Your Home Ortho Program
Getting to know the residents and faculty at your home Ortho program is crucial for several reasons.
It’s how you really find out if you want to do Orthopaedic Surgery (as detailed above)
You need to know people (and have people go to bat for you) to get strong LORs
The residents and faculty are a great source for advice on aways, interviews, and making your ROLs
In my opinion, the best way to build these relationships is to start taking night call with the Ortho residents. Just show up to their call room, tell them you’re a med student interested in Ortho and want to learn and help out. Every resident I’ve come across has been amenable to this. They love teaching students interested in Ortho and will let you do a ton of stuff, which is why we all want to do Ortho in the first place. While taking call, I’ve reduced fractures under resident supervision, placed tons of splints, thrown in traction pins, repaired countless lacerations and superficial injuries, and even put in screws and plates in the OR. This is not only fun, but you also learn a lot by actively doing. Taking call will prepare you very well for your home Ortho month and subsequent aways.
What to expect during Ortho night call
When it comes to your LORs, faculty members consult with residents to see which students are top notch and hard working. If you regularly take call and know the residents, work hard, and are enthusiastic to learn, they will vouch for you and ensure strong LORs. They were in your shoes only a couple years ago and know how stressful the process can be. I received some of my best advice from residents about where to do aways, the different styles of programs, how to ask for LORs, interviewing tips, etc.
Regarding faculty: I got to know a couple faculty members very well by shadowing them regularly in the OR and going to their clinics. And I made it a point to at least introduce myself to the attendings that I didn’t work with closely. The more people that know you (or at least recognize you as an eager student), the better. Some programs write a Departmental LOR (my home program, Baylor, did), so the more positive input from faculty and residents, the better for you.
Home Ortho Sub-I: during this month, you are expected to assume similar responsibility to a first year Ortho resident. That means long hours, taking night call, maintaining an up-to-date patient list, rounding on patients to check wounds and regularly change dressings, write daily notes, go to cases with your attending(s), and increase your gamut of knowledge over the month. Medical school teaches you nothing significant about Orthopaedic Surgery. Attendings and residents know this, so you are not expected to come into the rotation and be able to treat complex pelvic fractures. But you do have two expectations: work very hard & know your anatomy.
One of the best methods to learn relevant surgical anatomy is by knowing SURGICAL APPROACHES. Get a good textbook that teaches approaches, like Hoppenfeld’s. This will be immensely helpful because that’s how you will see the anatomy when you’re in the OR. You may be expected to know different internervous and intermuscular planes, and even eponymous names of different approaches and the merits of different ones for different situations.
You may be placed in different Orthopaedic sub-specialty services during your month, but the responsibilities are the same. Learn the big picture salient points for the sub-specialty you are on. For instance, if you’re on Hand & Upper Extremity, know the anatomy cold. Know all the muscles, innervation, dermatomes, vasculature, how to quickly but accurately perform the full hand, elbow, and shoulder exam, and common conditions you may encounter. Netter’s Concise Orthopaedic Anatomy and Handbook of Fractures are excellent resources.
Bones. Know all the bones
Just like I explained above about doing well in clinical rotations, solicit feedback. You are here to learn about Ortho and make a good impression. The best way to do that is to find out what your evaluator wants.
Don’t be afraid to show enthusiasm and ask to do stuff in the OR. After you’ve seen a couple cases and gotten comfortable with an attending, there’s no reason you shouldn’t ask if you can help close the wound at the end of a case. And practice. Practice like crazy. Really master how to throw multiple types of sutures, how to close the different layers of a wound, and become proficient at both instrument tying and hand tying knots. This will pay dividends if you show competence, because often the attending will leave the room towards the end of the case and the resident is left to close the wound(s). If you demonstrate that you can close the wound efficiently (and without screwing up), it will help the resident immensely. You both can simultaneously close the wound and place dressings, saving precious time.
Night call: take a lot of call, and don’t take a post-call day off. That may sound excessively brutal. And it is. But keep in mind that most of your attendings trained in the “good ol’ days” before resident work-hour restrictions. They often did not get post-call days. If you show that you can work at that same level, they will respect you more. I personally took Q3 call (every 3rd day), resulting in 11 total calls over the month. I never took a post-call day. And yes, it sucked. Working 36+ hours straight beats you down. That month I had no life other than Ortho. But the residents were impressed that I was essentially always at the county hospital and ready to work. Without even personally telling my attending, he knew I was taking a lot of call and commented to me that the residents had told him. He even went so far as to write this in my LOR. If by working really hard for one month you can secure fantastic evaluations, strong LORs, and learn a ton, it’s more than worth it.
To sum up: really use your home Ortho month to learn how to do an Orthopaedic rotation. Figure out the best way for you to manage the patient list, be efficient on morning rounds, and change dressings (there’ll always be a dressing bag for rounds…keep it stocked up so you’re always prepared). Know your anatomy cold; it’s the most common thing you’ll be pimped on. Practice suturing and splinting. And lastly, take a ton of night call to show your attending, the residents, and also yourself that you can do it.