Curriculum Template



PROMEDICA MONROE REGIONAL HOSPITAL FAMILY MEDICINE RESIDENCYORTHOPEDICS Curriculum (PGY-1, PGY-2)Description of Educational ExperienceThe Orthopedics curriculum is a required experience for family medicine residents, which provides a greater understanding of the fundamentals of common musculoskeletal injuries and disorders. Residents will have a four week block in each of PGY-1 and PGY-2, furnishing them with exposure to both inpatient and outpatient orthopedic practice. Residents will have the opportunity to develop advanced technical skills in examination and treatment of common orthopedic injuries and complaints, including common orthopedic procedures such as joint injections, splinting, and casting. Family medicine physicians should be able to effectively evaluate and manage the immediate care of patients with common orthopedic problems and refer patients appropriately for specialty care. Common orthopedic disorders seen in the primary care setting may include overuse injuries, sprains, strains, fractures, dislocations, infections, or degenerative diseases.Family physicians have the opportunity to prevent orthopedic injuries in patients through longitudinal continuity of care across the life span. Anticipatory guidance regarding pediatric home safety and the use of safety equipment such as safety gates, bicycle helmets, and automobile restraint devices can prevent common childhood injuries, while honest discussions with adolescents and young adults regarding sports injuries, risky behaviors, peer pressure and the use of drugs or alcohol may prevent traumatic, life-changing injuries. For older adults, awareness of fall risk and functional assessment play an important role in preventing hip fractures and other injuries that frequently cause a loss of independence and self-care. The curriculum for this rotation is based upon information from the American Orthopedic Association, the American Board of Orthopedic Surgery, and the American Academy of Orthopedic Surgeons. Educational Goals:The purpose of the Orthopedics rotation is to provide residents the opportunity to gain experience and competence in the diagnosis and effective management of common musculoskeletal injuries, diseases, and disorders, with a focus on primary prevention of common orthopedic problems. Knowledge of anatomy, biomechanics, pathology, and physiology are essential for the assessment of common musculoskeletal complaints, including range of motion, joint stability, surrounding muscle strength, soft tissue damage, neurovascular integrity and signs of a fracture or dislocation.Residents will gain an appreciation for the benefits and limitations of physical medicine and therapy, orthotics, prosthetics, and options for rehabilitation. Patients with life-changing injuries and diseases, such as spinal cord injuries, amputations, and degenerative diseases are acutely managed by specialists but the family medicine physician is responsible for coordinating and providing continuity of care longitudinally across the lifespan for these patients and their families.Patient CareGoalResidents must be able to provide patient care that is compassionate, appropriate, and effective for the treatment of health problems and the promotion of health. CompetenciesResidents are expected to: Gather essential and accurate information about their patientsDevelop and carry out patient management plansObjectivesPGY- 1 will be able to:Demonstrate basic clinical skills with the following:History and general physical examination skills:Focused musculoskeletal examinations of the:AnkleBackClavicleElbowHipKneeLower extremities/footNeckRibsShoulderUpper extremities/handInterpret with assistance of a consultant, the following diagnostic studies:Radiographic films for fractures or dislocationsOttawa ankle and knee rulesSalter-Harris classification system for growth plate injuriesCT or MRI for orthopedic injuriesBone density scansPerform common orthopedic procedures under supervision, which may include:Casting & SplintingUlnar gutter splintShort arm castRadial gutter/thumb spica splintPosterior leg splint/stirrup splintShort leg walking castSugar tong forearm splint Commercial splint devicesAir splintsArm slingsClavicle splintsCock-up splintsFinger splintsHare traction splintsJones dressingKnee immobilizersSling and swath arm immobilizersSoft and hard cervical collars Joint injectionsJoint aspirationsSimple closed fracture reductionsLocal nerve blocksEducate patients and families about risk factors, diet and nutrition, lifestyle habits, and medication management for primary or secondary prevention of orthopedic injuries or diseasesUnderstand psychosocial effects of disease process or injuries on the patient, family, and/or caregiversObjectivesPGY- 2 will be able to:Demonstrate improved proficiency in the previous year level objectives for Patient Care Medical KnowledgeGoalResidents must demonstrate knowledge of established and evolving biomedical, clinical, epidemiological, and social-behavioral sciences, as well as, the application of this knowledge to patient petencies:Residents are expected to: Demonstrate an investigatory and analytic thinking approach to clinical situationsKnow and apply the basic and clinically supportive sciences which are appropriate to their disciplineObjectivesPGY- 1 will be able to:Develop knowledge and skills in the following areas:Evaluation, differential diagnosis, treatment and management of various orthopedic injuries or diseases that may include:AC shoulder separationCervical strain/whiplashCompartment syndromeCysts – ganglion and baker’sDegenerative disc/joint diseaseDevelopmental dysplasia of the hipDislocations – site specificEpiphysial fracturesFractures – site specificGreenstick and torus fractures of the forearmInfections, including osteomyelitisKnee injuriesAnterior cruciateMeniscusCollateral ligamentLow back painOsgood-Schlatter diseaseOsteoarthritisOveruse injuriesCarpal tunnel syndromeTendonitisBursitisPlantar fasciitisTenosynovitisScoliosisSeptic jointSprainsSpondylolisthesis/spondylolysisSports injuries, including common gender specific injuriesSoft tissue injuriesStrainsDevelop age appropriate knowledge of common orthopedic disorders or injuries appropriate for patient education, counseling, and anticipatory guidanceKnowledge of associated orthopedic adjuncts and issues regarding their use such as:Application, maintenance, and removal of splints and castsAssessment of neurovascular status and signs/symptoms of compartment syndromeAssessment and treatment of painUse of orthotic devicesUse of prosthetic devicesUse of mobility devices including crutches, canes, walkers, wheelchairs, motorized chairsCorrect techniques for lifting and transferring patientsAvailability of rehabilitation facilities for specific types of injuriesRisks of immobility including DVT and PEPharmacological management and complimentary/alternative medicine management of acute and chronic musculoskeletal painObjectivesPGY- 2 will be able to:Demonstrate improved proficiency in the PGY-1 level objectives for Medical KnowledgeInterpret the principles of evidence-based medicine and statistics as they apply to clinical situationsApply knowledge with attention to clinical outcomes, cost-effectiveness, risk-benefit, and patient preferenceIndependently present up-to-date scientific evidence to support hypothesisDevelop and maintain a willingness to be a life-long learner by querying the literature on a regular basis, attending conferences, and pursuing answers to clinical questionsCritically evaluate current medical information by applying principles of evidence- based medicine and clinical effectiveness, thereby modifying personal knowledge base accordinglyPractice-based Learning and ImprovementGoalResidents must demonstrate the ability to investigate and evaluate their care of patients, to appraise and assimilate scientific evidence and to continuously improve patient care based on constant self-evaluation and lifelong learning. CompetenciesResidents are expected to develop skills and habits to be able to:Identify strengths, deficiencies and limits in one’s knowledge and expertiseIncorporate formative evaluation feedback into daily practiceLocate, appraise and assimilate evidence from scientific studies related to their patients’ health problemsUse information technology to optimize learningObjectivesPGY-1 will be able to:Locate and read medical literature to support decision-making and ask appropriate questions in morning report and on roundsIdentify personal limitations and ask for help when neededUtilize web-based and hand held technology (ex. MD Consult, UpToDate, etc.) to support and enhance patient careObjectivesPGY-2 will be able to:Appraise and assimilate scientific literature Acquire and use appropriate evidence-based information in routine patient careDemonstrate responsibility and leadership in engaging junior residents in the educational processInterpersonal and Communication SkillsGoalResidents must demonstrate interpersonal and communication skills that result in the effective exchange of information and teaming with patients, their families, and professional associates. CompetenciesResidents are expected to:Communicate effectively with patients and families across a broad range of socioeconomic and cultural backgroundsCommunicate effectively with physicians, other health professionals, and health related agenciesWork effectively as a member or leader of a health care team or other professional groupMaintain comprehensive, timely, and legible medical records ObjectivesPGY- 1 will be able to: Elicit initial and interval histories from patients using effective elements of communication - exploratory, affective, clarification and the riskier feedback to patients of your understanding of what patient says/means Provide thorough, legible and timely written and/or dictated documentation of patient care (i.e. progress and procedure notes) Establish rapport through understanding of critical cultural awareness and patient diversity issues, communicating at the patient’s educational levelCommunicate effectively and respectfully with other health care providers and ancillary staff to enhance patient care (i.e. nurses, case managers, unit secretaries, etc.) ObjectivesPGY- 2 will be able to:Facilitate continuity of care with the patient’s primary care physician, whether community-based physician, faculty physician or family medicine residentProvide constructive verbal and written feedback to other members of the health care teamTeach patients, junior residents, medical students and other health care staff effectivelyFunction as a team leader with decreasing reliance on attending physicians ProfessionalismGoalResidents must demonstrate a commitment to carrying out professional responsibilities and an adherence to ethical principles. CompetenciesResidents are expected to demonstrate:Compassion, integrity, and respect for othersResponsiveness to patient needs that supersedes self-interestRespect for patient privacy and autonomyAccountability to patients, society, and the professionSensitivity and responsiveness to a diverse patient population, including but not limited to diversity in gender, age, culture, race, religion, disabilities, and sexual orientationObjectivesPGY-1 will be able to:Arrive on time and be prepared for work; notify Residency Administration (Coordinator, Chief Resident and senior resident) of any need for urgent schedule changes Interact professionally with patients, families, and other health care providersDemonstrate respect and compassion regardless of age, gender, culture, values and beliefs of patients, families and other health care team membersMaintain appropriate patient confidentiality during history-taking, physical examinations, family meetings and team discussionsMaintain up-to-date procedure log, duty hour log, and other residency documentation requirements ObjectivesPGY-2 will be able to:Demonstrate proficiency in all objectives for Professionalism of previous resident level with increasing efficiency and independenceSystems-based PracticeGoalResidents must demonstrate an awareness of and responsiveness to the larger context and system of health care, as well as the ability to call effectively on other resources in the system to provide optimal health care. CompetenciesResidents are expected to:Work effectively in various health care delivery settings and systems relevant to their clinical specialtyIncorporate considerations of cost awareness and risk-benefit analysis in patient careAdvocate for quality patient care and optimal patient care systemsWork in multidisciplinary teams to enhance patient safety and improve patient care qualityObjectivesPGY- 1 will be able to:Work collaboratively within the core clinical team including other residents, attendings, nurses, therapists, and other personnel involved in the care of their patientsConsider cost/benefit analysis in providing clinical care, whether in selection of diagnostic testing or choice of medication.Recognize resource limitation within the health care system and how it relates to individual patient insuranceObjectivesPGY- 2 will be able to:Recognize and advocate for patients and families who need assistance in dealing with system complexitiesFacilitate coordination of care with the patient’s primary care physician, whether community-based physician, faculty physician, or family medicine residentUnderstand how to write orders for various different diagnostic or therapeutic needs of the patient in an appropriate manner to assure best outcome and payment from various third party payers Practice cost effective health care that does not compromise quality of careRecognize system errors or problems and appropriately advocate for changes to improve patient care Learning Opportunities (residents)Clinical care, including direct patient care and interactions with attending physician Patient and family-centered conferences, including medical decision-making Performing and teaching proceduresRegular didactic conferencesAssessment Method (residents)Resident assessment at the end of each rotation of attending physician(New Innovations)Procedure log review at the end of each rotationResident performance on annual In Training ExaminationAssessment Method (Program Evaluation)Annual program review and assessment by residents and facultyEvaluation of In Training Examination performance by resident year and by overall programGraduate performance on ABFM certification examinationLevel of SupervisionThe resident functions under the direct supervision of the attending physician. Educational ResourcesEvidence at the point of care: UpToDate, MD Consult, EpocratesFamily Medicine residents are encouraged to complete the appropriate questions under the musculoskeletal section of Core Content Review at American Orthopedic Association website at .American Board of Orthopedic Surgery website at American Academy of Orthopedic Surgeons website at Common medical journals, such as New England Journal of Medicine, American Family Physician, Journal of the American Medical Association Assigned articles and searches in the course of care ................
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