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Resident rotations, on-call schedules, and duty hours are structured to be in full compliance with the institutional policies and ACGME requirements regarding limits on resident work hours.

PGY-1 Year Internship

PGY-1 residents spend time rotating through various surgical and primary care services at Carolina Medical Center, with six months dedicated to orthopedic surgery. The PGY-1 year focuses on learning the basics of patient care and developing relationships with other providers throughout the hospital.

Service rotations:

  • Orthopedic Trauma (three one-month blocks): Interns split time between the operating room, patient floor care, orthopedic consults and night float in preparation for transition to the PGY-2 year. 
  • Pediatric Orthopedics: (one month): Interns spend time working with the CMC pediatric orthopaedic surgery faculty, including Drs. Brighton, VanderHave and Scannell. The intern will split time between the operating room, the patient floor care and clinic duties.
  • Orthopedic Oncology (one month): Interns spend time working with Drs. Kneisl and Patt. Both attendings have a broad referral base of patients with both benign and malignant bone and soft tissue neoplasms. This rotation provides exposure to very complex patients and challenging surgical exposures. They split time between the operating room, patient floor care and clinic duties.
  • Orthopedic Hand Surgery (one month): Interns work with the OrthoCarolina Hand Surgery Department at CMC Main, the OrthoCarolina Hand Center, and various outpatient surgery centers. This rotation provides exposure to shoulder, elbow, and hand surgery including microscopic surgical techniques.  Interns split time between the operating room and outpatient clinic.
  • Trauma Surgery (one month): This rotation is overseen by traumatologist from the Division of Trauma and Critical Care in the General Surgery Department. Interns are vital team members from the initial ATLS protocol in the emergency department, where interns preform the primary survey, to patient work-up, including procedures, to patient discharge.
  • Trauma Surgery Intensive Care Unit (one month): The TICU rotation focuses on management of the most seriously injured patients in the hospital under the direction of the Trauma and Critical Care attendings. Residents preform procedures, and manage ventilators and intravascular monitoring, in addition to developing clinical judgment in caring for critically ill patients.
  • Pediatric Surgery (one month): Provides lessons in basic pediatric surgical care.
  • Vascular Surgery (one month): Interns are exposed to a wide variety of vascular diseases and injuries while on this rotation, from acute arterial transections in trauma patients to vascular bypass and AAA repair in patients with peripheral vascular disease.
  • Neurosurgery (one month): Physicians from the largest neurosurgical group in the Charlotte area direct this rotation and teach valuable lessons regarding care for brain injury patients, microsurgical technique and neurosurgical spine surgery perspectives.
  • Emergency medicine (one month): Interns spend approximately twenty 12-hour shifts in the ED during this month learning how the department functions and building relationships with residents and attendings who will be consulting them in the future for orthopedic patients.

Sample PGY-1 Rotation Schedule

July: General Surgery Trauma January: Surgical Trauma ICU
August: Ortho-Trauma February: Vascular Surgery
September: Ortho-Oncology March: Ortho-Trauma (2 weeks night float)
October: Emergency Medicine April: Pediatric General Surgery
November: Ortho-Pediatric May: Ortho-Hand
December: Ortho-Trauma (2 weeks nightfloat) June: Neurosurgery

PGY-2

The PGY-2 year is the first full year of clinical orthopedics. Residents rotate through the trauma, tumor, spine, sports, and foot and ankle services in 2 month blocks. Residents, as in each successive year, work one-on-one with a fellowship-trained attending during each rotation in the mentorship fashion of our training philosophy. Additionally, during the PGY-2 year residents begin taking junior call. During the first-two months, the upper level resident is in-house to teach and assist the junior resident. Once juniors gain sufficient experience, the upper levels begin taking home-call and coming in when extra assistance is needed for consults or cases going to the operating room. The junior call is night float based. Trauma residents cover from Sunday evening to Thursday with junior residents on other services covering Friday through Sunday. This averages to one weekend call responsibility per month and no weekday call for non-trauma residents.

Sample PGY-2 Rotation Schedule

July - August: Trauma January - February: Sports
September - October: Spine March - April: Trauma
November - December: Foot and Ankle May - June: Pediatric

PGY-3

This year continues in the same fashion as the PGY-2 year. Rotations for PGY-3 residents include trauma, adult reconstruction, tumor, and hand. Residents finish rotating through all orthopedic subspecialties by the years end, providing a useful experience for residents to make educated fellowship decisions. PGY-3 residents are also part of the junior call pool. This year also allows residents to participate in research activities which are presented at the end of the year Resident Research Day.

Sample PGY-3 Rotation Schedule

July - August; Hand January - February: Adult Reconstruction
September - October: Pediatric March - April: Oncology
November - December: Trauma May - June: Trauma

PGY-4

The PGY-4 year residents become upper levels and begin rotating through the various orthopedic subspecialties again with more independence and responsibility. Rotations include pediatrics, hand, sports, foot and ankle, spine and adult reconstruction all in two month blocks. Additionally, PGY-4 residents take home call on a rotating basis. Call is roughly one in every six nights for upper levels currently.

Sample PGY-4 Rotation Schedule

July - August: Pediatric January - February: Foot and Ankle
September - October: Hand March - April: Sports
November - December: Adult Reconstruction May - June: Spine

PGY-5

All PGY-5 residents are Chief Residents, and thus responsible for running the orthopedic services. Duties include teaching junior residents and medical students, and preparation of weekly sub-specialty clinical conferences. Additionally, during the trauma rotation, PGY-5 residents are acting administrative chiefs and schedule all other clinical conferences, vacations and monthly call schedules. Fifth year rotations include trauma, adult reconstruction, tumor, and sports.

Sample PGY-5 Rotation Schedule

July - August: Trauma January - February: Sports
September - October: Trauma March - April: Oncology
November - December: Adult Reconstruction May - June: Adult Reconstruction

Orthopedic Service Rotations

Adult Reconstruction

Residents rotate on the Adult Hip and Knee Reconstruction service as third, fourth and fifth-year residents. The residents’ time is split between mentorships with Dr. Masonis, Dr. Springer, Dr. Mason, and a variety of OrthoCarolina Hip and Knee attendings. The experience is rich and diverse as this serves as a top referral center for complex cases. Residents get ample exposure to primary and revision hip and knee arthroplasty, unicompartmental knee arthroplasty, direct anterior approaches to the hip, as well as joint preservation surgery such as arthroscopy and acetabular osteotomies. In addition to arthroplasty lectures and cadaver labs as part of the core curriculum, residents attend weekly OrthoCarolina case conferences where the most complex cases are discussed with the fellows and attendings. With the highest arthroplasty volume in the state, clinical research opportunities abound.

Foot and Ankle

During the foot and ankle rotation, the residents have an opportunity to work with nationally and internationally known surgeons Drs. Davis, Cohen, Jones, Irwin, Shawen and Ellington. Each has a hand in the education of residents and all are accomplished physician-scientists with an interest in product development as well as clinical research. All of the residents’ experience is based at Mercy Hospital at the OrthoCarolina Foot and Ankle Institute. Residents rotate through the foot and ankle service for two months during both the PGY-2 and PGY-4 years (total four months). This rotation is mentor-based and each resident is assigned to a single attending for a period of one month. During that month, residents work one-on-one with the attending and participate in their clinical and surgical practice. Residents are exposed to forefoot and flatfoot reconstruction, tendon transfers, various arthrodesis procedures, total ankle arthroplasty, sports/arthroscopy, as well as trauma and post-traumatic reconstruction. There are three foot and ankle fellows who are assigned to a different surgeon each month, but the schedule is created such that a resident and fellow are not assigned to the same attending physician, insuring resident mentorship and dedicated teaching.

Hand

The Orthopaedic Hand rotation is a part of the PGY1, PGY-3 and the PGY-4 curriculum. Based on the apprenticeship model, the majority of the resident's time is spent with Drs. Gaston, Chadderdon, Ward, Gantt, Loeffler, Lewis, Gart, and Garcia however, all OrthoCarolina hand attendings are receptive to working with residents and residents are encouraged to participate in any case they find interesting. Drs. Gart and Garcia are also trained in plastic surgery and perform a wide array of free tissue reconstruction procedures. Three hand fellows are chosen each year and traditionally have had close working relationships with the residents, especially regarding emergent cases that present on call. Residents can expect to participate in the management of a wide variety of patients and will experience a broad case-load that includes brachial plexus injuries, complex upper-extremity fractures, microsurgery, upper extremity amputees and congenital deformity. The majority of the operative cases that the resident will participate in are at local surgery centers, however residents also work with the OrthoCarolina attendings at CMC main ORs on cases that come in through the consult service or at CMC Main’s One-Day Surgery. 

Oncology

This rotation offers residents a significant opportunity to expand their orthopedic knowledge and operative skills. This rotation is focused around the busy and diverse practices of Dr. Jeffrey Kneisl and Dr. Joshua Patt. Both attendings have a broad referral base of patients with both benign and malignant bone and soft tissue neoplasms. This rotation provides exposure to very complex patients and challenging surgical exposures. It also allows the resident to interact and share patients with other services such as medical oncology, radiation oncology and MSK pathology and radiology. Additionally, this rotation provides time to focus on high quality research with significant faculty support. Dr. Kneisl is also the Chief Surgical Officer for Atrium health.  Dr. Patt serves as the Section Chief for Orthopaedic Oncology and is dual fellowship trained in Musculoskeletal Oncology and Orthopedic Spine Surgery, giving him expanded expertise and perspective. Drs. Kneisl and Patt are dedicated to resident education and provide invaluable experiences in a complex multi-disciplinary field.

Orthopedic Trauma

During this rotation, residents work with Drs. Hsu, Bosse, Phelps, Kempton, Sims and Karunakar. Trauma is a team-based service for junior level residents, while the chief on service is paired with an attending for one-month rotations in our typical mentorship fashion.  Being a Level I trauma center as well as a tertiary referral center with a large catchment area, including rural and urban settings, affords residents vast exposure to all types of orthopedic trauma, from low-energy ankle fractures to complex acetabulum fractures in critically ill patents. Dr. Hsu heads the limb deformity program which allows a unique training opportunity in spatial frame corrections amongst other surgical interventions. Residents on trauma work closely with other departments to coordinate patient care from presentation to discharge. Starting in the PGY-1 year, residents participate in operative cases, taking a lead role in cases appropriate to their level of training. Three trauma fellows are expected to be an educational resource for residents without impinging on the resident learning experience. At least one Friday AM conference is a hands-on training with sawbones models.  Additionally, cadaveric sessions spearheaded by Dr. Kempton are held to help fellows and residents familiarize themselves with approaches and various instruments/implants used in the OR. 

Pediatrics

The Pediatric Orthopedic service at Levine's Children's Hospital was once again named to the U.S. News report Top 50 list. Residents rotate with well-respected, fellowship-trained pediatric orthopedic surgeons for two-month blocks during the PGY2, PGY3, and PGY4 years. The rotation uses the preceptor model, and residents alternate months with Drs. Brighton, Scannell, Casey, Paloski, and Clark. Residents are involved in all phases of patient care from the clinic to the operating room and have exposure to patients from a referral network spanning North Carolina and South Carolina. The operative case logs involve everything from club foot reconstruction to congenital deformity correction to a wide spectrum of basic to the most complex forms of scoliosis.

Spine

Residents spend two months during both their second and fourth years on this service. You will work with Dr. Patt as well as Ortho Carolina faculty (Drs. Laxer, Darden, Milam, Segebarth, and Chapman). There are typically no more than two residents on spine, and as such, you will have significant autonomy and responsibility for the service and your own patients. Your time is split between clinic and operative cases. The operative experience ranges from basic cervical and lumbar discectomies to complex deformity procedures. The orthopaedic department shares spine call with Carolina Neurosurgery and Spine Associates, which will allow you to evaluate and care for a spectrum of traumatic spinal injuries. Time is spent one morning each week at the Myers Park spine clinic, which provides you the opportunity to refine your clinical skills and develop treatment plans with the oversight of the spine faculty. Additionally, the last Thursday afternoon of every month is reserved for cadaver labs where the attendings and fellows lead residents through anatomical approaches and hands on training with instrumentation.

Sports

During this rotation, done in the PGY 2, 3, & 5 year, residents work with Drs. Fleischli, Connor, Piasecki, Weeks, Hamid and with Dr. Moorman, our Chairman. The rotations are set up on the mentorship model with each resident being paired with one attending for a month at a time. Residents get hands on, one-on-one operative and clinic experience with their attending covering the gamut of sports medicine such as knee, shoulder & elbow arthroscopy, reconstructive surgery of the knee and shoulder, and shoulder arthroplasty among other types of pathology. Residents will have the opportunity to cover sports clinics at local colleges such as UNC-Charlotte and Davidson when rotating with certain attendings. They also have the opportunity to cover football games for local high schools. Occasionally residents will have the opportunity to work with players for the local NFL team as well. There are three sports medicine fellows each year as well, who also work one on one with their own attending on the mentorship model ensuring no resident-fellow conflicts.

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