Curriculum for PGY3‑5

Faculty:
Dr. C.P. Coles
Dr. R.K. Leighton
[link to profiles]

The Trauma Service will expose the resident to a wide variety of traumatic soft-tissue, articular and osseous injuries of the extremities and pelvis. This is a busy service involves care of many patients with often complex injuries. Many patients will have multiple systems involved, requiring communication and collaboration with other surgical and nonsurgical disciplines.

You will be expected to be an active participant and develop proficiency in the ATLS assessment, investigation and triage of the polytraumatized patient. You will learn to recognize and treat urgent life- and limb-threatening conditions, including hemorrhage, compartment syndrome, open fractures, and vascular injuries. Most trauma patients will be encountered through oiur busy emergency department and will require organization and efficiency in providing initial assessment and care. This includes reductions and casting/splinting of a variety of fractures and dislocations, and local anesthetic or intravenous sedation administered by the resident with nursing/paramedic assistance. Many patients will require admission to the trauma service for further investigation, monitoring, and often surgical treatment.

Our residents are also encouraged to attend the trauma clinic on Wednesdays for an opportunity to follow the natural course of operatively and non-operatively managed patients over time, as well as the private office for the assessment of new patients with post-traumatic conditions.

This rotation will expose you to the surgical management of both simple and complex fractures and soft-tissue injuries, as well as the management of the long-term complications, such as malunion, nonunion, and post-traumatic arthrosis. You will be expected to demonstrate competency in the surgical management of common orthopaedic injuries consistent with your level of training, progressing to more complex cases in the senior years.

Often more important than surgical management is the postoperative care of multiply injured patients, as well as the isolated injury in the frail elderly. This will continually challenge your medical knowledge and diagnostic skills as you seek to prevent and treat perioperative complications. You will have the opportunity to interact closely with patients and families throughout this experience, and be expected to develop appropriate communication and counseling skills. Overall, a busy, challenging, and rewarding experience awaits the resident of the Trauma Service! 

Faculty: 
Dr. Ron El-Hawary
Dr. Jason Howard
Dr. Karl Logan
Dr. Ben Orlik
[link to profiles]

The pediatric rotation at Dalhousie is located at the IWK Health Centre. Our busy tertiary care service operates on over 1,000 pediatric patients annually and has a thriving clinic as well. Our orthopaedic residents will be exposed to a wide variety of pediatric problems. You will gain insight into the assessment, investigation, and non-operative and operative management of many conditions that include cerebral palsy, club feet and scoliosis.

Teaching: Teaching on our service is largely through interaction with the staff. Formal teaching sessions are integrated into the academic half-day throughout the year. There are also Friday morning case-oriented teaching rounds in which a variety of interesting cases from the week are presented. In addition, Dr. Cook [NOTE: WHO IS DR COOK? NOT LISTED AS FACULTY] traditionally hosts an evening series of case discussions at his home for the senior residents to prepare them for the examinations.

Service: There will be one or two residents on the service during each rotation. Residents' duties include covering the emergency during the daytime as well as a rotating night call. You are also be expected to participate in clinic and in the surgical and post-surgical management of the inpatients.

Faculty:
Dr. David Alexander
Dr. Bill Oxner
[link to profiles]

The adult spinal service is based entirely at the Halifax Infirmary. Our service sees approximately 4,000 patients per year with spinal pathology and performs over 400 operations annually. The majority of the conditions are of a degenerative nature and include degenerative conditions that affect the cervical through lumbar spines. You will become proficient in treating other conditions affecting the spine such as deformity, infection, tumour, fracture, etc. 

Teaching:  There is a strong emphasis on learning on a case-by-case basis. You will be expected to review the operative cases for the following week in order to prepare for each case. Every patient treated in the operating theatre should have a history and physical done by the resident so that discussion around the case can lead to optimal learning. There will be a graded level of responsibility given in the operating room depending on prior exposure and level of training. In addition, follow-up of patients in the fracture clinic can help the resident see such rare conditions as primary spinal tumours that they may not have had exposure to on the service rotation. Formal teaching occurs during the spine block of the academic half-day and there are also a combined Neurosurgery and Orthopaedic spine rounds once per month. 

Service: You will be expected to round on the patients daily while in hospital and should attend the follow-up clinics. In the event that there is conflict in the schedule, the resident is expected to attend the operating room or clinic that holds the most educational value to them for their level of training. 

Evaluation:  Evaluations are to be carried out face-to-face with both Dr. Oxner and Dr. Alexander near the end of the rotation. Evaliuations follow the CanMeds 2005 format.

Faculty: 
Dr. David Johnston
Dr. Andrew Trenholm

This is a busy service with two fellowship-trained upper-extremity surgeons. Our upper extremity service has a strong emphasis on treating conditions that affect the shoulder, elbow, wrist and hand. Wide experience can be gained in the clinic, office, operating theatre and ambulatory care settings. 

Service: Whenever possible, you should attend the outpatient fracture clinic. When conflict arises you will be encouraged to attend the session that has the most educational merit for your level of training. 

Evaluation: Evaluation is carried out near the end of the rotation and is organized in the CanMeds 2005 format.

Faculty:
Dr. Mark Glazebrook

This is a busy service with a fellowship-trained foot and ankle surgeon. Wide experience can be gained in the clinic, office, operating theatre and ambulatory care settings. The foot and ankle service is led by Dr. Glazebrook,who dedicates 40% of his time to basic science and clinical research. You will be exposed to a variety of simple and complex tertiary care foot and ankle problems and their management. 

Service: You will spend this rotation working with one surgeon. You will be expected to round on the patients daily and attend outpatient office on a weekly basis. You will be expected to prepare for cases the week before and should feel free to discuss the pre-operative planning with the attending surgeon. Whenever possible, you should attend the outpatient fracture clinic. When conflicts arise, you will be encouraged to attend the session that has the most educational merit for your level of training.

Evaluation: Evaluation is carried out near the end of the rotation and is organized in the CanMeds 2005 format.

Faculty: 
Dr. M.J. Dunbar
Dr. G. Richardson

Dr. Dunbar and Dr. Richardson are fellowship-trained arthroplasty surgeons; Dr. Dunbar has a post-doctorate degree in Orthopaedic outcomes research. You will work mainly in a complex primary and revision arthroplasty practice, where you'll gain vast experience in everything from resurfacing arthroplasty to allograft revisions of total hips.

Service: You will spend this rotation working with both surgeons. The clinic schedule is such that both surgeons are in their follow-up clinic on the same day but at different times. You will be expected to round on the patients daily and attend outpatient office on a weekly basis. You will be expected to prepare for cases the week before and should feel free to discuss the pre-operative planning with either surgeon.

Teaching: Teaching is largely on a case-by-case basis. The academic sessions on the half-day incorporate sessions on arthritis and arthroplasty as well as orthopaedic oncology. There are intermittent Thursday afternoon planning arthroplasty rounds as well.

Faculty: 
Dr. M Biddulph
Dr. D. Wilson

This is a combined rotation in which you'll gain considerable exposure to musculoskeletal oncology as well as to the treatment of patients with arthritis, primary joint replacement, and revisions surgery. Dr. Gross is a fellowship-trained Orthopaedic Oncologist who serves the entire province as well as New Brunswick and Prince Edward Island for both adult and pediatric musculoskeletal oncology. Our residents gain wide exposure to the diagnosis, imaging, and treatment of a wide variety of both benign and malignant soft tissue and bone neoplasms. We emphasize on multi-disciplinary care and you will be expected to attend joint musculoskeletal oncology rounds in the cancer centre. You will gain considerable experience with operative management, particularly in the details of the appropriate workup and biopsy of suspected lesions. In addition, Dr. Gross has a very busy practice in primary and revision hip and knee arthroplasty, which complements the arthroplasty component of the rotation nicely.

Service: You will spend this rotation working with both surgeons. Our clinic schedule is such that both surgeons are in their follow-up clinic on the same day but at different times. You will be expected to round on the patients daily and attend outpatient office on a weekly basis. You'll be expected to prepare for cases the week before and should feel free to discuss the pre-operative planning with either surgeon.

Teaching: Teaching is largely on a case-by-case basis. The academic sessions on the half-day incorporate sessions on arthritis and arthroplasty as well as orthopaedic oncology.  There are intermittent Thursday afternoon planning arthroplasty rounds as well.

Faculty: 
Dr. J. D. Amirault
Dr. G.P. Reardon 

The general orthopaedic rotation covers a wide range of orthopaedic problems. Our residents are expected to obtain a grasp of the following issues as they pertain to a general orthopaedic practice:

• Trauma: Both staff take regular wait lists for trauma as well as weekend call for trauma. This would involve the management of all fractures related to the axial skeleton, except for spinal trauma and complex pelvic trauma. You are expected to obtain a grasp of the indications for non-operative as well as operative treatment of these fractures.  As well, you are expected to be comfortable with the various options for operative treatment of the individual fractures.
• Knee Reconstruction: You will be exposed to sports medicine injuries and their management. You will be expected to become skilled at arthroscopy as well as arthroscopic knee ligament reconstruction. You will be exposed to and expected to become familiar with osteotomy about the knee, including distal femur and proximal tibia.  Total knee replacement will be the most common knee reconstructive procedure on this service. As well, you'll be expected to be comfortable with revision total knee replacement.
• Hip Reconstruction: Our residents are expected to become adept with diagnosis and management of problems about the hip, including hip arthroscopy and osteotomy about the hip. Osteotomy about the hip will include femoral osteotomy and pelvic osteotomy, such as the Ganz and Chiari osteotomies. Total hip replacement is one of the more common procedures. You will be expected to develop a plan for hip replacement in both the young and the elderly. This will include cemented as well as cementless total hip replacement. You will also be exposed to revision total hip replacement. 
• Shoulder Reconstruction: This rotation provides broad exposure to rotator cuff disease.  Again, you will be expected to become familiar with the non-operative as well as the operative approach in rotator cuff pathology. Shoulder instability is another common problem dealt with on this rotation. You'll be expected to become familiar with both the open and arthroscopic technique correction of shoulder instability. Complex reconstruction of the AC joint is also a feature of this rotation. Finally, shoulder replacement is performed on a regular basis on this rotation, as well. 
• Foot and Ankle Reconstruction: You will become familiar with all problems of the forefoot dealing with hallux valgus and hallux rigidus. Deformities of the minor toes will also be addressed.  There will be exposure to ankle ligament reconstruction as well as tendon transfers about the ankle. Arthritis of the ankle and the hindfoot will be addressed and the resident will be expected to become familiar with ankle arthrodesis and subtalar arthrodesis. No ankle arthroplasty will be performed on this service.

There is no exposure to spinal surgery, or complex wrist and forearm reconstruction on this service. There is ample opportunity for collaborative research in projects related to hip and knee reconstruction that are ongoing within the Division of Orthopaedic Surgery. Our residents attend a clinic on a regular basis with the attending staff to assess follow-up of surgical cases. New consultations are evaluated in an office setting in the hospital. You will have ample opportunity to attend these sessions to develop an approach to the elective orthopaedic patient.

Faculty: 
Dr. C. Coady
Dr. I. Wong 

Our objective is to expose the orthopaedic resident to the full spectrum of disorders within the realm of sport medicine. You will obtain experience with pathologies unique to the active individual, including disorders of the lower and upper extremities (as well as the axial skeleton) commonly seen in an orthopaedic/sport medicine practice. Overuse injuries of the knee and shoulder prevail, as do acute traumatic insults to the ligaments and tendons.

Forum: You will participate in a multi-disciplinary sport medicine team at the Orthopaedic and Sport Medicine Clinic of Nova Scotia. Clinical interactions and surgical techniques will be assimilated within the operating room facilities at the QEII Health Sciences Centre, Infirmary Site.

Teaching: You will be mentored on the proper techniques on the extracting of a medical history and the physical examination of the musculoskeletal system. Such teaching will be augmented with direct one-on-one supervision. Experience in operating techniques will be developed in the operating room suite. You will be given responsibility in a progressive fashion, with the ultimate objective of performing surgery independently (with supervision constantly available). 

Other resources: Our residets will be encouraged to develop research initiatives. Assistance and support within this quest are available from established collaborators within the School of Biomedical Engineering, Kinesiology, Department of Psychology and the School of Physiotherapy.

The team: You will be exposed to the Orthopaedic Sport Medicine fellows who come to our program from all over the world. Elective medical students and PhD students are often present, augmenting the total experience.