Curriculum is based upon requirements set by the American Board of Orthopaedic Surgery.
Call Schedules Within the master schedule of rotations, each hospital develops its own internal call schedules, which determine weekly working hours. As with all residency training programs at LAC+USC Medical Center, the Department of Orthopaedic Surgery complies with the basic guidelines established by the Office of Graduate Medical Education.
Time Away from Program Duties In addition to at least one 24-hour period each week, every resident receives a one month paid vacation, 3 days of educational leave, and 12 days of sick leave annually.
The ACGME requires 12 months of general education, which is satisfied in the PGY-1 year. The first year of training is organized into thirteen 28-day rotations in various services relevant to the care of patients. Orthopaedic interns are considered part of the surgical internship pool which consist of 6 general surgery rotations and 6 orthopaedic rotations.
A unique aspect of our program is an intern year generally tailored towards developing and advancing skills expected of an orthopaedic surgery resident. For example, during the Rehabilitation/Amputee service rotation at Rancho Los Amigos Medical Center in Downey, residents learn to manage chronic and debilitating conditions of neurological, congenital, metabolic, infectious, and traumatic origins. They are taught basic prosthetics and orthotics as well as basic principles in rehabilitation. Weekly lectures augment clinical training. By the end of their rotation, residents are expected to be competent in performing basic and complex amputation as well as limb salvage procedures. Residents will also be skilled in the appropriate workup and management of patients with orthopaedic complications due to diabetes, infections, and trauma.
In addition to rotations, interns complete a year long curriculum of modules to develop skills in casting, suturing, basic orthopaedic trauma principles, and joint arthroplasty, amongst other topics. All modules are faculty-taught. In addition, every Friday the PGY-1 residents are freed from clinical duties to attend the Core Curriculum lectures that are the cornerstone of the Department’s didactic teaching initiative for the orthopaedic surgery residents. The PGY-1 residents also attend the monthly Journal Club and Grand Rounds.
The American Board of Orthopaedic Surgery requires all residents to complete 12 months of orthopaedic trauma, 12 months of adult orthopaedics, 6 months of basic science and/or clinical specialties, and 6 months of pediatric orthopaedics. The resident must spend 4 years in a program whose curriculum is determined by an orthopaedic residency director. Rotations are organized to assure increasing responsibility and exposure to all aspects of orthopaedics as residents grow in knowledge, skills, and maturity. As such, the formal residency begins as a PGY-2, and the junior residents follow a two-year track. The total weeks per service over the two year junior resident period are as follow: Trauma – 30 weeks; Sports Medicine – 10 weeks; Adult Reconstruction – 10 weeks; Hand – 10 weeks; Pediatric Orthopaedics at Children’s Hospital Los Angeles – 10 weeks; County Pediatrics and Oncology – 5 weeks; Kaiser General Orthopaedics – 10 weeks; Spine – 5 weeks.
Junior Resident Rotations Orthopaedic Trauma (30 weeks – 15 weeks each year) – LAC+USC Medical Center There are two trauma teams on the trauma service. The Saturday “Green Team” call is covered by a PGY-2, PGY-3, and a Senior Resident (PGY4 or PGY-5) from non-trauma services.
The PGY-2 and PGY-3 residents on the trauma teams will learn to evaluate orthopaedic patients and manage acute orthopaedic problems emergently and effectively including pre- and post-operative care of patients. Their responsibilities include evaluating all consults from the emergency department and inpatient wards in addition to operating under the supervision of attending physicians and senior residents. The LAC+USC Medical Center is unique in that it contains a designated Orthopaedic Evaluation Treatment Area (OETA) within the emergency department reserved for patient evaluation and treatment. The junior resident on call is responsible for evaluating and treating patients in the OETA and will perform minor procedures such as fracture manipulation & casting, extensor tendon repairs, traction pin placement, and revision digit amputations. There are numerous highly experienced physician assistants dedicated to this area responsible for assisting the resident with these procedures.
In the trauma outpatient clinic, the junior residents see patients and then present to senior residents and attending physicians who staff the clinic. In addition, residents perform all procedures in the outpatient clinic, including any repeat fracture manipulation, basic hardware removal, or other minor outpatient procedures. The continuity of the trauma experience, from E.D. evaluation through outpatient care, encourages the residents to develop comprehensive plans for fracture management.
Sports Medicine (10 Weeks) – Keck Medical Center of USC and LAC+USC Medical Center The junior resident gains exposure to basic and complex sports related injuries including workup, diagnosis, operative and non-operative treatment, and rehabilitation. The focus of the rotation is on early and frequent exposure to arthroscopic surgery. Multiple conferences throughout the week provide the framework for the evaluation and treatment of sports medicine patients. This includes working with the USC team orthopaedic surgeons Dr. Vangsness, Dr. Gamradt, Dr. Hatch, Dr. Tibone, Dr. Omid, and Dr. Weber. There are opportunities to attend training room sessions at the USC undergraduate campus. In addition, Dr. Weber leads an exciting new program for local high school football team coverage for those junior residents interested in a team coverage experience supervised by sernior residents. Residents take home calls during this service in addition to any “Green Team” call described above.
Adult Reconstruction (10 weeks) – Keck Medical Center While at Keck Medical Center, a team consisting of a PGY-2, 3, 4, and 5 participate in total joint surgery as well as the clinical management of adult orthopaedic joint conditions. Residents perform numerous total joint replacements as well as receive training in both pre- and post-operative management of joint reconstruction patients. In addition to primary total joint replacement, Junior residents have the opportunity to assist with complex revisions as well as cutting edge procedures like unicompartmental arthroplasty using the MAKO robotic system. There are weekly conferences and didactics led by attendings. Residents take home calls during this service in addition to any “Green Team” call described above.
Hand and Upper Extremity (10 Weeks) – LAC+USC Medical Center and Keck Medical Center This service consists of a PGY-2, PGY-3, PGY-4 or PGY-5, plastic surgery senior resident, and hand fellow. The residents participate in surgery at LAC+USC Medical Center, as well as Keck Medical Center. This rotation provides residents with comprehensive training in all aspects of hand surgery, including acute trauma, congenital, reconstructive, and micro-vascular surgery of the hand. LAC+USC Medical Center is a major center for upper extremity revascularization and replant procedures, which provides an excellent experience for residents who assist with nearly all of these cases. Residents share home call for replantation cases, however do not take in-house call while on this service unless they are scheduled for “Green Team” calls. There are weekly didactics and monthly mortality and morbidity conferences.
Pediatric Orthopaedic Surgery (10 Weeks) – Children’s Hospital Los Angeles This service is located at Children’s Hospital Los Angeles, one of the nation’s leading pediatric orthopaedic centers. The team consists of two USC junior residents (PGY-2 and PGY-3), a USC senior resident (PGY-4 or PGY-5), one Cedars Sinai resident and one Harbor-UCLA resident. During this rotation, residents gain exposure to acquired, congenital, developmental, oncologic and traumatic orthopaedic conditions in children through surgery and outpatient clinics. Daily morning lectures from attending physicians focus on key concepts within pediatric orthopaedic surgery, and provide excellent preparation for the annual Orthopaedic Surgery In-Training examination (OITE). There are also weekly staff conferences designed to review all pre- and post-operative cases, a monthly journal club, as well as a monthly morbidity and mortality conference. Residents take in-house call approximately once per week throughout their time on service.
Pediatric Orthopaedic Surgery and Orthopaedic Oncology (5 weeks) – LAC+USC Medical Center Junior residents are paired with a senior resident and collectively cover the pediatric and oncology services at LAC+USC. There are daily didactics with the pediatrics or oncology attendings. Also, one day per week is dedicated to Pediatric Sports, with clinic in the morning and surgery in the afternoon. Residents will have no call except for “Green Team” call as detailed above.
General Orthopaedic Surgery (10 Weeks) – Kaiser Permanente Baldwin Park The PGY-2 and PGY-3 on service experience a comprehensive adult orthopaedic practice, with exposure to a broad range of subspecialties, including arthroscopic, oncologic, reconstructive, traumatic, and hand surgery cases. In addition, they are frequently able to attend the AO Basic Principles of Fracture Management course during this rotation. Residents take two in-house calls during this 10 week service.
Spine (5 weeks) – Keck Medical Center and LAC+USC Medical Center The junior resident on this service splits their time between the LAC+USC Medical Center and the Keck Medical Center. During this time, the resident will gain exposure through surgery, inpatient care and out-patient services. Multiple conferences are held on a weekly basis designed to discuss core concepts in orthopaedic spine as well as reviewing radiographs, MRI, CT, and other diagnostic modalities. Residents will have home call responsibilities for Keck Medical Center and may additionally have “Green Team” call during this rotation.
The senior years of residency training are designed to continue to expand on orthopaedic knowledge and surgical skills as well as to prepare the resident for supervisory and teaching roles. Residents are given graduated responsibility to be more active and independent in patient care decisions.
Senior Resident Rotations Orthopaedic Trauma (30 weeks – 15 weeks each year) – LAC+USC Medical Center The fourth and fifth years on the trauma rotation are responsible for performing more complex surgeries as well as transitioning into roles as teachers and administrators of the service. With the help of each service’s physician’s assistant, they are responsible for managing the surgical schedule as well as assisting with decision making both pre- and post-operatively. This includes determining the operative plan as well as requesting surgical equipment. Call is once to twice weekly.
Adult Reconstruction (10 weeks) – Keck Medical Center While at Keck Medical Center, a team consisting of a PGY-2, 3, 4, and 5 are responsible for participating in total joint reconstruction surgery and other adult reconstruction procedures as well as the management of adult orthopaedic problems. The residents are expected to be well trained in performing basic orthopaedic total joint replacements as well as an appropriate workup of reconstruction patients, including both pre- and post-operative treatment. There are weekly conferences and didactics with attendings. Residents take occasional home calls during this service in addition to any “Green Team” call described above.
Adult Reconstruction (5 Weeks) – Rancho Los Amigos The senior resident runs the surgical arthritis service at Rancho Los Amigos Medical Center. During this time, the resident is exposed to two days of surgery per week as well as managing pre- and post-operative management of joint replacement patients. Residents do not take in house call but do share in a pool of rotating service calls. They may have “Green Team” call during this time.
Spine (5 weeks) – Keck Medical Center The senior resident is responsible for managing inpatient and out-patient treatment of the spine. This service provides broad exposure to the operative treatment of spinal deformity, degenerative conditions of the spine and spinal trauma. There are two weekly conferences which augment clinical training. Residents take home call in addition to any “Green Team” call as above.
Sports (10 weeks) – Keck Medical Center and LAC+USC Medical Center The PGY-4 and PGY-5 on the sports service are responsible for managing the sports services at LAC+USC and Keck Medical center respectively. These services include both inpatient and out-patient treatment of acute and chronic sports injuries as well as training in sports injury rehabilitation. This service provides an extensive experience in arthroscopic surgery as well as many open surgical procedures.
Hand and Upper Extremity (5 Weeks) – LAC+USC Medical Center and Keck Medical Center As a senior resident, the rotation builds on the exposure to hand and upper extremity gained earlier in the residency. Senior residents are involved in more complex surgical cases and have increased responsibility in the operating room. The senior resident is responsible for the organization of the service and dictates the operative schedule. Residents share home call for replantation cases, and are occasionally scheduled for “Green Team” calls. There are weekly didactics and monthly mortality and morbidity conferences.
Pediatric Orthopaedic Surgery (5 Weeks) – Children’s Hospital Los Angeles During this rotation, the senior resident is responsible for increasing clinical and surgical responsibility. This service includes daily lectures from attending physicians focusing on key concepts within pediatric orthopaedic surgery as well as preparation for the annual Orthopaedic Surgery In-Training examination (OITE). Also, there is a weekly staff conference designed to review all pre- and post-operative cases including patient presentation, diagnoses, radiographs, and surgical details. This conference includes a monthly journal club review as well as morbidity and mortality conference. The residents take in-house call approximately twice a week throughout duration of the service.
Pediatric Orthopaedic Surgery and Orthopaedic Oncology (5 weeks) – LAC+USC Medical Center Junior residents are paired with a senior resident and collectively cover the pediatric and oncology services. There are daily didactics with the pediatrics or oncology attendings. Also, one day per week is dedicated to Pediatric Sports, with clinic in the morning and surgery in the afternoon. Residents will have no call except for “Green Team” call as detailed above.
Orthopaedic Oncology (5 weeks)– Keck Medical Center The senior resident will gain experience in the diagnosis and treatment of musculoskeletal neoplasms at one of the largest orthopaedic oncology practices in the country. Residents assist in numerous operative cases, ranging from small biopsies to definitive endoprothetic reconstructions. There is a weekly tumor board conference with pathology, radiology, medical and radiation oncology. The residents take home call in addition to any “Green Team” call as described above.
Foot and Ankle/Reconstruction (5 Weeks) – Keck Medical Center and LAC+USC Medical Center This rotation involves a comprehensive educational experience involving workup and treatment of common and complex foot and ankle diagnoses. The senior resident operates both at Keck Hospital and LAC+USC. Additionally, there is a weekly resident education conference in which key concepts are reviewed and complex cases are discsused. Residents take home calls during this service in addition to any “Green Team” call described above.
Administrative Chief Residents
Two PGY-5 residents are selected yearly by the faculty to function as Administrative Chief Residents. They are given advanced responsibilities in teaching, organization, and administration. The Chief Residents work closely with the Program Director and the Director of Resident Education to provide continuous resident feedback about various aspects of the program.
The Norris Medical Library on the USC Health Sciences Campus has an extensive orthopaedic surgery section. The affiliated hospitals also have libraries which have current and past orthopaedic periodicals and reference books. Faculty and Alumni have donated funds to establish a collection of books located at the LAC+USC Medical Center. Also, the Norris Medical Library website includes access to numerous medical literatures, including multiple orthopaedic surgery full online books, journal databases, as well as other digital resources.
Conferences & Courses
Residents are encouraged to attend educational conferences and courses throughout the PGY-1 through PGY-5 years. During this time, residents are frequently able to attend AO Basic and advanced courses as well as more specialized courses related to their desired field of interest. Also, all fifth year residents are provided time off to attend both the annual American Academy of Orthopaedic Surgery conference as well as the annual Miller’s Board Review conference.
Research is encouraged at all points during the residency program. Residents must complete at least one publication-worthy project during their residency. Projects may be clinically based or basic science. Residents are guided throughout the research process by regular meetings with the Resident Research Committee, consisting of clinical and basic science faculty members who are themselves active researchers. All projects are supervised by full-time faculty members and may be completed at any affiliated research centers. Additionally, projects may be completed at the Gait Laboratory at CHLA or Rancho Los Amigos Medical Center, or at the Orthopaedic Biomechanics Laboratory at the Long Beach Veterans Affairs Hospital. One resident each year will have the opportunity to take a year off from clinical duties to do basic science research for a year. The research year will be supervised by Dr. Lieberman.
Didactics & Educational Activities
Core Curriculum is the cornerstone of resident education and is held every Friday from 6:45 am until 8:30am. Residents are excused from all clinical responsibilities during this time. All lectures are given by faculty members. As part of the Core Curriculum there are special review sessions to prepare the residents for the annual Orthopaedic In-Training Exam (OITE). The Core Curriculum covers all aspects of Orthopaedic Surgery and runs on a 2-year cycle.
Once a month, Morbidity and Mortality conferences are held during part of this time in order to further educate residents.
Department of Orthopaedic Surgery Journal Club is held once a month at Keck Hospital of USC, and each service also holds a conference or journal club each week in which residents are expected to prepare and present topics related to their respective services.
Orthopaedic In-Training Exam
Monthly Grand Rounds are given by renowned visiting faculty. These lectures include the Joseph H. Boyes, MD Memorial Lecture focusing on Hand and Upper Extremity topics, and the Robert K. Kerlan, MD Memorial Lecture focusing on Sports Medicine related topics.
Subspecialty Conferences – Each subspecialty service also has at least one weekly faculty-conducted educational conference for the residents on that particular service.
Evidence-Based Research Conference – This conference meets monthly. The purpose is to review evidence-based literature or an interesting article related to health policy or economics.
Other educational opportunities include cadaver dissection, arthroscopy tutorials, and sawbone labs.
One unique aspect of the education here includes the use of an arthroscopy simulation tower at LAC+USC Medical Center. Our program is one of only a handful of institutions to have this equipment available. This tower allows life-like simulation of multiple shoulder and knee arthroscopic procedures as well as step-by-step instruction for performing these procedures. There are also multiple research projects underway evaluating the use of this equipment in training residents and attending surgeons.