Patient Care Competency
The Fellow must be able to provide patient care that is compassionate, appropriate, patient-centered and effective for the diagnosis and treatment of orthopedic pathology, degenerative arthritis and the promotion of health.
Objectives
The Fellow is expected to:
- Demonstrate caring and respectful behaviors (verbal and non-verbal) with patients and families.
- Elicit complete patient medical history information using effective questioning and listening skills.
- Perform a comprehensive orthopedic evaluation and physical exam for degenerative, inflammatory, and post traumatic arthritis and deformities, with special attention to pain, rangeof-motion, instability, and function.
- Formulate a medical and surgical problem list delineating goals to be achieved, and complications to be avoided when reconstructive surgery is performed.
- Learn to prevent intra-operative technical complications during hip and knee arthroplasty.
- Make an early diagnosis and provide prompt treatment of acute post-operative complications, including hypotension, nerve palsy, DVT, PE, wound dehiscence and infection.
- Integrate the clinical presentation of hip and knee pain with imaging data to make decisions regarding operative care.
- Assess post-operative progress of arthroplasty patients.
- Follow developed care pathways.
- Counsel patients and families and caregivers about the plan of care.
- Be a vital part of the inpatient team under the supervision of attending faculty.
- Identify and provide post-arthroplasty precautions and goals for therapists.
- Diagnose and treat hip implant dislocations in the emergency department, when appropriate, under faculty supervision.
- Utilize treatment algorithms for the work up and treatment of the infected arthroplasty.
- Be capable of independently performing primary hip and knee arthroplasty.
- Plan and perform revision total hip and knee arthroplasty under supervision.
Medical Knowledge Competency
The Fellow 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.
Objectives:
The Fellow is expected to be able to:
- Understand and use the classification systems for periprosthetic fractures and bone loss in hip and knee arthroplasty.
- Discuss and understand the biomechanics of hip and knee arthroplasty.
- Know and describe the surgical steps and relevant anatomy during the anterior and posterior approaches to the hip.
- Know and describe various approaches for total knee arthroplasty (quad split, subvastus, vastus split, rectus snip, etc).
- Know and understand implant options for hip and knee arthroplasty, based on anatomical and patient characteristics.
- Know and understand evaluation of patients with failed arthroplasty and post-traumatic arthritis.
- Promptly identify common post-arthroplasty complications and discuss their prevention.
- Know and be able to cite outcome studies, and factors that predispose to complications for hip and knee arthroplasty.
- Know appropriate study design for the evaluation of an arthroplasty technique or specific implant.
- Differentiate patients who are best treated by non-operative means
Practice- Based Learning and Improvement Competency
The Fellow 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 lifelong learning.
Objectives:
The Fellow is expected to develop skills and habits to be able to:
- Evaluate one’s own knowledge, incorporating feedback from others, especially faculty and chief resident(s).
- Modify self-directed learning appropriately.
- Appraise and assimilate evidence from scientific studies to enhance patient care, especially as it relates to hip and knee arthroplasty and reconstructive diagnoses and treatments
- Effectively use information technology to access and manage patient information.
- Effectively use information technology and other resources to support one’s own ongoing self- education (Arthroplasty DVDs, CDs, Vumedi, etc.).
- Contribute to discussions concerning patient care with other health care professionals, attendings, and consultants.
- Attend and participate in teaching conferences and rounds.
Systems Based Practice Competency
The Fellow must demonstrate an awareness of and responsiveness to the larger context and system of health care, as well as be able to effectively call on other resources in the system to provide optimal health care.
Objectives
The Fellow expected to:
- Collaborate with and maintain appropriate professional attitudes and behaviors toward other medical professionals and allied health personnel.
- Assess how one’s own actions affect others, especially in the arthroplasty service setting.
- Integrate the care of arthroplasty patients in inpatient settings. Use clinical pathways.
- Use diagnostic and therapeutic procedures appropriately and judiciously.
- Carefully and thoughtfully evaluate the risks, benefits, limitations, and costs of patient care.
- Provide data for M&M conferences to positively affect patient care.
- Participate in clinical pathways designed to improve patient outcomes.
- Serve as patient advocates in dealing with system complexities.
- Serve as patient advocates for quality patient care.
- Work effectively with other services, health care agencies, and case managers.
- Work to improve the system of medical care at all service locations.
- Provide information on systems issues that may improve patient care (this performed at department meetings).
- Learn about different health care delivery models (ACO, bundled payment system).
Professionalism Competency
The Fellow must demonstrate commitment to carrying out professional responsibilities and an adherence to ethical principles.
Objectives
The Fellow is expected to:
- Exemplify and display an observable respect and compassion toward patients.
- Exemplify reliability, punctuality, integrity, and honesty.
- Accept responsibility for one’s own actions and decisions.
- Apply sound ethical principles in medical practice, including issues of patient confidentiality, informed consent, provision for the withholding of care, and interactions with insurance companies and disability agencies.
- Consider the effects of personal, social, and cultural factors in the disease process and patient management.
- Demonstrate non-judgmental sensitivity and responsiveness to the age, culture, disability status, and gender of patients and colleagues.
Interpersonal and Communication Skills Competency
The Fellow must demonstrate interpersonal and communication skills that result in the effective exchange of information and teaming with patients, their families, and professional associates.
Objectives
The Fellow is expected to:
- Establish trust and maintain rapport with patients and families.
- Complete dictations and chart notes in a timely manner (monitored by medical records department and rotation coordinator).
- Discuss diagnoses, prognoses, and treatment options clearly and accurately to patients.
- Synthesize information and present clinical and diagnostic information clearly to colleagues.
- Utilize effective listening skills.
- Communicate and interact with staff/team in respectful, responsive manner.
- Promote teamwork, and coordinate the work up and treatment of patients on the arthroplasty service
