Work Rounds
The day starts as early as necessary to complete work rounds prior to conferences and the start of OR cases.
Work rounds at HJD are directed by the fellows, a senior resident, and a junior resident. At Tisch Hospital, the fellow and the junior resident are assigned to make rounds. Every patient on the Spine Service is to be seen every day; patients on the rehabilitation service are to be seen at least twice weekly. Routine patient care issues-wound care, pain control, and so forth-are managed by the fellow, according to the instructions of the Attending Physician.
Fellows have no evening in-house on-call assignments, but perform weekend rounds once a month. Fellows are on-call for emergencies on a rotating basis, one weekend a month.
Research Day
One day per week is reserved for research related activities: library time, laboratory research, chart or x-ray review, writing, and/or lecture preparation. While clinical activities are not prohibited, research activities should take precedence.
Administrative Chief Fellow
The fellow designated as administrative chief has the additional responsibility of coordination of the daily activities of spine fellows and spine rotation residents. This includes clinic coverage and operative case assignment. Conflicts over assignments will be resolved by the Program Director.
Clinical Responsibilities
Fellows function independently under the direct supervision of the Attending Orthopaedic Surgeon. In private practice offices, the fellow's responsibility is determined by the Attending. Fellows participate in preoperative evaluations with case presentation and specific plans of care.
At HJD I-Care, fellows are on-call for emergency general orthopaedic cases. At Tisch Hospital, fellows are on-call for emergency spine-related cases.
At both Tisch and HJD, patients are initially evaluated by the resident on-call, who then consults the fellow on-call. The Attending Physician is available for consultation, as necessary.
The administrative chief fellow assigns on-call schedule monthly. Weekend call is shared between two fellows.
Clinic Coverage
Fellows cover the clinic with the residents. Complex cases are discussed with the Attending during each clinic. Attending Physicians cover all clinics. Fellows' responsibilities for the patient include preoperative, operative, and postoperative care. Each clinic case is thoroughly discussed and planned with the Attending Physician. On HJD clinic days, fellows must also be available to supervise and advise residents who cover I-Care.
Operating Room
The weekly schedule for the Spine Service operative cases at both HJD and Tisch Hospital is reviewed on Friday for the upcoming week. OR assignments are made by the administrative chief fellow.
The day prior to surgery, fellows, like the residents on Service, discuss the cases on which they will be assisting the Attending Physician. Discussion includes the indication and the operative plan. If patients are admitted the day before surgery, they should be interviewed and examined by the fellow, if possible.
Attending Physicians allow the fellow to operate to their level of ability. Operative experience by the fellow is at the discretion of the Attending Physician. This typically is limited at the beginning of the fellowship and increases as experience and skill increase and the Attending Physician becomes more comfortable with the fellow's overall competence.
A fellow or resident should always be present for Service cases. When the Attending Physician determines that the fellow has achieved a sufficient level of competence on the Service, the fellow and the resident should perform Service cases (if coverage of other cases permits) under the direct supervision of the Attending.
Case Log
Fellows are required by the ACGME to maintain a log of operative procedures. The Program Director reviews the case logs monthly and at Fellows' semi-annual evaluations. The log is accessed through the ACGME website (www.acgme.org). Additional information can be obtained from the Residency Coordinator.
Supervisory Lines of Responsibility
Every patient, whether seen in an outpatient clinic, treated in ambulatory surgery, or admitted to the hospital, is assigned an Attending Physician. This physician, the Attending of Record, is ultimately responsible for all care provided to the patient. It is the responsibility of the fellow to ensure that the care plan developed for each patient is reviewed and approved by the Attending of Record. As well that any modification of the plan or significant change in patient status is reviewed by the Attending of Record.
In Immediate Care facility/outpatient emergency room (I-Care), patients are initially evaluated by the resident on-call, who then consults the fellow on-call. The Attending Physician is available for consultation to the resident or fellow, as necessary.
In the clinic, fellows cover with the residents. Each clinic case is thoroughly discussed and planned with the Attending Physician.
In the Operating Room, Attending Surgeons allow the fellow to operate to their level of ability. Operative experience by the fellow is at the discretion of the Attending Physician.
In private practice offices, the fellow's responsibility is determined by the Attending.
Participation in Medical School Anatomy Dissection
Fellows provide assistance for the 1st year medical students in their anatomy sessions. This program was initiated three years ago and has been very beneficial both for the students and the orthopaedic department. The students perform upper limb dissection during the last week of August and the first week in September. The lower limb dissection occurs at the end of October and concludes the beginning of November. Each fellow is assigned to a series of laboratory sessions. Each day consists of three separate laboratories with different groups of students. Each laboratory session is approximately 90 minutes in length. Fellows are present for all three laboratories.