Clinical Rotations

The 5 years of clinical residency consist of the PGY–1 orthopaedic surgical internship and the orthopaedic resident rotations PGY–2 through PGY–5:

The PGY-1 year consists of 12 one-month blocks, with six months of orthopaedic training and an additional one-month of basic orthopaedic education. Consistent with the ACGME’s intern-year requirements, the remaining months are rotations in non-orthopaedic fields including critical care neurosurgery, plastic surgery, physical medicine & rehabilitation, general surgery, and musculoskeletal radiology.

Years 2-5 are divided into 7-8 two-month blocks to maximize the clinical experiences and available elective time.

Basic Surgical Skills
All PGY-1 residents participate in the Basic Science Orthopaedic Course during the month of October. During this month, all interns are free of all clinical and call duty as they go back to medical school for a month. Seminars led by faculty, staff and residents focus on the diagnosis and examination of common musculoskeletal complaints. Additionally, radiology lectures, labs for the development of psychomotor skills and the principles of internal fixation - including splinting, casting and traction techniques, the use and care of hand and power instruments, and internal fixation methods are also explored and practiced.

Multiple cadaver labs and sawbones activities are offered during this month. Fresh frozen cadavers are provided for dissection led by attending faculty focusing on common surgical approaches. In addition, basic research skills such as clinical statistics and study design are presented by the basic science faculty of the department.

Chief Elective
Chief Residents are afforded the opportunity to design portions of their rotation tailored to their own educational interests as they round out their orthopaedic surgical training during this 2-month rotation.

Chief Residents are encouraged to pursue a 1-3 week elective away rotation in pursuit of research, volunteer, or additional clinical shadowing opportunities based on the resident’s interests either domestically or internationally.

Community Rotation/Ahuja General
Residents have the opportunity to experience community-style orthopaedics during their PGY-5 year As the remainder of our residency is spent rotating Level I Trauma centers and Tertiary referral centers, this rotation allows the resident to gain exposure to a community orthopaedics practice and gain insight to practice management. The Ahuja General rotation during the PGY-4 year takes a similar approach to the chief community rotation. It allows the PGY-4 resident the opportunity to experience a community orthopaedic practice by working with attending surgeons who have a more general orthopaedic practice.

Foot & Ankle
PGY-3 Orthopedic Residents spend a dedicated block participant in the care of patients with foot and ankle conditions in the clinic and operative room. Thanks to the diverse training of the faculty, residents learn how to manage a wide variety of foot and ankle pathology, including but not limited to sports injuries, degenerative conditions, and deformity correction.

Hand & Upper Extremity
UH: Residents participate in the care of the hand and upper extremity patient as both a PGY-2 and PGY-4 resident in a predominantly outpatient focus. This rotation mainly focuses on pathology of the hand, wrist, and forearm.
Metro: Residents participate in the care of hand and upper extremity surgery patient in the elective and trauma settings. The resident will rotate on service as a PGY-4. This rotation is a combination of outpatient hand and upper extremity pathology as well as upper extremity trauma that covers all injuries from the clavicle to fingers.

MetroHealth Ortho
As a PGY-3, you spend time at Metro focusing on arthroplasty, sports medicine, spine, and foot and ankle. The PGY 3 resident takes an active role in patient care and surgical planning for primary and revision hip and knee arthroplasty. This rotation is unique as it allows for a wide breadth of exposure and is open for the PGY 3 to tailor their experience to their interest.

MetroHealth Trauma
The Metro trauma rotation is during both PGY 2 and Chief year. As a PGY-2 , you focus on the foundations of orthopaedic trauma and the acute management of patients with orthopaedic injuries in the emergency department as well as operative and non-operative treatment in the OR and in clinic. As a chief, your role is to help run the trauma service at Metro and take an active role in teaching junior residents in the OR, on call, and in clinic. Chiefs on the Metro rotation also work with the Trauma Fellow to plan the weekly indications conference, a resident-run conference that take a practical approach to orthopaedic trauma education.

MSK Radiology
Residents participate in the interpretation of Musculoskeletal Imaging studies encountered during the rotation. The resident rotates with the Musculoskeletal Imaging service- as a PGY-1. This takes place primarily in the radiology reading room, but also offers the opportunity to accompany radiology faculty as they perform CT-guided biopsies in the procedure suite.

Oncology
Residents participate in the dedicated evaluation and care of the orthopaedic oncology patients. The resident receives this education as a PGY-4. During this rotation, residents have the opportunity to participate in the multidisciplinary hospital-wide tumor board meeting where they assist with coordination of patient care in the setting of musculoskeletal oncology, including both metastatic disease and primary bone and soft-tissue tumors.

Pediatrics
Residents participate extensively in the care of pediatric orthopaedic patients. This is a balanced educational experience in line with competency-based principles of pediatric orthopaedics including, but not limited to- scoliosis, limb deformity, congenital malformations, sports, and trauma. Residents have exposure to outpatient clinical evaluations, inpatient consultations, and inpatient nonoperative and operative care, as well as surgical cases and technical training. Residents also participate in the weekly pediatric indications conference where they review cases with faculty and discuss high yield topics of interest.

Plastic Surgery
Residents learn the principles of correction and reconstruction of congenital and acquired defects of the head, neck, trunk and extremities, and to manage acute, chronic, and neoplastic defects not requiring complex reconstruction.

PM&R
The Physical Medicine and Rehabilitation physician at MetroHealth Hospital will help the resident become familiar with clinically applicable principles of basic science, anatomy, pathology, and biomechanics, with an emphasis on the clinical care of patients with musculoskeletal disorders. The goal of this elective rotation is to provide exposure to a broad base of physiatric learning and to encourage critical thinking, such that learners can provide compassionate care at the forefront of medical knowledge.

Research
Residents participate in a dedicated 7 week research block. Enabling them tp prepare and complete research in preparation for fellowship applications. The resident will complete this rotation as a PGY-3.

Shoulder & Elbow
Residents participate in the care of the shoulder and elbow patients with 2 fellowship trained shoulder and elbow surgeons. The resident will complete this rotation on the service, as a PGY-4, participating in the management of complex patients and cases involving the shoulder and elbow.

Research
Residents participate in a dedicated 7-week research block. Enabling them tp prepare and complete research in preparation for fellowship applications. The resident will complete this rotation as a PGY-3

Shoulder
Residents will observe and participate in the care of the shoulder and elbow patients with two fellowship trained shoulder and elbow surgeons. The resident will complete this rotation on the service, as a PGY-4, participating in the management of complex patients and cases involving the shoulder and elbow.

SICU
On this PGY-1 rotation at MetroHealth, residents learn the principles associated with the diagnosis and management of critically ill patients, including simple and complex multiple organ system abnormalities, the pathophysiology of all types of shock, and the mechanisms and pathophysiology of cardiopulmonary arrest.

Spine
Orthopedic residents play an active role in all aspects of the evaluation and care of patients treated by the Orthopaedic Spine Division. Each resident builds and expands their knowledge of spine diseases and furthers their diagnostic, surgical, and peri-operative patient care skills during their rotation. Residents are expected to perform in a reliable, professional, and compassionate fashion.

Sports Medicine
Residents participate in the care of the sports medicine patient throughout residency. The resident completes three rotations on the sports service, as a PGY-1, PGY-3, and PGY-5. During their rotation, residents gain exposure to multiple sub-specialties of orthopaedic sports medicine including shoulder and elbow, hip, and knee, on which they develop both open and arthroscopic surgical techniques for the management of sports injuries.

Total Joint Replacement
Residents participate extensively in the care of the total joint patient. The resident completes three separate rotations on the total joint service, as a PGY-1, 2, and PGY-4. Residents have the opportunity to participate in clinic learning appropriate indications for total joint arthroplasty, as well as assist in the OR in a breath of total joint cases including both primary arthroplasty, learning multiple approaches to the hip, as well as complex revision cases.

Trauma
Residents spend two months each during their PGY-1, PGY-2, and PGY-3 years learning both operative and non-operative treatment options for orthopaedic trauma patients at UH. They spend extensive time on primary call as well as in the operating room gaining exposure to a variety of orthopaedic trauma pathologies and treatment options and growing significantly in their preoperative and intraoperative decision-making. As a PGY-5, residents spend another rotation as the trauma chief with a strong focus on operative management of orthopaedic injuries, as well as running daily fracture conference to take an active role in resident education.

VA
Residents participate in the care of the VAMC veterans with reconstructive, hand, and sports conditions. The resident will do two separate rotations of the VAMC service, as a PGY-3 and again as a PGY-5.

Call Schedule

At UH Cleveland Medical Center (Level 1 adult and pediatric trauma center), residents spend 2 months on night float as a PGY2, where they take call on weekday nights, Sunday to Thursday. Weekend call at UH Cleveland Medical Center is covered by the remaining PGY2s and PGY3s, with interns taking “buddy call” to prepare for very busy solo call nights as a PGY2. Residents rotating at MetroHealth Medical Center or Louis Stokes Cleveland VA Medical Center are not included in the UH call pool.

At UH Ahuja Medical Center

At MetroHealth Medical Center (Level 1 adult, Level 2 pediatric trauma center), residents take call as part of a rotating Q system. Residents are part of this call pool for 4 months as a PGY-2 and 2 months as a PGY-3. PGY-2s and PGY-3s take in house call. Interns also take buddy call with a PGY-2 or PGY-3 two Saturdays per month at MetroHealth while on the PM&R and SICU rotations.

At the Louis Stokes Cleveland VA Medical Center, all call is taken as home call by the on service PGY3s.

Senior Call at all institutions, our senior residents (PGY-4, PGY-5) take exclusively home call. At the VA, Metro, and Cleveland Medical Center, our PGY-4s and chiefs thus come into the hospital overnight/on the weekend only for surgical cases. In very rare instances, they may also come into the hospital when the junior resident requires help for a particularly difficult clinical scenario.