This year consists of 6 months of general surgery and 6 months of orthopaedic surgery as mandated by the ACGME . Experience is gained through rotations in surgical critical care, trauma and surgical disciplines closely related to musculoskeletal medicine. The intern takes general surgery call for the first six months of the year. The second half of the year (6 months) the intern will take ‘buddy’ call with another in-house resident for a more seamless transition to full-time orthopedics. The six months of orthopedic surgery stresses the fundamentals of orthopaedics and serves as a basis for continued training in which the PGY-1 is viewed as a fully integrated junior resident on the orthopedic team. Surgical Skills Modules mandated by the ACGME are interspersed throughout the 6 months of orthopaedic surgery. This multidisciplinary year of study provides a well-rounded foundation and fully meets the training requirements of the Accreditation Council for Graduate Medical Education (ACGME) Residency Review Committee and the American Board of Orthopedic Surgery (ABOS).
Fundamentals are stressed as is an early operative experience. A thorough grasp of the orthopedic evaluation of a patient and trauma management is mastered. The opportunity to develop proficiency in the management of fractures by closed and open methods and in the proper application of casting materials is provided. The resident is expected to learn the basic science behind all aspects of orthopedic surgery and is given instruction in biomechanics and gait. Patient care issues are taught. Under the supervision of an attending, the PGY-2 resident is directly responsible for the pre-and postoperative care of patients assigned to his service. Details of the history and physical exam specific to orthopedic problems are emphasized. The resident will learn basic surgical skills in the operating room for all orthopedic cases and surgical anatomy and approaches. Due to the mentorship structure of the Program, all residents (PGY 2-5) work one on one with the attending on their service, both in and out of the operating room.
During the second year, one month of protected time is allotted for basic science and clinical research projects. The resident is relieved of clinical duties with the exception of Monday and Friday afternoon clinic as well as the normal call schedule.
Development of a broad understanding of indications and the more common surgical procedures is fostered. The resident is expected to assume greater responsibility for patient care. At this level of training he/she will be expected to perform basic arthroscopic procedures of the knee and shoulder. The resident is expected to perform, with assistance, the repair of shoulder dislocations, long bone plating, intramedullary fixation, tension band techniques and uncomplicated fractures of the hip. He/she must be able to properly apply and use external fixations and become familiar with various diagnostic roentgenographic procedures. He/she will develop expertise in the operative treatment of joint fractures. The PGY-3 resident's educational experience is supplemented by participation in the treatment of adult spine disorders involving the traumatic adult spine, degenerative scoliosis, myelopathy and other disease of the adult spine. Due to the mentorship structure of the Program, all residents (PGY 2-5) work one on one with the attending on their service, both in and out of the operating room.
One of two residents in the PGY-3 year will serve a six-month pediatric orthopedic rotation at Shriners' Hospital and St. Christopher's Hospital for Children. The other resident will complete his/her pediatric orthopedic training in the first six months of the PGY-4 year.
Operative and nonoperative experience is gained as a senior resident. Advanced theory and techniques are mastered with attending supervision. Decision-making skills are honed with regards to the treatment of reconstructive surgery, joint replacement, upper extremity and hand surgery, neuromuscular disorders and sports medicine. The fourth-year resident should be able to manage complex trauma by open and closed means. He/she receives extensive training and experience in the evaluation and surgical management of patients with complex neuromuscular disorders including stroke and traumatic brain injury. Due to the mentorship structure of the Program, all residents (PGY 2-5) work one on one with the attending on their service, both in and out of the operating room.
During the fourth year of orthopedic training, one resident is involved in full-time pediatric orthopedic training at Shriners Hospital for Children for four months, immediately followed by two-months of pediatric orthopedics/trauma at St. Christopher's Hospital for Children. During this experience the resident participates in the entire spectrum of pediatric orthopedic surgery. The leadership at Shriners Hospital for Children , include Einstein alumni Scott Kozin, MD, Chief of Staff and Joshua Pahys MD, Residency Program Co-Director. Both surgeons are leaders in their respective orthopedic fields with numerous publications and presentations. Einstein residents have collaborated with the faculty at Shriners Hospital on various research projects resulting in multiple abstracts and publications. St. Christopher's Hospital for Children is a busy Level One pediatric trauma center that offers the resident an unparalleled experience in pediatric orthopedics.
During the fourth year, one month of protected time is allotted for basic science and clinical research projects. The resident is relieved of clinical duties with the exception of Monday and Friday afternoon clinic as well as the normal call schedule.
Residents at this level of training begin to take on the responsibilities of an independent orthopedic surgeon. In addition to clinical responsibilities, the chief resident assumes a role as educator for junior residents and medical students. The administrative chief resident is responsible for scheduling of resident on-call assignments, structuring of conferences and attendance and supervision of the outpatient clinic. A senior resident is on call at all times as a back-up to the junior resident for clinical, educational, administrative and support issues including leading the junior residents through orthoapedic trauma cases. The fifth-year resident should be knowledgeable with operative arthroscopy and surgery of the hand, foot and spine. He/she should be able to manage complex and severe trauma in its various aspects. He/she provides consultation to other services under the guidance of the attending orthopedic staff and takes a major role in management of interdisciplinary problems as seen in the multiply injured patient.
Chief residents are allotted one month for a clinical elective in a subspecialty of their choice under the auspices of a prominent orthopedic specialist. Several residents have applied for and have been accepted for AO electives in Europe.
Each resident under the direct supervision of an attending, experiences firsthand the nonoperative, preoperative and postoperative care of patients and learns the clinical practice of orthopedic medicine from an experienced practitioner. In the operating room the resident functions on a one-on-one basis with an attending and learns surgical techniques firsthand. By the PGY-5 year, the resident will fully mature to the level of an independent orthopedic surgeon under the direct supervision of an attending surgeon.
||Pediatric Rotation/Shriner's Hospital
||Pediatric Trauma Rotation/St. Christopher's Hospital
||Ortho Surgery Junior Resident
||Ortho Surgery Senior Resident
||Ortho Surgery Chief Resident
The curriculum provides each resident (PGY- 1-5), by graduation, with 6 months of training in each subspecialty area (spine, hand/upper extremity neuromuscular, foot and ankle/lower extremity neuromuscular, joints, sports medicine, and pediatrics) in addition to 2 months of research and 1 month senior elective. Education in orthopedic trauma is ongoing throughout the course of training with 6 months specifically dedicated to trauma education on the Orthopaedic consult/ER service. All faculty members participate in trauma call. Due to the high volume of trauma cases seen in the Level One trauma center, the night float resident frequently has the opportunity to scrub emergent orthopedic cases during their shift.
The Department of Orthopedic Surgery is in full compliance with the Accreditation Council for Graduate Education (ACGME) 80-hour duty regulations.
- PGY-1: The orthopaedic surgery resident assigned to general surgery follows general surgery call guidelines. The department of general surgery is in full compliance with the ACGME work hour standards.
- NIGHT FLOAT: The Department of Orthopedic Surgery has fully met the ACGME work hour standards with the implementation of a night float rotation into the orthopedic surgery resident schedule/curriculum. The resident on night float is available for emergent surgical cases, in-house and emergency room consultations and care of inpatient orthoaedic patients.
The night float resident attends all mandatory orthopedic surgery educational conferences, including daily fracture and reading conferences.
- IN-HOUSE CALL: In-house weekend call, Friday and Saturday, is covered by PGY 2 - 4 residents who are not on night float. With this system, the PGY 2 resident will take in-house call approximately 3 weekend days per month, the PGY 3 resident will take in house call approximately 1 weekend day per month and the PGY 4 resident will take in house call approximately 5 weekend days per year.
- Clinical responsibilities on weekends are the responsibility of the on-call team of residents. The remaining residents are free of all hospital duties.
- BACKUP (HOME) CALL: Senior level residents (PGY 4, 5) take call from home and are available for consultation by the in-house resident. The backup is required for all operative procedures during the call day/night. The PGY 4 resident is on backup call approximately 2 days per week and 2 weekends per month; the PGY 5 resident takes back up call approximately 1-2 days per week and 1 weekend per month.
PATIENT CARE EXPERIENCE
Residents are integrated into all phases of patient care including the Operating Room, inpatient floor, outpatient clinic, private office practice and the Emergency Department. The program is divided into 6 major services, with the majority of the services comprised of one resident and two attendings. The services are set up in a mentorship format.
THE OUTPATIENT EXPERIENCE
All residents participate in private office hours with the attending on their service. This experience provides the resident with a more global view of all aspects of orthopedic practice. Resident orthopedic clinic fracture clinic (weekly) is supervised by a senior resident and an attending physician. The residents function as practicing physicians, diagnosing and implementing treatment plans for the orthopedic patients, working with outpatient support staff, and learning proper billing and coding techniques.
THE INPATIENT EXPERIENCE
On the inpatient services, residents are integrated into all phases of patient care including the inpatient floor and the emergency department. Independent resident rounds in addition to attending teaching rounds are made daily on all patients on service. During teaching rounds the resident and attending discuss the pertinent details of clinical cases. Aspects of basic science also are integrated including anatomy, biomechanics and pathology. Residents (with attending supervision) are expected to make clinical decisions and initiate treatment within the scope of their level of knowledge and patient care skills.
THE OPERATIVE EXPERIENCE
Departmental, institutional and educational policies necessitate attending presence in the operating room. An early operative experience is stressed for junior residents (PGY 2-3) and routine cases are allotted with this in mind. Throughout residency, the delegation of operative responsibility is directly related to the resident's preoperative planning, grasp of anatomy, mastery of the surgical technique and the level of difficulty of the case. Supervised operative independence affords a smooth transition of the resident to post-residency practice.
THE EMERGENCY EXPERIENCE
The resident on call actively participates in evaluation and treatment of acute trauma patients in the Department of Emergency Medicine. The resident evaluates and treats, on a preliminary basis, all orthopedic patients, who are then admitted to the hospital for further definitive care, referred to the office of an orthopedic staff physician or followed in the outpatient clinic. Einstein Medical Center is a Level One Trauma Center which receives a mixture of blunt and penetrating orthopedic trauma. The resident will learn how to work up and treat patients with the highest level of acuity.
Resident conferences are the backbone of the educational experience. Our residents consistently achieve high scores on the Orthopedic In-training Examination, having ranked nationally over 90% for 9 of the last 13 years. This outcome is evidence of our exceptional conference schedule.
- Resident Didactic Reading Conference is held Monday through Thursday from 7-8 am with assigned readings selected from current and classic orthopedic textbooks, journals and various multimedia resources. Morning conference is mandatory and considered protected time. Members of the attending teaching staff are assigned to daily conferences based on their area of expertise or special interest.
- Teaching Faculty Didactic Conference is held on Friday from 7-8am. The topic and material presented is decided on by the faculty member assigned and utilizes an evidence-based medicine approach. An assigned selection of literature is distributed to the residents for review prior to conference in preparation for discussion.
- Bioskills is incorporated into the conference schedule on Wednesday mornings (8-8:30am) when a new procedure is contemplated which the residents have not been exposed to previously. In-services are arranged with the attending and/or the hardware representative so that procedures may be reviewed prior to entering the operating room.
- Fracture conferences (Monday-Friday, 6:45am) are a daily review of cases treated in the Emergency Room and ward consults from the previous 24 hours. With faculty guidance, residents present a thorough and concise review of each case with radiographs, current classification schemes and treatments.
- The educational curriculum for Orthopedics includes Anatomy labs. Six - 1.5 hour sessions are held annually using cadavers. Specific areas of the musculosketal area are assigned and dissected. Anatomy labs are run by an orthopedic faculty member and held on campus at Einstein Medical Center.
- Journal club is held monthly and hosted by a member of the teaching faculty.Major journals are available for review with specific emphasis on theJournal of Bone and Joint Surgery. The majority of Journal Clubs are held in conjunction with monthly Philadelphia Orthopaedic Society meetings. The residents with the assigned faculty member will review assigned articles over dinner at a local venue and then report as a group to the scheduled Philadelphia Orthopaedic Society lecture.
- Joint Orthopedic/Radiology MRI Conferences between the Departments of Orthopedic Surgery and Radiology residents and faculty are held as part of the Grand Rounds Conference schedule. Residents from Orthopedic Surgery and Radiology with faculty oversight work collectively to present a comprehensive review of pre-operative MRI's and correlate the intraoperative findings for various orthopedic cases.
- The Department is pleased to sponsor three annual lectures: the Earl C. Marmar, MD Lecture, the Abraham Rechtman, MD Lecture and Orthopedic Alumni Day. Well known orthopedic surgeons from across the country are invited to speak at these lectures which are the highlight of the academic year.
Grand Rounds are mandatory educational conferences for the orthopedic residents and faculty. Grand Rounds are held every Wednesday morning.
- Patient Safety Conferences: A bi-monthly review of morbidity and mortality statistics from the previous month and are part of the department's quality improvement program. Residents and faculty review the root cause analysis of near misses/adverse events and whether or not these occurrences were secondary to a breakdown in a systems-based management.
- Teaching Faculty Presentations: On a rotating basis, teaching faculty present a formal power-point presentation on a topic of their choice based on their subspecialty or area of interest. These lectures are presented as continuing medical education events.
- Invited Guest Speakers: Speakers are invited to present a lecture on a topic of their expertise within their specialty field. These lectures are presented as continuing medical education events. Guest speakers include Einstein resident alumni and well-known speakers from orthopedic, medical and non-medical professions.
- Formal Case Presentations: Clinical vignettes on current cases of interest are presented by the residents to the faculty, resident and clinical staff. Academic discussions regarding diagnosis and treatment are held. Case Presentations are seen as a valuable teaching module for resident education in preparation for oral board presentation and national/local research presentation.
- Resident Presentations: Each resident presents on a topic of their interest every year. The resident is required to complete a full literature search on the topic and present a power point presentation to the audience. For this presentation, PGY5 residents present on their senior elective rotation experience. Our most recent graduates completed electives overseas and presented on their experiences in Spain and Australia.
Residents attend the following educational conferences as part of their educational curriculum. Tuition and travel cost are funded by the Department.
- PGY 1: AO Basic Fracture Course for Residents
- PGY 2: Mount Sinai Orthopaedic Musculoskeletal Pathology Course
- PGY 3: Arthroscopy Association of North America (AANA) Junior Resident Fundamental Arthroscopic Skills Course
- PGY 4: International POSNA/AAOS Pediatric Orthopedic Symposium
- PGY 5: American Academy of Orthopedic Surgeons (AAOS) Annual meeting AND Miller Orthopedic Surgery Board Review Course
Resident research within the Department of Orthopedic Surgery is designed to provide resident education in basic science and clinical research, research design and methodology. These experiences offer the resident an opportunity to explore an area of special interest and focus on the scientific aspects of orthopedic surgery. Residents are required to participate in research throughout their five years of training. Full-time physicians actively engaged in research are available at all times for project ideas and supervision.
PGY 2 and PGY 4 residents complete a required one-month research rotation as part of their educational curriculum. The Program requires that two projects of sufficient quality for publication or presentation at a national/local meeting be completed prior to graduation. Residents are encouraged to submit their research for presentation at local and national meetings. Funding is provided by the institution for costs associated with research accepted for presentation at local and national meetings.
The Department of Orthopedic Surgery Bioengineering Laboratory is located on campus in the Korman Research Pavilion. The orthopedic laboratory is fully equipped with personal computers, a C-Arm dedicated for research, a mechanical testing machine (Test Resources Inc) and a small machine shop. The laboratory is stocked with the necessary essentials needed for orthopedic research such as a biological safety cabin, standard microscopes, microscope camera, chemical hood, electronic weighing balances, spectrophotometer, ultrasonic baths, electroporator, centrifuges, tissue culture incubators, water baths, ovens, diamond saw, dental light curing oven, etc.