Rotating Medical Student Orientation

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UNMC Orthopaedic Surgery

• Rotating Medical Student Orientation

Department of Orthopaedic Surgery and
Rehabilitation
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Introduction

• 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.

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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.

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WELCOME

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

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UNMC Orthopaedics
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About our hospital

• 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.
• 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
• www.unmc.edu
• www.nebraskamed.com

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About our program

• 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

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About our program

• 4 residents per year (20 total)
• Divided among
• Interns (4)
• Childrens Hospital (2)
• VA Hospital (3)
• UNMC Sports (1)
• Private Sports / FootAnkle (2)
• Adult Reconstruction (2)
• Trauma / FootAnkle / Tumor (3)
• Hand Upper Extremity (2)
• Spine (1)

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Rotation Schedule

• 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
• 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

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Rotation Schedule

• 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 (Childrens Hospital and UNMC)
• With Drs. Esposito, Scherl, Hasley, Jenson
• VA HOSPITAL

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Expectations

• 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.
• 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.

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Expectations General

• 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

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• 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

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• 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

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Note 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.

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Chart note example

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

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Post op Note

• 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

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Post op note example

• Pre-op
• Left Closed Femur Fracture
• Post op
• Same
• Procedure
• Closed reduction IM fixation
• Surgeon
• Dr. Mormino
• Assistant
• Dr. Buck HOV and Dr. Johnston HOIII
• Anesthesia
• GETA
• EBL
• 50cc
• Fluids
• 1000cc crystalloid
• Complications
• None
• Status

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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.

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• CALL

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• 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.
  Wed 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.

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• 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.

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• CONFERENCES

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Conference Schedules

• 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

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Conference Schedules
Mon Tues Wed Thurs Fri
600am Textbook Conference 630am Grand Rounds 600am Gold Joint Conference 600am Pediatric Ortho Conference 600am Trauma Conference 600am Hand/Upper extremity/ Spine Conference
Sorrell Center Room 1005 UNMC Ortho Library Childrens Hospital Glow Aud. 3rd Floor UNMC Ortho Library UNMC Ortho Library
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Lectures
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Lectures

• 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.
• 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

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Library
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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.
• If you are not sure what to read, ask the
  residents. We can help you find appropriate
  reading material.

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Commonly used books and websites

• Useful textbooks
• Hoppenfelds Surgical exposures
• Hoppenfelds Physical Examination of the Spine
  and Extremities
• Netters Anatomy
• Millers Review of Orthopaedics Textbook
• The Handbook of Fractures
• Campbells Operative Orthopaedics
• Browner and Jupiter and Rockwood and Green Trauma
  Textbooks
• Useful websites
• http//www.wheelessonline.com/
• http//www.aaos.org/
• http//www.ota.org/
• http//osrr.orthosurg.net/

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Miscellaneous Information
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Contact person

• Geri Miller is the contact person for rotating
  medical students.
• Email
• gmiller_at_unmc.edu
• Phone
• 402-559-2258

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Key Phone Numbers

• Geri Miller 559-2258
• Ortho Clinic 559-5360
• Resident Room 559-5614
• Radiology File Room 559-1001
• Emergency Room 559-6637
• Univ OR Pre-Op 559-5859
• Univ OR Recovery 559-4133

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Nuts Bolts

• 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)
• 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)
• Last word is for patient information including
  labs, notes, and other reports. You will get
  access to this.
• Scrub valet codes
• Scrub codes will be given for the scrub valet.
  This is done at the OR front desk on your first
  day.

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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.
• Most of all HAVE FUN!