Orthopaedic Surgery Clerkship Guide

PA students
Written By Anne
 
 
 

Orthopaedic Surgery is a specialty focused on diagnosis, treatment and prevention of musculoskeletal conditions. This can include everything from sports injuries and fractures to arthritis and spinal disorders.

Orthopaedic surgeons work to restore the function of bones, joints, ligaments, tendons, and muscles to help patients regain mobility and improve their quality of life.

 

I. What is Orthopaedic Surgery Surgery?

a) Definition of Orthopaedic Surgery

Orthopaedic Surgery is a specialty of medicine that focuses on the diagnosis, treatment, and prevention of musculoskeletal conditions. This can include everything from sports injuries and fractures to arthritis and spinal disorders. Orthopaedic surgeons work to restore the function of bones, joints, ligaments, tendons, and muscles to help patients regain mobility and improve their quality of life.

b) Orthopaedic Subspecialties

  • Foot & Ankle Surgery

  • Hip and Knee Arthroplasty

  • Orthopaedic Hand

  • Orthopaedic Oncology

  • Orthopaedic Spine

  • Orthopaedic Trauma

  • Paediatric Orthopaedics

  • Shoulder and Elbow

  • Sports Medicine

c) Description of Practice Settings in Orthopaedics

  • Fracture Clinic: A specialized outpatient clinic that deals with assessment, management and follow-up care for patients with fractures and other acute MSK injuries. Procedures done including casting, splinting, stitch and staple removal, K-wire removal. Often staffed by RNs/RPNs/patient care coordinators, orthopaedic technicians, PAs and more. Patients referred here are seen urgently after an acute injury.

  • Orthopaedic Clinic: Consultation and follow-up of non-urgent/chronic MSK conditions and injuries.

  • Operating Room: Where Orthopaedic Surgeries are performed. . Orthopaedic surgeons, along with a team of nurses and anesthesiologists, work in the operating room to perform various orthopaedic surgeries, such as joint replacements, fracture fixation, arthroscopies, and ligament reconstructions, with the goal of addressing musculoskeletal conditions and injuries.

  • Orthopaedic Inpatient Floor: This is a dedicated unit within a hospital where patients with orthopaedic conditions or injuries are admitted for specialized medical care and treatment. The inpatient service is staffed by orthopaedic surgeons, nurses, and other healthcare professionals who provide comprehensive care, including surgery, postoperative monitoring, pain management, and rehabilitation, for patients requiring hospitalization due to their orthopaedic needs.

  • Orthopaedics On-Call: Orthopaedic Surgery on-call service provides expetise, assistance or services as needed to the Emergency Department and other departments in the hospital. They are typically available through pager/phone. This can include seeing new consults, or addressing inpatient/ward management needs.

d) Common Conditions seen in Orthopaedic Surgery

Here are a few conditions you may come across during your Orthopaedic Surgery clerkship rotation:

  • Fractures: Fractures of the shoulder, clavicle elbow, wrist, hip, pelvis, femur, tibia plateau, ankle, and foot. Compression fractures of the spine, crush injuries, and stress fractures. Growth plate fractures (Salter-Harris fractures), green stick fractures.

  • Dislocations: Joint dislocations can include dislocations of the shoulder, elbow, wrist, fingers. Multidirectional instability of the shoulder, Ehlers-Danlos Syndrome, AC joint separation.

  • Upper Extremity:

    • Shoulder: Rotator cuff tear, shoulder instability, impingement syndrome, adhesive capsulitis (frozen shoulder), SLAP tear, labral tear, AC joint separation

    • Elbow: lateral epicondylitis, medial epicondylitis, instability, osteoarthritis, olecranon bursitis, distal biceps tendon rupture, cubital tunnel syndrome/ulnar neuropathy, triceps tendon rupture, ulnar collateral ligament (UCL) tear.

    • Hand and Wrist: Carpal tunnel syndrome, ganglion cyst, De Quervain’s tenosynovitis, TFCC tear, Kiebock’s Disease, Dupuytren’s contracture, trigger finger (stenosing tenosynovitis), Gamekeeper’s thumb, flexor tendon injuries, mallet finger, Boutonniere’s deformity

  • Lower Extremity:

    • Hip: femoral acetabular impingement (FAI), avascular necrosis of the femoral head, labral tear, GT bursitis, Piriformis syndrome, IT band syndrome, snapping hip, gluteus medius tear, Perthes Disease

    • Knee: ACL tear, PCL tear, meniscus tear, patellar tendonitis, patellar dislocation, osteoarthritis, prepatellar bursitis, pes anserine bursitis, extensor mechanism injuries, patellofemoral syndrome

    • Ankle: Ankle sprain, Achilles tendonitis/tear, Ankle impingement, osteochondral defect of the talus, ankle instability, peroneal tendonitis, syndesmotic injury, ankle osteoarthritis (ankle and subtalar joint)

    • Foot: Plantar fasciitis, metatarsalgia, Morton’s neuroma, Hallux valgus (bunion), 1st MTP joint OA, hammertoes, claw toes, tarsal tunnel syndrome, Lisfranc injuries, midfoot arthritis, Pes Planus, Pes Cavus, Charcot foot, diabetic foot ulcers, gout.

  • Other Conditions: Septic arthritis, osteomyelitis, bone tumours, metabolic bone disease (osteoporosis, osteomalacia, avascular necrosis), management of metastatic bone disease (and prophylactic surgical fixation of high-risk/impending pathologic fractures e.g. Mirel’s score), Compartment syndrome, periprosthetic fracture, fracture nonunion/malunion.

  • Orthopaedic Spine: Spinal Stenosis, Spondylolisthesis, degenerative disc disease, scoliosis, kyphosis, vertebral compression fractures, herniated discs, cervical fracture and dislocation, thoracolumbar fracture

  • Paediatric Orthopaedics: Radial head dislocationsScoliosis, Osteogenesis imperfecta, Legg-Calve-Perthes Disease, slipped capital femoral epiphyses (SCFE), congenital limb deficiencies (born with a limb that is missing or underdeveloped), Clubfoot, Developmental dysplasia of the hip (DDH), Osteochondrosis (Osgood-Schlatter Disease and Sever Disease) and child abuse.

e) Common Surgical Procedures in Ortho

  • Joint replacement surgery: Involves replacing a damaged joint with an artificial joint, such as a hip or knee replacement.

  • Arthroscopy: A minimally invasive surgical procedure that uses a small camera (arthroscope) to view, diagnose, and treat problems inside a joint.

  • Fracture open reduction internal fixation (ORIF): Surgery to repair broken bones, which may involve using pins, screws, plates, or rods to hold the bone in place as it heals.

  • Spine surgery: Involves the surgical treatment of conditions affecting the spine, such as herniated discs, spinal stenosis, and spinal fractures.

  • Soft tissue repair: Surgery to repair damaged or torn muscles, tendons, or ligaments, such as rotator cuff repair or ACL reconstruction.

  • Irrigation & Debridement (I&D): The removal of damaged or dead tissue from a wound to promote healing.

  • Osteotomy: Surgery to change the alignment of a bone to relieve pressure on a joint.

  • Joint Fusion: Surgery to fuse two or more bones together to provide stability, such as spinal fusion or ankle fusion.

  • Amputation: Surgery to remove a limb or part of a limb, usually as a result of a serious injury or disease.

f) Examples of Procedures in Orthopaedic Surgery

  • Inta-articular joint injections

  • Soft tissue injections

  • Joint aspiration

  • hematoma block using local anesthetic

  • Closed reduction of fractures and dislocations

  • Application of splints and casts

  • Cast and splint removal

  • Wound debridement

  • Ring/digital blocks

g) How is Orthopaedic Surgery helpful?

The skills and knowledge gained during a rotation in Orthopaedic Surgery can be applied to various aspects of medicine, including emergency medicine, internal medicine, and pediatrics.

For example, musculoskeletal complaints (acute MSK pain, fractures, dislocations) are common in the emergency department, and knowledge of Orthopaedic Surgery and experience in the fracture clinic will give you experience with assessment and management of common trauma presentations.

 

II. Typical Schedule in Orthopaedic Surgery

As a clinical clerk in Orthopaedic Surgery, you will have a busy schedule that will likely vary from day to day. Your typical schedule will depend on the specific clinic or hospital you are working at and the specific subspecialty you are exposed to. However, here is an example of a day in the life and a week in the life of an Orthopaedic Surgery clerkship:

a) Daily Schedule

  • 6:00 AM - Morning Rounds

  • 6:30 AM - Handover

  • 7:00 AM - Resident Teaching Rounds

  • 8:00 AM - Fracture Clinic/Ortho Clinic or Assist in the Operating Room

  • 4:00 PM - leave for the day

b) Sample Weekly Schedule

  • Monday:

    • AM Fracture Clinic

    • PM Shoulder and Elbow Ortho Clinic

  • Tuesday:

    • Operating Room - Hip and Knee Arthroplasty

  • Wednesday

    • AM: Hip and Knee Ortho Clinic

    • PM: Academic half day off for study

  • Thursday:

    • Operating room - Foot and Ankle Surgery

  • Friday

    • AM Orthopaedic Spine Clinic

    • PM Fracture Clinic

c) Other Clinical Activities

  • Occasional Teaching: In the afternoon, you may have time to attend lectures, grand rounds, or case presentations, depending on the schedule of your institution.

  • Completion of Documentation: After finishing your clinical duties, you will need to complete your documentation, which may include writing SOAP notes, operative notes, post-op notes, and inpatient round notes.

  • Responding to calls from the ward: Clinical clerks may also be expected to respond to pages from the ward during the day (outside of overnight call). Responding to issues on the ward refers to the daily care and management of patients who are admitted to the surgery ward. If there are missing medication orders, requirement for consults, changes in patient’s status (on exam, on labs, etc.). This allows for prompt prevention and response to complications from surgery or medical conditions that surgery patients may develop during their hospital stay

 

III. Clerkship responsibilities in Orthopaedic Surgery

a) Getting started in Orthopaedic Surgery

Introduce yourself to the attending physician, residents, and staff

  • Familiarize yourself with the hospital or clinic's protocols and procedures

  • Attend orientation sessions or lectures

  • Review the patient schedule for the day or week

  • Ask questions and seek feedback from attending physicians and residents

b) Expectations for Learning

  • Demonstrate knowledge of common Orthopaedic Surgery conditions and treatments

  • Develop skills in the diagnosis and management of musculoskeletal conditions

  • Improve communication skills with patients, attending physicians, and other healthcare providers

  • Participate in discussions and ask questions during rounds and didactic sessions

c )What you’ll get to do in Orthopaedic Surgery

  • Participate in patient evaluations and consultations

  • Observe surgeries or procedures

  • Write SOAP notes

  • Review imaging studies

  • Attend didactic lectures or conferences

  • Participate in research projects or case presentation

c) Being On-Call

When “On-Call” the Orthopaedic Surgery service is available to provide urgent medical care and surgical interventions. This can include being on call during the day, evenings, overnight or on weekends.

As a clinical clerk, when you hold the pager, you will be responsible for evaluating patients who present with acute Orthopaedic conditions, such as fractures, dislocations, infections, compartment syndrome, septic arthritis, osteomyelitis, cauda equina and more . The patients that you evaluate may eventually require performing urgent surgeries such as hip fracture ORIF, distal radius fracture ORIF, irrigation and debridement, and amputation or procedures such as closed reduction of a difficult to reduce ankle fracture-dislocation.

  • On Call Orthopaedics in the Emergency Department

    • Admitting patients in the ED to the Orthopaedic Inpatient Service

    • Upper Limb Trauma: clavicle fractures, AC joint separation, shoulder dislocations, proximal humerus fractures, humeral shaft fractures, supracondylar fractures, olecranon fractures, radial head fractures, elbow dislocation, forearm fractures, distal radius fractures, carpal bone fractures, scaphoid fracture, boxer’s fracture

    • Lower Limb Trauma: Pelvis fractures, Femur fractures, hip dislocation, distal femoral fractures, tibial plateau fractures, patella fractures, knee dislocations, tibial shaft fractures, tibial plafond fractures, ankle fractures, syndesmotic injuries, TMT fractures, Lisfranc fractures, metatarsal fractures, toe fractures

  • On Call Ward Issues that you may need to address on the Orthopaedic Floor:

  • Abdominal Pain

  • Constipation

  • Diarrhea

  • Drug Reactions/Withdrawal

  • Dysrhythmias

  • Falls

  • Fever

  • Fluids, Electrolytes, and Acid-Base Balance

  • GI bleeding

  • Glucose management

  • Headache

  • Hypertension

  • Hypotension and Shock

  • Insomnia

  • Leg Pain

  • Mental status changes

  • nausea and vomiting

  • pain management

  • Post-operative bleeding

  • Seizures

  • Shortness of Breath

  • Syncope

  • Tubes and Drains

  • Urine output changes

  • Wound complications: dehiscence, evisceration, stitch abscess

 

Recommended Book for On-Call!

Our favourite reference to respond to on-call issues you may receive on the ward including is On-Call: Surgery by Adams.

 
 

IV. Opportunities for Learning in Orthopaedic Surgery

a) Expanding your medical knowledge.

This will involve learning about the common surgical procedures, the indications for surgery, the pre-operative and post-operative management of patients, and the potential complications associated with different surgical procedures. You will be expected to participate in rounds, attend teaching sessions, and read relevant textbooks and journals to enhance your understanding of surgical principles and practices.

To help you in this process, you can use your academic half day each week to read around cases, review common presentations in Orthopaedic Surgery, and learn about the latest advancements in the field. This will not only be helpful on your End of Rotation exam (EOR), but also when you practice it the future, knowing when to refer patients to this service and specialty clinics.

You can also:

  • Participate in patient care conferences and case discussions

  • Attend lectures, grand rounds, and seminars related to Orthopaedic Surgery

  • Read up on the relevant literature and discussing cases with your team

  • Participate in research projects and quality improvement initiatives

b) A Note on “Pimping” in Orthopaedic Surgery

In medical education, "pimping" is a teaching technique where a senior physician, often the attending or chief resident, asks rapid-fire, pointed questions to a medical learner, such as a PA/medical student or resident, to test their knowledge and understanding of a particular topic.

Examples of “pimping questions” that can be asked in Orthoapedic Surgery:

  • What is the difference between an open and closed fracture?

  • What are the different types of Salter-Harris fractures?

  • What are the small bones in the foot?

  • What are the names and functions of the rotator cuff muscles?

  • What are the four findings of osteoarthritis on x-rays?

  • What are the symptoms of cauda equina?

The term "pimping" has a negative connotation and can be stressful for the learner, as they may feel embarrassed or intimidated if they do not know the answer to a question.

However, the intent of pimping is to teach and reinforce important concepts, and it can be an effective way for medical learners to solidify their understanding and improve their performance.

 

Tips on How to Approach a Pimping Question

  • Stay calm: It's natural to feel nervous when you're being questioned, but try to stay calm and composed. Remember that the person asking the question is trying to help you learn.

  • Listen carefully: Listen carefully to the question being asked. Make sure you understand what is being asked before you start answering.

  • Be concise: Answer the question in a clear and concise manner. Avoid giving extraneous information that is not relevant to the question.

  • Don't be afraid to say "I don't know": If you don't know the answer to a question, don't try to guess. Instead, say "I don't know" and ask for clarification or for the answer.

  • Show your thought process: Even if you don't know the exact answer, try to show your thought process. Explain how you would approach the question and what factors you would consider.

  • Be respectful: Remember to be respectful and professional when answering pimping questions. Even if you feel like you are being put on the spot, maintain a positive attitude and treat the person asking the question with respect.

  • Remember the answer - sometimes the preceptor will ask you the question again in the future!

 
 

V. What to Bring

a) Dress code

  • Scrubs:

    • Hospital-issued scrubs MUST be worn in the operating room (you cannot wear your own scrubs). Keep in mind any jewellery (rings) cannot be worn when you are scrubbed in.

    • You can otherwise wear your own scrubs or hospital issued scrubs on the ward, or for clinic.

  • Business Casual: for fracture clinic or Orthopaedic Clinic, however in clinics where there are more procedures (e.g. requiring casting, wound debridement, etc.), consider wearing scrubs that can be easily washed.

  • White Coat (optional) to be worn over your scrubs or business casual outfit.

b) Optional Medical Gear to Bring

  • Reflex hammer (only if applicable): if you are on-call or rotating through the Orthopaedic Spine service, this is helpful for checking reflexes.

  • Comfy shoes for clinic and the OR and long clinic days on your feet!: Some surgery cases are less than an hour, and some are over 5 hours (e.g. Spine cases!). Nonetheless, with a lot of standing, comfy shoes make a big difference.

  • Sloggers or Rain Boots (at least to midcalf): During arthroscopic surgeries a lot of water can fall onto the ground and get your socks wet. If there will be a lot of arthroscopies (e.g. shoulder scope, hip scope, knee scopes, etc.) consider bringing some OR-only waterproof boots.

  • Stethoscope: you may require this if rounding on inpatients, but otherwise in day to day clinic and the operating room you can leave your stethoscope at home.

  • Retractable measuring tape: useful for measuring compartments when ruling out compartment syndrome, or checking leg length discrepancy.

  • Pocket-sized notepad and pen to take notes and jot down reminders

  • Pocket reference books or electronic resources (mobile apps, online references) related to Orthopaedic Surgery (see favourite resources below!)

  • Suture Practice Kit with suturing tools, silicone suture pad and suture thread and needles

 

VI. Documentation in Orthopaedic Surgery

a) Different types of Documentation

  • Consult note/Pre-Op Assessment: This is a standardized form that is completed prior to the surgery, usually during the patient's pre-operative visit. It includes a comprehensive medical history, physical examination, and relevant investigations. The purpose of this documentation is to ensure that the patient is medically optimized for the surgery and to identify any potential risk factors.

  • Operative Note Template: This is a documentation of the surgery that was performed, which includes details about the procedure, any complications encountered during surgery, and any other relevant information

  • Post-Operative Note: This is documentation of the patient's post-operative course, which includes information about the patient's pain management, vital signs, any complications that may have arisen during surgery, and the patient's overall condition.

  • Surgery Progress Note: A brief note that uses the SOAP format to track the progress of the patient while in hospital post-operatively.

  • Discharge Summary: This is a documentation that summarizes the patient's hospitalization, including the reason for admission, the course of treatment, and any significant events that occurred during the hospital stay. It also includes information about any medications prescribed at discharge, follow-up appointments, and any recommendations for ongoing care.Cheat Sheets

 

Example Consult Note from the Orthopaedic Surgery Service

ORTHOPAEDIC SURGERY ON-CALL

Consulted requested from: John Shoe, PA, Emergency Dept
Consult performed by: Jane Doe, PA-S2, Clinical Clerk, Orthopaedic Surgery

ID: 45M Right ankle fracture date of injury: June 5, 20___.
History of Presenting Illness: Earlier today, patient had a trip and fall down stairs landing with full body weight through the right ankle/foot. No head injury or LOC. Was unable to weightbear. Taken by ambulance to ED.
PMHx: Otherwise healthy. Previous Appendectomy.
Meds: None
Allergies: NKDA
SocHx: Carpenter, self employed. Smokes 1 ppd x 15 years. Drinks 2 alcohol beverages per day. No recreational drug use. Enjoys skiing, hiking and kayaking.
O/E: Visible deformity with moderate swelling to ankle, bruising noted over medial and lateral malleolus. No midfoot tenderness/Lisfranc tenderness. No proximal fibula tenderness. Skin intact over fracture sites. DNVI. Distal pulses palpable.
Ix: X-ray demonstrates bimalleolar fracture, with significant medial clear space widening.
A/P: Closed reduction with posterior and U-Slab applied by Ortho team. To remain NWB with crutches. Will require Right ankle fracture ORIF, consent obtained today and patient booked as level 7. Right ankle CT scan ordered for pre-operative planning. Discussed with staff.

Jane Doe, PA-S2
Clinical Clerk, Orthopaedic Surgery

Example of a Brief Operative Note for an Orthopaedic Surgery Patient

ORTHOPAEDIC SURGERY OPERATIVE NOTE

  • Pre-Op Diagnosis: Right hip severe osteoarthritis

  • Post-Op Diagnosis: Right hip severe osteoarthritis

  • Procedure: Right primary total hip arthroplasty using lateral approach

  • Surgeon: Dr. ____

  • Assists:

    • Jane Langhorn, PA-S2

    • John Doe, PGY3.

  • Anesthesia: Dr. Y, General Anesthesia

  • Estimated Blood Loss (EBL): 100 cc

  • Complications: None

  • Plan:

    • PACU x-rays of right hip

    • May WBAT, AAT

    • Transfer from PACU to 10A Orthopaedics Floor

    • Enoxaparin 40 mg SC starting AM of POD#1

    • To discharge home POD#1 once cleared by PT, and on PO pain medications

Jane Langhorn, PA-S2
Clinical Clerk, Orthopaedic Surgery

In service of: Dr. ______

Orthopaedic Surgery Progress Note

ID: 72M POD#1 Right total hip arthroplasty (DOS: January 15, 20__ by Dr. ___)

S:
- Mild incisional pain, well controlled with Acetaminophen
- No nausea/vomiting
- Diet returned to baseline
- passing gas, and BM earlier today
- Urinary output adequate

O:
On exam:
AVSS
- Incision clear, dry, intact - with no signs of infection
- No erythema, drainage or tenderness
- Able to WBAT without assistance

Ix: Hb 104 (pre-op 120). Lytes otherwise normal.

A/P: Recovering well.

  1. APS has signed of.

  2. Activity: Continue WBAT, Lateral hip precautions for 3 months post-operatively.

  3. Diet/Fluids: Increase fluid intake as tolerated

  4. Disposition: Discharge home in 1 day. Follow-up in clinic 2 weeks post-op for stitch removal and re-assessment

Orthopaedic Surgery Discharge Summary

 
 

VII. Surgery Orders

a) Writing Orders in Orthopaedic Surgery

Writing a surgery order means providing clear and detailed instructions to the surgical team about the patient's specific surgical procedure and details/instructions for patient’s care before, during and after surgery. This may include medications, labs/investigations, consultations with different services, blood products, fluids, activity level and more.

These orders can be “hand written”, or inputted electronically in an electronic medical record system. Surgery orders can also be part of an order set which is a pre-established set of orders and protocols. Order sets can be used as “checklists” to ensure all steps are taken to optimize patient outcomes and minimize complications.

Examples of Surgery Orders include:

  • Admission/Pre-operative orders: These orders are written prior to the patient undergoing surgery and are designed to prepare the patient for the operation.

    • Admission orders typically include orders for diagnostic tests (e.g. bloodwork, imaging studies), consultations with other specialists (e.g. cardiology, pulmonology), and medications (e.g. antibiotics, prophylactic anticoagulation).

    • Pre-operative orders typically include orders for fasting, bowel preparation, and medications that may be required before the surgery (e.g. sedatives, anxiolytics).

  • Post-op Orders: These orders are written after the patient has undergone surgery and are designed to manage the patient's post-operative care. Post-op orders typically include orders for pain management (e.g. analgesics), nausea/vomiting management (e.g. antiemetics), deep vein thrombosis (DVT) prophylaxis (e.g. compression stockings, anticoagulants), wound care, and mobilization orders. The orders will vary depending on the type of surgery performed and the patient's medical condition.

  • Discharge orders: These orders are written when the patient is ready to be discharged from the hospital. Discharge orders typically include instructions for wound care, medications that the patient will need to continue taking at home, follow-up appointments with the surgical team, and any activity restrictions. The discharge orders should also include clear instructions for the patient on what to do if they experience any complications or concerns after they leave the hospital.

See below for templates and example orders.

Admission Orders (AD DAVID mnemonic)

ADDAVID is a mnemonic that can be used to remember the essential components of admission orders for a patient in the hospital setting. Each letter in the mnemonic represents a different component of the orders:

  • Admit

  • Diagnosis/DNR

  • Diet

  • Activity

  • Vitals

  • Investigations

  • IV fluids

  • Drugs: 5 P’s: pain (analgesic), puke (antiemetic), prophylatic (anticoagulants), pus (antibiotic), previous meds.

 

VIII. How to Study during your Orthopaedic Surgery Rotation

a) Review Materials

At the beginning of your rotation, review the core materials and textbooks that are relevant to___ . This will help you establish a strong foundation of knowledge and familiarize yourself with common surgical procedures and conditions.

  • Approach to undifferentiated MSK Pain (e.g. shoulder pain, elbow pain, hip pain, etc.)

  • Common Conditions

  • Surgical Anatomy

  • Common Surgical Procedures

  • Focused physical examinations (and special tests): Shoulder, elbow, hand and wrist, hip, knee, ankle and foot. C-spine, T-spine and L-spine exams. Neurological exam.

  • Surgical Principles:

    • Prophylactic antibiotics

    • DVT prophylaxis following Orthopaedic Surgery

  • Post-operative Care

  • Suturing Skills

  • Imaging: Reading and interpretation of MSK x-rays, being able to identify normal anatomy and fractures, utilization of MRI’s and CT scan.

  • On-Call Surgical Problems: Read around issues you may be paged about when on-call, this can include: abdominal pain, bowel function (constipation, diarrhea), chest pain, drug reactions, dysrhythmias, falls, fever, fluid, electrolyte and acid-base balance, GI bleeding, glucose management, nausea vomiting, pain management, SOB, syncope, tubes and drains, urine output changes and wound complications.

b) Reading Around Cases

As you encounter patients with various surgical conditions, take the opportunity to read around the cases to deepen your understanding of the pathophysiology, diagnosis, and treatment options. This will help you contextualize the information you're learning and apply it to real-world scenarios.

c) Attend Teaching Rounds

If your institution offers lectures and conferences related to Orthopaedic Surgery, take advantage of them to supplement your knowledge and learn from experts in the field.

d) Seek Feedback and Guidance

Throughout your rotation, seek feedback and guidance from your supervising physicians and other healthcare providers. This will help you identify areas for improvement and tailor your learning experience to your individual needs.

e) Learning to Suture

Suturing is one of those skills where you learn by doing. See if you can obtain some suturing equipment and tools during your surgery rotation, or you can grab a suturing kit online that you can use to practice at home.

  • Observe and practice: Observe experienced surgeons, residents, fellows or other experienced staff as they suture, and ask them to provide feedback as you practice. You can also use online resources, such as videos and tutorials, to supplement your learning.

  • Start with basic suturing techniques: Begin by learning simple interrupted sutures and progress to more complex techniques, such as continuous sutures and subcuticular sutures, as you become more proficient.

  • Use the right equipment: Ensure that you have the correct instruments, such as a needle holder and forceps, and the appropriate suture material for the type of tissue you are suturing. You can ask the perioperative nurses if there’s any extra suturing tools you can take home to practice (e.g. expired sutures).

  • Practice on a variety of materials: Practice suturing on a range of materials, such as foam blocks, chicken breasts, and pig feet, to simulate different tissue types.

  • Build muscle memory: Repetition is key to building muscle memory and improving your suturing skills. Practice consistently and regularly to build your confidence and proficiency.

  • Get feedback and reflect: Seek feedback from experienced surgeons or colleagues to help identify areas for improvement. Reflect on your performance and adjust your technique accordingly.

  • Attend suturing workshops: Attend suturing workshops and surgical skills courses to supplement your learning and gain hands-on experience in a supervised setting.

 

IX. Favourite Resources in Orthopaedic Surgery

a) Mobile Apps

  • AO Surgery Reference Mobile App (free): Apple App Store, Google Play

  • OrthoBullets Mobile App (free access)

  • Orthopaedic Patient Education iPad App: Impressive 3D animation-based graphics and videos to demonstrate normal anatomy and common Orthopedic conditions

  • Teach Me Surgery Mobile App: encyclopedia covering over 400 surgical topics in a visual and easy to read format. Includes topics on General Surgery and Basic Surgery Concepts.

  • UptoDate: If your school or institution has access, see if you can get this set up on your phone!

  • MDCalc (free): Over 275 calculators for health care providers to calculate algorithms, scores and risk.

  • Firstline (Institution-specific antimicrobial approach/Antibiotic Steward): An app which provides guidelines on which antibiotic to use against certain pathogens based on profile of your area. You can look up data and guidelines including biogram data by antibiotic, dosing (afdults and peds), and by pathogen. (e.g. Firstline is used by a few hospitals in Alberta Health Sciences, Manitoba, CHEO - Ottawa, SickKids - Toronto, Joseph Brant Hospital - Burlington and more).

b) Recommended Books

c) Textbooks

In general, you do not have to obtain large surgery textbooks to get through your rotation.

However, if you do have access to these books through your university or hospital library (electronic or physical copies), try to find these texts:

d) Online Resources

  • AAOS OrthoInfo: This website provides patient-friendly information on common Orthopaedic Surgery conditions and treatments. It is a great resource for reviewing patient education materials and developing your communication skills.

  • AO Surgery Reference (free access); in a resource for management of fractures including operative vs. non-operative management.

  • OrthoBullets (free access): This online learning platform offers comprehensive and up-to-date information on Orthopaedic Surgery topics. It includes review articles, practice questions, and a mobile app for convenient studying.

  • ShoulderDoc: information for health care providers and patients, with an entire section dedicated to “medical education” of various shoulder conditions.

  • Wheeless’ Textbook of Orthopaedics (free access): This online textbook is a great resource for in-depth coverage of Orthopaedic Surgery topics. It includes detailed information on anatomy, pathophysiology, and treatment options.

  • Teach Me Surgery: Cover core concepts like basic surgical skills, peri-operative care, clinical exams, and foundations in General Surgery.

e) Journals

 

Final notes

Completing a clinical clerkship in Orthopaedic Surgery can be a valuable and enriching experience for PA students, even if you ultimately choose a different specialty. The knowledge and skills gained during this rotation can have a lasting impact on their medical education and future clinical practice.

Anne

I am a Canadian trained and certified Physician Assistant working in Orthopaedic Surgery. I founded the Canadian PA blog as a way to raise awareness about the role and impact on the health care system.

http://canadianpa.ca
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