The Orthopedic Surgery Internship has four positions for PGY-1 training. First year residents receive a broad surgical experience. The following is a list of the required rotations:
- Orthopedic Surgery – 6 Rotations
- Sports, Foot/Ankle, General
- Trauma, Total Joint,s Peds, General
- Hand/Spine Team
- General Surgery – 2 Rotations
- Surgical ICU
- Vascular Surgery
- Emergency Room
Orthopedic Surgery Residency is a training program with progressive responsibilities and duties. At the first year level, the resident will be a member of a surgical team and be expected to conduct an evaluation of a patient, develop a differential diagnosis, participate actively in proposed procedures, and present at conferences. Attending surgeons closely supervise the residents of all levels on their teams. First year residents in Orthopedic Surgery are expected to attend all the educational activities scheduled for Orthopedic Residents. One lecture a week, which is devoted specifically to topics of interest and presented at a level for those early in their training, is also required of first year residents.
Resident Hours & Call
The William Beaumont Army Medical Center Orthopedic Surgery Residency is fully compliant with the ACGME guidelines on resident work hours. Residents’ in-house time is limited to a maximum of 80 hours per week. Each resident will have at least one 24-hour period per week, totally away from the work place. No resident will be in the hospital for more than 30 hours in one continuous period. Each resident is responsible for recording his/her weekly hours and for notifying the Chief Resident if he/she is approaching the hourly limit for that week. Each resident is still expected to devote some time to reading each day outside the hospital environment.
The composition of the call team is a junior resident (PGY-2 or 3), a senior resident (PGY-4 or 5), and an attending surgeon. The presence of a first year resident is dependent upon the PGY-1 rotation schedule. The senior resident may take call from his/her residence. The usual frequency of call days is approximately five per month, depending upon rotations and leaves.
The junior resident is responsible for all calls from the inpatient ward and consultations from the Emergency Room. He/she is to evaluate and treat the patient within his/her level of training and confidence. The senior resident is to be contacted on all emergency operative cases, admissions, possible operative cases, and any situations where the junior resident is in need of further assistance. The senior resident is then expected to come into the hospital, evaluate the patient, and assist the junior resident as needed. If the patient is to be admitted or taken to the operating room, the attending surgeon must be notified. No resident will take a patient to the operating room without an attending surgeon being present.
During the duty day, from 7:00 AM to 5:00 PM, the on call pager is carried by a PGY-1 resident in the outpatient clinic. If there is no 2nd year, then a midlevel resident will carry the pager. All ER consults will be discussed with a member of the staff prior to disposition of the patient. Inpatient consults from other services will be completed by the Chief Resident after discussion with the appropriate attending.
The WBAMC Texas Tech Orthopedic Surgery Residency is a training program with progressive responsibilities and duties. Each resident is expected to take an active part in the care of the patients on their team’s service, commensurate with their level of training. The attendings on the WBAMC teams are as follows:
WBAMC Ortho Services
- Sports Medicine
- Pediatric Orthopedics
- Foot and Ankle
- Shoulder & Elbow
- Adult Reconstructive
Residents in the program will also have rotations at Texas Tech University in downtown El Paso. There are a few outside rotations, to which the residents will be assigned. These include the following:
Shriner’s Hospital for Children and Primary Children’s Medical Center at University of Utah, Salt Lake City.
Rush Medical Center, Chicago, IL
El Paso Orthopedic Group, El Paso, TX
Academics, Lectures & Conferences
The purpose of Orthopedic Residency is to acquire the knowledge, clinical, and surgical technical skills necessary to practice the broad and varied field of Orthopaedics. The acquisition of this critical knowledge comes through formal and informal education as well as self study.
Morning report is held daily at each clinical site. It serves several functions. It is a process of communication, which is both expedient and deliberate. Residents present preoperative cases, on-call cases from the previous 24 hours, and post-operative case discussion from the previous day.
Education provided in this venue is multifaceted. First, residents begin to develop the formal clinical presentation skills expected during Step 2 of the Orthopedic Boards. Second, cases are used as platforms to discuss physical examination skills, radiologic evaluations, surgical techniques, and outcomes. Residents are encouraged to review current orthopedic articles and to present relevant information in their presentations.
Formal Academic Schedule
The majority of formal education is provided during protected academics held each Wednesday from 7:00 AM to 2:00 PM, alternating between TTUHSC/Paul Foster School of Medicine on the first and third Wednesdays of each month, and WBAMC on the second and fourth Wednesdays. Clinics and OR time are limited to allow both resident and staff participation. Clinical duties during this period are limited to pager coverage for a few residents. Academic activities during these days fall under several categories.
Attendings participate in a rotating 2-year schedule of specialty-specific core lectures in the fields of Trauma, Sports Medicine, Adult Reconstruction, Spine, Hand, Pediatrics, Tumor, Foot & Ankle, and Physical Medicine and Rehabilitation. Between July and November, there are one to two attending lectures weekly. This allows scheduling time for the Anatomy, Resident Review Lectures, and PGY-1/-2 Core Skills Lectures which form the foundation for pre-OITE academics. Following the OITE, the attendings present 2-3 lectures each Wednesday.
Between July and November, the core anatomy program is central to resident education. On the first and third Wednesdays of each month, a PGY-5 leads a team of residents for a given anatomic region (e.g. Pelvis/Acetabulum, Hip/Thigh, Knee, etc.). Staff supervision is provided for each of these sessions as appropriate. The PGY-1 is responsible for the “Bone of Contention,” wherein the osteology, morphology, and relevant anatomic landmarks of a given bone are discussed in depth. The responsible chief resident then provides a comprehensive lecture covering the anatomy and relevant surgical approaches. The residents then attends a practical session in the state-of-the-art Paul L. Foster School of Medicine anatomy lab, where there are 2-3 cadavers dedicated to Orthopedics each year. The assigned PGY-2 (supervised by the chief resident and staff) then leads a “pimp” session utilizing cadavers prepared earlier in the week with the PGY-1.
On the second and fourth Wednesday of the month, a PGY-4 or PGY-3 presents a lecture correlating to the preceding week of anatomy. These lectures focus on physical examination and radiologic evaluations of the relevant region. These lectures are typically supplemented with review of relevant OITE questions from the past several years.
Resident Core Review Lectures
Between July and August, there are two lectures each week based on the core texts. The core texts include a review text generally chosen by the chief academic resident with program input (typically AAOS Comprehensive Review, OKU, or Miller) as well as Orthopaedic Basic Science. The PGY-3 presents a formal lecture based on the review text, while PGY-2s are usually responsible for Basic Science lectures. Whenever possible, these lectures correlate to the anatomic region of the week (e.g. Osteoarthritis core lecture and Biomaterials/Aseptic Loosening basic science lecture during Hip Anatomy week).
PGY-1/PGY-2 Core Skills Lectures
Core Skills Lectures are directed to PGY-1/-2 residents and are given each Wednesday throughout the first six months of the year. The goal of this program is to rapidly prepare junior residents for increasing levels of independent responsibility in caring for patient seen in the ER or on-call. Didactic lectures are presented by a PGY-5 and PGY-4 and are usually accompanied by a hands-on session. The series is started in July with lectures on orthopedic emergencies and consults, casting and splinting, Stryker needle use, skeletal traction application, arthrocentesis/injection, etc. Subject matter advances to include basic skills and knowledge appropriate for residents entering the orthopedic OR environment (e.g. external fixator application, plate/screw ORIF, IM nailing, etc.) and are accompanied by sawbones or cadaveric labs.
OITE Subject Reviews
OITE subject reviews are generally held 2-3 times a month between July and November. These sessions may manifest either as lectures of relevant testable points, review of prior year OITEs, or a combination of both, and are generally led by the PGY-4 class. Beginning in the winter, these sessions involve a detailed group review of the current year OITE test answers. Each year, residents prepare detailed answer explanations in the form of powerpoint presentations which are compiled for future review and test preparation.
Cadaver / Sawbones Practical Skills Labs
Incorporation of frequent practical labs using both cadavers and sawbones is extremely beneficial in solidifying knowledge base and developing technical skills. These are incorporated throughout the year, with 2-3 labs prior to the OITE and 1-2 labs monthly thereafter. Cadaver labs are typically held at the medical school. Dedicated orthopedic department cadavers as well as cadaver parts provided by industry support allow residents to practice both surgical approach and instrumentation in an anatomically realistic model. In the past year alone, we have held cadaver labs for open reduction and internal fixation of the proximal humerus, distal humerus, elbow, forearm, wrist, tibial plateau, distal tibia, ankle, and foot. We have also supplemented these on-site cadaver labs with learning opportunities using mobile arthroscopy labs for both the knee, shoulder, wrist, and ankle.
Visiting professors in various specialties are typically invited to speak 3-4 times each year. These visits typically consist of a Tuesday night dinner accompanied by a professor lecture and case presentations, as well as 1-2 lectures during academics the following day. One of these visits is typically held concurrently with WBAMC/TTUHS Resident Research Day, where the speaker also serves as a moderator and judge. Recent speakers have included: Dr. Steven Olson (Duke), Dr. Kevin Black (Penn State), Dr. Marc Swiontkowski (Mayo), and Dr. Brian Cole (Rush), Dr. Alexander Vaccaro (Rothman Institute), Dr. Felix Buddy Savoie (Tulane Univ.).
Journal clubs are held regularly throughout the year, both intramural during formal academic days and, 5-6 times a year, extramurally with community attendings encouraged to attend. Intramural journal clubs between July and November are held on one Wednesday each month and draw articles from both JAAOS and JBJS, with residents assigned to critically review each article.
Courses / Conferences
In order to augment the resident’s education in Orthopaedic Surgery and Rehabilitation, participation in several courses is integrated into residency. Residents typically will attend one to two supported courses per year after internship. In years with only one supported course, residents are encouraged to take advantage of additional industry-sponsored courses. These are:
- Southwest Orthopedic Trauma Association Basic Fracture Care
- Arthroscopy Course (e.g. AANA Resident Course)
- Orthopedic Oncology Course (e.g. Florida Keys Musculoskeletal oncology Course, Enneking Musculoskeletal Pathology Course, etc.)
- Board Review Course (e.g. AAOS Comprehensive Review, Miller), AAOS Annual Meeting
Additional Industry-Sponsored Courses (examples): AO Advanced Course, Stryker Hip and Knee Symposium for Orthopedic Residents, Smith & Nephew SAIF Course, DePuy Hip & Knee Arthroplasty for the Junior resident, Arthrex
From clinical outcomes research to animal model studies, WBAMC has established itself as a robust center for innovative musculoskeletal research relevant to a contemporary orthopaedic practice and its military patient population. WBAMC has an outstanding Biomedical Research facility with a fully ACLAM accredited animal lab and bench laboratory space available for resident use. As a combined program with Texas Tech University Health Sciences Center and the Biomedical Engineering Department at University of Texas-El Paso, WBAMC boasts tremendous resources that are available for almost any research endeavor.
The Department of Clinical Investigations assists residents with preparation of protocols for the Institutional Review Board, in obtaining funding for research projects, statistical support, and in preparation of the findings for publication/presentation.
The Clinical Audio-Visual Department has graphic artists and photographers who gladly help with poster presentation, manuscript submission, or PowerPoint presentations. It has the capability of producing artistic renditions as well as computer graphics.
Every resident is required to participate in at least two research projects that result in publication in a peer-reviewed journal and presentation at a national conference prior to graduation.