The most waited rotation for last
This was my elective rotation, yet I had no idea it was going to turn out to be orthopedic surgery. I had 11 months to get through my other rotations and decide what I wanted as my elective. Because FSU only gave us one elective rotation, it was a very hard decision. I decided to choose this specialty for numerous reasons. I enjoyed surgery so much that I wanted to explore another surgical specialty. I also knew I was going to work in family medicine and getting hands on experience in knee and shoulder exams was going to be very helpful. Andrew’s institute is known nationwide for their orthopedic surgery and having it 20 minutes from my house meant it was a one in a lifetime experience. I decided to pursue this specialty and I do not regret it one bit.
What it consisted of
I completed my rotation with a shoulder specialist in Andrew’s Institute in Pensacola, Florida. This rotation was a mixture of surgery, clinic, and a little bit of rounding. Not going to lie working in a specialty is very different right after spending 6 weeks in family medicine. My scheduled varied but it was from 7:30 AM – 5 PM most days. 2 days out of the week we were in surgery and the other days we spent them in clinic seeing pre-operative appointments, post-operative appointments, consultations, and new patients. A typical day in clinic consisted of having 50+ patients in the schedule.
What to study
Anatomy will come back and hunt you during an orthopedic rotation. Make sure you grab your old anatomy notes, textbook, use your online resources, or even YouTube videos to study anatomy. Your preceptor may ask you specific questions and you may not know the answer, but if you show effort and a motivation to learn, they will understand you are a student and you are there to learn. I treated this rotation similar to how I treated my general surgery rotation, I reviewed my next day’s surgery using Touch Surgery App. This helped me visualize what I was going to do the next day and it gave me an idea of what anatomy I needed to study. I also reviewed important muscles, bones, arteries, and veins in the area where we were doing surgery.
It’s also very important that you review how to perform specific exams, such as a total knee or shoulder exam. However, you will learn how your preceptor does it and what may work for you as you get through your rotation. Know the four tendons that make up the rotator cuff SITS (Supraspinatus, Infraspinatus, Teres minor, Subscapularis). In addition, you should review common orthopedic maneuvers, what muscle it tests, and know how to perform them, you can easily find these on YouTube.
Some of these can include:
SHOULDER:
Neer’s sign
Hawkins’ test
Drop-arm test
Cross-arm-test
Speeds test
O’Brien’s test
Empty Can test
Shoulder Exam
KNEE:
Lachman test
Anterior drawer test
Posterior drawer test
Medial valgus stress test
Lateral valgus stress test
McMurray’s test
Knee exam
Medical Conditions to be familiar with
Rotator cuff tears
Biceps tendon tears
SLAP
AC joint separation
Shoulder impingement
Shoulder dislocation/instability
Frozen shoulder
Fractures
Shoulder arthritis
ACL
osteoarthritis
Menniscus
Knee dislocation
Surgery time with the best team
This was my favorite part of the rotation, getting to spend time in the operating room. It was amazing to work with such an amazing team which consisted of an Orthopeadic surgeon and 2 PAs. One of the coolest things I experienced was seeing my preceptor, a PA-C start a knee surgery completely by himself. The surgeon trusted him so much that he would start one case alone and the PA will start another case by himself. I couldn’t believe what my eyes were seeing, the PA making the first incision and about to start knee surgery all by himself. The physician trusted him deeply and gave him a lot of autonomy, something I had never seen a PA do. Later after about 30-40 minutes of surgery the physician would come in and we will all participate in the surgery. Not going to lie performing knee replacements was my favorite surgery. It was challenging at times because we had to manipulate the leg and do trail and error with different prosthetics, but it was rewarding and pretty amazing to do.
Orthopaedic surgery is a different beast compared to general surgery. Surgery days are very long, and they are non-stop. You can jump from operating room to the next trying to get all of the cases done as soon as possible. Make sure you have some confrontable shoes, snacks for the go, and speak up if you need a quick break. I see orthopedic surgery kind of like a construction worker for the body, you use a lot strength to manipulate bones, to insert nails, to cut up stuff and it takes a lot of force and strength, you are using your body and you will eventually get tired. My favorite part was wearing the big helmet and looking like an astronaut in surgery. It was so much better than wearing a face mask and not be able to breath or see other’s facial expressions while in surgery. This gave you a lot more freedom in your face and it just felt pretty cool.
See how your team performs surgical knots, how they do their suturing, and go home and practice it. Give it a shot, ask if you can finish one day and let them teach you the essentials.
No EOR, just PANCE studying
Because this was my elective, I had no EOR exam. This was also my last rotation so studying for PANCE was not an option. I spent every day reviewing a little bit of what I saw in clinic and studying anatomy, and specific orthopedic maneuvers, but the majority of the time, I studied for the PANCE. I will create a separate blog on how I studied and passed the PANCE =)
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