Orthopedic Surgery Residency Program in Baltimore

The PGY-1, or internship year, is a combination of general surgical and orthopedic rotations. Currently, these are divided into four-week blocks, creating a total of 13 rotations during this first postgraduate year. Five of those blocks are divided into general surgical, emergency room, anesthesia, and intensive care units experiences. The PGY-1 resident will join his/her PGY-1 counterparts from Georgetown University, Johns Hopkins University, and the University of Maryland for a month of orthopedic skills training, which takes place at different locations throughout the city. Extensive cadaver work for surgical exposures and arthroscopy is provided.

The remainder of the PGY-1 year consists of one block of hand surgery and multiple rotations on existing orthopedic services such as spine, foot and ankle, shoulder and elbow, total joint arthroplasty, sports medicine, and the chief resident service. The resident will be exposed to emergency room evaluation and the treatment of musculoskeletal injury, as well as the outpatient clinic experience.

The purpose of the PGY-1 year is to begin the resident's exposure to multiple areas of orthopedic surgery, while broadening their knowledge and experience on the basics of preoperative and postoperative care, as well as the evaluation and treatment of critically ill patients.

The PGY-2 year is the point at which residents become fully immersed in orthopedic surgery and its various subspecialties. The PGY-2 year consists of five rotations. Four months are spent with the chief resident service. Here, the PGY-2 resident acts as first responder and first assist on a variety of emergency, elective, and operative cases under the guidance of the chief. Four other two-month rotations are scheduled in subspecialty areas including, spine, total joints, foot and ankle, and sports medicine.

Goals for the PGY-2 year include the attainment of basic knowledge in the areas of orthopedic disease, management of ambulatory orthopedic trauma, and basics of anatomy, physiology, and biomechanics of the musculoskeletal system. The resident also receives a basic understanding of surgical approaches to the musculoskeletal system. Management of the preoperative, intraoperative, and postoperative orthopedic patient is emphasized in the PGY-2 year. Residents are encouraged to use the orthopedic literature in a critical way, and to begin constructing their interests in research.

The PGY-3 year includes a three-month rotation on hand surgery and pediatric orthopedic surgery. The former takes place through MedStar Union Memorial’s Curtis National Hand Center, and the latter is located at Johns Hopkins Hospital in East Baltimore. In the pediatric orthopedic service, residents will gain experience in the evaluation and management of pediatric orthopedic disorders, including congenital and acquired disorders, neuromuscular disorders of the spine and musculoskeletal system, and trauma. The remainder of the year is divided into three two-month rotations in spine, shoulder and elbow, and research.

While the two-month rotation on research is often not long enough for a resident to design and complete a research project, this time permits exposure to the scientific process and the biomechanics laboratory. Residents are expected to take part in one or more research projects during their residency, and the time for the finalization of those projects must be allotted by the resident outside of this two-month introduction to research. Research is performed in both the clinical and biomechanical arenas, and “mini” grants for starting these projects are requested through the Research Committee.

The PGY-4 year is spent mostly away from MedStar Union Memorial Hospital. This year consists of four three-month rotations. While the sports medicine rotation occurs at “home,” much of that time is spent in satellite outpatient clinics and outpatient surgery centers. Care is taken to not have the sports medicine fellows interfere with the education and experience of the PGY-4 resident.

Second, the resident returns to Johns Hopkins for his/her second three-month rotation in pediatric orthopedic surgery, completing their required six-month experience in that discipline. The third rotation of this year is in orthopedic oncology, where residents gain valuable experience in the diagnosis and management of benign and malignant primary and secondary tumors affecting the musculoskeletal system, including radiologic assessment of lesions as well as their pathologic analysis. This rotation takes place at MedStar Franklin Square Medical Center in Baltimore.

During the remaining three months, PGY-4 residents rotate through the Shock Trauma Unit of the University of Maryland Medical Center, one of the nation’s premier trauma centers. Here residents gain valuable experience in the management of Level-1 multiple orthopedic trauma. Residents learn the principles of evaluating a patient with multiple injuries, the prioritization of surgical management and postoperative management, and rehabilitation techniques.

The PGY-5 Chief Resident year allows each chief resident to function in a more autonomous, yet supervised role, as the administrative chief resident. During this six-month rotation, the chief resident conducts his/her own clinic, maintains admitting privileges, and has assigned block operating room time.

The chief residents gain valuable insight into continuity of care issues, planning of surgical and nonsurgical treatment, and management of the postoperative patient. The chief resident chooses which faculty will provide oversight for each case, depending on the patient’s diagnosis. The remaining six months is equally divided between foot and ankle, hand, and total joint experiences.