Adult Reconstruction Fellowship Description

RESPONSIBILITIES

At the University of Minnesota Medical Center (UMMC) and the Veterans Affairs Medical Center (VAMC), the fellows function as consultants to the orthopaedic residency staff. The fellow will work with the attending staff as well as the orthopaedic residents on service in caring for patients seen in clinic, admitted to the inpatient service, and in the operating room. Fellows are responsible for day-to-day management of assigned patients admitted to the Adult Reconstruction service at UMMC and oversight of residents at VAMC.  Fellows are also responsible for ensuring availability of radiographs and special tests prior to the undertaking of the surgery.

At UMMC, the services consists of a fellow and 5th year senior resident who care for patients jointly including tasks such as operative notes, physical examinations, admission histories and physicals, chart notes, and discharge summaries.

Fellows attend scheduled clinic sessions and assist physicians in the evaluation and management of patients within the clinic. The fellows are given the opportunity to oversee and manage a clinic in conjunction with the attending staff wherein they can develop individual relationships with patients on a recurring basis.

RESEARCH AND EDUCATION

Projects
The fellow is expected to develop a list of projects, which he or she would like to consider during the fellowship year. The list will be reviewed during the first week of the fellowship, and at least one topic will be selected by the end of the first month of the fellowship. This will ensure that the fellow will have 11 months to initiate and to bring to fruition the project planned as well as have the opportunity to initiate and complete as well as present the project at a national meeting. 

At no time should charts or radiographs be removed from a clinic or taken home without specific written permission from the clinic supervisor or medical record department.

All fellows are expected to participate in a minimum of one clinical research project and bring that project to fruition for presentation at a national meeting and submission for publication. In general, the project should be of sufficient quality to be submitted for publication in a peer-reviewed journal.  Top of Page

Reports
The fellowship is supported in part by grants.  As such, the fellow is expected to prepare a report outlining their experience to any major industry sponsor. Top of Page

Conferences
Fellows are expected to attend and participate in appropriate conferences at the UMMC well as at VAMC.  The fellows will be responsible, in conjunction with the director of the fellowship program, to organize the Weekly Preoperative Planning sessions held on Wednesday mornings at UMMC.  Fellows are invited to attend all Departmental educational conferences such as Grand Rounds, etc.  Top of Page

Medical Student/Resident Education
The fellows are responsible for lectures to medical students and residents at the direction of the program director.  At no time should the fellows' experience impinge upon the residents' experience which takes priority.  Fellows are expected to teach residents and students in the clinical setting. Top of Page

SPECIFIC PROCEDURES & CLINICAL RESPONSIBILITIES

Admissions
Patients are frequently admitted to the hospital as a day-of-surgery admission. Preoperative medical evaluation is often done by an outside family physician or referral source. The fellow needs to make certain that x-rays and related patient data are available, and that the patient has been seen in the preoperative holding area. If the case is being done with a resident in addition to the fellow, the fellow should review the indications and salient physical findings with the resident prior to proceeding with preparation of the patient for surgery. The fellow is expected to review radiographs and anatomical details with the resident both before as well as during the case without staff encouragement. Top of Page

Surgery
As noted above, the fellows are expected to maintain a general awareness of all patients preparing for surgery. This is done in conjunction with the attending staff secretary and nursing assistants. The fellow should be certain that any specialized equipment needed is available by contacting the operating room area directly. The fellows should avail themselves of all resources necessary to ensure that they are familiar with the equipment being utilized for a particular surgical procedure. Top of Page

Daily Rounds and Postoperative Care
In general, Adult Reconstruction patients do remain in the hospital postoperatively. Significant complications can occur in the postoperative period; therefore, fellows are expected to be prompt, courteous, and vigilant with respect to patient related problems and telephone calls from the nursing station and/or residents. When in doubt, any questions regarding patient management should be brought directly to the attention of the staff surgeon or the person on call. The patients in the hospital will be cared for by both the resident on service and, at the UMMC site, by the fellow as well, working as a team, but it is expected that the fellow will maintain awareness of all patients hospitalized following surgery. Discharge medications may vary between attending physicians; when in doubt it is best to check with the attending physicians, specifically regarding discharge medications to be given to a particular patient. Top of Page

Evening and Weekend Coverage
Hospital patients are seen every day by the resident and fellow together.  Weekend rounds are the responsibility of the fellow (2nd and 4th weekend) and resident (1st, 3rd, and 5th weekends) on an alternating basis.  The program director rounds with the resident or fellow every Saturday morning.  The fellow is expected to be available for calls and surgery on nights and weekends as attending staff surgery schedules demand. Top of Page

Clinics
Fellows will assist attending staff on an assigned basis at the Veterans Affairs Medical Center and University of Minnesota Medical Center in clinical evaluation of patients.  Top of Page

Medical Records
Discharge summaries, operative notes and clinic notes are to be done promptly by the fellow.  The fellow is expected to maintain a log of all surgical patients that she/he is involved with, including the patient's age, diagnosis and surgical procedure(s) and to submit them to the Accreditation Council for Graduate Medical Education (ACGME) surgical case log. Top of Page

Telephone Messages From Patients
Fellows who are on call during the weekend shall maintain a phone log of contacts with patients and document it in the electronic record. If questions arise that require management on a weekend, it is expected that the fellow would contact the staff member on call. Or, if it can be deferred, the fellow should contact the appropriate staff surgeon the next working day morning. Top of Page

VACATION AND CONFERENCE TIME

Two weeks of vacation and one week of conference time will be allocated each year. This includes time for interviews, business and other miscellaneous days off. Additional time may be requested and approved by the staff if specific arrangements are made in advance. These activities should be coordinated through the fellowship director. Fellow absences should be scheduled with prior consideration of any attending staff absences. The only exception to this would be fellows presenting papers at the same meeting as the attending. Extenuating circumstances do arise and will be dealt with fairly when appropriately presented to staff.  Unused vacation time/conference time will not be paid out to the fellow at the end of their fellowship. Top of Page

TRAVEL

Each fellow is encouraged to present a research paper at the academic meeting conference and submit his/her request to attend these meetings well in advance. If travel for presentation at meetings is desired, approval for time away and reimbursement must be approved by the program director. Travel expenses encompass the following guidelines:

• Transportation shall be reimbursed at economy class.
• Meals and room accommodations have specific limitations based on location.
• Registration and course fees are paid at cost.
• Transportation, taxis, parking, etc. are paid at cost.
• Reimbursement for conference travel will be for one meeting per year.
• All receipts for expenses shall be accrued by the fellows and submitted to the program director's office. Top of Page

INSURANCE AND BENEFITS
The fellows will receive benefits and insurance coverage as appropriate to PGY6 levels at the University of Minnesota. This will include health, dental, life, and disability insurance. If questions arise in this regard, please check with administrative staff at the University Orthopaedic Surgery Office.

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