I. Patient Care
Outpatient Clinics - Residents should first see all new patients. A time limit of 10-15 minutes should be used to access the problem. The resident may be unfamiliar or confused by the patient's problem. Asking a lot of inappropriate questions will not help your educational experience. Don't be afraid to tell the attending that you don't know what is wrong with the patient!! Take notes and record the physical examination.
The resident should elicit a chief complaint, ie, what is bothering the patient the most; why have they come to see us? Carefully check the patient generated history form. Make certain it is complete.
Pertinent negatives should be recorded: "The patient is not a diabetic," etc.
Examination should include the musculoskeletal system, peripheral neurovascular system, and ligamentous laxity. Residents should be careful with the patient and not elicit excess pain.
The resident should organize the radiographs and tests brought by the patient.
It is important to obtain the name and address of any physician who has directly referred the patient.
All residents should be able to interpret radiographs of the foot and ankle.
Residents should be able to remove dressings and casts when necessary. Post operative wounds should be evaluated and suture removed when appropriate. Repeat dressings may require assisting or the assistance of the attending surgeons. Aspirations and any injections must be performed using strict aseptic technique and usually with the attending surgeons.
II. Medical Knowledge
A. General: Both R3 and R5 residents should have basic knowledge regarding adult foot and ankle pathology, diagnosis, treatment and anatomy. R5 residents will be expected to have full knowledge regarding the more difficult cases: ie, posterior tibial tendon rupture, Tibiotalocalcaneal arthrodesis, and complex forefoot pathology. R5 residents must have a full command of all diagnostic and technical details on all patients who are having a surgical procedure. R3 residents are expected to have basic knowledge regarding the routine cases: ie, mild, moderate bunions, hammertoe, tenodesis, basic arthrodesis procedures (ankle, triple, LisFranc, hallux MTPJ), and plantar fasciitis.
III. Practice-Base Learning and Improvement
A. Residents should utilize available printed textbooks (in the orthopaedic library). Online text and medline sources for application to specific foot and ankle pathology. The goal is to demonstrate the ability to locate and interpret scientific studies and well-known medical knowledge into an appropriate knowledge base that will be direct benefit to patients.
B. The resident will be expected to formulate a plan of treatment, which will then be reviewed in detail to confirm or alter as necessary to achieve optimum patient outcome.
C. The resident will play an active role in teaching of senior and junior medical students on the service.
D. The resident should demonstrate expertise in use of available technology and hospital information systems to manage patient data and access online information that will be of direct benefit to the resident's education.
IV: Interpersonal and communication skills
A. Residents must demonstrate and ability to communicate effectively with all members of the foot service including medical students, residents, technicians and nurses.
B. Residents must demonstrate ability to communicate effectively and work well with all members of the hospital staff including nurses, nursing assistants, radiology staff, social workers, discharge planners, physical therapists and operating room staff.
C. Residents must demonstrate the ability to interact effectively, professionally and emphatically with patients and family members.
D. Residents must demonstrate the ability to develop an appropriate relationship with a patient that fosters communication, respect and ethics of the highest degree.
E. Residents must demonstrate the ability to recognize important cultural and generational differences that may affect patient care and to apply appropriate changes and approach to these in a respect with these important differences
A. Residents must demonstrate a strict adherence to medical/ethical principals.
B. Residents must demonstrate a keen sensitivity to the differences and challenges that a diverse group of patients may present, especially in the context of the known multi-racial and multi-cultural patient population in the Los Angeles area.
C. Residents must treat all patients with respect, empathy and with compassionate care. All patient inquiries and requests will be considered seriously, professionally and in a timely manner.
D. Residents must maintain patient confidentiality, including strict adherence to HIPPA guidelines.
E. Residents should obtain informed consent from patients in accordance with established guidelines that insure full patient comprehension after detail discussion of all pertinent issues related to patient care. This includes the opportunity for the patient to ask and have answered questions related to any proposed procedures or operations.
VI .System-base practice:
A. Residents should develop an awareness of how the care that they provide to patients can affect other caregivers and even the UCLA Medical Center in general. The resident must recognize that they are a representative of the UCLA Medical Center and must act in accordance with UCLA guidelines and patient care.
B. Residents should demonstrate an ability to affectively utilize hospital resources in a way that directly benefit patient care.
C. Residents should develop a basic understanding of the different types of medical practice available in the context of orthopaedic foot and ankle surgery.
D. Residents should begin to develop an understanding of the necessity to provide efficient, cost/effective healthcare in the context of appropriate use of limited medical resources, yet without sacrificing quality of care.
E. Residents should act as a patient advocate and assist patients in obtaining necessary care, including coordination of post discharge care of necessary (home healthcare, post-operative foot therapy, placement into appropriate rehabilitation facility, etc.).
Evaluation of residents: The adult foot and ankle reconstructive surgery program will evaluate all residents assigned to this rotation.
Faculty member assigned to the service will evaluate residents: N.SooHoo, MD. Residents will be evaluated as to their activities in clinics and in the operating room. Additionally, and if possible, residents will be evaluated as to their interests and efforts in research activities.
Resident evaluations will be done per protocol in the Department of Orthopaedic Surgery. Additionally residents will be evaluated on a one on one basis and given oral evaluations while in clinic and during and following operative procedures.
Evaluation of Residents performance on the in-training examination, specifically regarding questions on adult foot and ankle reconstruction will be considered.
A resident evaluation of orthopaedic faculty and orthopaedic rotations will be carefully assessed. Any recommendations by the residents for improvement in adult foot and ankle reconstructive surgery will be carefully considered and implemented if possible.