Rotation Level: PGY 1 

The first year of orthopaedic surgery residency establishes the critical foundation of both orthopaedic and general surgical knowledge and skills. A strong foundation in patient evaluation, diagnosis, and surgical management sets the tone for continued growth throughout orthopaedic surgical residency and beyond.

Intern year is structured to emphasize hands-on learning in a team setting. Residents are exposed to the breadth of orthopaedics and they will become proficient in settings from routine outpatient clinic visits to high-energy musculoskeletal injury and polytrauma. Residents learn to manage a large inpatient service, gain efficiency and competence in evaluating emergent and non-emergent consultations, perform bedside procedures and skeletal stabilization, and collaborate in inter-disciplinary care. Senior residents and attending surgeons provide constant guidance and feedback through dedicated conferences, radiology review, and discussion of treatment plans, ensuring appropriate understanding and application of core orthopaedic principles. Specifically at the James A. Haley VA, interns regularly scrub orthopaedic cases and begin to develop their surgical skils.

Interns participate in a dedicated Skills Lab and Boot Camp led by experienced attending surgeons, occurring weekly for the first 4 weeks. The Skills Labs are based off of the American Board of Orthopaedic Surgery (ABOS) curriculum and include multiple cadaveric dissections to instill the basics of musculoskeletal anatomy, demonstrate and practice appropriate surgical techniques, understand soft tissue handling, and gain familiarity with instrumentation for fracture fixation and arthroplasty. Additionally, the Boot Camp provides a lecture series encompassing the orthopaedic consultation, physical examination, and efficient evaluation of orthopaedic surgical emergencies. Finally, hands-on skills are taught for reduction of long bone fractures and joint dislocations, and correct methods of provisional stabilization (splinting, casting, skeletal traction, etc). In addition to this intensive curriculum, regular cadaveric anatomy and surgical skills labs continue throughout the year.

PGY1 year is broken down as follows:

• 3 months of General Orthopaedics (James A. Haley VA Hospital)
• 3 months of Orthopaedic Trauma at a Level 1 Trauma Center (Tampa General Hospital)
• 1 month of dedicated Musculoskeletal Radiology (Moffitt Cancer Center)
• 5 months of General Surgery Training including 1 month each of Neurosurgery, Plastic Surgery, Vascular Surgery, General Surgery Trauma, and Surgical ICU

Rotation Level: PGY 2

The second year resident will begin taking primary call via night float, and be exposed to Spine, Pediatric Orthopaedics, Sports, and Orthopaedic Oncology. The experience is invaluable, as residents participate in patient care through a busy private practice, an academic Level 1 Trauma Center, Ambulatory Surgery Centers, a nationally recognized Cancer Center, and a dedicated pediatric hospital providing both bread-and-butter pediatric orthopaedic care and specialized deformity correction in a philanthropic model.

A prime focus of second year is to build upon the foundation that was established. Residents will enhance their surgical skills and dexterity under the direct tutelage of experienced, high-volume surgeons. During Sports, residents will become proficient in the indications, techniques, and surgical execution of large and small joint arthroscopy and open sports related procedures. Sports coverage is available for interested residents at local high schools, the University of Tampa, University of South Florida, and St. Leo University. Spine surgery occurs both at Tampa General Hospital and Advent Carrollwood, where residents take Level 2 call and perform both outpatient surgery and complex deformity correction. Both the Spine and Sports rotations benefit from the mentorship model of education. Orthopaedic Oncology and Pediatric Orthopaedics are hosted by specialty hospitals with team based services comprised of numerous sub-specialists. Each rotation provides a formal academic experience with complex surgical planning, rare diagnoses, and referrals from throughout Florida.

Additionally, residents gain independence and autonomy through taking call at Level 1 adult and pediatric trauma centers throughout the year. This is invaluable to teach one how to manage the differing acuity of consults, stabilize traumatic injuries, communicate effectively with senior residents and attending surgeons, and to understand and execute appropriate treatment plans for surgical and non-surgical care.

Research is encouraged during this time and supported with ample dedicated research coordinators, PhD statisticians, engineers, and departmental funding. This allows the second year resident to focus on study design, craft a protocol and IRB, collect and analyze data, and compose a manuscript. The goal of this research is to explore specialty interest and gain familiarity with the scientific process in order to answer meaningful orthopaedic questions.

PGY2 year is broken down as follows:

• 6 weeks of Musculoskeletal Oncology (Moffitt Cancer Center)
• 3 months of Pediatric Orthopaedic Surgery (Johns Hopkins All Children’s Hospital)
• 3 months of Sports
• 6 weeks of Spine Surgery
• 3 months of Night Float

Rotation Level: PGY 3

The third year resident begins the year armed with a strong foundation of basic orthopaedic surgical principles and an understanding of basic surgical techniques and execution. The expectation as the year progresses is for the third year resident to gain continued proficiency with pre-operative surgical planning, intra-operative surgical execution, and post-operative patient management and activity progression. Third year residents are further expected to assume greater responsibility in educating junior residents and are also afforded greater autonomy as the year progresses.

Residents return to the Pediatric Orthopaedic Service for the completion of the ACGME required 6 months education. Similarly, third year residents rejoin the Orthopaedic Trauma (TGH) and General Orthopaedic (VA) services in a new role. As the intermediary resident, they will continue to develop surgical skills while also helping educate the intern on consult and inpatient management, as well as encouraging surgical involvement when at all possible. Surgical exposure at the VA varies between arthroplasty, hand, oncology, shoulder and elbow, sports and trauma. Finally, Foot and Ankle surgery takes residents back to the busy private setting and includes Ankle Arthroplasty, arthroscopy, complex reconstruction, and trauma. As with other outpatient services, education is primarily mentorship model. Furthermore, third year residents continue developing research topics and advancing projects of interest throughout the year. Time and funding are afforded for regional and national conference presentation, as public speaking and academic achievement are vital in cultivating capable orthopaedic surgeons who will become leaders in the field.

PGY3 year is broken down as follows:

•  3 months of Orthopaedic Trauma (Tampa General Hospital)
• 3 months of General Orthopaedics (James A. Haley VA Hospital)
• 3 months of Pediatric Orthopaedics (Johns Hopkins All Children’s Hospital)
• 3 months of Foot and Ankle Surgery

Rotation Level: PGY 4

Fourth year continues to build upon the development seen in third year, with residents gaining additional surgical autonomy and understanding of more complex patient management. They complete the remaining subspecialty rotations including Shoulder and Elbow, Hand and Upper Extremity, and Adult Reconstruction.

Shoulder and Elbow is both high volume and research focused, and incorporates custom implantation, anatomic and reverse arthroplasty, and arthroscopic surgery. Adult reconstruction is a high volume service with numerous experienced surgeons and midlevel providers. There is a high proportion of revision arthroplasty, arthroplasty for fracture, and all types of nonrobotic and robotic systems. Lastly, Hand and Upper Extremity is unique in that is involves busy outpatient clinics and surgery center exposure while also covering replants and upper extremity trauma at Tampa General Hospital. Residents leave this service being able to confidently manage routine hand pathology as well as complex trauma. 

A key element during the first half of PGY4 year is the preparation, application, and interviews for fellowship. Residents have developed mentor relationships within a potential field of interest, and tailored one’s research initiatives towards a sub-specialty interest. Thus, PGY4 residents are well prepared for fellowship applications with strong recommendation letters, valuable research experiences, and wide exposure.

Like the more junior years, fourth year residents also participate in monthly cadaveric anatomy sessions and skills labs to solidify surgical execution, practice more rare or subtle surgical scenarios, and become familiar with less common instrumentation. PGY4 residents are expected to adopt a stronger leadership and guidance role for junior residents.

PGY4 year is broken down as follows:

• 3 months of Shoulder and Elbow
• 3 months of Adult Reconstruction
• 3 months of Hand and Upper Extremity
• 6 weeks of Orthopaedic Oncology
• 6 weeks of Spine

Rotation Level: PGY 5

The chief resident has built upon the initial foundation, mastering basic orthopaedic principles. They have had multiple exposures to all orthopaedic sub-specialties and have managed patients on services in a variety of clinical and surgical settings. The prime goal of chief year is to serve as a capstone, solidifying more advanced orthopaedic surgical techniques and mimic independent practice. The ability to operate with autonomy is not only allowed but is expected. Chief residents lead the inpatient teams at the larger hospitals (TGH and the VA), ensuring that all patients have appropriate treatment plans and engaging with other chiefs/attendings of inpatient services to dictate appropriate, timely inter-disciplinary patient care. Chiefs are expected to educate junior residents regarding patient evaluation and management, provisional reduction and stabilization, and guide junior residents through level-appropriate surgical cases.

Advent Wesley Chapel and Brandon Regional Hospital are home to 6 months of invaluable operative experience for chief residents. These are largely non-academic centers where our private practice preceptors take Level 2 call and specialize in Sports, Adult Reconstruction, Spine, Foot and Ankle, Hand and Upper Extremity, and Shoulder and Elbow, allowing chief residents the flexibility to train in areas of interest with junior-attending level autonomy.

The importance of leadership is also strongly emphasized, and dedicated lectures and meetings are scheduled with mentoring attending surgeons, the Residency Program Director, and Department Chairman. The business of orthopaedic surgical practice is strongly emphasized, and guidance and advice are provided during the evaluation of potential employment opportunities. Further career development opportunities are available, with time and funding provided to pursue regional, national, or international conferences of interest.

PGY5 year is broken down as follow:

• 3 months of General Orthopaedics (James A. Haley VA)
• 3 months of Orthopaedic Trauma (Tampa General Hospital)
• 3 months of General Orthopaedics (Brandon Regional Hospital)
• 3 months of General Orthopaedics/Elective (Advent Wesley Chapel) 

Orthopaedic Surgery Milestones & Core Competencies

The University of South Florida & Florida Orthopaedic Institute Orthopaedic Surgery Residency Program strives to train exceptional orthopaedic surgeons and physicians and adheres to the Orthopaedic Surgery Milestones and Core Competencies set forth by the ACGME (Accreditation Council for Graduate Medical Education) and the ABOS (American Board of Orthopaedic Surgery).

These are freely available through the ACGME and ABOS website:

ACGME

ABOS