Program Description 2016-11-16T12:17:22+00:00

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.

Residents have opportunities to gain experience in the diagnosis and management of each of the following areas:

Trauma training occurs primarily at Harbor-UCLA Medical Center with rotations on the trauma service every year. The high volume, severity and complexity of the trauma that is seen at Harbor-UCLA provide outstanding training opportunities for residents. As the second busiest Level 1 Trauma center in Los Angeles County, Harbor-UCLA provides residents with a regular opportunity to treat multiply injured trauma patients and interact with multi-specialty teams. Pathology includes multi-system organ involvement as well as complex pelvic and acetabular fracture management. As a tertiary referral center, complex management cases provide a variety of challenges in decision-making and surgical management that contribute substantially to the development of critical clinical skills both in the operating room and in pre-op and post-operative management. Residents spend six months as a PGY2, and three months as a PGY3 as junior residents on the team. As a PGY4, residents take on heightened responsibility as a chief on the trauma rotation for three months and as a PGY5 spend three months as chief resident running the service. The rotation provides a comprehensive exposure to pre-admission assessment of the patient, intra-operative management, post-operative care, as well as long-term follow-up care.

Joint Reconstruction

Joint Reconstruction training exists at multiple facilities throughout the course of residency training. At Harbor, the PGY2 and PGY5 residents each spend a three-month rotation block on a subspecialty team whose primary focus is the management of the Orthopaedic Arthritis/Joint Replacement Service. Further training in Adult Joint Reconstruction is provided at Kaiser Permanente West Los Angeles and Santa Monica-UCLA rotations as a PGY4. Further exposure can be augmented into the Kaiser Permanenta Downey PGY5 rotation.

Sports Training

Sports Training occurs during both the PGY3 and PGY4 years while on the Sports Medicine subspecialty service at Harbor-UCLA for three months. Further training in Shoulder, Knee, and Hip Arthroscopy occur as a PGY4 at Kaiser Permanente West Los Angeles. Additional training can be pursued during the Kaiser Permanente Downey rotation as a PGY5 if the resident desires to further augment their Arthroscropy training.

Pediatric Orthopaedic

Pediatric Orthopaedic experience begins at Harbor during the PGY2 year while on the Trauma/General and Spine rotations. Further training occurs in the PGY3 year while on the Harbor Peds rotation, focusing on General Pediatric Orthopaedics, Scoliosis, as well as Adolescent Sports Medicine. Pediatric Orthopaedic training continues in the PGY3 year at Children’s Hospital of Los Angeles with operative and clinical experience in treating Pediatric Spine and Hip Disorders, Cerebral Palsy, Upper and Lower Extremity Deformity, Adolescent Sports, and Pediatric Tumor Pathology. Pediatric training is solidified as a PGY5 when returning as chief on the Trauma/General and Spine services. Extensive experience is gained in the diagnosis and treatment of the spectrum of pediatric trauma and elective pediatric spinal disorders during this time.

Hand

Hand experience is abundant at Harbor with a plethora of hand pathology involving acute trauma related injuries, multiple digit re-implantation, post-traumatic reconstruction, rheumatoid reconstruction, and the management of common disorders of the hand such as peripheral entrapment neuropathies. With the size of Harbor’s patient population and the active life styles of that Southern California population, the hand service is exceptionally busy. Training begins in the PGY2 year on the Hand service and also during the Trauma/General rotation. As a PGY5, residents run the Hand service and in collaboration with the PGY5 on Trauma/General, manage elective and emergent hand patients in the clinics and operating rooms. Hand call is shared with Plastic Surgery, with Orthopaedic Surgery taking 2 out of every 3 days. More elective hand cases can be sought out while at Kaiser Permanente Downey as a PGY5.

Spine

Spine experience starts as a PGY2 on the Spine rotation at Harbor-UCLA during a 3 month block. Training continues during the PGY3 year with opportunities to participate in pediatric spine deformity cases at Children’s Hospital of Los Angeles. As a PGY5, residents are expected to run the Spine service at Harbor, managing the clinic and all operative spine patients. Further spine experience can be augmented while on rotation at Kaiser Permanente Downey as a PGY5.

Foot and Ankle

Foot and Ankle training occurs while on subspecialty rotation as a PGY3 and PGY4 for 3 months each at Harbor-UCLA. The foot clinics are some of the busiest at Harbor-UCLA and the variety and severity of pathology enhances resident experience and training. On the Trauma/General Orthopaedic service, foot and ankle fractures are among the most common injuries treated. Extensive surgical experience is provided in the treatment of disorders of the adult foot and ankle. Further training in pediatric congenital and acquired disorders of the foot and ankle occurs during the Harbor-UCLA Peds rotation and during the Children’s Hospital of Los Angeles rotation as a PGY3. As a PGY4, the resident runs the Foot and Ankle service, managing inpatients and clinic patients, and performing elective foot and ankle cases in conjunction with the faculty.

Orthopaedic Oncology

Orthopaedic Oncology exposure first occurs during the 3 month rotation at Children’s Hospital of Los Angeles, where residents will be exposed to diagnosing and managing pediatric orthopaedic tumors. This experience is further solidified during the rotation at Santa Monica-UCLA as a PGY4. During this rotation, residents will be trained in diagnosing, managing, and treating the spectrum of Orthopaedic tumor pathology. Residents participate in clinics as well as performing resections and providing reconstructive services for orthopaedic oncology patients.

Intern Year

The Orthopaedic Intern year is a categorical intern year spent entirely at Harbor-UCLA where residents get exposure to a wide variety of surgical subspecialties that supplement and improve upon their orthopaedic education. The intern year consists of six months of Orthopaedics where interns will manage Orthopaedic patients on the wards, assist junior residents with consults including performing fracture reductions, splints, and casts, and gain early hands-on exposure in the operating room. There is also one month each in the services of Vascular Surgery, Plastic Surgery, General Surgery Trauma, Surgical ICU, and the Emergency Department. Furthermore, there is an “Introduction to Orthopaedics” series consisting of weekly meetings, such as OITE reviews and teachings of fundamental techniques in orthopaedics.

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.
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