Orthopedics

This 2-week rotation allows you to have a lot of freedom with respect to how/ where you want to spend your time. Your time is spent either in the OR (scheduled slate or trauma room) and the cast clinic. You are free to choose where you will spend your day and which days you want to be on call. There is usually a family medicine resident and often a senior orthopedics resident during this rotation, who are great resources for learning. Each week, they have x-ray rounds (currently on Tuesday afternoons), during which you go through interpreting different ortho x-rays with the residents and orthopedic surgeons.

There is quite a large group of orthopedic surgeons at the hospital currently. They all have different teaching approaches and you will have the opportunity to work with most of them over your two weeks. You will find preceptors who you enjoy working with and can join their ORs and cast clinic days more often.

OR: It is recommended that in the OR, you try and see each of the main joint replacements (knee, hip, shoulder, though shoulders are a lot less common). You will have the opportunity to scrub in and potentially do some suturing. A couple days a week, a trauma room is run that handles all of the trauma ortho procedures (eg: fractures). You can choose to either be in the trauma room or scheduled OR. If you are going to be in the scheduled OR room, look at the slate ahead of time and review the anatomy (questions they ask are mostly about anatomy). It is usually a good idea to be in the OR area by 7:30 at the latest so you have time to review the patient chart and introduce yourself to the patient before the case starts.

Cast Clinic: This is the clinic across from minor treatment where orthos will see new consults and follow-ups. This is a good opportunity to see a large variety of ortho problems and practice your MSK exams/ x-ray reading. This is a very high volume clinic.It usually opens around 8am, though when the surgeon will show up is varying. You can ask the nurse working in the clinic for the week's schedule so you can see who will be working in the clinic and decide which preceptors you would like to work with. Your level of involvement is preceptor dependent, but most of you will have you do new consults and do lots of MSK exams. Some also get you to dictate your consults, and sometimes follow-ups, at the end of the day.

Rounding/Wards: Rounding is very dependent on whether or not you have a resident and what they want to do. Some residents will have you round on all ortho patients every day as a team, while others will just have you only round on patients who you have been directly involved with their care. Rounding is completed before you start in the cast clinic/ OR.

The call for this rotation is 1 in 4, so you usually end up doing 2 weekdays and 1 weekend call. You get to choose which days you are on call, so it is a good idea to look and see which preceptors are on-call and think about who you would like to work with. Officially, call is home-call, but whether or not you end up staying late/overnight will depend on your preceptor and workload. When you are on-call, you should text whoever is on-call that day in the morning to let them know. Often, they are working in the trauma room that day, so you can work there with them there. Once the regular slate is done for the day, you will work with the on-call surgeon on the emergency slate. Often, you will do a quick consult on the patient before they go into the OR. As well, they may have you see consults that come into the ER throughout the day. Generally, you will finish the emergency slate by 9 or 10pm and can usually go home after that. It is usually a good idea to check up on the ward before you go home and tie up any loose ends there. You do not get a post-call day on this rotation. If you end up staying later into the night in the OR and feel you need a post-call day, you can take one.

On weekend call, it is a good idea to text the on-call surgeon the night before to let them know you will be on call with them and ask what time they want you there in the morning. Depending on the schedule for the day, you may start in the OR, or you may start with rounding. If you start in the OR, you will round as a team between cases.

This rotation gives you a lot of freedom to learn how you want. If you prefer the OR, you can spend more time there than in cast clinic, or vice versa. However, it is a good idea to spend time in both as there is valuable learning in both settings.

Consults for ortho are usually pretty to the point, but doing a detailed MSK is important and helpful. Also, don’t forget your neurovascular assessment- particularly in trauma!

The MSK videos from clinical skills in 2nd year are good to review if you’re forgotten your MSK exams.