SURG 410/410s Orthopedic Surgery

Transcription

1 Kansas City University of Medicine and Biosciences College of Osteopathic Medicine SURG 410/410s Orthopedic Surgery Course Description: This elective clerkship is a four (4) week experience in the management of injury and illness of the musculoskeletal system. The student may be required to travel to the clinic, outpatient surgery center and/or hospital facility during his/her rotation time. 5 semester credits Repeatable: no Background Orthopedic surgery clerkship takes place in a wide variety of settings and presents a unique opportunity with respect to the spectrum of clinical situations encountered. The availability of a multitude of potential experiences allows flexibility to individualize the clerkship and accommodate learning needs. Potential for individualization is considered a valuable component of any high-quality educational experience. Orthopedic surgery curriculum has been developed to ensure consistency of expectations and knowledge acquisition across varied clerkships. Utilization of the core curriculum will assist students in the acquisition of adequate knowledge necessary for their practice as osteopathic physicians. Such knowledge is required in order to respond to orthopedic surgical issues in a variety of clinical settings. Course Structure Students rotate in assigned clinical settings in order to complete the orthopedic surgery clerkship. Surgical preceptors will specify site requirements for the clerkship and ensure students are provided with an appropriate level of clinical and didactic experience. To ensure consistency among orthopedic clerkship experiences, this standardized curriculum is provided. In order to successfully complete the orthopedic surgery clerkship, all students must fulfill requirements specified by their preceptor AND complete the required elements of the standardized curriculum. The KCUMB-COM standardized orthopedic surgery curriculum describes student expectations and requirements to achieve competency in the diagnosis and management of common orthopedic surgical conditions. In so doing, students will gain an appreciation for appropriate utilization of a variety of diagnostic and treatment modalities. Students will have some flexibility with respect to the time line in which they complete course requirements, as well as have the opportunity to make the required activities relevant to their clinical experiences. 1

2 Expectations: The Orthopedic Clerkship curriculum is designed to ensure that osteopathic medical students develop clinical skills in orthopedic surgery. The overall goal of this rotation is to provide a basic understanding of the pre- and post-operative evaluation of the emergent and elective surgery cases, basic knowledge of surgical decision making, proper wound and musculoskeletal management. Emphasis will be placed on the following: Demonstrating an understanding of the basic science, physiology, pathophysiology, pathology, and natural history of common orthopedic conditions and injuries. Obtaining and report a basic history and physical examination, both operative and non-operative, as it relates to common acute and chronic orthopedic injuries and conditions. Recognizing and articulating of the pathology and biomechanics of injury. Knowledge of possible preventative measures to avoid common orthopedic conditions and injuries. Recommending appropriate laboratory and radiologic testing to determine an appropriate diagnosis. Devising a working differential diagnosis for common orthopedic conditions. Discriminating between appropriate treatment modalities for orthopedic surgical conditions. Functional understanding of integrated osteopathic manipulative treatment for orthopedic surgical patients Differentiating between injury requiring immediate treatment and those that can be treated non-operatively. Recognizing injuries for which a minor delay in treatment would not be deleterious to the patient Demonstrating understanding of the indications, risks, and limitations of the commonly performed procedures in orthopedics Assisting in the management of preoperative, peri- and post-operative patient care under supervision. Developing fundamental psychosocial skills by observing physician-patient interactions during this rotation. 2

3 Recognizing the psychological effect of injury on the patient and when to select those that need further consultation to assist in their management. Competencies & Objectives The KCUMB educational program has identified specific broad areas that students should develop during their training. These help ensure that the students are able to demonstrate and/or develop specific skills. This overarching competencies and objectives specifically addressed in the Orthopedic Surgery clerkship are denoted in bold: 1. Demonstrate basic knowledge of osteopathic philosophy and practice and osteopathic manipulative treatment; 2. Demonstrate medical knowledge through one or more of the following: Passing of course tests, standardized tests of the NBOME, end-of-clerkship tests, research activities, presentations, and participation in directed reading programs and/or journal clubs; and/or other evidence based medical activities; 3. Demonstrate interpersonal and communication skills with patients and other health care professionals; 4. Demonstrate knowledge of professional, ethical, legal, practice management, and public health issues applicable to medical practice; 5. Demonstrate the ability to effectively treat patients, provide medical care that incorporates the osteopathic philosophy, patient empathy, awareness of behavioral issues, the incorporation of preventive medicine, and health promotion; 6. Demonstrate the ability to critically evaluate their methods of clinical practice, integrate evidence-based medicine into patient care, show an understanding of research methods, and improve patient care practices; 7. Demonstrate an understanding of health care delivery systems, provide effective and qualitative patient care with the system, and practice costeffective medicine. Course Objectives: Four weeks is an insufficient amount of time to cover a comprehensive list of objectives in any area of practice. Clearly, subjects addressed in any clerkship are dependent on the numbers of patients and kinds of disease entities presenting to a particular service. Nevertheless, certain minimum content must be addressed, either by clinical exposure or by didactic materials so that students are prepared for board examinations and other testing. Broad goals listed above are a minimum; objectives for rotations not specifically listed in these guidelines should include the Affective Objectives listed below. The University depends on the supervising physician to establish more specific objectives dealing with the scope of the particular specialty. Therefore, the following sections contain relatively broad, basic objectives for which students are responsible. Patient Care 3

4 Demonstrate the ability to obtain and report a basic orthopedic patient history for common orthopedic conditions and injuries with particular emphasis on the chief complaint, inciting events, mechanism of injury, exacerbating and alleviating factors, timing of symptoms and associated symptoms. Demonstrate an ability to perform and report a basic orthopedic physical examination of the spine, shoulder, elbow, wrist and hand, pelvis and hip, knee, foot and ankle Demonstrate the ability to perform and record an osteopathic structural examination on a surgical patient and document such using acceptable osteopathic terminology. Demonstrate the application of the osteopathic philosophy into the pre- and postoperative care of the surgical patient. Demonstrate an ability to develop and execute patient care plans appropriate for level of training and follows the SOAP/problem oriented format. Describe different suture materials and how selection for use is based. Describe alternative methods of wound closures dependent on anatomical location. Demonstrate aseptic technique in the OR and in ER when asked to manage a wound. Demonstrate patient safety concerns regarding body alignment, padding bony prominence, proper tourniquet application, and environmental safety preoperatively when preparing the patient for surgery. Demonstrate proper extremity immobilization methods, drain care, surgical site assessment postoperatively and rehabilitation. Demonstrate an understanding of palpatory findings, which are found in common conditions, encountered in a surgical practice. Demonstrate ability to assess sensory and perfusion of extremities after injury and after reconstruction. Demonstrate ability to assess unique congenital deformities in the head, neck, and spine that can affect pre- and postoperative care. Medical Knowledge Define, describe and discuss the following: o Open and closed fractures, dislocations, and subluxations. o Clinical and radiological features of fractures. o Management priorities in treating fractures, dislocations and subluxations. Discuss common fractures and joint injuries Identify specific problems with their diagnosis and management Discuss the indications and contraindications for replantation of an amputated appendage Discuss the proper method of transporting the amputated part Professionalism Demonstrate a commitment to continuity of patient care. Display a sense of responsibility and respect to patients, families, staff and peers. Demonstrate cultural sensitivity. Maintain a professional appearance, well groomed, appropriately dressed. Punctual in attendance, prompt and available when called upon. 4

5 Demonstrate motivation to learn, shows appropriate assertiveness, flexibility, adaptability toward education. Demonstrate appropriate attitude, cooperative, receptive to feedback. Introduce self to those who you are working with, the patient, attending, resident, other physicians, nurses, staff, etc. Interpersonal and Communication Skills Communicate effectively with attending, resident, team members and other health care professionals. Document legible medical records entries Communicate appropriately and professionally with patient and family members Seek and respond to feedback Systems-based Practice Follow policy and procedures set forth by the health care facility and departments within that facility Report to appropriate institutional authority when absent following Clinical Affairs guidelines Assignments: The rotation director or preceptor may direct specific and general reading assignments from texts and current literature. Supplemental readings from current periodical literature are recommended. Blackboard will be utilized as the primary medium for the standardized course completion. Required Textbooks. Skinner, Harry B., Current Diagnosis and Treatment Orthopedics, 4th Ed., 2006, Lange McGraw Hill. DeLee: DeLee and Drez's Orthopaedic Sports Medicine, 3rd ed Saunders, An Imprint of Elsevier. Evaluation Evaluations of student must be completed within one week from completion of the rotation. On the last day of service, the supervising physician should review the student s performance with the student. An end-of-clerkship examination is not required. Grade: This clerkship is graded S/U. If a student signs the evaluation the signature, simply indicates that the student has received a grade directly from the attending; it does not indicate agreement with the grade. 5

6 Student Responsibility It is required that the student meet with their preceptor at the beginning of the rotation to discuss the learning objectives outlined in this document. Students should also seek and receive preceptor feedback midway through the rotation. Because of the short duration of this rotation, students must be professionally assertive, attentive, and well prepared. These characteristics are imperative for the student to get the most out of this rotation. Student must develop a trusting relationship with the attending before asking to attempt skills on a patient. Contact Faculty - for additional information about this elective John Dougherty, DO [email protected] 6

7 Detailed Learning Objectives The Orthopedic Clerkship Curriculum has been designed to ensure that osteopathic medical students develop clinical skills in orthopedic surgery. The overall goal of this rotation is to provide the student with a basic understanding of the pre- and post-operative evaluation of the emergent and elective surgery cases, basic knowledge of surgical decision making, proper wound and musculoskeletal management. Psychomotor Skills Adequately perform and record a history and physical examination on an orthopedic surgical patient. Demonstrate knowledge/proper use of common orthopedic surgical instruments. State and demonstrate principles of clean and sterile technique. o Ability to scrub, gown, glove alone and with assistance, and maintain proper o Sterile techniques within the surgical setting. o Understand and apply basic OSHA guidelines in patient care areas. Perform the following procedures: o Suture simple surgical wounds o Staple simple surgical wounds o Remove sutures and skin staples o Apply steristrips for simple surgical wounds o Placement and change of orthopedic surgical dressings State indications and contraindications for and apply osteopathic manipulative treatment, when appropriate, for: o The preoperative surgical patient o The postoperative patient Fractures, Dislocations, and Subluxations: o Define, describe and discuss the following: Open and closed fractures, dislocations, and subluxations Clinical and radiological features of fractures Management priorities in treating fractures, dislocations and subluxations Fractures o Type Open Closed Stress fracture Pathological fracture o Site Proximal epiphysis Distal epiphysis Metaphysis Diaphysis o Pattern Transverse Spiral or Oblique 7

8 Comminuted Impacted Compression Greenstick o Displacement Apposition Angulation Rotation Length o Growth Plate Fractures Salter-Harris type I-V o Dislocation and Subluxation Clinical and radiologic features of dislocations and subluxations Management o Rehabilitation of Function o Complications Local - infection, delayed union, nonunion, malunion, avascular necrosis. Systemic-shock, sepsis, tetanus (open injuries), gas gangrene, venous thrombosis, pulmonary embolism, fat embolism Evaluation of Patients with Musculoskeletal Trauma o Symptoms o Vascular integrity o Radiology Fracture Management Discuss indications and complications o Reduction o Maintenance of Reduction Cast Internal Fixation External Fixation Traction Compartment Syndrome o 4 Ps Common Fractures, Dislocations, and Ligament Injuries o Carpal Scaphoid Fracture o Colles Fracture o Olecranon Fracture o Supracondylar Humerus Fracture o Shoulder Dislocation Hip Fracture o Femoral Shaft Fracture o Hip Dislocation 8

9 o Tibia/Fibular Shaft Fracture o Ankle Injures o Spinal Fractures o Pelvic Fractures Discuss common fractures and joint injuries Identify specific problems with their diagnosis and management Traumatic Amputations and Replantation Discuss the indications and contraindications for replantation of an amputated appendage. Discuss the proper method of transporting the amputated part. SPORTS MEDICINE Common Injuries Define, describe and discuss the following: o Stress Fractures o Lateral Epicondylitis (Tennis Elbow) o Rotator Cuff Tendinitis (Shoulder Bursitis) o Plantar Fasciitis (Heel Spur) o Patellar Overload Syndrome (Chondromalacia Patella) o Exercise Compartment Syndrome (Shin Splints) o Sprains o Ankle Sprains o Knee Ligament Sprains o Meniscal Injury o Acromioclavicular (Shoulder) Separation o Gamekeeper s Thumb o Mallet (Baseball) Finger o Boxer s Fracture o Achilles Tendon Rupture o Turf Toe o Myositis Ossificans Describe the pathophysiology of attritional sports-related injuries as they affect bone, muscle, and tendon. Define the term sprain and its three gradations o Discuss the methods of diagnosing the common sprains at the knee and ankle. Musculoskeletal Infection and Patholgy Define, describe and discuss the following: o Ostomyelitis o Septic Arthritis o Infection Hand Flexor Tenosynovitis 9

10 o Discuss the symptoms and signs of infectious, processes of bone and joints (osteomyelitis and septic arthritis) o List and discuss the diagnostic workup used in making a definitive diagnosis of bone and joint infection. Arthritis Define, describe and discuss the following: o Osteoarthritis o Rheumatoid Arthritis o Discuss the symptoms and signs of inflammatory (noninfectious) joint disease. o List and discuss the laboratory and radiological techniques used in making the diagnosis of rheumatoid arthritis and osteoarthritis. o List and discuss the nonsurgical and surgical treatment options of degenerative joint disease of the hip, knee, and spine. Metabolic Endocrine Disorders Define, describe and discuss the following: o Osteoporosis o Osteomalacia o Hyperparathyroidism o Paget s Disease o Define osteoporosis and osteomalacia and list common etiologies of each. o Discuss the pathophysiology, symptoms, and laboratory and radiographic findings of hyperparathyroidism and Paget s disease. Bone Necrosis Define, describe and discuss o Discuss the pathophysiology of osteonecrosis. Spine Define, describe, and discuss o Lumbar Spine Etiology of Low Back Pain Lumbar Strain Spondylolysis Disc Herniation Spinal Stenosis o Cervical Spine Cervical Disc Protrusion Cervical Spondylosis Rheumatoid Arthritis of the Cervical Spine 10

11 o List and discuss common causes of low back pain and cervical pain o Discuss the symptoms and signs and outline the diagnostic workup for a patient with lumbar or cervical herniation. Osseous Tumor Define, describe and discuss o Discuss the diagnostic workup for a patient with a suspected primary and secondary malignant neoplasm of bone. Gait Define, describe and discuss o Discuss the basic components of gait and discuss common gait abnormalities in relation to mechanical or neurological disorders. 11