Clinical Rotation Structure

Resident rotations, on-call schedules and duty hours are structured to be in full compliance with Atrium Health's institutional policies and ACGME requirements.

PGY-1 Year Internship

PGY-1 residents rotate through various surgical services and emergency medicine at Carolina Medical Center. Seven months are dedicated to orthopaedic surgery including a full month of surgical simulation in August. The PGY-1 year focuses on learning the basics of patient care and developing relationships throughout the hospital.

Service rotations:

• Surgical Simulation (one month): Interns meet daily with attendings from every orthopaedic subspecialty for small group discussions and cadaveric dissections to learn basics of orthopaedic anatomy, imaging, treatment principles and application of surgical and nonsurgical techniques. Other sessions are focused on becoming a good resident, surgeon, researcher and leader.
• Orthopaedic Trauma (three one-month blocks): Interns split time between the operating room, patient floor care, orthopaedic consults and night float in preparation for transition to the PGY-2 year.
• Pediatric Orthopaedics: (one month): Interns work with the OrthoCarolina pediatric orthopaedic surgery faculty, splitting time between the operating room, inpatient care and the outpatient clinic.
• Orthopaedic Oncology (one month): Interns work with 3 musculoskeletal oncologists who 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.
• Orthopaedic Hand Surgery (one month): Interns work with the OrthoCarolina Hand Surgery Faculty at Carolinas Medical Center, the OrthoCarolina Hand Center and various outpatient surgery centers. This rotation provides exposure to shoulder, elbow and hand surgery, including microscopic surgical techniques and treatment of brachial plexus. Additionally, interns are exposed to other neurological injuries, including procedures like targeted muscle reinnervation (TMR). Interns split time between the operating room and outpatient clinic.
• Trauma Surgery (one month): This rotation is overseen by trauma surgeons 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 through patient work-up and surgical treatment to patient discharge from the hospital.
• 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 perform common ICU procedures and are taught ventilator management and intravascular monitoring. This rotation emphasizes the importance of clinical judgment in caring for critically ill patients.
• Vascular Surgery (one month): Interns are exposed to a wide variety of vascular diseases and injuries while on this rotation from arterial transections in trauma patients to vascular bypass and AAA repair in patients with peripheral vascular disease. Additionally, interns gain initial exposure to various lower extremity amputations.
• Neurosurgery (one month): Interns work with neurosurgeons from Carolina Neurosurgery and Spine Associates (CNSA), which is part of the Atrium Musculoskeletal Institute. Much of this rotation is focused on principles and practice of spine surgery, and residents are also exposed to intracranial pathology and microsurgical technique.
• Emergency medicine (one month): Interns spend approximately twenty 12-hour shifts in the ED treating patients, learning how the department functions and building relationships with residents and attendings who will be consulting them in the future for orthopaedic patients.
  

Sample PGY-1 Rotation Schedule

PGY-2

The PGY-2 year is the first full year of clinical orthopaedics. Residents rotate through the trauma/night float, spine, pediatrics, sports and foot and ankle services in 2-month blocks. Residents are assigned to subspecialty fellowship-trained attendings during each rotation in the mentorship fashion of our training philosophy. Additionally, residents begin taking junior call. Early in the academic year, 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. Junior call is night float-based. The night float resident covers nights from Sunday through Thursday with junior residents on other services covering Friday and Saturday. For residents not on the trauma service, this averages to one weekend call responsibility per month and no weekday call.

Sample PGY-2 Rotation Schedule

PGY-3

This year is set up in a similar fashion as the PGY-2 year. Rotations for PGY-3 residents include trauma, adult reconstruction, oncology, pediatrics and hand. At the end of this year, residents will have rotated through all orthopaedic subspecialties and have sufficient experience to make educated decisions regarding fellowship applications. PGY-3 residents are also part of the junior call pool as described above. Early residency research activities culminate in a presentation at the end-of-year Resident Research Day.

Sample PGY-3 Rotation Schedule

PGY-4

The PGY-4 residents are considered senior residents and begin rotating through the various orthopaedic subspecialties again with more independence and responsibility. Rotations this year include 2-month blocks of various subspecialties such as pediatrics, hand, sports medicine, foot and ankle, spine, adult reconstruction and a general orthopaedic elective. Rotations may vary based on clinical interests to maximize learning opportunities. Additionally, PGY-4 residents take home call on a rotating basis. Senior call is frequency is approximately one out of every ten nights.

Sample PGY-4 Rotation Schedule

PGY-5

All PGY-5 residents are Chief Residents and run the orthopaedic services on which they rotate. Duties include teaching junior residents and medical students and at times may assist in organization of weekly sub-specialty clinical conferences. Additionally, during the trauma rotation, PGY-5 residents are acting administrative chiefs and oversee resident day-to-day schedules. Fifth year rotations will vary based on clinical interests and what is needed to meet ABOS (American Board of Orthopaedic Surgery) requirements. Our primary goal with PGY-5 rotations is to better prepare each resident for their career endeavors. Additional rotations, including a local general orthopaedic rotation and an opportunity to work at Fort Bragg (Womack Army Medical Center) for a month, are available for interested chief residents.

Sample PGY-5 Rotation Schedule

Orthopaedic Service Rotations

Adult Reconstruction

Residents rotate on the Adult Hip and Knee Reconstruction service as third, fourth, and fifth-year residents. Consistent with the mentorship model, residents are assigned in 1-month blocks to one of many OrthoCarolina Hip and Knee attendings. Dr. John Masonis is the subspecialty chief for this rotation. The experience is rich and diverse as the Hip and Knee Center is a major 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, and 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, residents have an opportunity to work with nationally and internationally known surgeons including the subspecialty chief of this service, Dr. Scott Shawen. 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. Residents’ experiences are based at CMC 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 an attending for a month, working one-on-one with the assigned attending in their clinical and surgical practice. Residents are exposed to forefoot and flatfoot reconstruction, tendon transfers, various arthrodesis procedures, total ankle arthroplasty, arthroscopy, trauma and post-traumatic reconstruction.

Hand

The Orthopaedic Hand rotation is a part of the PGY-1, PGY-3 and PGY-4 curricula. Dr. Gaston is the subspecialty chief of this service. Based on the mentorship model, residents are assigned to one attending per month. All other 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 soft tissue reconstruction procedures. Three hand fellows per year have close working relationships with the residents, especially regarding emergency cases that present on call. Residents will participate in the management of a wide variety of patients with pathology such as brachial plexus injuries, complex upper-extremity fractures, upper extremity amputation and congenital deformity. Microsurgery, replantation and targeted muscle reinnervation are some of examples of common experiences on this rotation. The majority of the operative cases are at local surgery centers; however, residents also work with the OrthoCarolina attendings at CMC main for cases that come in through the consult service.

Oncology

This rotation offers residents a significant opportunity to expand their orthopaedic knowledge and operative skills. This rotation is focused around the busy and diverse practices of three fellowship-trained orthopaedic oncologists. Dr. Joshua Patt is the subspecialty chief. All 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 residents to interact with other services such as medical oncology, radiation oncology, and MSK pathology and radiology.

Orthopaedic Trauma

Residents are assigned to one of five fellowship-trained orthopaedic traumatologists on this rotation. Dr. Steven Sims is chief of the trauma service. As a Level I trauma center and tertiary referral center with a large catchment area, including rural and urban settings, CMC affords residents vast exposure to all types of orthopaedic trauma, from low-energy ankle fractures to complex acetabular fractures in critically ill patents. Dr. Hsu also heads the Limb Lengthening and Deformity Program which allows training opportunities 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 with level-appropriate hands-on experience. Three trauma fellows are an extra educational resource. 

Pediatrics

Residents rotate with fellowship-trained pediatric orthopaedic surgeons for two-month spans and are assigned to individual attendings in one-month blocks consistent with our mentorship model of education. Dr. Brian Brighton is the subspecialty chief for pediatric orthopaedics. Residents are involved in all phases of patient care from the clinic to the operating room with a referral network spanning North Carolina and South Carolina. This leads to exposure to a patient population with a wide variety of pathologies from trauma to complex congenital and developmental deformities.

Spine

Residents spend two months during their PGY-2 and PGY-4 years on this service for a total of 4 months working with orthopaedic spine surgeons from OrthoCarolina and neurosurgeons from Carolinas Neurosurgery and Spine Associates. Dr. Eric Laxer is the subspecialty chief. There are typically only one or two residents on the spine service at a given time, and therefore, residents have significant autonomy and responsibility for the service. Time is split between clinic and operative cases. The operative experience ranges from basic cervical and lumbar discectomies to complex deformity procedures. Residents are also exposed to traumatic spinal injuries as the attendings participate in spine call at CMC.

Sports

Residents work with a variety of orthopaedic sports medicine and shoulder and elbow reconstruction fellowship-trained attendings, including Dr. Patrick Connor who is the subspecialty chief. The rotations are scheduled consistent with the mentorship model with each resident paired with one subspecialty fellowship-trained 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 over a large spectrum 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 cover football games for local high schools as a primary responder on the sidelines. 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, who provide additional education resources for residents while also working one-on-one with their own assigned attending.