from
Faculty of Medicine
if they exist –
Melissa to search
3. Victoria ElliottGibson to provide
source docs :
Contribute effectively
to interdisciplinary
team activities.
Share knowledge
effectively to
formulate a health
care plan.
treatment algorithms
for osteoporosis X2;
Toward a Fracture
Free Future article
from COA Journal;
article from ortho lit
on nonunions
secondary to
bisphosphonates;
recent Cdn
guidelines;
powerpoint
presentation with
cases (to be run by
Victoria?) q 3
months
Specific
Competencies
foot and ankle
fractures
Resident will be
able to manage
patients with
staff supervision
in the fracture
clinic and the
post-fracture
osteoporosis
bone clinic 1-2
days (Dr.
Josse).
The resident will
also attend the
Metabolic Bone
Clinic (i.e. with
Drs. Josse, Erin
Norris, Una Lee,
Christine
Derzko, or
Lawrence
Rubin) for 1-2
Mondays over
course of
module at St.
Michael’s
Hospital and will
attend the multidisciplinary
osteoporosis
rounds from 12
to 1 PM on
20January15 Version
Learning/
Evaluation Method
Teaching
or Tools
Strategies
supervision
fracture staff
supervisor
Review of source
documents
Resident to work
as team member
with staff
surgeon and
allied health
professionals in
post-fracture
osteoporosis
bone clinic,
metabolic bone
clinic, and
fracture clinic
At end of rotation,
360 form to be filled
out by nurses,
chiropodist, clinic
co-ordinator,
supervising surgeon
in fracture clinic - to
be organized and
obtained Victoria
Elliott-Gibson
7
Orthopaedic Surgery Residency Program: COMPETENCY BASED STREAM
Phase 2: Module 12: Foot and Ankle Dr. Tim Daniels
Learning
CanMEDS
Learning
Source Doc(s)
Context
Role (s)
Outcomes:
Goals/Objectives
Specific
Competencies
20January15 Version
Learning/
Evaluation Method
Teaching
or Tools
Strategies
those dates
Health Advocate
Appropriately
manage patients with
a diabetic foot,
including identifying
risk factors that can
lead to nonunion,
foot ulceration,
amputation, and
Charcot foot, and
advise patients on
lifestyle modifications
to improve
outcomes.
1. Departmental
POS lectures on
being a Health
Advocate
2. any other expert
sources from
Faculty of Medicine
if they exist –
Melissa to search
3. Literature to be
reviewed:
a. Chapter 2 and 3
in Surgery of the
Foot and Ankle:
Edited by M
Coughlin and R
Mann
b. The diabetic foot:
basic mechanisms
of disease. Instr
Course Lect.
2002;51:169-81
c. The Diabetic Foot:
Edited by M Levine,
L O'Neal, J Bowker
Outline
Review of source
resources
documents
available to
patients/families Resident to work
dealing with a
as team member
diabetic foot,
with staff surgeon
including:
and allied health
• Social work
professionals in
• Physiotherapy managing
• Occupational
patients with a
therapy
diabetic foot in
• Dietary/
Foot and Ankle
nutritional
Clinics
services
• Prosthetic
Resident to
support
discuss patient care
with chiropodists,
social workers,
nurses, vascular
surgeons,
endocrinologists,
internal medicine
physicians
At end of rotation,
360 form to be filled
out by nurses,
chiropodist, clinic
co-ordinator,
supervising surgeon
in Foot and Ankle
Clinic ?– to be
organized and
obtained by Dr. J.
Lau or Dr. P.
Alexander? Needs
to be confirmed with
them and ok’ed by
Dr. Daniels.
M. Nousiainen
willing to facilitate
organization of
these evaluations as
needed.
Standardized OSCE
(from Faculty of
Medicine bank) to
assess health
advocate skills if
they exist – Melissa
to search
8