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Veterans' Administration Medical Center About the rotation The VA is a general orthopaedic rotation that encompasses the tertiary care of patients from the northwest region of the country and Alaska. The service is directed by Dr. Howard Chansky. Other faculty that participate in the general orthopedic rotation are Drs. Ted Greenlee and Fred Huang. The hand and spine services at the VA are directed by Drs. John Sack and Rick Bransford, respectively. Dr. Bruce Sangeorzan also directs the PACT service, a specialized care system for patients with vascular diseases and diabetes affecting the lower extremity. Although there is a focus on adult reconstructive and spine surgery, there is a broad spectrum of operative cases which includes: fracture, arthroscopic, oncologic, and upper extremity surgery. These are often complex revision cases from our broad referral base. There are over 800 surgical cases performed each year. Although the residents are busy, this is regarded as a very rewarding rotation. Residents rotate on this service as R2s for six weeks, and their role is to manage the inpatient service as well as the PACT service. Not only are they involved in perioperative management, but they also actively participate in the surgical care of patients. Residents return to the VA as R4s where they assume more independence inside and outside of the operating room, but continue to be in a closely supervised environment. As R5s, the residents have their chief rotation at the VA during which they assume a leadership role in managing the service. Goals & objectives The three rotations emphasize graduated responsibility. The R2 learns basic principles in evaluation and management of orthopaedic injury and disease in the clinical setting as well as the emergency department. In addition to being the primary resident in the PACT clinic, he or she is also the primary resident surgeon on all amputations. The R2 typically acts under the guidance of senior residents and faculty on other cases. The R4 functions as the primary resident surgeon on most of the basic and intermediate level orthopaedic cases. In this capacity, with close supervision, the R4 is responsible for surgical decision-making, detailed surgical-planning, and perioperative management of their patients. As the chief resident, the R5 is expected to be responsible for multiple aspects of the orthopaedic service, including: the orthopedic clinics, the inpatient service, and the surgical schedule. The R5 reviews the cases of all surgical patients scheduled by the R4 and oversees the R2 and R4 in clinic. The R5 functions as the primary resident surgeon on the complicated cases and supervises the R2 on the more basic level cases. One of the primary goals of the VA rotation is to tailor the educational and clinical experience to the individual needs of the resident. There is a strong team approach where the attendings and residents work closely, while also maintaining respect for the unique abilities of residents at various levels in their training. |
