Resident education finds its foundation in Tuesday & Wednesday conferences, with supplemental “service-specific” conferences on various other days. A general skeleton didactic week is as follows:
Monday – Service specific conference
Tuesday – Academic Day
Wednesday – Fracture Conference, Grand Rounds, or M&M
Thursday – Service specific conference
Friday – Service specific conference
- »Academic Day
Basic Didactic Sessions (except Adult Reconstruction): Tuesdays 7 a.m. to 10:30 a.m.
Adult Reconstruction Sessions: Fridays 7 a.m. -10:30 a.m. (as assigned)
With the exception of the Adult Reconstruction topics, Academic Days are setup to occur on Tuesday mornings, regardless of the topic. These are typically structured in three 1-hour lectures (starting at 7 a.m.). The first lecture revolves around a basic science topic, and approximately 60% of the time is done by a resident. The following two topics are given by staff within a certain discipline (i.e. Foot & Ankle, or Trauma, etc). The final 30 minutes of each session are reserved for OITE practice questions.
With each Academic Day, there is an assigned resident. PGY-2 though PGY-5 residents are typically responsible for coordinating 2-3 Academic Day sessions per year. The topics for the year are assigned in July, along with staff assignments. The resident is responsible for reminding staff about their presentation topics, and for putting together a basic science discussion/presentation, if needed. In addition to Orthopaedic staff, Neurosurgical, Infectious disease, Basic Science, Rheumatologic, and Radiology staff all participate in the orthopaedic resident Academic Day discussions.
- »Fracture Conference
Fracture Conference occurs 2-3 Wednesdays per month (shared with M&M and Grand Rounds on alternating Wednesdays). This occurs from 7 a.m. - 8 a.m., with the conference being led on a certain fracture topic by a PGY-4 level or research resident. Topics are taken from previous OTA presentations and updated each year, and staff is frequently present in order to stimulate discussion and offer guidance for diagnosis and management. Examples of topics may include “Olecranon and Radial Head Fractures” or “Acetabular Fracture Classification.”
Also during these Wednesday sessions, rotating medical students will give their 10 minute case presentation on an interesting patient they encountered during their time at Cleveland Clinic, with a brief discussion on overall diagnosis, management, and treatment strategies concerning particular orthopaedic disability/disease.
- »Grand Rounds
This conference occurs once per month, and is given as a topic of choice by staff from each sub-specialty department. The final Grand Rounds of each Academic Year is typically given by the chief residents, and has turned into a tradition of staff versus residents Orthopaedic Jeopardy.
- »Quality Assurance (M&M) Conference
This conference occurs once per month (second Wednesday), and revolves around those complications and unplanned re-admissions for the previous 30-day period. Residents involved with the cases present 5-10 minutes, including any pertinent literature that supports (or undermines) a decision making process. The goal of this conference is to learn from past experiences, with the eventual goal of enhancing patient care in both efficiency and quality. Overall speaking, this is an incredibly benign environment, with a cordial atmosphere intent on learning, not on bemoaning.
- »Service Specific Didactics
A multi-disciplinary Musculoskeletal Oncology Conference occurs with staff and residents/fellows from various specialties (Pathology, MSK Radiology, Rad-Onc, Heme-Onc, Orthopaedics). Upcoming cases are presented in a stepwise fashion, typically starting with clinical presentation, MSK imaging, biopsy results, surgical plans, and adjuvant/neoadjuvant therapy plans. This conference occurs 7 a.m. - 8 a.m. on Monday mornings, and is attended by the intern and PGY-4 residents on the tumor services.
Thursday and Friday mornings (6:30 a.m. - 7:30 a.m.) revolve around and Indications Conference (Thursday) and a Resident Presentations Conference on a selected topic (Friday). All pediatric staff are in attendance, with both conferences being interactive between residents and staff. In addition to these conferences at Cleveland Clinic's main campus, those residents rotating at Akron Children’s Hospital also have Monday/Tuesday morning Indications and Resident presentation conferences, in addition to a Wednesday morning Pediatric Fracture conference.
Friday morning conference (6:30 a.m. - 7:30 a.m.) is at Cleveland Clinic's Sports Health Center. These discussion are led by a Sports Medicine Fellow through a PowerPoint presentation, and interactive between staff and residents/fellows. Approximately 30-40 people are in attendance, including all Sports Medicine staff, residents/fellows, and MSK Radiology staff.
Monday mornings (7 a.m. - 8 a.m.) include an Indications conference on the Joints service, with cases for the upcoming week presented by staff/fellows. The discussion revolves around indications, exam findings, surgical treatment options, and pertinent literature concerning each case. Residents and fellows on the main campus Joints service are in attendance, as well as multiple joints staff.
Hand & Upper Extremity
Once a week (typically Mondays or Wednesday mornings), the Hand service has a “Selected Topics” conference, as selected by the staff. The Hand fellow is responsible for finding 4-5 pertinent articles from the literature, and leading an interactive discussion. Typically, the resident will present one of these articles, in a brief 5-minute synopsis. In addition, there are once-monthly (on average) cadaver workshops in order to learn new approaches or understand different manufacturer’s device options. Finally, Journal clubs occur once per month at up-scale local Cleveland area restaurants, where the hand residents will be responsible for discussing one article, a piece. These dinners are attended by multiple hand staff from all over Northeast Ohio, including MetroHealth and Case Western.
- »Off Campus Rotations
As indicated in the above Pediatrics section, Akron Children’s Hospital has multiple weekly conferences to supplement your clinical experience while rotating. MetroHealth has daily morning sign out conferences attended by all trauma staff, in addition to weekly Grand rounds presentations. During a 2 month rotation, the Cleveland Clinic resident will be responsible for giving 1-2 Grand Rounds lectures on previously selected topics.
- »Saturday Conferences
To make it perfectly clear, Saturday conferences are not a regularity within Cleveland Clinic's orthopaedic residency. Residents are required to attend a Saturday conference 4-5 times per year. These conferences only occur when there is a funded visiting professor lectureship, with invited speakers from all over the world. Conferences typically last on Saturdays from 8 a.m. - 10 a.m., with a frequent Friday afternoon resident session, where case presentations are made to the visiting professor concerning difficult problems or interesting management strategies in the “not-so-straightforward” orthopaedic patient. Residents are excused from all clinical responsibilities during the Friday resident sessions. Examples of past lectureships:
Reich Lectureship Series
2011 - Alan Gross (University of Toronto)
2010 – Marc Garcia- Elias (Institut Kaplan, Barcelona)
2009 – David Helfet (Hospital for Special Surgery)
2008 – Daniel Berry (Mayo)
Dickson Lectureship Series
2011 – Shepard Hurwitz (UNC-Chapel Hill)
2010 – Matthew Ramsey (Thomas Jefferson)
2009 – Jeffrey Eckardt (UCLA)
Duncan Lectureship Series
2010 – David Fuller (University of Pennsylvania)
2009 – Terry Axelrod (University of Toronto)
President’s Lectureship Series
2011 - Peter Stern (University of Cincinnati)
2008- J. Tracy Watson (St. Louis University)
2011 – Kurt Spindler (Vanderbilt)
2010 – James Wright (Hospital for Sick Children, Toronto)
2009 – Michael Yaszemski (Mayo)
- »OITE Reviews
From September to November, each Thursday evening (5:30 p.m.– 7:30 p.m.) is spent amongst the residents going through previous OITE tests and AAOS Self-Assessment questions. This is an interactive discussion with food provided on a weekly basis. Staff are frequently in attendance. Once the OITE is taken in early November, the Thursday evening reviews are substituted for the Academic Day morning OITE review block (see above “Academic Day” section). In addition, the department also purchases the most up to date AAOS self-assessment tests each year, for the residents to use in their own individual AAOS accounts.
- »Journal Clubs
General orthopaedics journal clubs occur about 10 times per year, rotating through the various sub-specialty discipline topics. Typically 4-5 articles are selected for presentation (by the research resident and staff), and presented in a short 5-minute synopsis by PGY-1 thru PGY-3 residents. The rest of the time is open to interactive discussion, with multiple staff present during each journal club. Depending on the season of the year, different venues are utilized. In the summer/spring/fall, journal clubs are typically at staff homes, with recreational activities surrounding the discussions including full-field soccer games, 3 vs 3 basketball tournaments, or a BBQ overlooking Lake Erie from a backyard. This is an informal, yet educational environment dedicated toward increasing resident apprehension of recent literature, and learning how to critically analyze a variety of journal literature pertaining to orthopaedic practice.
- »Cadaver Lab
There are two opportunities for wet lab dissection and surgical practice outside the operating room.
This is a wet (and dry) lab that is dedicated to the orthopaedic residents and fellows. Uses of this lab can include arthroscopic practice on human cadaveric body regions (including cartilage work, ligamentous/tendon repair, meniscal repairs, etc), as well practice with various ORIF or bony work techniques. About 8-10 times per year, a portion of a Tuesday Academic Day will be devoted to residency education within Mo’s lab, lead by various Sports Medicine staff. The lab is also open to individual resident practice, with cadaveric specimens available with prior appointment.
The “dry” lab portion of this includes various shoulder, knee, and hip models that allow for further fine tuning of arthroscopic knot tying and instrument techniques, without the need for a cadaver.
This lab is the main Cleveland Clinic Medical School anatomy facility, located in the basement of the L-Building on Cleveland Clinic's main campus. Here, large-scale approach dissection can be undertaken, with some limited examples ranging from lower extremity trauma approach techniques, acetabular approached, approaches to the scaphoid, or total hip approaches. Another use of this lab is the orthopaedic resident opportunity to help with educating medical students, including prossection and in-class teaching.
- »Saw Bones Workshops
Approximately from 8-10 times per year, residents will have the opportunity to participate in sponsored outings to local area venues for the purpose of simulating techniques with various orthopaedic implants on saw bone models. These times can prove to be very useful in learning new instrumentation, or becoming familiar with well-known instrumentation for the younger residents.
- »Journal Subscriptions
The Department of Orthopaedic Surgery pays for each resident to receive subscriptions to JBJS-American, JBJS-British, JAAOS (Yellow Journal), and the Journal of Sports Medicine. Further journal subscriptions are readily available in the resident reading room (located in the A41 orthopaedic offices building), including other such well-known journals as Journal of Trauma, CORR, or Spine.
- »Resident CORE Reading List
Starting in 2010, the residency program has implemented a CORE Reading list, with pertinent articles that are either “classic” to the formation of each sub-specialty discipline within orthopaedics, or are groundbreaking in terms of new techniques or thought strategies. Each sub-discipline has between 10 and 20 articles that are marked as “must reads” for each resident prior to graduation, with all articles passed along to incoming residents. Each article list was created with the close input of various staff in each sub-discipline of the department.