Rotation Lists
During each year of your orthopaedic surgery residency, you will spend two months at Audie L. Murphy Veteran's Administration Hospital on the VA Orthopaedics Rotation. This rotation is designed to provide exposure to adult reconstructive procedures, shoulder, hand, spine, and an extensive experience in general orthopaedics. Clinics and surgery take place each day. Along with the general orthopaedic clinics, each of the surgical subspecialists within the department has one half day of clinic at the VA to provide subspecialty coverage. While on the VA service, residents are responsible for night call, on average, once every fourth night.
Methodist Hospital System Private Rotation:
Residents are assigned to the Methodist rotation for two months during their second, third, and fourth years. The resident's time is divided between the main Methodist Hospital and the Methodist Ambulatory Surgery Hospital (MASH). At the inpatient hospital, the residents will see a great variety of general orthopaedics including treatment of musculoskeletal trauma including osteoporotic fractures in the elderly as well as some low-level trauma. Most of the clinical and surgical experience will involve adult reconstruction, spine, as well as pediatric orthopaedics at the Children's Hospital. At the MASH, residents are exposed to outpatient hand, shoulder, knee ligament reconstruction, and shoulder and knee arthroscopy. The Methodist rotation provides an outstanding experience for the residents in general orthopaedics as well as the subspecialties in a private practice environment. Each month Methodist conducts a Grand Rounds which provides an excellent didactic conference that is centered on case presentations and discussion. Residents on the Methodist rotation take night call every third night.
Christus Santa Rosa Children's Hospital / Methodist Hospital Pediatric Orthopaedics:
Each resident will spend a total of six months on the Pediatric Orthopaedic rotation during their residency. The primary educational objective for this rotation is to expose the residents to the entire spectrum of general pediatric orthopaedics as well as routine and complex pediatric spine surgery. A portion of the time is spent under the direction of Dr. Robert Campbell at the Thoracic Institute. Dr. Campbell has become internationally renowned for his innovative treatment of patient with thoracic insufficiency syndrome using a vertical, expandable titanium rib prosthesis. Approximately 30-40% of the resident's time on this rotation is spent at the Methodist Children's Hospital with a group of very busy pediatric orthopaedic surgeons. We emphasize continuity of care and residents are expected to be involved in all aspects of the care of the same patient including preoperative evaluation, surgical management, perioperative management, and outpatient follow-up. An excellent didactic program has been organized by Dr. Kent Reinker which includes a one-hour Pediatric Grand Rounds, a fracture conference with Dr. Kaye Wilkins, a weekly core curriculum lecture, and a weekly spine conference. Residents on the Christus Santa Rosa Children's Hospital/Methodist Pediatric Rotation take night call every third night.
Orthopaedic Red Rotation (Hand/Upper Extremity):
Each PGY 2 and PGY 5 spends two months on the Orthopaedic Red Service. The PGY 2 resident spends the majority of his/her time under the direction of our senior hand staff, Dr. Fred Corley. This busy service provides a broad general exposure to the management of hand pathology including congenital, degenerative, and traumatic injuries. The PGY 5 resident spends the majority of his/her time with the shoulder service under the direction of Dr. Charles Rockwood, Dr. Michael Wirth, and Dr. Anil Dutta. The majority of the clinical and surgical experience involves treatment of traumatic and degenerative shoulder pathology with an emphasis on shoulder reconstruction. This rotation provides a balanced exposure to both open and arthroscopic treatment of shoulder pathology. Residents have no night call responsibility while on the Orthopaedic Red Service.
Orthopaedic Orange Rotation (Orthopaedic Oncology):
This rotation is supervised by our chairman, Ronald P. Williams, M.D., Ph.D. Each PGY 4 resident spends two months on the Orthopaedic Oncology service which provides a truly comprehensive exposure to benign and malignant soft tissue and bony tumors. Residents on this rotation attend a combined orthopaedic/radiology conference as well as a combined orthopaedic/pathology conference on a weekly basis. Although many of the surgical procedures are intricate and complex, the faculty emphasize basic diagnosis and management of soft tissue tumors from a general orthopaedic surgery standpoint. Residents are instructed on basic techniques for incisional and excisional biopsy and the principles of amputations and limb salvage. A weekly amputee clinic staffed by Dr. Williams, Dr. Carlisle, and a prothestist allows the resident to understand the basic principles of rehabilitation of the amputee as well as formulating and designing an appropriate prosthesis for individual amputees. The resident has no night call responsibilities while on the Orthopaedic Orange Service.
Orthopaedic Green Rotation (Adult Reconstruction/Sports Medicine):
Each resident spends two months on the Orthopaedic Green service as a PGY 2 and a PGY 5. The faculty on this service include lower extremity adult reconstruction surgeons as well as a fellowship trained sports medicine surgeon. This very busy clinical and surgical service provides an outstanding opportunity for residents to participate in the clinical and surgical management of degenerative joint disease as well as acute and chronic sports injuries. Journal Club is held on a monthly basis providing a well rounded review of the total joint and sports literature. Residents have no night call responsibility while on the Orthopaedic Green Service.
Each PGY 3 residents spends two months on a rotation with a busy group of private spine surgeons at the South Texas Spine Clinic, P.A. Nine fellowship trained spine surgeons provide supervision during this rotation with the resident spending approximately a week and a half to two weeks with each of the individual surgeons. This provides an excellent diversity of clinical and surgical management for diseases of the spine. The faculty provide a series of 20 didactic lectures that are included in our Core Curriculum which takes place on Monday evenings. To gain appropriate experience in the treatment of traumatic spine injuries, the resident on the spine rotation is also scheduled to attend clinic and surgeries with the faculty in the Department of Neurosurgery at the University of Texas Health Science Center. The resident on the spine service takes call at University Hospital with the neurosurgery team every fourth night to allow for the resident to participate in the initial evaluation and treatment of acute spine injuries.
Orthopaedic Foot and Ankle Rotation:
Each PGY 3 resident spends two months with a group of fellowship trained foot and ankle surgeons at the San Antonio Orthopaedic Surgery Center. The residents are assigned to Dr. Casillas though they spend an equal amount of time with Drs. Galindo and Brown in clinic and in surgery. Dr. Casillas provides a series of didactic lectures that are given during our Core Curriculum on Monday afternoons. The residents have no call responsibility while on the Foot and Ankle Rotation.
Orthopaedic Research Rotation:
Research is an integral part of the training during the orthopaedic residency. In PGY 1, residents are given a one day orientation to research and then a one-month rotation to define a research topic and identify a mentor. In PGY 2 and PGY 3, the details of the project are further refined and data collection accomplished. As a PGY 4, each resident is given two months to finalize their research project. Residents who are fortunate enough to have completed all of their research requirements, use this time for additional basic science study as well as augmenting their residency education by spending time on an elective service of their choice. This rotation adds an element of flexibility to the residency program and allows each resident to "customize" their training experience. While on the research rotation, the residents have no night call responsibilities.
One of the major strengths of this residency program is its excellent exposure to orthopaedic trauma. The large volume of trauma allows for more junior residents to become involved in the surgical care of patients earlier than would be possible in a hospital with a lower volume of patients. To comply with the new resident duty hours guidelines, we have added additional resident manpower to the trauma team and have created a three-team system. This schedule also includes a 12-hour night float resident as well as orthopaedic trauma PA which allows for each resident on the trauma service to remain in compliance with all of the resident duty hours guidelines without sacrificing their clinical and surgical experience. The rotation is supervised by Dr. Animesh Agarwal who is the chief of our Trauma Division. Each of the subspecialty faculty take night call at University Hospital and are available to provide subspecialty care for complex trauma related to their areas of expertise.