2009 - 2010
Goals and Objectives

Parkland Health and Hospital System, University Hospital - Zale Lipshy, 

University Hospital - St. Paul

Introduction

The Department of Orthopaedic Surgery at the University of Texas Southwestern Medical Center at Dallas is dedicated to the education of residents in the field of orthopaedic surgery. The goal of the Department is to train outstanding orthopaedic surgeons who are surgically and academically sound. The Department will provide each resident with the tools and opportunity to complete their training in both an enjoyable, and more importantly, a rewarding fashion.

A Brief Overview of the Residency

PGY-1     AN INTRODUCTION TO SURGERY AND PATIENT CARE

The PGY-1 is a member of the Department of Orthopaedic Surgery. Rotations are coordinated by the Program Director within the Department of Surgery. The year includes twelve one-month rotations in which the RRC/ACGME requirements for the PGY-1 year are met. One-month rotations with orthopaedics (2), neurosurgery, anesthesiology, ICU, and plastics/burns are included. During this year the PGY-1 is expected to attend conferences that are required by the general surgery and subspecialty departments (grand rounds, trauma conference, etc.). Additionally, the PGY-1 will take monthly tests administered by the Department of Surgery. During this year, the intern will gain a basic understanding of patient care, as well as the workings of the OR and the ER within the various University Hospital's and Parkland Health and Hospital System.

PGY-2     THE EVALUATION AND TREATMENT OF THE ORTHOPAEDIC PATIENT

This is the first year entirely within the Department of Orthopaedic Surgery.  During this year, PGY-2 will learn more orthopaedic surgery than during any other year of their training. This is also often the most difficult year of the residency.
 
The PGY-2 will learn the evaluation and management of the orthopaedic inpatient and outpatient. It is imperative that during this year the PGY-2 read about the conditions of each of his/her patients. Although the PGY-2 is not expected to solve the more complex issues, they should acquire a basic understanding of orthopaedic conditions and their potential treatments.
 
Much is expected of the PGY-2. The year is spent rotating through six rotations (2 months each) on the various services at each of the University's hospitals and at Parkland Health and Hospital System.  While these rotations used to be “hospital-based,” they are now “service-based.” Each service will be responsible for covering all the patients of their subspecialty at these three hospitals. Typically, each of these services has a senior and junior resident. Some services will have fellows and some may have interns (see breakdown of the services later in this handout). The basic organization of junior/senior, however, is always present.
 
The PGY-2 remains the backbone of each service. Ultimately, he/she is responsible for the everyday workings of the subspecialty services including ward rounds, ER coverage, routine patinet care including preoperative and postoperative evaluations.  Communication between the junior and senior resident is extremely important. The junior and senior resident on the service must develop a synergistic relationship during the care of each patient.  If the junior does not know how to handle a particular problem, or has questions regarding a patient, case, it is his/her responsibility to seek the advice of the senior resident.  Although this is a busy year the PGY-2 is still expected to read and be prepared for operative cases, conferences and clinics. The team approach makes this easier.
 
There are many things that the PGY-2 is expected to do. Pre-rounding on patients is essential. Typically the workday starts at 0700 with fracture conference. The PGY-2 should arrive early enough to round on the patients and prepare those going to the OR that day. The PGY-2 should not rely on the intern or medical students to provide these important services.  Patient care is ultimately the responsibility of the second year resident.
 
Presentations at the various conferences (fracture conference) are also the responsibility of the PGY-2. Organization of films (injury, post-reduction, pre-op, post-op, etc.) is expected and disorganization will be noticed. A busy orthopaedic surgeon must be efficient. The PGY-2 year is an invaluable time to learn efficiency while not sacrificing thoroughness.
 
Individual subspecialty services and conferences are described later in this handout.

PGY-3     BROADENING THE ORTHOPAEDIC EDUCATION

The PGY-3 year is the second year with the Department of Orthopaedic Surgery. There is more time to read and prepare for cases during this year. It is not as labor intensive as the second year. One half of this year is spent at Texas Scottish Rite Hospital(TSRH) and at Children’s Medical Center (CMC). During this time, the PGY-3 learns the evaluation and treatment of pediatric orthopaedic problems. These six months can be very rewarding. This is also a great opportunity to start a research project. The TSRH staff members are very committed to teaching and provide excellent conferences (see the TSRH rotation later in the handout).
 
The other half of the year is spent at the Dallas Veterans Affairs Medical Center (four months) and on the Spine Service (two months). Please see each these rotations later in the handout for more details.

PGY-4     DEVELOPMENT OF AUTONOMY AND CONFIDENCE

The PGY-4 year is the first year in which there is some flexibility within the schedule. Not every fourth year does the same rotations. Certainly some of the year is spent at Parkland Health and Hospital System in 2-month or 3-month blocks. This second rotation at PHHS is a very different than the first (as a PGY-2). This is the first time that the resident is a senior resident and therefore, this is the first time that he/she is responsible for a junior resident.
 
As a senior resident, the PGY-4 resident is not only expected to learn the more complex issues of orthopaedic surgery, but is also expected to teach the junior resident and medical students. This can be both rewarding and frustrating. The fourth year or senior resident is also the liaison between the junior resident and the staff.
 
Although the senior resident is not expected to spend as much time on the wards as before, he/she is still expected to be aware of the conditions of each of the patients on his/her service. Also, the junior is often unable to accurately diagnose and/or manage patients within the ER. The senior should not only be available, but must offer help to the junior resident and assure superb patient care is being provided. Superb patient care is the primary and common goal. The senior resident, in combination with the junior resident is accountable for the outcomes of all the patients treated on his/her service.
 
The PGY-4 should develop more autonomy and confidence in the operating room. In addition, experience breeds more confidence with the management of orthopaedic problems. Interest in specific areas within orthopaedics should be cultivated. The PGY-4 year is the year that applications for subspecialty fellowships are to be submitted (if the resident so desires.).

During this year, the PGY-4 also rotates at the VAMC, Texas Institute for Surgery and the University Hospital's.   Each of these rotations is rewarding in that they provide the PGY-4 with increasing responsibility and greater autonomy.

PGY-5     REFINEMENT OF THE ORTHOPAEDIC EDUCATION

The PGY-5 year is obviously the last year within the Department of Orthopaedic Surgery. During this year the resident should refine his/her treatment of  orthopaedic surgery patients. During this year the PGY-5 is expected to complete his/her research and be able to present his/her work during the Charles F. Gregory Memorial Lecture.
 
The PGY-5 year consists of both 2-month and 3-month blocks. Most residents will spend at least one or two rotations at PHHS. The role of the PGY-5 at PHHS is to function as senior resident of the service.  With an additional year of training, he/she is expected to be able to efficiently treat patients with more complex conditions than before.  As the senior resident demonstrates his/her competence more and more independence is permitted.

last edited: June 10, 2009