I would be extremely surprised if you will ever set a fracture as a medical student. Do not worry about this. Know your anatomy and know how do be the low man on the totem pole. Know how to write a tight ortho note so that when the resident is doing something, you can be writing instead of just watching him. Know your place, dont ask dumb questions, and be willing to do anything. They are not looking for you to be able to do stuff that a 2nd or 3rd year resident can do, they want you to be willing to learn and be a team player.

good luck

I set a couple of distal radius Fx's during my sub-I's. The resident stood right next to me the whole time, but I put in the block, did the reduction, and splinted the arm. Seemed like this wasn't a common thing to let a MS4 do.

However, you will be taught how to do it. You don't need to know beforehand. I would echo the previous poster:

Be able to write notes, post op patients, tie knots, and be willing to do anything (within reason)

Just to follow this up with a related question...for those who are in residency programs associated with Level 1 trauma centers, what role can the MS4 expect to play as a member of the trauma team on an away elective? Are there opportunities to assist in fixing a fractured pelvis, put traction on femurs, etc? I'm sure this relates to the experience and initiative of the medical student, but I'm curious at what I can expect on rotation. Will make sure to have my op note and ortho note skills down, thanks.

On My trauma away I was able to put in a few femoral traction pins and halos but was shown multiple times and walked through each time. You scub in cases but just like anything else the amount you do is variable. Usually delegated to retract, help close and if I was being really good put in a K-wire. You really should act the same as you do on a home rotation. You want to be yourself and see if you fit in. That being said if you are a slacker you should hide it.

The best advice I was given for an away is by a program director the first day. "You are not here to learn, that would be a bonus. You are here to see if you like us and if we like you. Work hard and be yourself and things will work out how they should, where ever you end up."

Thanks for that ortho...perhaps the most comforting advice I've heard in a long while. In a specialty this competitive I think you would definitely have to be a super sluth to hide being a slacker. Any advice on programs with great trauma aways? I was thinking of 4 weeks at the pit in Chris Hani Baragwanath SA in addition to a few US aways...any suggestions appreciated!

Can't speak for what it is like as an away rotation since I did it as a third year, but we are super busy at USC. The rotation is done at the LA county medical center and we see a ton of trauma. I saw closed reductions, treatment room traction pin insertions (OR time is hard to get so anything that can get done in the "house of pain" does get done), simple ORIF's, and complex surgery on mangled extremities. The residents do four months of trauma every year, and it is in house call even for the chiefs. It's not for everyone but if you like trauma, I recommend this program

I think it makes sense to point out that a lot of what we "do" are procedures and most anyone can learn how to do these procedures, I remember having 5 or 6 chest drains under my belt in the few days following M2. Thumb, you may be shocked and say "holy schmoolly, that's illegal! (with a BIG exclamation mark" however I was taught how to do the procedure by an experienced resident and closely observed in each scenario...I didn't make the decision "let's put in a chest drain", but could do it under command. The reason we spend all these years in medical school amd clinical training is to 1. learn how to effectively and efficiently do procedures but more importantly 2. when and when not to do them. My initial post was an aim to find out what skills should be expected to impress at an ortho away, the answer seems clear: nothing, just a smile, work ethic, and perhaps a bit of intiative.

You will also impress people when you can describe a fracture on an Xray well in front of a group of people. Each student is asked to do this at least a couple of times-- and they usually do a mediocre job.
-adaman

adaman--great point. for those of you without a lot of experience reading films (and i'm certainly no expert) start with basics: view, location, then just describe what you see. look for fracture lines, intervals, STS, periosteal rxn, sclerosis, lucency etc. usually you won't be expected to know anything on CT or MRI. also, if you can identify some of the more common named fx (bennets, boxers, jones, monteggia...) you will look like a total stud.

cheers.
fg

When I was on my ortho sub-I at the county hospital, I was allowed to give knee injections (under the supervision of an attending or resident) to all the patients whom I had seen personally in the clinic. I had the opportunity to evaluate one patient on her first visit to the clinic, where synvisc injection X 3 over a three week period was the chosen route for her knee pain. Not only was she aware of my status as a medical student, but she was happy to know that the person that spent the most time with her in the clinic was giving her the injection. I also happened to have seen her on her second return visit where she had no complaints over the quality of care and I again injected her knee sucessfully. On her third and final return visit, I happened to have been seeing a different patient when a resident was preparing to inject this patient's knee. Despite his MD status, the patient said that she wanted me, the medical student, to give her the injection. The resident ended up hunting me down so that I could give her the injection.

The reason why I post this story isn't to start some fight. I'm just saying that sometimes medical students can make a lasting connection with patients and they don't care 100% if you're 8 months from your degree or have your MD.

for those of you without a lot of experience reading films (and i'm certainly no expert) start with basics]

Thanks for this great advice. Any textbook or online resource you'd recommend that covers the principles/basics of reading ortho films?

bonehawk-- orthopaedic secrets has some help with that stuff, although it's kind of an advanced read for a MS. if you go to your school library and just flip through the MSK rads texts, they can be pretty helpful. i used to check one out to keep with me during sub-i. unfortunately as far as passing on info, i learned mostly from residents, and i did 2mo of rads during 4th yr. sorry not more helpful.

cheers.
fg

well I have been a resident for almost 4 1/2 years now, and I can tell you that when someone says "medical students get to reduce fractures" they probably dont mean the resident on call is sitting in the call room eating cheetos while the student is performing procedures/reductions unattended by the resident. I try to let all of our medical students get some sort or hands on procedures as long as I think they have been doing a god job. Reducing a mildly angulated BBFA is a good example and we have a C-Arm in the ER so I can immediatly show them how they did AS I WATCH THEM. Ortho is a very hands on tactile field, so unless someone allows you to "get your hands dirty" all the comcepts they may have told you (exagerate the deformity, pull traction and then flex the wrist, blah blah blah) are just that, abstract concepts. Speaking of "personality", I gotta say if I had a student that had an attitude like you have shown here, theres no way I would recommend ranking them