a) At least six months of approved residency in pediatric orthopedic surgery; b) At least six months of senior residency in orthopedic surgery;

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Gwendolyn Berry
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1 ORTHOPEDIC SURGERY () INTRODUCTION The orthopedic surgeon strives to maintain and restore proper function of the musculoskeletal system in patients of all ages. They usually have detailed experience in, and knowledge of, basic prosthetics and orthotics and the medical aspects of rheumatic disease. Using surgery, medications, and physical therapy, their goal is to preserve maximal functioning of the musculoskeletal system. They utilize elaborate surgical and imaging equipment. Orthopedic surgeons commonly surgically treat fractures, joint and soft tissue injuries, and common congenital deformities (especially developmental dysplasia of the hip and clubfoot). Specialty Training Requirements Five years of approved residency training. This period must include: ) Two years of core training in surgery ) Three years of approved residency training in orthopedic surgery. This must include: a) At least six months of approved residency in pediatric orthopedic surgery; b) At least six months of senior residency in orthopedic surgery; This may include: c) A maximum of twelve months of basic science/research training within the residency program, at the discretion of the program director, with specific objectives to be met. It may include rotations to such related specialties as radiology, pathology, rheumatology, or others. Research outside the residency program will be acceptable only if approved in advance by the Orthopedic Surgery program director. The above represents the minimal requirements for training in Orthopedic Surgery and further training may be required prior to the examinations depending on the results of in-training evaluation. () ORTHOPEDIC SURGERY PROGRAMS ACROSS CANADA Memorial University Dalhousie University Université Laval Université de Sherbrooke Université de Montréal McGill University University of Ottawa / Université d'ottawa Queen's University University of Toronto McMaster University

2 The University of Western Ontario University of Manitoba University of Saskatchewan University of Alberta University of Calgary University of British Columbia All eligible candidates compete for the same positions as graduates of Canadian and United States medical schools International Medical Graduates are not eligible to compete for positions (Revised on March 8, 7) () THE UNIVERSITY OF MANITOBA PROGRAM PROGRAM CONTACT Dr. Michael Johnson Section of Orthopedics AD7, 8 Sherbrook St. Winnipeg MB RA T Tel: () 787-9, Fax: () sbeaudet@hsc.mb.ca PROGRAM INFORMATION APPROXIMATE QUOTA: Number of applicants /6: Number of interviews /6: Average out-of-town applicants matched -6: % Resources General Hospital Health Sciences Centre Children's Hospital Health Sciences Centre Rehabilitation Centre Health Sciences Centre Concordia Hospital PAN AM Sports Medicine Centre The residents are provided with a desktop and laptop computer, digital camera, CD burner and scanner which they share when doing rotations as some of the sights. Quick Facts There are no mandatory rural rotations. There are opportunities for inter-provincial and international electives. Ratio of 6 residents to staff.

3 PGY- & This will conform to RCPS "core surgery" training principles and include rotations in orthopedic surgery. Seminar series designed to assist the student to pass the MCCQE Part II exam and prepare for the POS exam will be presented. Rotations months orthopedic surgery, including; pediatric rotations Spine Arthroplasty Arthroplasty Trauma Intensive Care rotations General/Trauma rotations Internal Medicine rotation Plastic surgery rotations rotations which may include a combination of Pathology, Radiology, and Rheumatology, although there is flexibility in this regard. PGY- & Clinical orthopedic training in all aspects including pediatric orthopedics. Pathology/radiology rotations are included. An elective/research rotation is also offered. PGY- Rotations Sports medicine rotations are recommended Pediatric orthopedic rotations Miscellaneous orthopaedic rotations Research rotations PGY- Rotations Elective rotations (external or internal) Reconstructive rotations - St. Boniface Spine surgery Pediatric rotations PGY- "Chief " resident year. Every opportunity is given for graduated responsibilities and the development of skills and attitudes needed for independent practice. PGY- Rotations 6 Chief resident rotations pediatric rotations Sports medicine rotations Seminars Weekly orthopedic teaching seminars are organized during protected time. Weekly anatomy sessions and a monthly Journal Club are also held. Grand Rounds must be presented by residents once a year.

4 Resident Research A -month block for research is optional. Research projects are mandatory each year from PGY--, and are presented at the annual Manitoba/Saskatchewan orthopedic residents' day. (Revised on January, 7) () ORTHOPEDIC SUGERY PHYSICIAN S SURVEY There are orthopedic surgeons in Manitoba. All surveys were sent, of which 9 replied. BACKGROUND How many years have you been in practice? to years 6 to to 6 to to 6 to above Population Setting Winnipeg 9 Brandon Rural South North of Where are they predominantly practicing? Private practice with hospital 8 Private practice without hospital Community clinic Hospital -academic hospital -community hospital Teaching Other Gender Male 9 Female Marital Status Single Married 7 Divorced

5 Do you have children, if so how many? Yes 8 No child children children children children How much do you interact professionally with other physicians? (-on my own most of the time, - as a part of a team most of the time) Are you in a solo practice or group practice? Solo Group If in a group, how many doctors do you share a practice with? 7 Average Day How many patients do you see on an average per day? to 6 to to to to In the OR - per day In the office - per day How many hours per week do you work - not including call time? (I.e. including CME, clinical work, administration, teaching) 6 to to to to 6 6 to 8

6 What sort of schedule do you have in your work? (- irregular/unpredictable, -regular/predictable) Are you ever on remunerated call? Yes 8 No How many days are you on call? #days/month to 6 to to to How many hours per shift? #hours/shift to hours How much routine (similar work or diversity (different tasks, activities) do you have in your work? (-great deal of routine, - great deal of diversity) What type of intellectual approach to problem solving do you need to have to perform your work duties? (-specific problem approach, -theoretical)

7 Do you have a sharply defined area of expertise or general expertise? (-General expertise, - sharply defined expertise) How much do you need to use manual/mechanical activities for highly skilled tasks? I.e. doing procedures, performing operations (-never, - most of the time) Job Satisfaction Overall, how satisfied are you with your career? (- dissatisfied, - very satisfied) What is the most appealing aspect of your job? Technical challenge Good surgeon/ patient relationships Good interproffessional relationships Interacting with patients and their families Seeing improvement in lifestyle Great variety Very challenging clinical problems Rapidly changing technology (no grass growing here!!!) Surgery Fixing fractures, joints, doing arthroscopy High level of patient satisfaction after successful intervention OR time

8 What is the least appealing aspect of your job? Dissatisfaction with funding agencies for income and surgical program development Trying to get a hospital bed, and trying to get OR time Constant hassle due to shortage and interference politically from administration and other sources. Bed shortage and nursing shortage = unable to do the job best trained for Lack of resources, lack of resources, lack of resources FORMS Limited access to hospital facilities Paperwork Terrible hours Patient Characteristics Presenting complaints most often seen? pain shoulder pain deformity hip pain loss of functions hand pain amputations degenerative joint abnormalities joint and back problems knee pain soft tissue and bone injuries elbow pain arthritis fractures sport injury rheumatoid arthritis neck pain foot pain trauma back pain pain from fractures pain from arthritis Age group most often treated? 8 6 Infants Children Adults Elderly All groups General Health Status of Patient Population? 7 6 Gen. Healthy Chronically ill Terminally ill Acutely ill

9 Do you have short-term or long-term relationships with patients? (- short term, -long-term) How much time do you spend in direct contact with patients? (No time at all, Most of my time - ) How much opportunity to see end results do you have in your work? (- little opportunity, - great deal of opportunity) Financial What is your income bracket after taxes and overhead, etc? below, - 7, 7-, -, -, -, above

10 What income level do you feel you have in comparison to other specialties? (-lower, - higher) Are you satisfied with your income? very satisfied satisfied somewhat dissatisfied extremely dis Comments about income: Too many taxes to pay in Manitoba - GST + PST Income tax; gives me a headache just thinking about overtaxing Manitobans Fee schedule inequities are the biggest problem New recruits to the same specialty are assured income equivalent to TWICE my current income, financed by the recruitment fund to which I was FORCED to contribute! Do you feel your current income compensates your workload? Yes No 6 What is the Basis of your current income? Fee for service 8 Family Life/Free Time How much time does work allow for family/leisure activities? ( - Little free time, - Ample free time)

11 Are you satisfied with the amount of free time you have? Very satisfied Satisfied Somewhat Dissatisfied Extremely dis Do you have the ability to limit your workload should you need more free time? Yes No -At the expense of my income! Do you take vacations? Yes 8 No How much time for vacations annually? w eek w eeks w eeks w eeks weeks 6 w eeks 7 w eeks 8 w eeks How much time away from work for CME related conferences? - days - days -6 days 7- days - days + days Maximum amount of consecutive days away from work annually -7 days 8- days - days -8 days 9 + days unlimited

12 Personal What were your main reasons for choosing your specialty? Able to improve the quality of life after accidents: Tremendous challenges with satisfying results Better than anything else I've experienced Role models The power tools - it looked fun and it was Aptitude Newly developing surgical treatments Opportunity for research and development Sports inclined - I wanted to treat sports injuries Are your reasons for being in this specialty now different? Yes No If yes, what are your reasons now? Good income Low call duty Good family time Lots of vacation time The power tools are still fun - probably hard to find a more fun area of surgery than orthopedics (lots of toys) Sense of accomplishment when you to home after a total joint/ OR IF - you've built something What were the major factors that guided your decision to choose this specialty? Friend/family Clerk exp. Med.sch.exp Dr. example Type of pt. Lifestyle Residency Others a pamphlet - ortho looked fun and interesting MOST IMPORTANT Mentor Able to help people Type of patient Clinical experience Related to sports Would you choose the same specialty again? Yes 6 No If no, please indicate your reason(s) Hours much too long Patient expectations far too high

13 What specialty would you now choose and why? Ophthalmology, much greater chance to control work schedule What professional status (in comparison to others) do you feel you have? (- lower - higher) Do you feel your specialty is respected by colleagues in other specialties? Yes 6 No Do you feel your specialty is respected by the community at large? Yes 7 No Pressure How much pressure do you have in your work? What aspect of your job do you find the most stressful? Trauma service on call Lack of adequate operating time in HSC Patients have to wait too long Trying to get sufficient surgical time for fracture surgery without being constantly bumped. Decrease in call periods for trauma Repeated cancellations or shortages of beds and elective surgical time Decisions made by non-medical staff without consultation or medical reason w/c acutely change planned or ER surgery Trying to make sure we have the best and maximum access to available resources A hard operative case, or shattered intra-articular fracture to OR Pressures from patients and families to provide timely interventions in a system that maintains delays Have you ever considered taking a leave of absence due to stress? Yes No 6

14 Have you ever taken a leave of absence due to stress? Yes No 7 Gender Issues Do you feel discrimination in your job based on your gender? Yes No 8 What qualities do you think a student needs for this specialty or area of practice? Desire to be a surgeon Technical expertise Have a keen interest in trauma and orthopedics. Have a desire to help others within their specialty Willing to be available at all hours for surgery when on call Hard working Creative Enjoy solving complex problems Stamina to finish residency (You don t have to be smart in ortho - just keep showing up!) Enjoy working with your hands Aptitude for surgery D appreciation Physical strength and fitness Understanding of complex mechanical tools Needs to like fixing broken toys What advice would you have for a student considering this specialty or area of practice? Make time for study, research away from direct patient contact and secure funding for this If you have an interest and try hard and study; you are bound to succeed in the end Not a 9- specialty. Quite gratifying especially after treating patients with fractures Have a good look first before leaping Do some time in ortho and see if you like it Try working as a clerk with a busy orthopedic surgeon Do NOT hesitate Consider a different specialty Planning your future as a doctor in Manitoba

PHYSICAL MEDICINE & REHABILITATION

PHYSICAL MEDICINE & REHABILITATION () INTRODUCTION The consultant in Physical Medicine and Rehabilitation (or physiatrist) is a medical specialist expert in the comprehensive diagnosis, management and