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Orthopedic Surgery Program Structure and Clinical Rotations

Resident rotations, on-call schedules, and duty hours are structured to be in full compliance with the institutional policies and ACGME requirements regarding limits on resident work hours.

PGY-1 Year Internship

PGY-1 residents spend time rotating through various surgical and primary care services at Carolina Medical Center, with six months dedicated to orthopedic surgery. The PGY-1 year focuses on learning the basics of patient care and developing relationships with other providers throughout the hospital.

Service rotations:

  • Orthopedic Trauma (four one-month blocks): Interns split time between the operating room, patient floor care, orthopedic consults and night float in preparation for transition to the PGY-2 year. 
  • Pediatric Orthopedics: (one month): Interns spend time working with the CMC pediatric orthopaedic surgery faculty, including Drs. Brighton, VanderHave and Scannell. The intern will split time between the operating room, the patient floor care and clinic duties.
    Orthopedic Oncology (one month): Interns spend time working with Drs. Kneisl and Patt. Both attendings have a broad referral base of patients with both benign and malignant bone and soft tissue neoplasms. This rotation provides exposure to very complex patients and challenging surgical exposures.They split time between the operating room, patient floor care and clinic duties.
  • Trauma Surgery (two one-month blocks): This rotation is overseen by traumatologist from the Division of Trauma and Critical Care in the General Surgery Department. Interns are vital team members from the initial ATLS protocol in the emergency department, where interns preform the primary survey, to patient work-up, including procedures, to patient discharge.
  • Trauma Surgery Intensive Care Unit (one month): The TICU rotation focuses on management of the most seriously injured patients in the hospital under the direction of the Trauma and Critical Care attendings. Residents preform procedures, and manage ventilators and intravascular monitoring, in addition to developing clinical judgment in caring for critically ill patients.
  • Pediatric Surgery (one month): Provides lessons in basic pediatric surgical care.
  • Plastic Surgery (one month): Under the direction of the CMC Plastic Surgery attendings, residents study the basics of wound care and soft tissue coverage, with attention to good surgical technique when handling soft tissues and performing microscopic procedures.
  • Vascular Surgery (one month): Interns are exposed to a wide variety of vascular diseases and injuries while on this rotation, from acute arterial transections in trauma patients to vascular bypass and AAA repair in patients with peripheral vascular disease.
  • Neurosurgery (one month): Physicians from the largest neurosurgical group in the Charlotte area direct this rotation and teach valuable lessons regarding care for brain injury patients, microsurgical technique and neurosurgical spine surgery perspectives.
  • Internal Medicine (one month): This rotation allows residents to develop relationship with the hospital’s medicine services and provides a refresher on basic care of patients with chronic medical conditions.
  • Emergency medicine (one month): Interns spend approximately twenty 12-hour shifts in the ED during this month learning how the department functions and building relationships with residents and attendings who will be consulting them in the future for orthopedic patients.

Sample PGY-1 Rotation Schedule

July: Trauma January: Trauma ICU
August: Ortho-Trauma February: Vascular Surgery
September: Ortho-Oncology March: Ortho-Trauma
October: Emergency Medicine April: Pediatric Surgery
November: Ortho-Pediatric May: Ortho-Trauma
December: Ortho-Trauma June: Neuro Surgery

PGY-2

The PGY-2 year is the first full year of clinical orthopedics. Residents rotate through the trauma, tumor, spine, sports, and foot and ankle services in 2 month blocks. Residents, as in each successive year, work one-on-one with a fellowship-trained attending during each rotation in the mentorship fashion of our training philosophy. Additionally, during the PGY-2 year residents begin taking junior call. During the first-two months, the upper level resident is in-house to teach and assist the junior resident. Once juniors gain sufficient experience, the upper levels begin taking home-call and coming in when extra assistance is needed for consults or cases going to the operating room. The junior call is night float based. Trauma residents cover from Sunday evening to Thursday with junior residents on other services covering Friday through Sunday. This averages to one weekend call responsibility per month and no weekday call for non-trauma residents.

Sample PGY-2 Rotation Schedule

July - August: Trauma January - February: Sports
September - October: Spine March - April: Trauma
November - December: Foot and Ankle May - June: Pediatric

PGY-3

This year continues in the same fashion as the PGY-2 year. Rotations for PGY-3 residents include trauma, adult reconstruction, tumor, and hand. Residents finish rotating through all orthopedic subspecialties by the years end, providing a useful experience for residents to make educated fellowship decisions. PGY-3 residents are also part of the junior call pool. This year also allows residents to participate in research activities which are presented at the end of the year Resident Research Day.

Sample PGY-3 Rotation Schedule

July - August; Hand January - February: Adult Reconstruction
September - October: Pediatric March - April: Oncology
November - December: Trauma May - June: Trauma

PGY-4

The PGY-4 year residents become upper levels and begin rotating through the various orthopedic subspecialties again with more independence and responsibility. Rotations include pediatrics, hand, sports, foot and ankle, spine and adult reconstruction all in two month blocks. Additionally, PGY-4 residents take home call on a rotating basis. Call is roughly one in every six nights for upper levels currently.

Sample PGY-4 Rotation Schedule

July - August: Pediatric January - February: Foot and Ankle
September - October: Hand March - April: Sports
November - December: Adult Reconstruction May - June: Spine

PGY-5

All PGY-5 residents are Chief Residents, and thus responsible for running the orthopedic services. Duties include teaching junior residents and medical students, and preparation of weekly sub-specialty clinical conferences. Additionally, during the trauma rotation, PGY-5 residents are acting administrative chiefs and schedule all other clinical conferences, vacations and monthly call schedules. Fifth year rotations include trauma, adult reconstruction, tumor, and sports.

Sample PGY-5 Rotation Schedule

July - August: Trauma January - February: Sports
September - October: Trauma March - April: Oncology
November - December: Adult Reconstruction May - June: Adult Reconstruction

Orthopedic Service Rotations

Adult Reconstruction

Residents rotate on the Adult Hip and Knee Reconstruction service as third, fourth and fifth-year residents. The residents’ time is split between mentorships with Dr. Mauerhan, a CMC faculty member, and Dr. Masonis, an OrthoCarolina faculty member. The experience is rich and diverse. Residents get ample exposure to primary and revision hip and knee arthroplasty, unicompartmental knee arthroplasty, direct anterior approaches to the hip, as well as joint preservation surgery such as arthroscopy and acetabular osteotomies. In addition to arthroplasty lectures as part of the core curriculum, residents attend OrthoCarolina fellow conferences where the most complex cases are discussed. Due to the highest arthroplasty volume in the state, clinical research opportunities abound.

Foot and Ankle

During the foot and ankle rotation, the residents have an opportunity to work with nationally and internationally known surgeons Drs. Anderson, Davis, Cohen, Jones and Ellington.  Each has a hand in the education of residents and all are accomplished physician scientists with an interest in product development as well as clinical research.  All of the residents’ experience is based at Mercy Hospital at the OrthoCarolina Foot and Ankle Institute.  Residents rotate through the foot and ankle service for two months during both the PGY-2 and PGY-4 years (total four months).  This rotation is mentor-based and each resident is assigned to a single attending for a period of one month.  During that month, residents work one-on-one with the attending and participate in their clinical and surgical practice.  Residents are exposed to forefoot and flatfoot reconstruction, tendon transfers, various arthrodesis procedures, total ankle arthroplasty, sports/arthroscopy, as well as trauma and post-traumatic reconstruction.  There are three foot and ankle fellows who are assigned to a different surgeon each month, but the schedule is created such that a resident and fellow are not assigned to the same attending physician, insuring resident mentorship and dedicated teaching.

Hand

The Orthopaedic Hand rotation is a part of the PGY-3 and the PGY-4 curriculum. Based on the apprenticeship model, the majority of the resident's time is spent with Drs Gaston, Chadderdon, Ward, Gantt, and Lewis, however, all nine OrthoCarolina hand attendings are receptive to working with residents and residents are encouraged to participate in any case they find interesting. Residents can expect to participate in the management of a wide variety of patients and will experience a broad case-load that includes brachial plexus injuries, complex upper-extremity fractures, microsurgery, and congenital deformity. The majority of the operative cases that the resident will participate in are at One-Day Surgery at the CMC Main campus, however residents also work with the OrthoCarolina attendings at a local surgery center.

Oncology

This rotation offers residents a significant opportunity to expand their orthopedic knowledge and operative skills. This rotation is focused around the busy and diverse practices of Dr. Jeffrey Kneisl and Dr. Joshua Patt. Both attendings have a broad referral base of patients with both benign and malignant bone and soft tissue neoplasms. This rotation provides exposure to very complex patients and challenging surgical exposures. Additionally, this rotation provides time to focus on high quality research with significant faculty support. Dr. Kneisl is the Medical Director of Surgical Services for the Levine Cancer Institute and the self-proclaimed Chairman of the Maximally Invasive Surgery Department. Dr. Patt is dual fellowship trained in Musculoskeletal Oncology and Orthopedic Spine, giving him expanded expertise and perspective. Drs. Kneisl and Patt are invested in resident education and provide invaluable experiences in a complex multi-disciplinary field.

Orthopedic Trauma

During this rotation, residents work with Drs. Kellam, Bosse, Sims and Karunakar. Trauma is a team-based service for junior level residents, while the chief on service is paired with each attending for one-month in our typical mentorship fashion. A large catchment area, including rural an urban settings, affords residents vast exposure to all types of orthopedic trauma, from low-energy ankle fractures to complex acetabulum fractures in critically ill patents. Residents on trauma work closely with other departments to coordinate patient care from presentation to discharge. Starting in the PGY-1 year, residents participate in operative cases, taking a lead role in cases appropriate to their level of training. Three trauma fellows are selected each year and are expected to be an educational resource for residents without impinging on the resident learning experience.

Pediatrics

The Pediatric Orthopedic service at Levine's Children's Hospital was recently named to the U.S. News report Top 50 list. Residents rotate with well-respected, fellowship-trained pediatric orthopedic surgeons for two month blocks during the PGY2, PGY3, and PGY4 years. The rotation uses the preceptor model, and residents alternate months between CMC and OrthoCarolina faculty. Residents are involved in all phases of patient care from the clinic to the operating room and have exposure to a broad range of pathology with state-wide referral bases in North Carolina and South Carolina.

Spine

Residents spend two months during both their second and fourth years on this service. You will work with CMC faculty (Drs. Hanley and Patt) as well as Ortho Carolina faculty (Drs. Brigham, Milam, and Segebarth). There is typically a single resident on spine, and as such, you will have significant autonomy and responsibility for the service. Your time is split between clinic and operative cases. The operative experience ranges from basic cervical and lumbar discectomies to complex deformity procedures. The orthopaedic department shares spine call with Carolina Neurosurgery and Spine Associates, which will allow you to evaluate and care for traumatic spinal cord injuries. You will spend one morning each week at the Myers Park spine clinic, which provides you the opportunity to refine your clinical skills and develop treatment plans with the oversight of the spine faculty.

Sports

During this rotation done in the PGY 2, 3, & 5 year, residents work with Drs. D'alessandro, Fleischli, Connor, Piasecki, and Hamid. The rotations are set up on the mentorship model with each resident being paired with one attending for a month at a time. Residents get hands one-on-one operative and clinic experience with their attending covering the gamut of sports medicine such as knee, shoulder & elbow arthroscopy, reconstructive surgery of the knee and shoulder, and shoulder arthroplasty among other types of pathology. Residents will have the opportunity at times to cover sports clinics with local colleges such as UNC-Charlotte and Davidson. Occasionally residents will also have the opportunity to work with players for the local NFL team as well. Two sport medicine fellows are selected each year as well who also work one on one with their own attending on the mentorship model ensuring no resident-fellow conflicts.

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