R3s should be able to independently obtain the above details for patients with a complex medical history.

Transcription

1 Educatinal Gals & Objectives Musculskeletal cmplaints are extremely cmmn in the practice f primary care. They may reflect veruse r trauma, r be a manifestatin f a brad range f musculskeletal disrders r ther systemic diseases. The Office Orthpedics rtatin is a lngitudinal rtatin ver 3 years designed t expse the resident t cmmn musculskeletal cncerns in primary care, particularly in the geriatric ppulatin. The rtatin will prvide the resident with expsure t patients with musculskeletal disrders f autimmune, degenerative, r traumatic etilgy. The gal f the rtatin is t train the resident t becme cmpetent in the diagnsis and management f cmmn musculskeletal cnditins. Fcus will be n learning nrmal and abnrmal anatmy, the natural histry f musculskeletal disease (untreated, treated medically, and treated surgically), basic ffice prcedural skills, and the preventin, treatment and rehabilitatin f musculskeletal disease. Faculty will facilitate learning in the 6 cre cmpetencies as fllws: Patient Care and Prcedural Skills I. All residents must be able t prvide cmpassinate, culturally-sensitive, and apprpriate care fr patients with musculskeletal disrders. R2s shuld seek directed and apprpriate medical cnsultatin when necessary t further patient care. R3s shuld facilitate cmmunicatin seamless transitins f care between the patient s primary care physician and the cnsultant. II. Residents will demnstrate the ability t take a fcused histry and perfrm a systematic physical exam, with emphasis n the musculskeletal and neurlgic exams. R1s shuld be able t elicit the timing, intensity, and impact n functinal status f a patient s symptms. R1s shuld be able t btain the fllwing histrical details: Jint, muscular, and neurpathic symptms Systemic symptms, such as fatigue, fever, pr sleep, sweats, r weight lss Occupatinal histry, and histry f repetitive use Histry f antecedent events, such as trauma r injury Family r persnal histry f autimmune disease R2s shuld be able t differentiate inflammatry frm mechanical jint pain and recgnize the cntributin f cmrbidities and medicatin cmpliance t a patient s symptms. R3s shuld be able t independently btain the abve details fr patients with a cmplex medical histry. III. Residents shuld be able t characterize the fllwing physical findings: R1s Abnrmal psture r gait Baker s cyst

2 Dislcatin Ft drp Fracture Jint abnrmalities, including Buchard and Heberden s ndes, crepitus, instability, effusin, range f mtin, subluxatin, and ulnar deviatin Kyphsis Muscle atrphy Nail pitting Tendn abnrmalities Tphi R2s shuld als be familiar with muscle actin and innervatin as reflected n physical exam, as well as physical maneuvers t evaluate fr Hip muscle flexibility and gluteus medius weakness Ligamentus and meniscal injuries Limitatins in jint range f mtin and flexibility Patellfemral prblems Leg length discrepancy, sciatica, SI jint pathlgy, and spndylsis AC jint pathlgy, biceps tenditinits, labral tear, shulder jint instability, and subacrmial impingement R3s shuld be able t independently perfrm a cmplete exam and understand the sensitivity and specificity f physical findings IV. Residents will understand the indicatins, cntraindicatins, cmplicatins, limitatins, and interpretatin f fllwing prcedures, and becme cmpetent in the their safe and effective use: R1s: Knee and shulder injectins, cmmn injectins fr bursitis and tendinpathy, apprpriate applicatin f splints Medical Knwledge R2s: ther jint arthrcentesis and injectin (ptinal) R3s: indicatins and cnsent fr perative interventins in the setting f failed medical therapy I. R1s will develp an apprach t the evaluatin and treatment f the fllwing presenting cnditins: Back r neck pain, acute and chrnic Jint erythema, pain, swelling, r stiffness Muscle weakness, pain r swelling Musculskeletal trauma, fractures and dislcatins Overuse syndrmes R1s will explre the basic pathphysilgy, clinical presentatin, and treatment f mre cmmn cnditins, such as back pain, Baker s cyst, bursitis, carpal tunnel

3 syndrme, ganglin cyst, hallux valgus, labral and meniscal tears, plantar fasciitis, Mrtn s neurma, stearthritis, steprsis and vertebral cmpressin fracture, rtatr cuff tear, sclisis, tendnitis, and trigger finger. R2s will als develp a mre cmplete understanding f the pathphysilgy, clinical presentatin, and therapy fr the fllwing cnditins: Adhesive capsulitis Avascular necrsis Greater trchanteric pain syndrme Myfascial strain Nerve injuries Radiculpathy Sacriliac dysfunctin Spinal stensis Spndylarthrpathies Tendinsis, and tendn rupture R3s will als recgnize musculskeletal manifestatins f systemic diseases, such as diabetes (Charct jint), gut, hemchrmatsis, psriatic arthritis, and rheumatid arthritis be familiar with the preventin f and attentin t cmmn injuries in geriatric patients and weekend warrirs. II. III. Residents will understand the fllwing principles f management and therapy fr musculskeletal disease: Natural histry f acute and chrnic musculskeletal prblems and the expected curse with and withut therapy Use f braces, casts, splints, rthtics, and elasticized bandage and taping Use f prsthetics, assist devices, and durable medical equipment fr temprary r chrnic disability Risks and benefits f medical/cnservative therapies as well as alternative and cmplementary therapies All residents will be able t understand the indicatins fr rdering and the interpretatin f the fllwing labratry values and prcedures: Analysis f synvial fluids Imaging with plain films, CT, and MRI Sedimentatin rate and c-reactive prtein Uric acid R3s will independently, apprpriately rder studies and be able t interpret results within the cntext f patient cmrbidities, pretest prbability f disease, and patient values. IV. Residents shuld understand and be able t cunsel patients n

4 Fall risk activity and exercise in the setting f musculskeletal limitatins preventin f musculskeletal injury and re-injury Residents shuld als be able t apprpriately use physical and ccupatinal therapy and refer fr rehabilitatin. Practice-Based Learning and Imprvement I. All residents shuld be able t access current natinal guidelines (e.g. American Academy f Orthpaedic Surgens Research & Quality, Clinical Practice Guidelines t apply evidence-based strategies t patient care. II. R2s shuld develp skills in evaluating new studies in published literature, thrugh Jurnal Club and independent study. III. All residents shuld participate in case-based decisin-making and treatment planning, invlving the rthpaedic surgen, primary care prvider, rheumatlgist if apprpriate; and physical and ccupatinal therapists, and R3s shuld take a leadership rle. IV. All residents shuld respnd with psitive changes t feedback frm members f the health care team. V. Residents shuld understand when t refer t rthpaedic surgery clinic frm their wn practice and what t rder prir t referral. Interpersnal and Cmmunicatin Skills I. R1s must demnstrate rganized and articulate electrnic and verbal cmmunicatin skills that build rapprt with patients and families, cnvey infrmatin t ther health care prfessinals, and prvide timely dcumentatin in the chart. II. R2s must als develp interpersnal skills that facilitate cllabratin with patients, their families, and ther health prfessinals. III. R3s shuld demnstrate leadership skills t build cnsensus and crdinate a multidisciplinary apprach t patient care. Prfessinalism I. All residents must demnstrate a cmmitment t carrying ut prfessinal respnsibilities. II. R1s shuld be able t educate patients in a manner respectful f gender, cultural, religius, ecnmic, and educatinal differences n chices regarding their care. III. R2s shuld be able t use time efficiently in the clinic t see patients and chart infrmatin. IV. R3s shuld be able t cunsel patients and families bth n diagnstic and treatment decisins.

5 Systems-Based Practice I. R1s must have a basic understanding that their diagnstic and treatment decisins invlve cst and risk and affect quality f care. II. R2s must als demnstrate an awareness f alternative therapies and their csts, risks, and benefits. III. R3s must be able t identify current quality issues in rthpedic surgery where the primary care physician may be invlved in patient cunseling and/r subsequent care, such as pursuit f surgical treatment, use f vertebrplasty, and use f supplements fr stearthritis. Teaching Methds I. Supervised patient care in clinic. Residents will initially be directly bserved with patients t facilitate the acquisitin f excellent histry taking and physical exam skills. As residents becme mre prficient, they will interact independently with patients and present cases t faculty. Initial emphasis will be n diagnsis and basic management. When residents have mastered these skills, fcus will be n medical decisin-making and ffice prcedural skills, and residents will wrk with supervising physicians t finalize a care plan. II. Cnferences Daily nn cnference III. Independent study Jurnal and Textbk reading TBD by attending Online educatinal resurces American Academy f Orthpedic Surgens Agency fr Healthcare Research and Quality Lieberman s Learning Lab Musculskeletal System Up t Date Clinical Key Evaluatin I. Verbal mid-rtatin individual feedback II. 360 Evaluatin III. Attending written evaluatin f resident at the end f the mnth based n rtatin bservatins and chart review. Rtatin Structure

6 I. Residents will be scheduled in the resident clinic fr a full day each week when n elective r n radilgy. Residents will be invlved in discussin f patient presentatin, differential diagnsis, decisin fr r against surgical interventin, and patient fllw up. When pssible, residents shuld fllw the same patients in clinic during the rtatin. Case-based learning is mst effective. Nightly reading/study shuld be based n patients seen during the day. Residents may be asked t d fcused literature searches r presentatins When ding utpatient cnsults, the resident shuld understand the questin asked and prvide a cncise answer. II. Hurs wrked must be cnsistent with ACGME requirements and are subject t apprval by the Prgram Directr. III. Residents have nn cnferences and shuld be excused in a timely fashin t attend.