MS3/MS4 Expectations for Ortho Rotations

[jc294813]

Looking specifically for input from Ortho residents.

Scores are competitive (COMLEX 758/ USMLE 268) and I want to be as helpful a team member my 3rd/4th year as I can (third year elective is scheduled at a hospital I am interested in for residency).

I'd appreciate input on expectations for me as a third year in addition to showing up, working hard, and knowing the basic anatomy appropriate for my level of training.

Specifically, I'd like feedback on expectations for PE skills, RADs interpretation ability, surgical procedural knowledge (I already know the expectations for technical skills doesn't exceed basic knots and closing skin), and patient management/note taking.

Any input would be greatly appreciated.

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[massmocha]

Be interested without being annoying. People want a co-resident that they can be friends with, that will work hard without complaining. Don't try to show off how much you know, just always be there and be helpful and never ask to go home, always think of ways to make yourself useful: gathering and rolling out splint materials, refilling the rounding bucket, having scissors, dropping notes, cleaning up in the OR, making your resident's life easier.

Obviously be ready for your OR cases for the attendings, but just be a cool person for the residents.

 

[4thQTHailMary]

Don't get in a physical altercation with a resident. Believe it or not this actually happened somewhere last year. Not surprisingly, he didn't match.

Usually you get an idea of who sucks as a rotator and who you wouldn't want to spend the next five years with.

 

[orthojuniorfaculty]

Looking specifically for input from Ortho residents.

Scores are competitive (COMLEX 758/ USMLE 268) and I want to be as helpful a team member my 3rd/4th year as I can (third year elective is scheduled at a hospital I am interested in for residency).

I'd appreciate input on expectations for me as a third year in addition to showing up, working hard, and knowing the basic anatomy appropriate for my level of training.

Specifically, I'd like feedback on expectations for PE skills, RADs interpretation ability, surgical procedural knowledge (I already know the expectations for technical skills doesn't exceed basic knots and closing skin), and patient management/note taking.

Any input would be greatly appreciated.

I'd file this in the category of: very good question.

At some point or another, most surgeons (broadly speaking) learn about the key to success - following the 3 As.... be available, affable, and able (in that order of importance). This mantra filters down to MS rotations too. Firstly, be available - be the first to arrive, and the last to leave - willingly and without bringing attention to it. If this sounds appealing, congrats - you've made a good choice. If this sounds painful... then imagine 5 years of residency under such a regime followed by a life dictated by the same principles - maybe it ain't for you (not that I suspect this to be the case based on your very good question, just saying). Secondly, be nice... to residents, attendings, nurses, etc. No one is below you. Be the person everyone likes. No harm done by this, especially as a medical student.

The least important is ability/knowledge. Residency is supposed to teach you knowledge and skills. I was least interested in what people know or can do at the beginning of a rotation.. in contrast, what they manage to learn/understand DURING a rotation matters a lot. There isn't time to teach someone the same thing over and over and over. Don't worry about knowledge - worry about being someone who is teachable. The 'teachable, interest prospective resident' is the best, bar none.

 

[jet616]

The best advice I ever got as a medical student, that still applies to life as a resident is to imagine that every patient you interact with is yours. I'm a big picture thinker who struggled with lists of things to know so this rule of thumb helped me instinctively understand what questions to ask, what to look up, and how to think ahead.

One example scenario: You're on call with one of the 3rd year ortho residents and they tell you that there's a distal radius is in the ER that needs to be reduced. They have a couple of scripts to sign on floors 4, 5, and 6. Can you go down to the ER and get started? Imagine that on their way, they will get tragically ambushed by 50 nurses and will be delayed. It is up to you to treat this patient. How will you approach it?

Once you get to the ER, find the patient. Get to know the patient. What history would effect which treatment option would be best for them? What history would deter their ability to heal the fracture? Have you built enough rapport that they'll be comfortably with you injecting them and then yanking on their broken arm?

Look at their XR (This is hard to do if you don't have computer access. even though it's your 2nd week at the hospital... Get computer access ASAP, students.) How would you treat the fracture pattern? Is there a classification system that can help you decide? Does the history change your treatment plan? What needs to be done immediately for the patient? Is there anything you can do to have everything ready? Are there youtube videos or resources you need to look up to remind you about how to make a particular splint? (If you don't know where the splinting supplies are, ask someone! nicely. Lidocaine may or may not be available without a resident to order it but if it is, draw some up if you feel comfortable)

If your resident was truly ambushed and is still not there, obviously don't start the reduction but you can start writing the consult note (computer access again), watch some youtube videos on reduction maneuver and splint molding, and maybe reading some more in depth stuff on distal radius fractures. Don't worry if it's over your head because it can be a good source for questions to ask your resident or attending later that will show how enthusiastic you are about the topic.

This mindset helped me stay engaged and often put me in the perfect position to be helpful while I was a student. For better or worse, you'll be learning from residents who are often stretched pretty thin. We really appreciate students who are assertive, think ahead, and can get things done without pissing people off. We show our appreciation by letting you do more procedures and putting in a good word.