Orthopaedics and Rehabilitation

This 2-week elective provides the student with exposure to the specialty of PM&R under the direction of attending Physiatrists. The students will have the opportunity to gain clinical experience and participate in the evaluation and rehabilitation management of patients with various disabling conditions such as stroke, acquired brain injury, amputation, multiple trauma, arthroplasty, acute and chronic musculoskeletal conditions, and spinal cord injury. In addition to management of the medical care of patients with disabilities, the student will gain an understanding of the rehabilitation team approach, which is an integral part of the overall management of such patients. The student will also have the opportunity to participate in the management of patients with acute and chronic pain. Management of a patient’s care through interaction with other health professionals such as neurologists, orthopedic surgeons, psychiatrists, social workers, occupational therapists, speech and language pathology therapists, and physical therapists will be an integral part of this elective. The students will have the opportunity to participate in the interdisciplinary rehabilitation team meetings held regularly in the inpatient rehabilitation setting. The student will be exposed to the treatment modalities and therapeutic and diagnostic interventions performed by Physiatrists. These interventions can include, but are not limited to, therapeutic exercise, therapeutic modalities (heat, cold, functional electrical stimulation, biofeedback), intrathecal baclofen, and therapeutic injection procedures such as interventional spine injections, corticosteroid joint injections, and botulinum toxin injections. The students may also be exposed to diagnostic tools, used by Physiatrists in clinical practice, such as electro diagnostic testing (electromyography or EMG and nerve conductions studies) and musculoskeletal ultrasound. There will be emphasis placed on the student learning to take a comprehensive rehabilitation history and performing complete musculoskeletal and functional examinations. Students will have the opportunity to observe their assigned patients during the patient’s course of rehabilitation therapies (PT, OT, SLP). Clinical settings for the elective may include inpatient consultations in the Yale New Haven Hospital (both York Street and St. Raphael campuses), outpatient consultations at the Yale Spine Center at Long Wharf, outpatient consultations at the YNHH Center for Musculoskeletal Care in Stamford, Old Saybrook, Milford, and/or North Haven, outpatient consultations with the Physiatrists at the West Haven VA Hospital, and inpatient rehabilitation care of patients admitted to the YNHH inpatient rehabilitation unit (IRU) at the Rehabilitation and Wellness Center located in the Milford Campus of the Bridgeport Hospital in Milford, CT. Future potential elective locations may include Gaylord Hospital in Wallingford, CT and additional locations of the Yale Center for Musculoskeletal Care throughout CT.

Note: Students will be assigned to various sites and will need to have their own transportation.

At the end of the rotation, the student should be able to:

1. Demonstrate an understanding of the breadth of the specialty of Physical Medicine and Rehabilitation and an awareness of how the field functions in the healthcare setting.
2. Demonstrate an understanding of the team approach in the field of Physical Medicine and Rehabilitation and the importance of communication skills.
3. Demonstrate an understanding of the Physiatrist’s role in the management of patient’s with disabling conditions.
4. Demonstrate an understanding of the multiple facets involved in the management of patients with disabling conditions.
5. Demonstrate an understanding of the multiple therapeutic interventions routinely used by Physiatrists.
6. Demonstrate an understanding of the rehabilitation therapy prescriptions provided by Physiatrists.
7. Obtain a functional history from patients with neurological and musculoskeletal impairments.
8. Perform physical examinations with a focus on the neurological and musculoskeletal examinations.
   
   

Length of Rotation: 2 weeks (maximum- 1 student)

Scheduling Restriction(s): Not offered mid-June – mid-July

Student's Class Level: 4th year

Prerequisite: Completion of all clerkship medical school clinical rotations.

Accept Visiting Students: No

Learning Objectives

The rotations in the Department of Orthopaedics and Rehabilitation are limited to the third, fourth, and fifth clinical years of medical school. The student is expected to be an active member of one of the orthopaedic teaching teams listed below. The student will have the opportunity to assist in the management of orthopaedic in-patients as well as receive operating room experience in both the inpatient and outpatient settings. Participation in the orthopaedic outpatient clinics will afford the student experience in the evaluation and treatment of common musculoskeletal conditions. It is expected that students take call with the orthopaedic resident in the emergency room to gain insight into the principles of acute fracture management. The student's clinic and operating room experience will be supplemented by weekly subspecialty conferences in addition to the Wednesday and Friday morning residents’ education program. The rotation is offered throughout the year without restrictions to start and end dates. Site assignments are made with the Registrar once the student/subintern has been scheduled.

Rotations Choices Include:

• Inpatient: Adult Reconstruction and Orthopaedic Oncology, Orthopaedic Trauma and Fracture Care, Pediatrics Orthopaedics, Spine Surgery
• Outpatient: Hand and Upper Extremity Surgery, Sports Medicine and Arthroscopic Surgery, Foot and Ankle Surgery

Final rotation assignments will be made after successful scheduling of the subinternship, approximately one month in advance of the start date of the rotation. Once you receive your final schedule, you can contact Ms. Umlauf at 203-785-6907 and pick up “Orthopedic Surgery: Diseases of the Musculoskeletal System” a review article that is required to be read before the rotation begins.

Length of Rotation: 4 weeks (maximum- 5 students)

Scheduling Restriction: None; please contact Kathryn Umlauf with questions.

Student's Class Level: 3rd, 4th, 5th year

Prerequisite: 1st and 2nd years of Medical School education. Must speak English. Students should contact Kathy Umlauf at 203-785-6907 once they receive their schedule and pick up “Orthopedic Surgery: Diseases of the Musculoskeletal System,” an article that is required to be read before the rotation begins.

Accept Visiting Students: Yes – International Students must speak English and are required to have a prior orthopaedic rotation for a minimum of four weeks. International Students will also need to submit a personal statement as to why you want to do an away rotation at Yale and one letter of recommendation for an orthopaedic surgeon.

Disorders and diseases of the musculoskeletal system are a leading cause of pain, physical disability, and doctor visits throughout the world, but physicians have historically received inadequate training during medical school on how to examine, diagnose, and manage these conditions. This four-week elective provides medical students with an experience of a multidisciplinary approach to care for patients with musculoskeletal diseases and disorders. Medical students who elect to take this course will spend time on a weekly basis to learn from teams in outpatient orthopedics, physical medicine and rehabilitation (also known as physiatry), pain medicine, physical therapy, diagnostic radiology, and rheumatology—specifically, students will gain an appreciation for how each specialty examines, diagnoses, and manages patients with conditions of the musculoskeletal system to close the gap in medical education described above and cultivate foundational clinical skills beneficial for all physicians given the prevalence of musculoskeletal disorders and diseases in the United States such that all physicians, regardless of one’s ultimate choice in specialty/subspecialty training, will continually encounter patients with these conditions throughout their careers.

Length of Rotation: 4 weeks (maximum- 1 student)

Scheduling Restriction(s): n/a

Student's Class Level: 4th & 5th year

Prerequisite: Completion of all clerkships

Accept Visiting Students: No

Learning Objectives