Program Description

The Harbor-UCLA Orthopaedic Residency Training Program accepts 5 physicians each year into the PGY1 level for a total of 5 years of training. During their training, residents are exposed to all facets of Orthopaedic Surgery. At Harbor, the delivery of Orthopaedic care is structured around 4 services—Trauma/General, Hand/Spine, Joints, and Sports/Foot & Ankle/Peds/Amputation. Residents rotate on these services throughout their PGY2 through PGY5 years at Harbor. While the trauma service handles the spectrum of Orthopaedic trauma and general Orthopaedic problems, the three Orthopaedic Subspecialty teams provide non-trauma related, elective Orthopaedic services. These subspecialty teams manage all patients in the Sports Medicine, Joint Replacement, Foot /Ankle, Hand, Spine, and Amputation clinics. Pediatric Orthopaedic exposure at Harbor occurs on the Trauma/general rotations, as well as during the Peds/Scoliosis clinic.

The Orthopaedic Clinics provide a rich and diverse educational experience in outpatient management and long-term patient follow-up care. Serving a regional population of 1.7 million residents in the southwest Los Angeles County, the Orthopaedic Clinics are first in volume at Harbor-UCLA with approximately 56,000 outpatient visits per year.

The Harbor-UCLA Orthopaedic Residency Training Program is known for its balance of surgical volume, operative experience, didactic teaching, clinical supervision, and early emphasis on clinical decision-making and continuity of care.

Didactic Teaching

The didactic teaching activities include weekly Trauma Conference followed by Anatomy Conference on Wednesday and Friday mornings. Regular Noon Conferences are held throughout the week where a lecture is given on a variety of Orthopaedic topics by a faculty member. Once a month, a Motors Skill Training Lab is held in the Simulation Center.

In addition, monthly Quality of Care/Morbidity and Mortality Conferences are held on the last Monday of each month, and quarterly Grand Rounds are held on a Wednesday morning. A monthly Journal Club is also held where a faculty member chooses articles for all residents to read, review, and discuss in an informal setting. All PGY3 residents are required to complete an anatomic dissection from the posterior triangle of the neck to the foot. These residents give the presentation at the weekly Anatomy Conference under faculty supervision. All PGY3 residents also have a 3-month Basic Science rotation at Harbor. They are required to complete a Harbor Orthopaedic research project by the end of the PGY3 year. Research activities of faculty include multi-center trials involving investigational devices or pharmaceutical agents, implant and instrument development, biomaterials research, biomechanical testing, as well as clinical outcomes assessment. Resident and faculty projects are presented during the Department’s Annual Orthopaedic Education Program held each June also featuring keynote addresses from our annual Dana M Street Visiting Professor.

Specialty Rotations

Specialty rotations at affiliated hospitals during the PGY3, PGY4, and PGY5 levels afford additional training in Orthopaedic subspecialties. During the PGY3 year, the Children’s Hospital of Los Angeles rotation includes training in the management of pediatric disorders of the hip and spine, fractures, cerebral palsy, and adolescent sports medicine. During the PGY4 year, specialty rotations include training at Santa Monica-UCLA Medical Center for Orthopaedic oncology and joint replacement surgeries, and at Kaiser Permanente West Los Angeles for joint arthroplasty, community trauma, and sports medicine including arthroscopy of the hip, knee, and shoulder. During the PGY5 year, specialty rotations include training at Kaiser Permanente in Downey, where residents may tailor their experience to their fields of interest in order to gain additional operative exposure in several subspecialties, including hand, spine, joints, and sports.

Clinical Rotations

PGY-1 Year

Orthopaedic Interns in the PGY-1 class complete 4-week rotations on the following services all at Harbor-UCLA Medical Center:

-Orthopaedic Surgery (6 blocks)

-Surgical Skills (1 block)

-General Trauma Surgery (1 block)

-Surgical ICU (1 block)

-Musculoskeletal Radiology (1 block)

-Plastic Surgery (1 block)

-Emergency Department (1 block, split into two 2-week blocks)

-Vacation (4 weeks)

PGY2-PGY5 Rotations:

Orthopaedic residents complete rotations in all major orthopaedic subspecialties including trauma, adult reconstruction, sports medicine, spine, foot and ankle, tumor, pediatrics, and hand. Each clinical rotation is between 10 and 11 weeks beginning July 1 of each academic year.

PGY-2

PGY-3

PGY-4

PGY-5

Ortho Trauma Ortho Trauma Ortho Trauma Ortho Trauma
Ortho Trauma Rancho Los Amigos

Medical Center

FAPSA

(Foot/Ankle, Pediatrics,

Sports, Amputee)

Hand/Spine
Hand/Spine

MemorialCare Long Beach

Medical Center

UCLA Santa Monica

Medical Center

Joint Replacement
Joint Replacement Children’s Hospital – Los Angeles Shriners Children’s

Kaiser Permanente – South Bay

Medical Center

FAPSA

(Foot/Ankle, Pediatrics,

Sports, Amputee)

Research Kaiser Permanente – West LA

Medical Center

Kaiser Permanente – Downey

Medical Center

Resident Feedback

As is required in every rotation, resident feedback is provided via the Verinform system. This continual process of evaluation integrates the feedback of the resident in assessing the effectiveness of the program, and helps guide changes necessary to achieve competence in diagnosis and care of Orthopaedic patients.

Resident Supervision

A member of the academic teaching staff is assigned to each Orthopaedic service and provides oversight to all in-patient activities. A member of the faculty also does teaching ward rounds, and X-Ray Review teaching rounds on a regular basis. An academic staff member supervises every operating day. All elective surgical cases are supervised by an appropriate member of the teaching staff. Faculty members are on a rotating call schedule for emergencies handled by general Orthopaedic services. A combination of academic staff and clinical faculty supervise each of the Orthopaedic clinics. This program policy of supervision strictly follows Institutional Policy No. 622A governing the supervision of residents in accordance with ACGME requirements.

Resident Responsibilities

One of the fundamental objectives of the Harbor-UCLA Orthopaedic Residency Training Program is assumption of graduated responsibility commensurate with the resident’s capabilities. Managing the high volume of patients with Orthopaedic problems at the Harbor-UCLA Medical Center necessitates delegation of duties down through the ranks. The entire service makes rounds, attends clinics, and participates in surgeries as a unit. The PGY2 and PGY3 are responsible for pre-admission evaluations and a full history and physical for all elective admissions. These pre-admission evaluations and history and physicals are reviewed and countersigned by the appropriate attending. When on call, the junior residents (PGY2, PGY3) are responsible for conducting inpatient and emergency consultations, which are then presented to the Chief resident (PGY4, PGY5). The PGY2 or PGY3 perform closed reductions of fractures in the cast room. The Chief resident is responsible for overseeing all care administered and renders the decision-making and scheduling of all cases that go to the operating room. Surgical cases are presented and discussed with the faculty attending on service. Other academic staff members are used as consultants. The judgment and decision-making ability as well as the technical skills of each resident are assessed following each rotation, and recorded in written evaluations by the faculty. Performance, following each rotation, is reviewed and discussed at monthly faculty meetings. Additional direction, education and counseling are given as needed. As each resident advances, the level of responsibility is increased based on previous performance. The nature of the program and the fact that each resident rotates on the same services in subsequent years, allows the residents to observe and participate in the decision-making and management process, observe and participate in surgery, and ultimately, as a Chief resident, assume the lead in management decisions and operative procedures.

Motor Skill Instruction

Orthopaedic residents are instructed in basic motor skills on a regular basis via workshops and lectures. The supervising faculty member will typically present a lecture pertinent to the motor skills activity. This is followed by the motor skills workshop, frequently involving the use of saw bones. Each faculty member will aim to conduct at least one Motor Skills Workshop each year for the entire resident staff. In addition, small group motor skills activities are conducted on an as needed basis with individual Orthopaedic teams to supplement large group training. Residents are expected to attend basic instructional courses in principles and techniques of fracture fixation such as those provided by the AAOS and the AO group during their residency training. Residents are also encouraged to attend other advanced educational and instructional courses during their residency in any Orthopaedic subspecialty or topic of interest to them. The tuition cost for approved courses is borne by the Department to encourage the pursuit of supplemental motor -skills training and didactic course work.