1. Rotating Medical Student Orientation UNMC Orthopaedic Surgery Department of Orthopaedic Surgery and Rehabilitation

2. Introduction This presentation will give you an introduction to your rotation at UNMC. This presentation will give you an introduction to your rotation at UNMC. You should use it as a reference both before and during your rotation as it contains important information regarding your month with us. You should use it as a reference both before and during your rotation as it contains important information regarding your month with us.

3. Welcome Welcome to the orthopaedic surgery experience at the University of Nebraska Medical Center. We hope you find this rotation both challenging and rewarding. This rotation should allow you to expand your knowledge of basic orthopaedics as well as participate in diagnosis, treatment, and care of various orthopaedic patients. Welcome to the orthopaedic surgery experience at the University of Nebraska Medical Center. We hope you find this rotation both challenging and rewarding. This rotation should allow you to expand your knowledge of basic orthopaedics as well as participate in diagnosis, treatment, and care of various orthopaedic patients.

4. WELCOME We are here to teach you about the basic foundations of and help you gain a feel for a career in Orthopaedic Surgery We are here to teach you about the basic foundations of and help you gain a feel for a career in Orthopaedic Surgery

5. UNMC Orthopaedics

6. About our hospital Nebraska Medical Center Nebraska Medical Center –This is the combination of two hospitals that merged in 1997 including  Clarkson (Private)  Univ of Nebraska Medical Center (Academic) The Nebraska Medical Center is one of the region's premier health systems. The Nebraska Medical Center is one of the region's premier health systems. –735 bed state of the art hospital –Recent addition of new clinical center that includes nearly 30 new operating rooms, radiology suites, and emergency department. To learn more about our hospital and medical school To learn more about our hospital and medical school –www.unmc.edu www.unmc.edu –www.nebraskamed.com www.nebraskamed.com

7. About our program UNMC Department of Orthopaedics UNMC Department of Orthopaedics –A full description of our program is available on the department website. This includes a list of current and past residents, information about applying for a residency position, information regarding salaries, benefits and call, and finally information about our faculty –www.unmc.edu/orthosurgery www.unmc.edu/orthosurgery

8. About our program 4 residents per year (20 total) 4 residents per year (20 total) Divided among: Divided among: –Interns (4) –Children’s Hospital (2) –VA Hospital (3) –UNMC Sports (1) –Private Sports / Foot&Ankle (2) –Adult Reconstruction (2) –Trauma / Foot&Ankle / Tumor (3) –Hand & Upper Extremity (2) –Spine (1)

9. Rotation Schedule There are generally many medical students on rotation at UNMC each month There are generally many medical students on rotation at UNMC each month Requests for different services will be taken, but keep in mind that we have to make it fair for everyone Requests for different services will be taken, but keep in mind that we have to make it fair for everyone Generally speaking, each student is on one ‘team’ for the duration of the 4 week rotation Generally speaking, each student is on one ‘team’ for the duration of the 4 week rotation There are frequent opportunities to participate in clinics or cases with attendings from other teams There are frequent opportunities to participate in clinics or cases with attendings from other teams

10. Rotation Schedule Students will or may be assigned to the following services: Students will or may be assigned to the following services: –ADULT RECONSTRUCTION (UNMC)  The GOLD service with Drs. Garvin, Konigsberg, Hartman –TRAUMA / FOOT & ANKLE/SPINE (UNMC)  The GREEN service with Drs. Mormino, Reed, Cornett –ONCOLOGY (UNMC)  The GREEN service with Dr. McGarry –UPPER EXTREMITY (UNMC)  The BLACK service with Drs. Fehringer, Ferlic, Thompson, Crabb and Bruggeman –SPORTS MEDICINE (UNMC)  The RED service with Drs. Dietrich, Daccarett –PEDIATRICS (Children’s Hospital and UNMC)  With Drs. Esposito, Scherl, Hasley, Jenson –VA HOSPITAL

11. Expectations Each of you is interested in an orthopaedic residency and a career in orthopaedics. Each of you is interested in an orthopaedic residency and a career in orthopaedics. You will be rotating with us not only to learn about our residency program, but also to allow us to evaluate you as a potential resident. You will be rotating with us not only to learn about our residency program, but also to allow us to evaluate you as a potential resident. Please read through the following expectations carefully and try to use them as a guide for what we are looking for in a potential resident. Please read through the following expectations carefully and try to use them as a guide for what we are looking for in a potential resident.

12. Expectations: General We expect you to: We expect you to: –Show up on time, be available, and work hard –Read before surgical cases (anatomy and surgical plan) –Be helpful, be inquisitive, ask questions –Learn basic management of common musculoskeletal problems –Participate actively in rounds, clinics, conference, and general discussions about orthopaedic problems

13. The best medical students: The best medical students: –Work hard and ask appropriate questions at appropriate times –Take initiative and do things without being asked –Help write notes including chart notes, post op notes, and post op orders –Have labs ready for rounds in the morning –Update patient list with current patient rooms –Are sure case notes and x-rays are available for the current day and next day cases –Are prepared for daily conferences, clinics, and cases by reading beforehand –Function at an intern level

14. Clinical functioning at the level of an intern Clinical functioning at the level of an intern –Think about the patient care plan:  Pre-op planning  Medical workup before surgery  Antibiotics  Pain control  DVT prophylaxis  Therapy goals & restrictions  Dressing changes / drain output  Discharge planning & clinic follow-up  Read other consult service notes for their plan

15. Note writing We expect you to be able to write chart notes, post op notes, and assist with post- op order writing We expect you to be able to write chart notes, post op notes, and assist with post- op order writing Several examples follow. Use them as a guide for what we are looking for in notes. Several examples follow. Use them as a guide for what we are looking for in notes.

16. Chart note example Subjective Subjective  Pt was comfortable overnight, no pain issues, no nausea/vomiting. Good PO intake and had a bowel movement Objective Objective  Hgb 11  INR 2.1  Walked 110’ with PT  Afebrile  Alert/oriented  Wound is clean and dry  Neurovascular exam is intact Assessment Assessment  S/P Right Total Hip Plan Plan  Continue pain mgt  Increase activity  DVT prophylaxis  Discharge planning

17. Post op Note We write standard post op notes for each surgery We write standard post op notes for each surgery –Pre-op Diagnosis –Post-op Diagnosis –Procedure –Surgeon –Assistant –Anesthesia –EBL –Fluids –Complications –Post op status

18. Post op note example Pre-op Pre-op –Left Closed Femur Fracture Post op Post op –Same Procedure Procedure –Closed reduction IM fixation Surgeon Surgeon –Dr. Mormino Assistant Assistant –Dr. Buck HOV and Dr. Johnston HOIII Anesthesia Anesthesia –GETA EBL EBL –50cc Fluids Fluids –1000cc crystalloid Complications Complications –None Status Status –Return to floor in stable condition

19. Post Op Orders Most of the staff have standard post op orders. The residents will help you to figure out where these are and what they specifically want. We do not expect you to know what each staff wants, but we do expect you to have an understanding of typical post op orders for specific surgeries. Most of the staff have standard post op orders. The residents will help you to figure out where these are and what they specifically want. We do not expect you to know what each staff wants, but we do expect you to have an understanding of typical post op orders for specific surgeries.

20. CALL

21. Divide call on trauma nights between the students such that you average no more frequently than q4 during your month. Divide call on trauma nights between the students such that you average no more frequently than q4 during your month. Be sure to get at least one full weekend off. We’d like you to be able to both have a life and also get to know a little about our city. Be sure to get at least one full weekend off. We’d like you to be able to both have a life and also get to know a little about our city. The actual schedule is left up to the students to arrange. Be fair to each other. The actual schedule is left up to the students to arrange. Be fair to each other.

22. Carry the on-call pager and notify the junior resident on-call that you will be taking call with them that evening. Carry the on-call pager and notify the junior resident on-call that you will be taking call with them that evening. The best opportunity to learn how to suture, splint, cast, and possibly do reductions as a medical student takes place on-call and in the ER/trauma bay. The best opportunity to learn how to suture, splint, cast, and possibly do reductions as a medical student takes place on-call and in the ER/trauma bay.

23. CONFERENCES

24. Conference Schedules Three rules Three rules –Read assigned material before conference, if you are unsure, ask the junior resident on your service –No scrubs in conference, dress appropriately –Be on time

25. Conference Schedules MonTuesWedThursFri 600amTextbookConference630am Grand Rounds 600am Gold Joint Conference600amPediatricOrthoConference600amTraumaConference600am Hand/Upper extremity/ Spine Conference Sorrell Center Room 1005 UNMC Ortho LibraryChildren’sHospital Glow Aud. 3 rd Floor UNMC Ortho Library UNMC Ortho Library

26. Lectures

27. Lectures Each week the rotating medical students will participate in a lecture given by one or more of the residents in the ortho library. Each week the rotating medical students will participate in a lecture given by one or more of the residents in the ortho library. These lectures are interactive meaning that we expect you to read about the topic beforehand and be able to answer questions. These lectures are interactive meaning that we expect you to read about the topic beforehand and be able to answer questions. Weekly Educational Topics (Time and place determined on a week to week basis) Weekly Educational Topics (Time and place determined on a week to week basis) –Week 1: Trauma / Radiographs / Splinting –Week 2: Lower Extremity Injuries –Week 3: Upper Extremity Injuries –Week 4: Case Conference

28. Library

29. Orthopaedic Library We have an extensive collection of current and past textbooks and journals in our department library. It is a resource for everyone. Please take advantage of it. We have an extensive collection of current and past textbooks and journals in our department library. It is a resource for everyone. Please take advantage of it. If you are not sure what to read, ask the residents. We can help you find appropriate reading material. If you are not sure what to read, ask the residents. We can help you find appropriate reading material.

30. Commonly used books and websites Useful textbooks Useful textbooks –Hoppenfeld’s Surgical exposures –Hoppenfeld’s Physical Examination of the Spine and Extremities –Netter’s Anatomy –Miller’s Review of Orthopaedics Textbook –The Handbook of Fractures –Campbell’s Operative Orthopaedics –Browner and Jupiter and Rockwood and Green Trauma Textbooks Useful websites Useful websites – http://www.wheelessonline.com/ http://www.wheelessonline.com/ –http://www.aaos.org/ http://www.aaos.org/ –http://www.ota.org/ http://www.ota.org/ –http://osrr.orthosurg.net/

31. Miscellaneous Information

32. Contact person Geri Miller is the contact person for rotating medical students. Geri Miller is the contact person for rotating medical students. –Email  gmiller@unmc.edu gmiller@unmc.edu –Phone  402-559-2258

33. Key Phone Numbers Geri Miller559-2258 Geri Miller559-2258 Ortho Clinic559-5360 Ortho Clinic559-5360 Resident Room559-5614 Resident Room559-5614 Radiology File Room559-1001 Radiology File Room559-1001 Emergency Room559-6637 Emergency Room559-6637 Univ OR Pre-Op559-5859 Univ OR Pre-Op559-5859 Univ OR Recovery559-4133 Univ OR Recovery559-4133

34. Nuts & Bolts Accessing computers Accessing computers –The computers in the resident room are password protected. You will need to get access to these. Accessing electronic x-rays (Magic Web) Accessing electronic x-rays (Magic Web) –All of our x-rays are digital. Students are not given a password for magic web, but should be able to view x-rays with an available resident. Accessing medical record (Last Word) Accessing medical record (Last Word) –Last word is for patient information including labs, notes, and other reports. You will get access to this. Scrub valet codes Scrub valet codes –Scrub codes will be given for the scrub valet. This is done at the OR front desk on your first day.

35. Final Thoughts If you have questions, please ask the residents. We want you to have a great experience during your month with us at UNMC. If you have questions, please ask the residents. We want you to have a great experience during your month with us at UNMC. Most of all… HAVE FUN! Most of all… HAVE FUN!