The didactic teaching activities include Anatomy Conference on Tuesday afternoon, the Tuesday night Lecture Series, and Trauma Conference on Wednesday mornings. In addition, monthly Quality of Care Conference is held on the last Monday, and quarterly Grand Rounds on Wednesday morning. All PGY3 residents are required to complete an anatomic dissection from the posterior triangle of the neck to the foot. These residents give the actual presentation of the weekly Anatomy Conference under faculty supervision. All PGY3 residents also have a 2-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 elective orthopaedic reconstruction. At the VA Medical Center in West Los Angeles, residents refine their skills in joint arthroplasty, as well as knee and shoulder arthroscopy. The Cedars-Sinai Medical Center rotation includes training in joint arthroplasty, Orthopaedic oncology, adolescent sports medicine, as well as pediatric spine and hip disorders. At Rancho Los Amigos Hospital, experience is gained on the Spinal Cord Injury and Rehabilitation Service. During the PGY4 year, specialty rotations include training at the Shriners Hospital for pediatric hip and spinal disorders, as well as UCLA Medical Center for Sports Medicine, Orthopaedic Oncology, Spine, and Joint Replacement surgeries. Four months of the PGY4 year are spent at Harbor on one of the general services. Elective rotations in the PGY2 and 5 year include observation of sports related surgeries in the private hospital and private outpatient surgery center settings. These procedures involve primarily knee and shoulder arthroscopy. This experience is particularly valuable for the senior resident.
Residents have opportunities to gain experience in the diagnosis and management of each of the following:
 Adult orthopaedics including joint reconstruction exist at multiple facilities throughout the course of residency training. At Harbor, the PGY2 and PGY5 residents each spend a four-month rotation block on the Orthopaedic Sub-specialty Service where experience is gained on the Ortho Arthritis/Joint Replacement Service. Further training in adult reconstruction is provided at Cedars-Sinai Medical Center during a four-month rotation in the PGY3 year. The VA Medical Center in West Los Angeles as well as the UCLA rotations each provide generous four-month surgical experiences in Adult reconstruction during the PGY3 and PGY4 years respectively.
Pediatric orthopaedic experience begins at Harbor during the PGY2 year in the Peds Ortho/Special Peds Clinics on the four month Orthopaedic Sub-specialty Service rotation. This continues in the PGY3 year at Cedars-Sinai Medical Center w/ 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 their four-month service in the PGY4 year. On the general orthopaedic services at Harbor, extensive experience is gained in the diagnosis and treatment of the spectrum of pediatric trauma throughout the PGY2, 4, and 5 years.
Spinal cord injury and rehabilitation experience occurs principally at Rancho Los Amigos Hospital where the PGY3 resident serves on the Spine as well as Spinal Cord Injury 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 in the Spine Clinic. Spine experience is also gained throughout the PGY2, 4, and 5 years while on rotation at Harbor. Spinal trauma is managed on the general orthopaedic service, while elective procedures including discectomy, fusion, and treatment of spinal deformities are addressed. Similar surgical experiences are provided at Cedars-Sinai during the PGY3 year and at UCLA during the PGY4 year. Harbor-UCLA Medical Center is the principal facility where training is received in trauma and multi-system trauma. As the second busiest level one trauma center in Los Angeles County, there is a wealth of experience in the diagnosis and treatment of multiply traumatized patients. Pathology includes multi-system organ involvement as well as complex pelvic and acetabular fracture management experience. 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.
There are busy Hand Services 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, our two hand surgeons are kept very busy at our facility.
The Foot Clinic is one of the busiest outpatient clinics at Harbor. It is here that residents receive their primary experience in the diagnosis and treatment of disorders of the Foot and Ankle during the PGY2and PGY5 years. On the general orthopaedic services, foot and ankle fractures are among the most common injuries treated by the Harbor Orthopaedic Service. Extensive surgical experience is provided in the treatment of disorders of the foot and ankle, including traumatic disorders, throughout the PGY2, 4, and 5 years. The Pediatric Orthopaedic Clinic handles clubfoot and other congenital and acquired disorders of the foot and ankle in skeletally immature patients. Pediatric Trauma is managed by the general orthopaedic services at Harbor. At Cedars-Sinai Medical Center, elective pediatric reconstruction involving the spine, hip, and extremities is received during the PGY2 year, free of emergency call responsibilities. No acute pediatric trauma is handled in the Cedars rotation.
The Subspecialty Clinics provide focused exposure to the diagnosis and non-operative management of disorders involving the axial as well as the appendicular skeleton. Specialty orthopaedic clinics encompass Spine, Hand (including the elbow), Foot (including the ankle), as well as the assessment and treatment of hip, knee and shoulder disorders in the Arthritis and Sports Medicine Clinics. These anatomic regions, in the pediatric population, are addressed in the Pediatric Orthopaedic as well as Special Peds/Scoliosis clinics.
As is required in every rotation, Resident feedback is provided via the Verinform system. This continual process of program evaluation integrates the feedback of the resident in assessing the effectiveness of the program, and in guiding changes necessary in order to achieve competence in non- operative outpatient diagnosis and care, including all anatomic areas and patients of all age groups.
A member of the academic teaching staff is assigned to each general 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 daily basis. An academic staff member supervises every operating day. All elective surgical cases on the Ortho Subspecialty Service are supervised by a 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 general orthopaedic and sub-specialty 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 dictated history and physical for all elective admissions. These pre-admission evaluations and dictated history and physicals are reviewed and countersigned by the appropriate attending. When on call, the PGY2, PGY3 and PGY4 are responsible for conducting inpatient and emergency consultations, which are then presented to the Chief resident. The PGY2, PGY3 and PGY4 perform closed reductions and re-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 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 progresses, the level of responsibility is increased based on previous performance. The co-linear 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 monthly basis as a component part of the Tuesday evening lecture series. The supervising faculty member for the evening will typically present a formal didactic lecture pertinent to the motor skills activity for the evening. This is followed by the motor skills workshop, frequently involving the use of saw bones. For example, the motor skills training in the frame assembly and wire placement of the Ilizarov external fixation device is preceded by the lecture “Management of Peri-articular Fractures About the Knee and Ankle with the Use of Small Wire Fixation”.
Each faculty will 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 the large group training. Residents are encouraged to utilize an arthroscopy tower in our Orthopaedic Learning Center dedicated specifically for the purpose of in vitro resident training in the development of spatial orientation and dexterity.
While not a required activity, residents are encouraged to attend basic and advanced instructional courses in principles and techniques of fracture fixation such as those provided by the AAOS and the AO group. 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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