INTRODUCTION TO MUSCULOSKELETAL CARE
ORT 808
Course Department, Number & Title: ORT 808, Introduction to Musculoskeletal Care
Course credit or length: 2-4 Weeks
Course director and contact information (office phone and e-mail):
Dr. Felix Cheung; 304.691.1262,
Course coordinator and contact information (office phone and e-mail):
Ashley Taliaferro, 304.691.1149; , Department of Orthopaedics
Course location: Cabell Huntington Hospital, and the Marshall University Medical Cent er.
Brief Course Description: A 4th year elective in non-operative musculoskeletal care is offered, providing experience in multidisciplinary management of diseases of the musculoskeletal system. Rotations may include inpatient medical management of orthopaedic patients, non-operative sports medicine, general clinical orthopaedics, rheumatology, osteoporosis, and physical therapy. This course is Pass / Fail. There is no Call requirement. Evaluation is based on a LogBook of patients evaluated by the student. Visiting Medical Students are allowed enrollment, but preference will be given to Marshall students. For those looking for a subinternship experience, please consider ORT 807. For those looking to fulfill the General Surgery Elective requirement, please consider SUR 744, Orthopaedic Surgery.
Goals: The student will be introduced to office and hospital management of diseases of the musculoskeletal system. The goals of the course are: 1. Introduction to outpatient management of musculoskeletal problems. 2. Development of outpatient clinical skills, including outpatient procedures. 3. Development of a solid knowledge base of musculoskeletal conditions. 4. Introduction to inpatient medical management of orthopaedic surgical patients.
Institutional Objective
Patient Care - Students must demonstrate the ability to provide patient care that is compassionate, appropriate, and effective for the treatment of health problems and the promotion of health.
Course Objective
The student will provide care that is compassionate, appropriate, and effective for the following:
1. Development of procedural skills, including but not limited to casting techniques, reductions, suturing, bracing, taping.
2. Development of outpatient clinical skills, including but not limited to performance of a thorough musculoskeletal history and physical, diagnosis of musculoskeletal problems, medical clearance, joint specific musculoskeletal exams, interpretation of medical images, and injections of joints.
3. Development of inpatient clinical skills, including but not limited to post-surgical management of orthopaedic patients, and communications with ancillary staff and other services.
Outcome Measure
Faculty members and residents will observe and evaluate the student’s ability to: 1) assist in the care of inpatients assigned by faculty, including postoperative care, 2) provide care of outpatients assigned by faculty, including initial visits, treatment plan formation, and postoperative visits; and 3) participate in assigned conferences by the faculty of the Department of Orthopaedic Surgery. The student will keep a LogBook of patients that were seen and discussed with the attending, including be examining and evaluating the patients, offering differential diagnosis, management plans, and interpretation of laboratory results and imagining studies. This LogBook must be signed off by the attending for each encounter. It must include a minimum of 5 patients per week on the rotation.
Institutional Objective
Medical Knowledge- Students must demonstrate knowledge of established and evolving biomedical, clinical, epidemiological and social-behavioral sciences, as well as the application of this knowledge to patient care.
Course Objective
The student will develop a solid knowledge base of musculoskeletal problems including the evaluation and workup for a trauma patient, issues involved with total joint replacements, evaluation of sports injuries, inflammatory arthritis, and other common musculoskeletal problems.
Outcome Measure
The student’s solid knowledge base of musculoskeletal problems will be evaluated by the faculty through the LogBook.
Institutional Objective
Practice-based Learning and Improvement - Students must demonstrate the ability to investigate and evaluate their care of patients, to appraise and assimilate scientific evidence, and to continuously improve patient care based on constant self-evaluation and life-long learning.
Course Objectives
At the end of this course, students will be able to:
1. Identify areas for personal and practice improvement and implement strategies to enhance knowledge, skills, attitudes, and process of care.
2. Use information technology to manage information, access online medical information, and support own education.
3. Facilitate the learning of students and other health care professionals.
Outcome Measures
The faculty and residents will observe and evaluate the student’s ability to read and access current medical literature electronically to gain information about specific patient conditions encountered in the care of patients. The student’s will also be observed and evaluated on participation in the education of others, including patients, medical students and health care professionals. This will be documented in the LogBook.
Institutional Objective
Interpersonal and Communication Skills- Students must demonstrate interpersonal and communication skills that result in the effective exchange of information and collaboration with patients, their families, and health professionals.
Course Objective
At the end of this course, students will be able to:
1. Demonstrate interpersonal and communication skills that assist in effective information exchange and be able to team with patients, patients’ families, and professional associates.
2. Elicit and provide information using effective listening, non-verbal, explanatory, questioning, and writing skills.
3. Maintain comprehensive, timely, and legible medical records.
Outcome Measure
Faculty and residents will directly observe the students:
1. Communicating patient information to assist in the transition of care to and from the orthopaedic on-call teams.
2. Communicating patient information to faculty.
3. Documenting patient information in the form of history and physical examinations, progress notes, operative notes, discharge summaries, and other documentation as assigned.
4. Obtaining patient histories in the ambulatory and inpatient setting
5. Communicating findings and plans of care with patients and families.
The student’s performance will be documented in the LogBook.
Institutional Objective
Professionalism- Students must demonstrate a commitment to carrying out professional responsibilities and an adherence to ethical principles.
Course Objective
Students will demonstrate professionalism by:
1. Maintaining confidentiality of patient information.
2. Demonstrating punctuality in completing assignments.
3. Maintaining positive attitude and good work ethic.
4. Demonstrating respect, compassion, integrity, and responsiveness to the needs of patients.
5. Promptly responding to the needs of nursing and support staff.
Outcome Measure
The faculty and residents of the Department of Orthopaedic Surgery will evaluate the student’s abilities of the above professionalism standards and Institutional Objective using the LogBook.
Systems-based Practice - Students must demonstrate an awareness of and responsiveness to the larger context and system of health care, as well as the ability to call effectively on other resources in the system to provide optimal health care.
Course Objective
Students will demonstrate to the faculty a:
1. Basic understanding of methods to practice cost-effective health care and resource allocation that do not compromise quality of care.
2. Basic ability to demonstrate knowledge that patient safety is always the first concern of the physician.
3. Basic ability to describe how types of medical practice and delivery systems differ from one another.
4. Basic understanding of the coordination of long term care with social services, physical therapy, families, and other concerned parties.
5. Basic understanding of the principles of patient safety in a hospitalized setting.
6. Basic understanding of the universal precautions and how health care workers may decrease the risk of acquiring blood borne illness.
7. Basic understanding of the billing system in the United States, including the use of CPT, ICD9, and RVUs.
Outcome Measure
The faculty and residents of the Department of Orthopaedic Surgery will evaluate the student’s ability to justify the rationale for laboratory or imaging studies ordered during rotation and ability to help coordinate the care of the patient with ancillary services. The student’s performance will be documented in the LogBook.
Basic Science Objectives
The student will demonstrate understanding of the basic principles of orthopaedic surgery including:
· Molecular and Cell Biology in Orthopaedics
· Genetic Basis of Disorders with Orthopaedic Manifestations
· Biomechanics
· Biomaterials
· Evidence-Based Orthopaedics
The student will demonstrate understanding of the physiology of musculoskeletal tissues including:
· Thromboembolism
· Growth and Development of the Skeleton
· Form and Function of Bone
· Articular Cartilage and Osteoarthritis
· Form and Function of the Meniscus
· Form and Function of Tendon and Ligaments
· Form and Function of Skeletal Muscle
· Form and Function of Peripheral Nerves and Spinal Cord
· Form and Function of the Intervertebral Disk
· Kinesiology
The student will demonstrate understanding of the basic principles and treatment of musculoskeletal disease, including:
· Infections in Orthopaedics
· Orthopaedic Pharmacology and Therapeutics
· Bone Injury and Repair
· Articular Cartilage Repair
· The Biologic Response to Orthopaedic Implants
· Molecular Basis of Cancer
· Osteoarthritis and Rheumatoid Arthritis
· Metabolic Bone Disease
· Neuromuscular Diseases
Process
Reference Orthopaedic Basic Science, 3rd Edition 2007 textbook
Attend and take notes on all morning didactics
Attend and take notes on all Orthopaedic Grand Rounds
Participation on clinical rounds, outpatient clinics and surgeries
Independent reading on patient care
Outcome Measure for all Basic Science Objectives
Evaluation by faculty and residents of the Department of Orthopaedic Surgery at completion of rotation.
Orthopaedic examination at end of rotation.
Self-Directed Learning
As a medical student, you are encouraged to use any unstructured time as a time to read about your patients, research questions that arise during the day, prepare for case conferences, and prepare for student-faculty rounds. Preceptors have been specifically asked to look for evidence that you have read articles and books between clinic sessions. Use this time to build your knowledge of medicine and learn from your patients.
Additional Responsibilities of The Student
1. The student will contact the Orthopaedic Course Director 1 week prior to arrival for assignments.
2. The student will act and dress in a professional manner in compliance with the requirements and customs of his or her attending.
3. The student will be an active participant in all aspects of patient care and didactic sessions.
ASSESSMENT METHODS
Mid Point Evaluation
In accordance with LCME standard ED-30, the Course Director will evaluate student performance at mid-point to review the student’s professional, clinical and academic performance up to that point. The formative evaluation must be reviewed with the student and the student will have an opportunity to discuss with the Course Director. The form must be signed by the student and returned to the Course Director. The Course Director shall then forward a copy of the form to the Office of Academic Affairs. The form will NOT however be included in the student’s official academic record. For two week electives, oral feedback will be provided at the end of the first week.
LogBook
Selected patients that are seen and evaluated by the student and reviewed with the attending will be placed in the LogBook. The attending must sign off on every patient in the LogBook. There must be a minimum of 5 patients per week of rotation in the LogBook to achieve a passing grade.
Grading Policy
This course is pass/fail. The number of cases in the log book is equal to 5 per week of the elective. Failure to turn in the logbook with adequate cases within one week of the completion of the elective will result in failure.
MUJCESOM Policies: All medical students taking this course will comply with School of Medicine policies given at http://musom.marshall.edu/students/policies. Individual policies can be found at the following websites:
Student Infectious Material Exposure:
http://musom.marshall.edu/ups/postexposure.asp
MS-IV Attendance:
https://musom.marshall.edu/students/documents/policies/Yr4attendence.pdf
Academic Dishonesty Policy:
https://musom.marshall.edu/students/documents/policies/Standards-of-Professionalism-and-Honor-Code.pdf
Academic Standards Policy:
https://musom.marshall.edu/students/documents/Policies/ASC-FINAL-POLICY.pdf
Policy for Students with Disabilities:
https://musom.marshall.edu/students/documents/Guidelines.pdf
University Computing Services’ Acceptable Use Policy:
http://www.marshall.edu/ucs/CS/accptuse.asp
Affirmative Action Policy:
pp. 16-17
http://www.marshall.edu/catalog/Graduate/S2008/gr_sp08.pdf
Inclement Weather Policy:
https://musom.marshall.edu/students/documents/policies/MUSOM-Inclement-Weather-Policy.pdf
Notification of delays and cancellations of classes are posted on the Medical Education Home Page when Marshall University Main Campus is not in session
https://musom.marshall.edu/weather
LogBook Sample
Patient Initials: _________ Age: ________ Diagnosis:_______________________________
Did the student pass the institutional objectives of:
Patient Care Y N
Medical Knowledge Y N
Practice Based Learning Y N
Interpersonal Communication Y N
Systems Based Practice Y N
Professionalism Y N
Comments:______________________________________________ Initials __________________
Required References: Essentials of Musculoskeletal Care 3rd Ed (provided).