The physician assistant fellow is paired with an experienced PA during each rotation. They are provided with specific objectives, created by the fellowship director and PA mentor, which help guide the fellow’s focus during their time on each service. Find an example of these electives below; under “Sample PA Orthopaedic Fellowship Rotation Schedule.”
Access the full-length JBJS article about the establishment of the ground-breaking program.
Conferences and Didactics
The PA fellow is encouraged to attend all orthopaedic grand rounds and conferences. These are weekly meetings with residents, attending surgeons and APPs on specific topics relevant to the department. Additionally, each subspecialty team has a weekly meeting to provide specific education pertaining to their service.
The PA fellow schedule is flexible enough to allow time to attend continuing education conferences, whether local or distant. Specific conferences are offered to the fellow, however they are encouraged to seek conferences they are interested in.
Clinical Training
Sample PA Orthopaedic Fellowship Rotation Schedule
5 weeks; Frank Caruso PA-C (April 9 – May 11)
a. Wake One training
b. OR orientation
c. Hospital based service orientation
d. Administrative and research orientation
e. First Assist Training (Plate)
f. Orientation at Medical Plaza Miller (Black, Parks)–
g. Wake Wings training
h. Practice Management (Caruso)
i. Billing, coding, compliance
j. Core lecture series – musculoskeletal conditions/online learning/ power points/ etc.
k. Casting and splinting
l. Occupational Medicine, FCE, impairment rating education
m. Orientation ongoing, learning opportunities – location/scheduling grand rounds, journal clubs, etc.
n. Learning Modules – Infection Control, Patient Safety, Billing and Coding
o. Health stream training requirements
p. Performance Review expectations, learning objectives for fellowship
q. I share folders: PA Fellowship File – under development
Week One: April 9 - 13
Monday April 9: Orientation
Tuesday April 10 – Wake One
Wednesday April 11 – Ambulatory Provider and Wake One Surgical Provider
Thursday April 12 – photo shoot, effort certification, worker’s compensation and lab coats.
Friday April 13 – Michelle Saleeby – Davie Medical center
Week Two: April 16 – 20
Monday April 16 – Frank Caruso PA-C - DMC
Tuesday April 17 – Vince Hill – Miller Street
Wednesday April 18 – Hospital Based – Inpatient – Jennifer Jenkins Chao FNP
Thursday April 19 –Casting Room - Miller – Report to Jake Lookabill (please follow check off list, Jack will give to you)
Friday April 20 – Inpatient - DMC – Brittany Suth, NP
Week Three: April 23 – April 27
Monday April 23 – OR orientation – Main Campus – John Shilt PA-C
Tuesday April 24 – Vince Hill PA-C– Miller Street
Wednesday April 25 – Orthopedic Trauma – Baptist, Janet Syme PA-C
Thursday April 26 – Casting Room – Miller – Report to Jake Lookabill
Friday April 27 – Inpatient –Marybeth Harrigan NP (Spine)
Week four: Aril 30 – May 4
Monday April 30 – OR orientation – Main Campus – John Shilt PA-C
Tuesday May 1 – Vince Hill PA-C – Miller
Wednesday May 2 – OR Davie Campus – John Shilt PA-C
Thursday May 3 – Casting Room – Miller – Report to Jake Lookabill
Friday May 4 – Orthopedic Trauma – Baptist, Janet Syme PA-C
Week five: May 7 – May 11
Monday May 7: Frank Caruso PA-C – DMC
Tuesday May 8: Vince Hill PA-C – Miller
Wednesday May 9 – Consults – Baptist – Jennifer Jenkins Chao FNP
Thursday May 10 – Casting Room – Miller – Report to Jake Lookabill
Friday May 11 – Michelle Saleeby PA-C - DMC
4 weeks; John Shields MD, David Pollock MD, Max Langfitt MD, John Shilt PA-C, Joey Baker PA-C, Patrick Stridh, PA-C; Anne Plate PA-C; (5/14/2018 – 6/8/2-018)
a. Diagnosis and management of hip and knee arthritis
b. Indications for surgery in adult reconstruction
c. Implant selection in adult reconstruction; templating basics
d. Post-operative imaging surveillance
e. Identification, description, and management of peri-prosthetic fractures and dislocations and other complications
f. Joint aspirations and injections
g. Attendance at total joints conference
h. First assistant in OR including proper positioning and draping for joint replacement
i. Learning Modules - Polypharmacy
3 weeks; John Birkedal, MD, Tadhg O’Gara, MD, Beck McAllister MD, Maxim Efremov, FNP, Renee Bradford FNP (6/11/2018-6/29/2018)
a. Diagnosis and initial treatment of common spine conditions – neck and back pain, disc herniation, sciatica, arthritic spine conditions
b. Identification of abnormal neurologic findings that necessitate further work-up
c. Fracture management including knowledge of appropriate spine bracing
d. Appropriate utilization of advanced imaging in Spine
e. Description of spine injuries and fractures, including mechanism of injuries and potential associated conditions
f. Attendance at spine indications conference
g. First assistant in OR including proper patient positioning
h. Learning Modules – Discharge Planning, Rehabilitation Admission Criteria
2 weeks; Ben Graves MD, Cynthia Emory MD, Anne Lake DNP, Betsy Southern DNP (7/2/2018 – 7/13/2018)
a. Educational lectures including self-directed online learning regarding types of metabolic bone disease
b. Identification of patients with fragility fractures and appropriate initial medical treatment
c. Show proficiency in secondary fracture prevention education and guidelines for treatment of osteoporosis
d. Familiarity with medical conditions associated with primary and secondary osteoporosis and interaction with rheumatology and endocrinology services
e. Learning Modules – Medical Ethics
4 weeks; Jennifer Jenkins Chao FNP, Eileen Ronsheim NP, Janet Syme PA-C, Shruti Patel NP, Marybeth Halligan NP; Cynthia Emory MD, Orthopaedic residents, casting technicians (January 14, 2019 – Feb 8, 2019)
a. Assessment of wounds around joints and fractures
b. Laceration repair
c. Assessment of comorbidities and effect on surgery, pre-operative assessment
d. Informed consent for procedures
e. Joint aspiration
f. Fracture and dislocation reductions – adults and pediatrics
g. Splinting and casting
h. Application of skeletal traction
i. Identification and management of post-operative complications
j. Wound evaluations after surgery
k. Dressing changes and wound management including vacuum-assisted closure
l. Understanding of care coordination and discharge planning
m. Integrated multidisciplinary team approach to management of orthopaedic patient
n. Understanding and documentation of medical comorbidities and compliance with quality measures prior to patient discharge
o. DVT prophylaxis and pain management
4 weeks; Robert Teasdall MD, Aaron Scott MD, Vincent Hill PA-C; Robert Sprinkle DPM, Christina Long DPM, Paula Gangopadhyay DPM (August 20, 2018 – September 14, 2018)
a. Comprehensive foot & ankle exam
b. Diagnosis and treatment of common foot & ankle conditions – Achilles tendonitis, plantar fasciitis, posterior tibial tendon dysfunction, ankle sprains, fractures of the foot & ankle, deformities of the forefoot, midfoot, & hind foot, arthritis of the foot & ankle
c. Diabetic foot care and management of foot & ankle conditions in diabetics
d. Injections of the foot & ankle
e. Casting and splinting of the foot & ankle
f. Knowledge of inserts, bracing, and prosthetics in foot & ankle conditions
g. Attendance at weekly Foot & Ankle conference
h. First assistant in OR
i. Podiatric assessments and treatment plans
j. Referral patterns for orthopaedics versus podiatry
k. Prosthetics and Orthotics - introduction
4 weeks; Holly Pilson MD, Eben Carroll MD, Jason Halvorson MD and Janet Syme PA-C (September 17, 2018 – October 12, 2018)
a. Basic fracture classification
b. Initial fracture treatment
c. Criteria for surgical vs non-surgical treatment of fractures
d. Informed consent
e. Post-fracture care including weight bearing status, range of motion, and prevention/identification of complications
f. Management of wounds in trauma population: external fixation, wound management systems, skin grafts, flaps
g. Performance of secondary exam in trauma patient
h. Participation in multidisciplinary trauma rounds
i. Attendance at weekly trauma conference
j. First assistant in OR including proper positioning and familiarity with different OR tables
k. Learning Modules – Evidence Based Medicine
4 weeks; Ethan Wiesler MD, Christopher Tuohy MD, Zhongyu Li MD, PhD, Ben Graves MD, Brian Waterman MD, Randy Parks PA-C, Sandra Reynolds NP, Occupational Therapists (October 15, 2018 – November 9, 2018)
a. Comprehensive hand, elbow, shoulder exam
b. Diagnosis and treatment of common hand & upper extremity disorders – carpal tunnel syndrome, trigger finger, tendonitis, fractures of the hand, wrist and forearm, arthritis of the shoulder, elbow, wrist, and hand
c. Injections of the shoulder, elbow, wrist, and hand
d. Casting and splinting of the hand & upper extremity
e. Knowledge of bracing, splinting, and casting of hand & upper extremity
f. Rehab protocols for upper extremity injuries and surgery
g. Attendance at weekly hand conference and weekly case review
h. First assistant in OR
5 weeks; David Martin MD, Cristin Ferguson MD, Allston Stubbs MD, John Hubbard MD, Kevin Coates MD, Jason Heggerick PA-C, Frank Caruso PA-C, Michelle Saleeby PA-C, Dana Bifolck PA-C, Physical Therapists, Athletic Trainers)November 12 – December 14, 2018)
a. Diagnosis and initial treatment of common sports injuries – rotator cuff, tendon and ligament tears, cartilage tears, hip injuries
b. Understanding of injuries that require surgical referral
c. Understanding of role of athletic trainers and physical therapists along with services provided
d. Attendance at weekly sports conference
e. First assistant in OR
4 weeks; John Frino MD, Bettina Gyr MD, Matthew Ravish MD, Brent Sapp PA (December 17, 2018 – January 11, 2019)
a. Diagnosis and initial treatment of common pediatric orthopaedic conditions – scoliosis, clubfoot, growth disturbances, limb deformity, hip dysplasia
b. Identification and management of fractures and guidelines for surgical intervention
c. Casting, splinting, and bracing for common pediatric conditions – hip dysplasia, clubfoot
d. 1 week with pediatric radiology, including ultrasound
4 weeks; Leon Lenchik MD, Barham Kiani MD, Kamal Ajam MD, Allyson Bryant MD, Prutha Patel MD (February 11, 2019 – March 8, 2019)
a. Regular sessions with musculoskeletal radiology for interpretation of radiographs and advanced imaging including CT, MRI, bone scan including conference attendance
b. Exposure to scope of practice of PM&R and services provided to patients with orthopaedic conditions
c. Exposure to pain management specialists including indications for and types of chronic pain medications, image-guided advanced injections, and appropriate use of narcotic medications
d. Dedicated time with orthotics and prosthetics services
4 weeks (March 11, 2019 – April 5, 2019) Frank Caruso PA-C
a. To be coordinated with PA Fellowship Director and supervising provider of chosen elective
b. Learning Modules – Leadership Management