The didactic teaching activities include weekly Trauma Conference followed by Anatomy Conference on Wednesday mornings. Regular Noon Conferences are held throughout the week where a lecture is given on a variety of orthopaedic topics by a faculty member.
In addition, monthly Quality of Care/Morbidity and Mortality Conference is held on the last Monday of each month, and quarterly Grand Rounds are held on Wednesday morning. A monthly Journal Club is also held where a faculty member chooses articles for all residents to read, review, and discuss in an informal setting. All PGY3 residents are required to complete an anatomic dissection from the posterior triangle of the neck to the foot. These residents give the presentation of the weekly Anatomy Conference under faculty supervision. All PGY3 residents also have a 3-month Basic Science rotation at Harbor. They are required to complete a Harbor orthopaedic research project by the end of the PGY3 year. Research projects are also required of rotations at the Shriners Hospital and Cedars-Sinai Medical Center. Research activities of faculty include multi-center trials involving investigational devices or pharmaceutical agents, implant and instrument development, biomaterials research, biomechanical testing, as well as clinical outcomes assessment. Resident and faculty projects are presented during the Department’s Annual Orthopaedic Education Program held each June also featuring keynote addresses from our annual Dana M Street Visiting Professor.
Specialty rotations at affiliated hospitals during the PGY3 level afford additional training in orthopaedic subspecialties. At the VA Medical Center in West Los Angeles, residents refine their skills in joint arthroplasty, knee and shoulder arthroscopy, as well as hand and upper extremity, foot/ankle, and spine surgery. The Cedars-Sinai Medical Center rotation includes training in joint arthroplasty, orthopaedic oncology, adolescent and adult sports medicine, foot and ankle surgery, as well as pediatric and adult spine disorders. During the PGY4 year, specialty rotations include training at the Shriners Hospital for pediatric hip and spinal disorders, Santa Monica - UCLA Medical Center/Orthopaedic Hospital for sports medicine, orthopaedic oncology, and joint replacement surgeries, and Kaiser Permanente – South Bay for sports medicine and joint arthroplasty.
Residents have opportunities to gain experience in the diagnosis and management of each of the following areas:
 Trauma training occurs primarily at Harbor-UCLA Medical Center with rotations on the trauma service every year. The high volume, severity and complexity of the trauma that is seen at Harbor-UCLA provide outstanding training opportunities for residents. As the second busiest Level 1 Trauma center in Los Angeles County and also serving as a major referral center for southern Los Angeles County, residents have a regular opportunity to treat multiply injured trauma patients and interact with multi specialty teams. Pathology includes multi-system organ involvement as well as complex pelvic and acetabular fracture management. As a tertiary referral center, complex management cases provide a variety of challenges in decision-making and surgical management that contribute substantially to the development of critical clinical skills both in the operating room and in pre-op and post-operative management. Residents spend six months as a PGY2, and three months as a PGY3 as junior residents on the team. As a PGY4, residents take on heightened responsibility as a chief on the trauma rotation for three months and as a PGY5 spend three months as chief resident running the service. The rotation provides a comprehensive exposure to pre-admission assessment of the patient, intra-operative management, post-operative care, as well as long-term follow-up care.
Joint reconstruction training exists at multiple facilities throughout the course of residency training. At Harbor, the PGY2 and PGY5 residents each spend a three-month rotation block on a subspecialty team whose primary focus is the management of the Ortho Arthritis/Joint Replacement Service. Further training in adult joint reconstruction is provided at Cedars-Sinai Medical Center and at the VA Medical Center in West Los Angeles as a PGY3. Santa Monica – UCLA/Orthopaedic Hospital and Kaiser Permanente – South Bay rotations each provide further surgical experiences in joint arthroplasty as a PGY4.
Sports training occurs during both the PGY2 and PGY5 years while on the Sports Medicine subspecialty service at Harbor-UCLA for three months. Further training in shoulder, knee, and hip arthroscopy occur as a PGY3 at both Cedars-Sinai Medical Center and the VA Medical Center in West Los Angeles for a total of 6 months. As a PGY4, residents spend 6 months continuing to train in the diagnosis, management, and operative treatment of sports injuries at both Santa Monica-UCLA/Orthopaedic Hospital and Kaiser Permanente – South Bay. During all of these rotations, residents have the opportunity to work with a wide variety of faculty and attendings, enhancing the overall training received.
Pediatric orthopaedic experience begins at Harbor during the PGY2 year while on the Trauma/General and Spine rotations. Further training occurs in the PGY3 year while on the Harbor Peds rotation, focusing on general pediatric orthopaedics, scoliosis, as well as adolescent sports medicine. Pediatric orthopaedic training continues in the PGY3 year at Cedars-Sinai Medical Center with operative and non-operative experience in pediatric spinal and hip disorders, as well as extremity disorders. The Shriners Hospital rotation provides superb pediatric orthopaedic training with a large and diverse population of children during a three-month block in the PGY4 year. Pediatric training is solidified as a PGY5 when returning as chief on the Trauma/General and Spine services. Extensive experience is gained in the diagnosis and treatment of the spectrum of pediatric trauma and elective pediatric spinal disorders during this time.
Hand experience is abundant at Harbor with a plethora of hand pathology involving acute trauma related injuries, multiple digit re-implantation, post-traumatic reconstruction, rheumatoid reconstruction, and the management of common disorders of the hand such as peripheral entrapment neuropathies. With the size of Harbor’s patient population and the active life styles of that Southern California population, the hand service is exceptionally busy. Training begins in the PGY2 year on the Hand service and also during the Trauma/General rotations. More hand exposure occurs during the PGY3 year at the VA Medical Center in West Los Angeles and again on the trauma service at Harbor-UCLA. As a PGY4 on the Trauma/General service, residents participate and perform various hand and upper extremity procedures. More elective hand cases can be sought out while at Kaiser Permanente – South Bay as a PGY4. As a PGY5, residents run the Hand service and in collaboration with the PGY5 on Trauma/General, manage elective and emergent hand patients in the clinics and operating rooms. Hand call is shared with Plastic Surgery, with Orthopaedic Surgery taking 2 out of every 3 days.
Spine experience starts as a PGY2 on the Spine rotation at Harbor-UCLA during a 3 month block. Training continues during the PGY3 year with opportunities to participate in spine clinics and operative cases at both Cedars-Sinai Medical Center and the VA Medical Center in West Los Angeles. PGY4 residents have the opportunity to work with significant pediatric spine pathology at Shriners Hospital. As a PGY5, residents are expected to run the Spine service at Harbor, managing the clinic and all operative spine patients.
Foot and Ankle training occurs while on subspecialty rotation as a PGY2 and PGY5 for 3 months at Harbor-UCLA. The foot clinics are some of the busiest at Harbor-UCLA and the variety and severity of pathology enhances resident experience and training. On the Trauma/General orthopaedic service, foot and ankle fractures are among the most common injuries treated. Extensive surgical experience is provided in the treatment of disorders of the adult foot and ankle, including traumatic disorders, throughout the PGY2, 3, 4, and 5 years. Elective foot and ankle training is experienced as a PGY3 at Cedars-Sinai Medical Center and at the VA Medical Center in West Los Angeles. Further training in pediatric congenital and acquired disorders of the foot and ankle occurs during the Harbor Peds rotation and during the rotation at Cedars-Sinai Medical Center as a PGY3. This training continues with more exposure to pediatric foot and ankle problems while at Shriners Hospital for 3 months as a PGY4. As a PGY5, the resident runs the Foot and Ankle service, managing inpatients and clinic patients, and performing elective foot and ankle cases in conjunction with the faculty.
Orthopaedic Oncology exposure occurs during 3 month rotations at Cedars-Sinai Medical Center and at the VA Medical Center in West Los Angeles as a PGY3. During these rotations, residents will be trained in diagnosing, managing, and treating the spectrum of orthopaedic tumor pathology. This training is further solidified during the 3 month block spent at Santa Monica-UCLA/Orthopaedic Hospital as a PGY4, participating in clinics, and performing resections and providing reconstructive services for orthopaedic oncology patients.
As is required in every rotation, resident feedback is provided via the Verinform system. This continual process of evaluation integrates the feedback of the resident in assessing the effectiveness of the program, and helps guide changes necessary to achieve competence in diagnosis and care of orthopaedic patients.
A member of the academic teaching staff is assigned to each orthopaedic service and provides oversight to all in-patient activities. A member of the faculty also does teaching ward rounds, and x-ray review teaching rounds on a regular basis. An academic staff member supervises every operating day. All elective surgical cases are supervised by an appropriate member of the teaching staff. Faculty members are on a rotating call schedule for emergencies handled by general orthopaedic services. A combination of academic staff and clinical faculty supervise each of the orthopaedic clinics. This program policy of supervision strictly follows Institutional Policy No. 622A governing the supervision of residents in accordance with ACGME requirements.
One of the fundamental objectives of the Harbor-UCLA Orthopaedic Residency Training Program is assumption of graduated responsibility commensurate with the resident’s capabilities. Managing the high volume of patients with orthopaedic problems at the Harbor-UCLA Medical Center necessitates delegation of duties down through the ranks. The entire service makes rounds, attends clinics, and participates in surgeries as a unit. The PGY2 and PGY3 are responsible for pre-admission evaluations and a full history and physical for all elective admissions. These pre-admission evaluations and history and physicals are reviewed and countersigned by the appropriate attending. When on call, the junior residents (PGY2, PGY3) are responsible for conducting inpatient and emergency consultations, which are then presented to the Chief resident (PGY4, PGY5). The PGY2 or PGY3 perform closed reductions of fractures in the cast room. The Chief resident is responsible for overseeing all care administered and renders the decision-making and scheduling of all cases that go to the operating room. Surgical cases are presented and discussed with the faculty attending on service. Other academic staff members are used as consultants. The judgment and decision-making ability as well as the technical skills of each resident are assessed following each rotation, and recorded in written evaluations by the faculty. Performance, following each rotation, is reviewed and discussed at monthly faculty meetings. Additional direction, education and counseling are given as needed. As each resident advances, the level of responsibility is increased based on previous performance. The nature of the program and the fact that each resident rotates on the same services in subsequent years, allows the residents to observe and participate in the decision-making and management process, observe and participate in surgery, and ultimately, as a Chief resident, assume the lead in management decisions and operative procedures.
Orthopaedic residents are instructed in basic motor skills on a regular basis via workshops and lectures. The supervising faculty member will typically present a lecture pertinent to the motor skills activity. This is followed by the motor skills workshop, frequently involving the use of saw bones. Each faculty member will aim to conduct at least one Motor Skills Workshop each year for the entire resident staff. In addition, small group motor skills activities are conducted on an as needed basis with individual orthopaedic teams to supplement large group training.
Residents are expected to attend basic instructional courses in principles and techniques of fracture fixation such as those provided by the AAOS and the AO group during their residency training. Residents are also encouraged to attend other advanced educational and instructional courses during their residency in any orthopaedic subspecialty or topic of interest to them. The tuition cost for approved courses is borne by the Department to encourage the pursuit of supplemental motor -skills training and didactic course work.
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