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Rotations

Clinical Track Schedule

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* During PGY 1, residents complete 6 months of orthopedic rotations and 6 months of non-orthopedic rotations.
** During PGY 2-5, rotations occur in 10-11 week blocks.

– During PGY 3, residents complete two split rotations in Adult Sports / Pediatric Sports and Oncology / Foot and Ankle.
– During PGY 4, residents complete one split rotation in Oncology / Foot and Ankle. 
– During PGY 5, residents complete one split rotation in Oncology / Sports Medicine.

Orthopedic Trauma - UC San Diego Medical Center - PGY 2, 4, 5

After the first year of internship in the clinical or research track, PGY 2, PGY 4 and PGY 5 residents spend 10 weeks on the orthopedic trauma service at UC San Diego Medical Center (Hillcrest), a Level I Trauma Center verified by the American College of Surgeons (ACS). The trauma team is comprised of residents, fellows and faculty. A dedicated orthopedic trauma room is available 7 days a week, along with operating rooms and a clinic. 

Based on proficiency level, residents are granted graduated independence in the trauma service, given opportunities to diagnose and formulate treatment of bone, joint, muscle, nerve and other soft tissue injuries of the extremities. You will receive a high-level of exposure to the treatment of open and closed fractures, dislocations of the extremities and the management of multiple traumatized patients. Most trauma is blunt, including motor vehicle accidents (MVAs), occlusions of the middle cerebral artery (MCAs), and falls from heights. 

During rotations, you will learn to evaluate, diagnose, and formulate treatment plans for a variety of infectious processes, possibly including septic joints, osteomyelitis, and soft tissue infections such as cellulitis, necrotizing fasciitis, gas gangrene and abscess.

Outside of clinical facilities, additional training opportunities include various conferences, monthly journal clubs, a bimonthly trauma conference with the general surgery trauma service and a bimonthly fracture conference.

Hand - UC San Diego Medical Center, Jacobs Medical Center - PGY 2, 4

Residents rotate on the hand and upper extremity service in 10 week blocks during PGY 2 and PGY 4. This service is very busy and includes both elective and acute management of upper extremity pathology. There are three full-time hand fellowship trained attendings and one attending dual fellowship trained in hand and sports. There is also one hand and upper extremity fellow. There is a physician assistant who works both in clinic as well as the operating room.

Residents learn in detail the functional anatomy of the upper extremity. Residents will be able to perform a problem-oriented and nerve/motor specific examination. Residents will learn the pathophysiology and treatment of common disorders of the upper extremities. Additional training opportunities include a bimonthly journal club and a weekly anatomy session where the resident performs dissections.

After completion of the rotation, residents will be comfortable with the basic science principles and clinical practice of hand surgery, including:

  • Overuse syndromes: DeQuervain's; Trigger Finger, and Tennis Elbow.
  • Compressive Neuropathies: Such as Carpal Tunnel Syndrome, Pronator Syndrome, Radial Tunnel Syndrome, and Thoracic Outlet Syndrome.
  • Common Hand Tumors: Soft tissue tumors, ganglion retinacular cysts, mucous cysts, sebaceous cysts, giant cell tumors of tendon sheath and bone tumors such as enchondroma.
  • Trauma: Residents will understand and be proficient at the non-operative and operative management of fractures and dislocations involving the carpus, metacarpals and phalanges. Residents will also understand the indications for replantation, have experience in the treatment of tendon and nerve lacerations; understand the functional disabilities associated with nerve palsied; and be familiar with and understand basic tendon transfers to restore function.
  • Infections: Residents will be able to recognize and treat paronychais, deep space hand infections, flexor tenosynovitis and septic joints of the hand.
  • Congenital problems: Residents will be familiar with the common congenital problems of the upper extremities including polydactyly, syndactyly, radial club hand, clinodactyly, camptodactyly, Madelung's deformity, congenital amputations, and macrodactyly.
  • Acquired disorders: Residents should understand the rationale and treatment of Dupuytren's Contracture. Residents should understand the pathomechanics of hand and wrist deformities in rheumatoid arthritis and options for treatment. Residents should also understand the common disabilities of osteoarthritis of the hand, including arthritis of the thumb.

Spine - UC San Diego Medical Center, Jacobs Medical Center - PGY 2, 3

Residents rotate on the spine service in two 10-week rotations. The spine team includes surgeons, fellows, nurse practitioners, physician assistants and additional allied health providers.

The resident is responsible for participating in the care of all inpatients and assists with the pre-operative workup. Additionally, patients are seen in outpatient clinics at the Jacobs Medical Center. The residents provide care (non-operative and operative) for patients at the Veterans Administration Hospital and in the VA Spinal Cord Injury Unit in a consultative manner. Additional training opportunities include a weekly community spine conference.

Upon completion of the spine rotations, it is expected that the residents will:

  • Understand spine anatomy: Cervical, Thoracic, and Lumbar.
  • Develop an organized approach to evaluation and treatment of spine-injured patients: intact, incomplete and complete.
  • Assess spinal stability/instability.
  • Develop an organized approach to evaluate and treat outpatients with complaints of back/leg, neck/arm pain as related to degenerative conditions, tumor, infections, spondylo-arthropathies, and deformities.
  • Develop familiarity with adult scoliosis.
  • Develop an organized approach to spine surgery: pre-op, intra-op and post-op.
  • Understand the rationale and indications for using spinal orthoses: commercial and fabricated.
  • Improve surgical techniques.

Joint Reconstruction - UC San Diego Medical Center, Jacobs Medical Center - PGY 3, 6

The resident rotates on the arthroplasty service at UC San Diego twice during residency in 10-week rotations. The residents have earlier exposure to arthroplasty at the VA hospital during PGY 2 (see description of VA rotation). This rotation involves basic and complex reconstruction of adult hip and knee. There are three full time fellowship trained arthroplasty surgeons. There is one fellow. There are two full time allied health providers plus one part time.

The resident will learn various approaches to total hip arthroplasty, including anterior and posterior approaches. They are also provided with the unique exposure to biological reconstruction, including osteotomy and osteocartilaginous transplantation. This rotation provides an opportunity for the resident to have intimate one on one interaction with attending staff, perform a large volume of surgical procedures, and participate in patient care. This rotation also allows the resident to improve communication skills with the patient and hospital staff, and gain better understanding of the multidisciplinary approach to care. Additional training opportunities include a bimonthly teaching conference.

Upon completion of the joint reconstruction rotations, it is expected that the residents will:

  • Understand the pathophysiology of adult hip and knee disease, including osteoarthrosis inflammatory arthrosis, traumatic arthrosis and avascular necrosis, as well as other cartilage diseases.
  • Understand the mechanics of the hip and knee joint, including normal, pathologic, and reconstructed joints.
  • Understand the surgical anatomy of the hip and knee and multiple surgical approaches.
  • Understand the indications for surgical treatment for adult hip and knee disease.
  • Understand material science of prosthetic joint replacement.
  • Understand design-engineering principles underlying total joint replacement.
  • Understand the biological principles underlying osteotomy and cartilage transplantation. Understand the principle of prosthesis fixation and biological reaction to the prosthesis.
  • Recognize patterns of prosthesis failure.
  • Develop technical proficiency in the performance of basic hip and knee reconstructive procedures and have an understanding of the complexities of revision surgical procedures.
  • Understand the basic concepts and details of rehabilitation after joint reconstructive procedures and the use of clinical pathway in patient care.

Adult Orthopedics - VA Medical Center - PGY 2, 3, 5

During residency, residents rotate at the VA Medical Center in three 10-week blocks. The resident is exposed to a wide-variety of orthopedic pathology, both inpatient and outpatient, while receiving graduated responsibilities with a large caseload volume of arthroplasty, sports medicine, shoulder pathology, and fractures.

Residents receive education in the diagnosis and treatment of adult orthopedic patients, gaining responsibility for establishing an appropriate diagnosis for each patient by process of history taking, physical examination and instituting appropriate investigations for patients in the Triage Area, Outpatient and Inpatient services. These rotations provide more initial independence in patient care than most. Additional training opportunities include a weekly Monday morning conference attended by all VA faculty and residents.

During the adult orthopedics rotations, it is expected that the residents will:

  • Propose a plan for therapy, operative or nonoperative, and be able to institute and coordinate such therapy to its satisfactory conclusion.
  • Maintain adequate documentation of diagnostic and therapeutic plans for each of the patients.
  • Extensively read the orthopaedic literature, especially in relation to current patients.
  • Understand nature and treatment options for degenerative processesthe most frequently encountered problems at the VA.

Orthopedic Sports Medicine - UC San Diego Medical Center, Balboa Naval Medical Center - PGY 3, 4, 5

PGY 3 and PGY 4 residents rotate with the UC San Diego sports service. The chief of the sports service is the team physician for the San Diego Padres. There are three full time sports fellowship trained attendings, and one dual fellowship trained surgeon in both sports and hand/upper extremity. During PGY 5, residents rotate at the Balboa Naval Medical Center. Additional sports experiences are offered while rotating at the VA (please see description of the VA rotation).

The educational goal of the sports medicine rotations is to foster the clinical and surgical skills needed to provide excellent arthroscopic and sports medicine care after completion of the residency program. The sports medicine service focuses upon evaluation and treatment of shoulder and knee disorders, with particular emphasis upon basic and advanced arthroscopic surgical techniques. Residents will be comfortable with the basic science principles and clinical practice of orthopedic sports medicine.

Education is provided side-by-side with faculty physicians in the outpatient clinic as well as in the operating room. Considerable opportunity is available for longitudinal follow-up of patients from preoperative assessment through postoperative management. Team coverage is provided in the training room of the UC San Diego Intercollegiate Athletic Program. There is opportunity for the residents to be the team physician for high school football teams.

Specific attention is directed at gradual development of arthroscopic skills. Training includes model practice including simulation, and progresses from basic arthroscopic techniques through advanced procedures such as arthroscopic rotator cuff repair, instability management of the shoulder, posterior cruciate ligament reconstruction and meniscal allograft replacement. Emphasis is placed upon the basic science foundations of current procedures in preparation for future scientific and technologic advances in the field of sports medicine.

A large number of arthroscopic and open procedures are performed. Residents are expected to learn the surgical principals and techniques of open knee and shoulder surgery as well as diagnostic and surgical arthroscopy. Commonly treated disorders include:

  • Shoulder instability and superior labral (SLAP) tears
  • Impingement syndrome and rotator cuff tears
  • Glenohumeral arthrosis (including shoulder arthroplasty)
  • Adhesive capsulitis
  • Meniscus tears and knee chondrosis
  • Knee instability (including ACL, PCL, and Posterolateral Corner)
  • Patellofemoral disorders
  • Sports rated overuse syndromes
  • Stress fractures and chronic exertional compartment syndrome

Foot and Ankle - Jacobs Medical Center - PGY 2

PGY 2 residents work one-on-one with the foot and ankle attending physician, as well as a dual fellow trained in foot and ankle and trauma, and a part-time physician assistant. During a mostly outpatient rotation with some inpatient consults, residents will learn a large variety of surgeries and pathologies. 

Upon completion of the rotation it is expected that residents will have:

  • Developed and expanded a basic orthopedic fund of knowledge in the areas of foot and ankle conditions.
  • Developed knowledge of basic anatomy, biomechanics and the pathophysiology of foot and ankle conditions.
  • Performed non-surgical and surgical management of a wide variety of foot and ankle conditions under direct clinical and surgical supervision and instruction.

Pediatric Orthopedics - Rady Children's Hospital - PGY 2, 4

Rady Children's Hospital is routinely ranked as one of the top ten pediatric orthopedic programs in the United States. During residency, residents work in the hospital in two 10-week rotations. Residents should expect busy rotations with ample opportunities in nonoperative and operative treatment of pediatric orthopedic conditions.

Working alongside numerous attending surgeons, fellows, allied health professionals and orthopedic technologists, residents will learn details and specifics of numerous subspecialties, including spine/scoliosis, pelvic osteotomies, sports, and foot and ankle.

The goals for the pediatric orthopedic rotation include:

  • Cognitive: Completion of a comprehensive reading program in pediatric orthopaedics including complete reading of Lovell and Winter text on pediatric orthopedics, a practical fracture text (Rang) as well as a more comprehensive text on children's fractures (Wilkins-Rockwood and Green). This reading, plus weekly journal club and teaching conferences on pediatric orthopedic topics, will initiate the development of a cognitive base. The goal for clinical skills includes understanding the diagnosis and treatment of all common pediatric orthopedic surgery problems (especially fractures and infections). The resident in the senior year will be expected to read on more complex children's orthopedic topics including myelodysplasia (Menelaus), cerebral palsy (Bleck), hip dysplasia (Tonnis), and scoliosis (Moe, Bradford, Winter, Lonstein). This reading plus weekly journal club and teaching conferences on pediatric orthopedic topics will expand the cognitive base for the resident. The goal for clinical skills includes understanding the diagnosis and treatment of all common pediatric orthopedic surgery problems (especially fractures and infections) and also to assist in managing more complex problems. They will further their cognitive knowledge base by organizing the topics for journal club.
  • Psychomotor: The residents will learn to reduce common children's fractures both with local and general anesthesia. They will learn basic operative skills related to pediatric orthopedics including treatment of closed and open fractures, and aspiration and surgical drainage of suspected infections.
  • Operations: Common orthopedic elective operations (simple tendon lengthenings, muscle releases in cerebral palsy, simple corrective osteotomies, etc.). They will also assist with complex pediatric orthopedic operations (surgical treatment of scoliosis, congenital dislocation of the hip, Legg-Perthes disease, etc.).
  • Affective: The resident will learn the affective components of being a physician including good inter-professional and doctor patient skills. This will be achieved through close association with the attending staff who serve as a role model. Professionalism in the hospital, clinic and operating room will be emphasized.