University at Buffalo Department of Orthopaedic Surgery Sports Medicine Fellowship Program Overview

Transcription

1 University at Buffalo Department of Orthopaedic Surgery Sports Medicine Fellowship Program Overview The Fellowship is designed to provide a comprehensive sports medicine clinical and operative experience, teach the material required by the ACGME, help the fellow to develop into a critical reader and reviewer of the literature, allow meaningful contribution to the Sports Medicine literature, and provide sideline and training room expertise. The clinical and operative experience is provided during rotations with six to eight Attending Sports Medicine surgeons during the year, who have extensive expertise in shoulder, knee, elbow, ankle, and hip arthroscopy. The fellow spends several weeks to months with each attending to allow each to reach a level of comfort that doesn t occur with shorter rotations. This translates into a greater degree of Fellow autonomy. The Sports Medicine body of knowledge is formally taught during our Thursday morning conferences, during which the lectures progress from head to toe to cover the major topics in systematic fashion. These lectures are given by Attending s, Fellows, and nationally and internationally recognized guest speakers, which also afford the fellows valuable networking opportunities. Development of literature review skills occur via our monthly journal club, which is run by the fellows and well-attended by orthopaedic residents and the Sports Medicine Attending s. In addition, many of the staff is editorial board members or regular reviewers for several major sports medicine journals, affording the fellows the opportunity to review articles prior to publication. UB has extensive research activities, and members of our group regularly participate in prospective clinical trials, anatomic and biomechanical studies, meta-analyses, and other projects, and we have large rotator cuff and ACL databases for cohort and case-control studies. Finally, we work with several professional and collegiate sports teams, including the Buffalo Bills, Buffalo Sabres, Buffalo Bandits Lacrosse, UB men s football, basketball, and other sports, and Buffalo State Football. This gives the Fellow extensive exposure to the sideline and training room management of athletic injuries. Clinical Rotations and Operative Experience The fellows rotate with the Sports Medicine Attending s on an individual basis, with each rotation designed to allow an in-depth experience with their preceptor. Rotations are from one to three months, depending on the level of clinical activity of each Attending. Because there are seven sports medicine attendings and only two residents rotating on sports medicine at a time, there will be minimal competition for cases between residents and fellows. Buffalo Sabres The fellow rotating with Dr. Bisson from August to October will also work with the Buffalo Sabres NHL team for the full season. Duties include pre- and post-season physicals, as well as attending all home games. Depending on circumstances, there may also be an opportunity to attend an away game during the playoffs. This experience provides extensive exposure to hockey injuries, including lacerations, muscle strains, contusions, mild traumatic brain injury, and acute and chronic injuries to the shoulder, hip, knee, and ankle.

2 Buffalo Bills Fellow Duties The individual who chooses or is assigned the football track of the fellowship will begin the two month rotation at the Buffalo Bills NFL training camp at St. John Fisher College in Pittsford, New York, an approximately one-hour drive from Buffalo, New York. Under the direction and tutelage of Dr. John Marzo, the fellow will have the following duties: - Perform orthopedic physical examinations on all in-coming players - Be present at all practice and work-out sessions to provide for on-field evaluation of all injuries, medical and orthopedic - Perform examinations; formulate a differential diagnosis on injured players - Coordinate care with the athletic trainers, order and review diagnostic and imaging studies as necessary Additional duties include attending all of the pre-season and regular season home football games. The fellow can choose an away game during the season to experience the out of town medical coverage needed by the Football Club. During the season, each Monday afternoon the fellow accompanies Dr. Marzo during regular training room rounds, when all orthopedic injuries and follow-up examinations take place. During the season, the fellow will assist in performing orthopedic exams on all in-coming players acquired by the team. Throughout the year, the fellow will also assist with regularly scheduled examinations typically at the beginning and end of the season, and at an annual complete medical evaluation. During the four days of the annual NFL Combine exams, the fellow will travel to Indianapolis, Indiana with the Buffalo Bills medical staff to help in the performance of physical exams, review of associated diagnostic studies, and assigning of orthopedic grades to over 300 draft eligible college football players. University at Buffalo Bulls The fellow rotating with Dr. Fineberg (UB Football), Dr. Wind (UB Men s Basketball), and Dr. Smolinski (UB Women s Basketball) will have exposure to Division 1 collegiate sports. Duties may include pre- and post-season physicals, training room evaluations, as well as attending home games. Depending on circumstances, there may also be an opportunity to attend away football games. The fellows will also be variably exposed to multiple other collegiate sport injuries including baseball, softball, soccer, wrestling, volleyball, tennis, track and field, swimming and diving. This experience provides exposure to the entire spectrum of acute and chronic orthopedic injuries and other sports medicine related problems such as concussions Buffalo State College The fellow rotating with Dr. Bisson from August to October works as team physician for Buffalo State Football, covering all home games. In addition, this fellow makes a weekly Monday evening visit to the training room during the football season, as well as intermittently on an as-needed basis during the winter and spring seasons.

3 Buffalo Bandits The physicians of UB Orthopaedics & Sports Medicine provide medical coverage for the Buffalo Bandits of the National Lacrosse League. we are involved in providing the medical and orthopaedic pre-participation physicals, event coverage, and care for these athletes throughout their season. Games are usually played on the weekends from January through May. Similar to the NHL, the team physicians are available for Home games and provide evaluation and management services to both the home and away teams. Educational experiences include development of team relationships, acute injury management including acute diagnosis, radiographic interpretation, immobilization techniques, suturing, concussion management, and more. The games are events and are enjoyable to attend. Fellows are encouraged to participate; however, it is not mandatory. Research Opportunities UB has extensive research activities, and members of our group regularly participate in prospective clinical trials, anatomic and biomechanical studies, meta-analyses, and other projects, and we have large rotator cuff and ACL databases for cohort and case-control studies. We are upgrading our MRI software to allow for quantitative cartilage imaging, and will be creating a database for cartilage studies as well. Sports Medicine Conferences The fellowship has a weekly sports medicine conference every Thursday morning where numerous topics in sports medicine are presented by the Sports Medicine Faculty and their colleagues from the community. The conference schedule is comprehensive, covering both surgical and non-surgical topics in sports medicine and is listed on the website. There is a biannual Ralph C. Wilson lecture series, which is a part of the fellow conference schedule where the lecture is given by world renowned faculty. Previous guest speakers have included Brian Cole, MD, Thomas Gill, MD, and Robert Anderson, MD to name a few. Future speakers include Christian Gerber, MD and Steven Arnoczky, DVM. Fellows will be responsible for giving one lecture during the year. The conference schedule is an integral part of the fellowship and provides not only a review of sports medicine topics, but also informal discussions between the faculty and fellows. Educational Meetings Fellows are provided a stipend of $2,000 to attend a national sports medicine educational meeting/conference. These meetings provide not only educational exposure, but also are important in networking with sports medicine physicians around the country. Historically, most fellows have attended the AOSSM conference, and may attend other national meetings as well. Fellows will attend a three day fellow s course in Naples, Florida at the Arthrex facility. This course involves lectures and hands-on arthroscopic lab experience provided by the nationally recognized Arthrex faculty. Additional educational meetings include a three day course with the Sports Medicine Faculty where fellows will have lectures and one-on-one arthroscopic surgical technique instruction in the lab. This course provides more in-depth instruction in a more informal setting with the Faculty. Previous locations of this conference have included Vail, Colorado; Naples, Florida; and New York City. Fellows are also invited to attend a Cartilage Restoration Course in Santa Monica, California, where they will gain knowledge and experience in cartilage restoration and operative techniques.

4 Arthroscopy Lab: Fellows Dry and Wet Lab: The Arthroscopy Research and Educational Facility, housed within the Kenneth A. Krackow Orthopedic Research Laboratory of the Department of Orthopaedic Surgery at the University of Buffalo plays an integral role in the training of our orthopaedic residents and sports medicine fellows. Fellows and residents meet one day per month for a formal laboratory training session with Dr. John Marzo as faculty. Our laboratory was designed to simulate the arthroscopic operating room using realistic synthetic joint models and cadaveric specimens. A curriculum developed by the faculty progresses from the very basic physics and hardware of arthroscopy to increasingly advanced techniques performed on the shoulder, knee, and other body joints. Support from the Buffalo Bills team Physician s Fund is used to purchase models to replenish the inventory of the lab. The goals of the teaching lab are: - Provide for instruction of the basics of arthroscopy, including the physics, optics, and electronics of the equipment used in the operating room - Teach all relevant superficial and arthroscopic anatomy of the major joints of the body - Demonstrate and practice the navigational skills of arthroscopy, such as orientation, localization, triangulation, and quad angulation - Demonstrate and practice diagnostic arthroscopy of all of the major joints - Instruct and proctor performance of the basic and advanced arthroscopic procedures - Encourage research into existing and emerging arthroscopic technologies and procedures - Provide subjective and objective feedback on the acquisition of arthroscopic skill as it pertains to career guidance. Unless a fellow possesses and illustrates unusually advanced arthroscopic skills, for the first six months of the fellowship, instruction will be carried out with the residents and fellows as equal participant trainees, tutored by an attending. As the academic year progresses, the fellow is expected to become more proficient, and assume some teaching role in the arthroscopy lab, mentoring the residents in diagnostic procedures, knot tying, and mid-level arthroscopic surgical skills and procedures. Several wet labs are conducted each year to specifically address individual needs of the fellows, such as elbow arthroscopy and reconstruction, PCL and posterolateral knee reconstruction, and ankle arthroscopy and procedures. Virtual Simulation: The arthroscopy lab owns a virtual reality knee and shoulder arthroscopic simulator, as developed by Touch of Life Technologies, and the fellow is expected to spend substantial time and effort learning on the simulator. ArthroSim is the result of collaboration between the American Academy of Orthopaedic Surgeons (AAOS), the Arthroscopy Association of North America (AANA), the American Board of Orthopaedic Surgeons (ABOS) and Touch of Life Technologies (TolTec). ArthroSim is arguably the highest fidelity Virtual Reality based medical simulator ever built. Its underlying models come from cryosectioned data captured at 1/10th of a millimeter in x, y, and z. Its desktop PHANTOM devices display the full range of interaction forces associated with the procedures. This is contrasted with lower fidelity haptics, such as the Omnis3, which not only display additional friction, but are not capable of producing the forces associated with arthroscopy. Training is delivered through movies, text, and images. Throughout, the trainees must prove themselves utilizing the simulator pages. The Mentor requires the trainee to score 100% on each step before proceeding to a task, then a timed task. When they have successfully completed all timed tasks, they do the entire procedure and then the entire procedure timed. An outside image of the knee helps novices to understand where their probe and scope are with respect to the anatomy.

5 When the University of Buffalo took delivery of the ArthroSim diagnostic arthroscopy simulator on June 16, 2011, it was only the sixth unit to be made operational. The simulator has now become part of the core curriculum for teaching residents and fellows in the Arthroscopy Research and Educational Facility. The goals of the virtual arthroscopy simulator are: - Educate residents, fellows, and practicing physicians virtually - Demonstrate and practice the navigational skills of arthroscopy, such as orientation, localization, triangulation, and quadrangulation - Accelerated the process of arthroscopic skill acquisition - Objectively evaluate success rates in performing various diagnostic and therapeutic procedures - Evaluate a process of credentialing doctors based on simulator testing for competence (current validate that skill on a simulator indicates subsequent clinical performance (transfer validity) simulators can currently test efficiency of instrument movement, accuracy of instrument manipulation, speed of task completion, error rate, and number of collisions) - Develop a set of competencies in arthroscopic surgery (time, error rate, accuracy, efficiency, collisions) - Create case scenarios on the simulator that mimic real life situations, problems, and complications that are known to occur in real time Sports Medicine Journal Club The University of Buffalo Sports Medicine Journal Club is a critical component of the Sports Medicine fellowship. Its goal is to establish a foundation for Sports Medicine Physicians to remain at the cutting edge of the field by developing the habit of critically evaluating the current literature. The journal club is held the second Tuesday of each month in an informal setting over dinner at our Harlem Road location. The Sports Medicine Fellows select 4-5 current journal articles and work in conjunction with the UB Orthopaedic Residents to systematically review and discuss the articles. Fellows are encouraged to guide the discussion, evaluate the topics, and critically review how the findings may impact their own practice of sports medicine. The Orthopaedic Sports Medicine Faculty oversees the discussion and mentors the fellows and residents by providing their experiences and insights to complete the journal club experience.