Residency Education

Curriculum

Our five-year program begins with the PGY-1 year in the Yale-New Haven Hospital System in a diversified experience of monthly rotations that includes general surgery and polytrauma, vascular surgery, burn surgery, surgical intensive care unit, emergency room and orthopaedics. The content of the PGY-1 year is determined by the orthopaedic program director and the residents' education committee and is compliant with ACGME requirements.

Year 1
Reconstructive Orthopedics8 weeks
Pediatric Orthopedics8 weeks
General Surgery Trauma4 weeks
Vascular Surgery4 weeks
Burn Surgery4 weeks
Surgical Intensive Care Unit4 weeks
Emergency Room4 weeks
VA General Surgery4 weeks
Orthopedic Surgery Night Float8 weeks

*4 weeks of vacation are integrated into the year.collapse

During the second year, residents rotate exclusively through clinical orthopaedic services. These include orthopaedic trauma; pediatric orthopaedics; a foot and ankle service; a combined sports and hand service (designed to give exposure to these popular subspecialties early in the program); and the nearby West Haven Veterans Administration Medical Center. 

Year 2
Pediatric Orthopedics
Orthopedic Trauma
Foot & Ankle
VA Orthopedics
Sports & Hand Orthopedics

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Four-fifths of the year is spent at Yale-New Haven Hospital where the experience includes rotations on the trauma, spine, and adult reconstruction (joint replacement and oncology) services. A rotation at Waterbury Hospital involves each resident in a high volume, highly skilled and efficient hip and knee joint replacement experience where substantial clinical research opportunities exist. During the third year each resident is provided with an elective rotation at Yale that allows one to focus on those subspecialties that he/she is considering for fellowship education, devote protected time to research, or combine both in a self-designed experience.

Year 3
Orthopedic Trauma
Spine
Reconstructive Orthopedics
Waterbury Joint Replacement
Research

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The fourth year residents spend three-fifths of their time at Yale, one-fifth at the Veterans Administration Medical Center, and one-fifth at the Hospital of St. Raphael in New Haven. At Yale-New Haven Hospital there are separate sports, hand, and protected research rotations. At the Hospital of St. Raphael the resident is chief resident on the orthopaedic service. The Veterans Administration Medical Center rotation is also a chief resident rotation with a wide variety of adult reconstruction surgical cases and hand and upper extremity problems. A combined outpatient clinic with rheumatology adds essential experience with the non-operative management of joint diseases.

Year 4
VA Orthopedics
Hospital of St. Raphael Orthopedics
Sports
Hand
Research

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During the chief residency year four-fifths of the year is spent on clinical services at Yale and one-fifth is devoted to completion of research projects begun in the earlier years. The culmination of one's research is the presentation of results at the annual disputations conference held at the end of the academic year. The clinical rotations during the chief year are trauma, spine, pediatrics, and adult reconstruction.

Year 5
Orthopedic Trauma
Spine
Pediatric Orthopedics
Reconstructive Orthopedics
Research

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2nd Through 5th Year Residents

The rotations are composed of five time blocks per year (2.4 months/rotation) evenly divided so that each resident in each year rotates through the same services and has an equivalent experience. While five years of orthopaedic residency are mandated, a total of one year of flexibility is built into the second through fifth years as long as each resident has at least 12 months of trauma experience, 6 months of pediatric orthopaedics, and 10 months of adult reconstructive surgery. This allows ample block time for research and some elective time as well. Rehabilitation experience is integrated in virtually every clinical service and is particularly comprehensive in adult reconstruction, trauma, sports, hand, spine, and pediatric orthopaedics.

Conferences by Frequency

Grand Rounds: Each Friday, 8 to 9 A.M.
These lectures are presented either by PGY-3, 4, or 5 residents, Yale faculty, or visiting professors. Each resident presents no more than once per year with the majority of presentations provided by faculty and visiting professors. Topics span a wide spectrum of pediatric and adult clinical or research topics.

Clinical Orthopaedic Series: Each Friday, 9 to 10A.M.
This is an alternating sequence of conferences, as follows:

  • Morbidity and Mortality Conference
    First Friday each month. Residents present specific cases to the full-time and clinical faculty that reflect all instances of morbidity or mortality and then concentrate on either quality assurance issues or cases of unusual educational value.
  • Core Curriculum Follow-up Conference
    Second and third Friday each month. These conferences usually follow the topic of the weekly core conferences and often involve case discussions with visiting professors and/or faculty.

V.A. Hospital Surgical Conference
Each Monday, 5 to 7 P.M. Residents at the V.A. Hospital present patients being considered for surgical treatment and discuss the current status of inpatients with faculty.

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Radiology/Pathology Correlation Conference
Fourth Friday each month. Faculty from diagnostic imaging, pathology and orthopaedics present specific cases designed to illustrate the pathophysiology of disease and its correlation to clinical practice. Residents are required to individually describe x-rays and histology as well as comment upon clinical findings and treatment plans. Stress is given to interpretation of histologic material and correlation with a radiologic driven differential diagnosis.

Anatomy
10:00 AM to 12 Noon, 10 sessions March - May each year. Members of the faculty direct a two-year rotating schedule of upper extremity, cervical, thoracic and lumbar spine, and lower extremity anatomy with the use of cadaveric dissections and weekly self assessment quizzes. Prosections are prepared by two selected members of the housestaff in advance of the weekly conference. A final written and practical examination is given at the conclusion of the course.


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Southwick Fellowship Lecture
This endowed fellowship is held annually. A distinguished orthopaedic surgeon from outside the Yale community visits with the department for two to three days. There is ample opportunity for informal teaching between the guest professor and the orthopaedic residents.

Sports Medicine Seminar
This seminar is held in the late summer and focuses on the diagnosis, pathophysiology, and treatment of selected sports medicine injuries. Guest professors are invited for this half-day symposium and all faculty, housestaff and students are encouraged to attend.

Disputations Seminar
In the late spring, as the academic year draws to a close, a two day formal program includes the presentation of research by each chief resident and lectures by two or three guest professors. The resident presentations are critiqued by professors and then openly defended by the presenter. There is a strong emphasis on correlating basic science and clinical medicine.

The close of the academic year is also the occasion for three often memorable festive occasions: a private dinner for the graduating chief residents, their immediate families, and the faculty at the Yale Graduate Club; a more open graduation dinner at the Yale Golf Club; and a wide-open Chiefs Dinner, staged entirely by the chiefs and upcoming chiefs and funded by the faculty. At the latter event the entrees are by no means the only things roasted.

Few conflicts exist to prevent housestaff from attending all conferences and all housestaff are free of responsibilities for the entire Friday morning schedule. Faculty attend the major teaching conferences in large numbers and selected faculty are assigned to specialty specific activities.

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Research Opportunites

Research has been a long-standing strength of Yale University and of each department. The medical school requires each student to produce a thesis in partial requirement for their graduation, and this value is consistent with each department's emphasis on scholarly activity as well. In order to accomplish this mission, our department provides substantial financial investments. 

This supports a core histology laboratory, photographic services, computers and library facilities which are available regularly to all residents. Up to 8 months of protected research time is available during the final four years of the residency. Residents are assigned a research advisor and are exposed to faculty research interests through departmental publications and organized "research-in-progress" sessions given by senior residents and clinical and Full-time Research Faculty members. 

Residents are encouraged to apply for pilot funding through the department for their research projects. Projects are assessed and critiqued at a research forum held annually. Funds are allocated to support resident travel for educational courses and for presentation of research at national meetings.

Legal Medicine, Medical Ethics, Economics of Healthcare

Legal medicine and medical ethics are taught in yearly programs by staff from the risk management section of Yale-New Haven Hospital and ethicists from the Yale University School of Medicine as part of our core curriculum. Discussions regarding ethics are encouraged and integrated informally through faculty/resident interactions on an almost daily basis.

Health economics and cost containment are addressed in our core curriculum series by visiting speakers. These conferences traditionally generate substantial discussion and provide residents with new insights for the practice of cost effective quality care. In addition, the hospital is developing a generic program in ethics and medicolegal issues.