Orthopaedic Trauma Fellowship Curriculum

During the program, fellows will be exposed to the following training:

Management and surgery of polytrauma patients
Management of nonunions, malunions and infections
Clinical research and resident teaching

The basis for a fellow's training and education will be through clinical training, conferences and didactics, and research opportunities.

Clinical Training

Providing patient care is an important aspect of our Orthopaedic Trauma Fellowship Program. Fellows will examine patients admitted through the emergency room, outpatient and private offices; evaluate consults; and serve as a source of experience and knowledge to the resident staff.

Emergency Room

The fellow on call will be notified of orthopaedic trauma by the orthopaedic attending on call. The fellow has the opportunity to evaluate complex orthopaedic trauma problems in the emergency room and to formulate a treatment plan.

Emphasis is placed on resuscitation and the orthopaedic trauma surgeon’s role in the management of unstable patients. In addition to the formal emergency room consultation (written by the resident), fellows are expected to document their involvement. Supervision will be provided by the attending staff. Trauma fellows do not admit patients to the hospital or independently staff operating room cases.

Outpatient Clinic

Each trauma fellow has a half-day at an outpatient clinic every week. This allows for long-term follow-up and evaluation, and work-up of referred malunion and non-union cases. This clinic allows the fellow the opportunity to follow multi-trauma patients in the immediate post-operative period and to guide the rehabilitation process.

Operating Room

Each trauma fellow is assigned to the orthopedic trauma room (fracture room) on Monday, Tuesday, Wednesday and Thursday. All operative procedures are supervised directly by an attending who is physically present in the operating theater.

Call Schedule

Each fellow is responsible for four weekday call nights and one weekend call night per month. The fellow is always on call with orthopedic faculty, usually with faculty from the orthopedic trauma service.

Fellows direct their call schedule, with assistance from the trauma service coordinator. For any changes needed, fellows should notify the coordinator at least 4 weeks prior. The final schedule is submitted to the administrative scheduler by the 1st of the month.

Supervision and Administration

Fellows augment, not supplant, resident responsibility. Clinical care is the primary responsibility of the attending and resident staff. Final decisions regarding patient care are made at the attending level.

The inpatient orthopedic trauma service includes three attendings:

A chief resident (PGY-5)
A PGY-4 resident
One or two PGY-1 residents from general surgery, emergency medicine, or anesthesia

The chief resident directs team administration. There is also a midlevel who is dedicated to the orthopaedic trauma service.

Research Opportunities

Our orthopaedic trauma fellows actively participate in the research program of the Department of Orthopaedic Surgery at the Wake Forest School of Medicine.

You’ll be encouraged to develop and pursue your own individual projects, and may also participate in other ongoing research. You may be expected to engage in both anatomic dissections as well as clinical and basic science research.

You’ll have full access to the Department of Orthopaedic Surgery’s Research Laboratory, which has over 1,500 square feet of dedicated space. The lab includes:

A small animal surgical facility
An extremity laboratory
Access to animal housing facilities
Significant computer support and orthopaedic operating room equipment (including an arthroscopy setup)
Staff including two full-time PhD supervisors, two full-time laboratory technicians, a research secretary, a research center administrator, a research intern and two clinical research data coordinators

Prior to graduation, each fellow must complete one manuscript and have it ready for submission.

Conferences and Didactics

Formal training in orthopaedic trauma is an integral component of the Orthopaedic Trauma Fellowship Program. Training includes conferences, discussion and lectures.

Trauma Conference

The weekly trauma conference takes place on Monday mornings and involves the presentation of cases from the previous week. Discussion focuses on pre-operative workup, indications, critique of post-operative x-rays, and discussion of rehabilitation and expected outcomes.

Morbidity and Mortality Conference

On the first Wednesday of each month, trauma fellows participate in a department-wide morbidity and mortality conference. Every other month an orthopaedic trauma case will be selected for discussion.

Grand Rounds Conference

Trauma fellows participate in a department-wide grand rounds conference on Wednesday mornings.

Daily Triage Discussion

Trauma fellows meet each morning at 5:45 am to discuss and triage the trauma from the previous evening’s call team. The on-call senior from the previous night, the orthopedic trauma attending who is staffing the trauma room that day, research staff and our orthopedic trauma nurse coordinator are also present. Decisions regarding prioritization of cases for the day and indications are emphasized.

Didactic Lecture

A didactic lecture series for the orthopedic house staff covers core curriculum topics specific to orthopedic trauma. Fellows are expected to attend and to present two or three topics per year to the residents.

Attending Lecture

A weekly fellow-specific lecture is given by an attending on Friday mornings prior to orthopedic trauma clinic. This lecture is geared directly to the trauma fellow and involves higher-level topics with an emphasis on complex decision-making.

Journal Club

The Orthopaedic Trauma service hosts a quarterly journal club that includes all trauma faculty and orthopaedic residents. Fellows select the topics and articles, with mentorship from the trauma faculty. After a resident or fellow presents a paper, a question and answer discussion period is held.

Travel and Away Dates

Fellows are given three weeks of vacation and ten professional days that can be used for meetings and job interviews. All away dates must be approved by the chief of trauma. No vacation may be taken during the final week of fellowship. Fellows are expected to attend the annual Orthopaedic Trauma Association (OTA) meeting, the OTA fellow’s course, and the AO fellow’s course. Fellows can attend other educationally beneficial meetings with the fellowship director’s approval.

Evaluation

The fellowship is committed to critical evaluation and continued improvement. A 360-degree program evaluation takes place bi-annually, in which fellows and all trauma faculty and residents who have rotated on the trauma service take an online semi-confidential (confidential to all but the program director) survey.

All faculty and residents will also evaluate the fellow. Nursing and ancillary staff interfacing with the fellow in the clinic and in the operating room also have the opportunity to evaluate the fellow. The program director has bi-annual meetings with the fellow to discuss the results of these evaluations.

Fellow evaluation targets patient-centeredness, clinical decision-making and aptitude in the operating room, as well as the ability to work constructively with others and as part of a multidisciplinary care team. Particular emphasis will be placed on professionalism and its importance to long-term career success.

Prior to graduation, the fellow completes a final evaluation of the fellowship and individual faculty. These evaluations are a necessary part of successful program completion.

Faculty then meet to discuss the results of the fellow evaluations, and to make adjustments and changes as necessary.

Administrative and Work Space Support

The orthopaedic trauma fellowship has an administrative coordinator dedicated to our program. The fellowship coordinator assists the fellow with credentialing, travel arrangements and journal club organization. This person also serves as a point of contact for vacation, call, mandatory training, and data and case log entry, as well as a resource for questions. The fellow will have an office with a computer, and will be able to access all inpatient records, x-rays and library resources.

Grievance and Dismissal Policy

Fellows have the opportunity to make formal complaints regarding the structure, personnel or educational value of the fellowship to the fellowship director, any trauma faculty or the fellowship coordinator. Fellows have a meeting with the fellowship director once a month to provide a structured and formal opportunity to address any complaints or problems. This monthly meeting also affords the fellowship director the opportunity to address any fellow deficiencies. The fellowship adheres to the departmental and institutional formal grievance procedures.

Technology Transfer and Commercialization

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Research Focus Areas

Translation to Care

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Clinical Training

Emergency Room

Outpatient Clinic

Operating Room

Call Schedule

Supervision and Administration

Research Opportunities

Prior to graduation, each fellow must complete one manuscript and have it ready for submission.

Conferences and Didactics

Trauma Conference

Morbidity and Mortality Conference

Grand Rounds Conference

Daily Triage Discussion

Didactic Lecture

Attending Lecture

Journal Club

Fellowship Policies

Travel and Away Dates

Evaluation

Administrative and Work Space Support

Pagers

Grievance and Dismissal Policy