Clinical Rotations

The 5 years of clinical residency consist of the PGY–1 orthopaedic surgical internship and the orthopaedic resident rotations PGY–2 through PGY–5:

The PGY-1 year will consist of 12 one month block with six months of orthopaedic training, additionally, there will be one month of basic surgical skills and musculoskeletal education. The remaining months will be served in surgery, including critical care of both adult and pediatric patients, neurosurgery, plastic surgery and musculoskeletal radiology.

Years 2-5 are divided into 6 two-month blocks to maximize the clinical experiences and available elective time.

Rotation Year 1 Year 2 Year 3 Year 4 Year 5
Basic Surgical Skills 1 - - - -
Chief Elective - - - - 2
Foot & Ankle - - 2 - -
Hand & Upper Extremity - - 2 2 -
Metro Trauma/Ortho 1 4 2 - 4
MSK 1 - - - -
Oncology - - - 2 -
Pediatrics 2 2 - 2 -
Plastic Surgery 1 - - - -
PM&R 1 - - - -
SICU 1 - - - -
Spine - 2 - 2 -
Sports Medicine - 2 - 2 -
Total Joint Replacement 2 - - 2 2
Trauma 2 2 2 - 2
VA - - 4 - 2
Vacation 3 Weeks 3 Weeks 3 Weeks 3 Weeks 3 Weeks

Basic Surgical Skills
All PGY-1 residents participate in the Basic Orthopaedic Course during the month of October. During this month, all interns are free of all clinical and call duty as they go back to medical school for a month. Seminars led by faculty, staff and residents focus on the diagnosis and examination of common musculoskeletal complaints. Additionally radiology lectures, labs for development of psychomotor skills - including splinting, casting and traction techniques -- the use and care of hand and power instruments, and internal fixation methods are also explored and practiced. Multiple cadaver labs and sawbones activities are offered during this month. Fresh frozen cadavers are provided for dissection led by attending faculty focusing on common surgical approaches. In addition, basic clinical statistics, basic research, principles and concepts, and current techniques of in vitro and in vivo orthopaedic research, are presented by the basic science faculty of the department. All 6 interns also go to an AO Basic course (paid for by the residency) during this month together as well as take advantage of local orthopaedic courses given during the month of October.

Chief Elective
Chief Residents will be afforded the opportunity to design portions of their rotation tailored to their own educational interests or perceived deficiencies as they round out their orthopaedic surgical training during this 2 month rotation. Additionally the Chief Resident will be allowed the opportunity to pursue a 1-3 week elective away rotation in pursuit of research, volunteer, or additional clinical shadowing opportunities based on the resident’s interest.

Foot & Ankle
PGY-3 Orthopedic Residents will observe and participate in the care of patients with foot and ankle conditions. Residents will rotate with Dr. Miskovsky and Dr. Marcus in clinic and operating room, as both are primary faculty for this rotation. If there are no scheduling conflicts or other required service activities, Residents will have the additional opportunity to rotate with Dr. Feighan only in the operating room, as assigned by Chief Resident. Resident will also work with and coordinate patient care with the foot and ankle service physician assistant(s), where applicable.

Hand & Upper Extremity
UH- Residents will observe and participate in the care of the hand and upper extremity patient during a two month block as a third year resident.
Metro-Residents will observe and participate in the care of a hand and upper extremity surgery patient in the elective and trauma settings. The resident will rotate for 2 months on service as a PGY-4.

Metro Ortho
This is a complex arthroplasty rotation with an emphasis on population health and post traumatic reconstruction The PGY 3 resident will take an active role in patient care and surgical planning for primary and revision hip and knee arthroplasty as well as complex foot and ankle and sports medicine. The rotation is unique in that it offers advanced training in multiple subspecialties of orthopaedic surgery.

Metro Trauma
Residents will participate in the care of patient with traumatic orthopaedic injuries. This includes isolated extremity injuries and those in the polytraumatized patient. Additionally, residents will care for chronic traumatic injuries including nonunions and malunions.

MSK
Residents will observe and participate in the interpretation of Musculoskeletal Imaging studies encountered on the rotation. The resident will do one (1) rotation through the Musculoskeletal Imaging service, as a PGY-1.

Oncology
Residents will participate in the evaluation and care of the orthopaedic oncology patients. The resident will receive this education as a PGY-4.

Pediatrics
Residents will observe and participate in the care of pediatric orthopaedic patients. This will include a balanced educational experience in line with competency based learning principles. Residents will have exposure to outpatient clinical evaluations, inpatient consultations, inpatient nonoperative and operative care, as well as surgical cases and technical training.

Plastic Surgery
Residents will learn the principles of correction and reconstruction of congenital and acquired defects of the head, neck, trunk and extremities, and to manage acute, chronic, and neoplastic defects not requiring complex reconstruction.

PM&R
The Physical Medicine and Rehabilitation physician at MetroHealth Hospital will help the resident become familiar with clinically applicable principles of basic science, anatomy, pathology, and biomechanics, with an emphasis on the clinical care of patients with musculoskeletal disorders. The goal of this elective rotation is to provide exposure to a broad base of physiatric learning and to encourage critical thinking, such that learners can provide compassionate care at the forefront of medical knowledge.

SICU
Residents will learn the principles associated with the diagnosis and management of critically ill patients, including simple and complex multiple organ system abnormalities, the pathophysiology of all types of shock, and the mechanisms and pathophysiology of cardiopulmonary arrest.

Spine
Orthopedic residents will play an active role in all aspects of the evaluation and care of patients treated by the Orthopedic Spine Division. Each resident will build and expand their knowledge of spine diseases and further their diagnostic, surgical, and peri-operative patient care skills during their rotation. The residents will be expected to perform in a reliable, professional, and compassionate fashion.

Sports Medicine
Residents will observe and participate in the care of the sports medicine patient. The resident will do two separate rotations of the sports service, as a PGY-2 and PGY-4.

Total Joint Replacement
Residents will observe and participate in the care of the total joints patient. The resident will do two separate rotations on the total joints service, as a PGY-1 and PGY-4.

Trauma
Residents will participate in the care of orthopedic trauma patient. The residency will have three or four separate UH CMC orthopaedic trauma rotations, as a PGY-1, PGY-3, and PGY-5.

VA
Residents will participate in the care of the VAMC veterans with reconstructive, hand and sports conditions. The resident will do two separate rotations of the VAMC service, as a PGY-3 and PGY-5.

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