Program Review
Staff / Faculty / Chairman
The University of Florida Department of Orthopaedics Residency has an established tradition of providing orthopaedic surgical residents with outstanding educational opportunities in a collegial environment. Since the last review, the Department continues to grow, and likewise, the resident experience adapts to better meet the needs of today’s trainees. We welcome the opportunity for you to get to know us.
Dr. Scarborough (Oncology) became Chair in 2011. He continues to be a strong advocate for the resident and is always interested in improving the resident experience. The surgical faculty involved in our training now stands at 26, with 10 new faculty joining the Department over the last 5 years. Their training and backgrounds are diverse, which broadens our exposure to operative technique from outside our institution. New faculty additions include Jennifer Hagen, fellowship trained at Shock Trauma, and Sarah Molinari, fellowship trained at Texas Scottish Rite Hospital for Children. The arthroplasty division has doubled in size in the last 2 years with the addition of three new attendings: Hernan Prieto, Chancellor Gray and Dane Iams.
Seasoned faculty still form the cornerstone of our institution. Parker Gibbs (Oncology) and Thomas Wright (Hand and Upper Extremity), have maintained a culture where the faculty understand their role as educators and mentors. Rotators who became residents often state that the familial interaction between attendings and residents is one of the key reasons they wanted to be a part of our institution. This culture extends into all learning environments. In the clinic, attendings take the time to deliver educational pearls from patient encounters. In the operating room, they are committed to develop your surgical acumen and technical skill.
Didactics / Teaching
The academic experience outside the clinical arena starts with morning conference, held daily at 7AM. This is protected time for resident education, The curriculum is modeled off a core curriculum with rotating sub-specialty topics on each day of the week. Conferences are a mix of didactic lectures and case-based discussions. Over 50% of the lectures are given by the faculty. All of the lectures are attended by faculty of the presenting sub-specialty. Anatomy and operative technique cadaver labs held in our surgical skills are also an essential component of the curriculum, and occur on a monthly basis. The surgical skills laboratory is a state of the art facility located within our clinic building. There are surgical instruments as well as arthroscopic models and tools. It is great having this facility. This laboratory also permits focused independent study by residents on their own time. Grand Rounds (visiting professor) also takes place monthly in the evenings. We hold a resident journal club every other month.
Operating Experience
The operative experience continues to be the strongest asset of our program. Residents are now exposed to all sub-specialties once by the end of the PGY-3 year, and again as senior residents. Time spent in the OR versus clinic is well-balanced, averaging 3-4 operative days and 1-2 clinic days per week. Each Division has both outpatient and inpatient physician extenders, who work closely with the resident teams to offload the administrative and clinical work. Each division also has sufficient surgical volume and case exposure. Aside from trauma, where resident to resident teaching is an integral component of the education and operative experience, residents or fellows are rarely double scrubbed on cases. For the majority of cases, residents are treated as primary surgeon with the attending, fellow or senior resident guiding you through the technical aspects of the case. The volume of cases is high yet not overwhelming. The diversity of cases is excellent ranging from general orthopedics to complex tertiary orthopedics. We get to see and scrub on not just the ordinary cases, but also complex specialized cases in most of the subspecialties.
The VA, which provides an excellent training ground, also comprises a junior rotation and a senior, transition to practice rotation. The VA experience is high volume with a good deal of autonomy under appropriate levels of supervision.
The Advanced Clinical Elective (ACE) rotation is a 12-week senior resident block, which allows the resident to craft an experience specific to their own interests. This is supported by Department funding. Residents have traveled to Australia and Taiwan to operate. Others have spent time with local community practices, who welcome our presence.
Clinic Experience
On average, 1-2 days per week is spent in clinic. There is frequently a physician extender (PA or ARNP) who also assists in each clinic, which reduces the patient load, and allows more educational time with the attending. That said, the clinics are run very efficiently by the department permitting the evaluation and management hundreds of patients each day. The entire UF Health system operates within the EPIC EMR. Most clinics are held in our clinic facility, the Orthopedic & Sports Medicine Institute (OSMI). This building is excellent and is due for further expansion to be completed by about mid 2018.
Sports team coverage is available. The PGY-4 on Sports typically covers UF athletics, including Gator Football home games. Residents may also elect to cover high school football games for $300 in compensation for each game.
There are a few ACGME-approved moonlighting opportunities available:
OrthoCare After-Hours: A 4 hour evening and weekend urgent care clinic.
Joints and Trauma OR coverage: Elective ORs are run on Saturday for both arthroplasty and trauma cases. Residents may volunteer and are compensated to staff these weekend ORs.
Research Opportunities
Resident research is well supported by the department. Clinical research coordinators assist the residents throughout the process, from proposal to manuscript. The research focus of the department continues to improved. The department is one of the top research producers for an orthopedic department in the USA. Based on NIH funding the department has ranked from top 11-30 over the past decade. The department is currently seeking to grow the resident and fellow productivity with project development earlier in residency and more regular instructional conferences and workshops. Recent faculty hires with strong research interests have also provided more mentors for resident projects. A dedicated research rotation will likely be built into our schedule in the near future. Funding for research is plentiful. Financial support for travel is available for residents with accepted conference presentations. Residents have presented their projects on a local and international stage, as far as Hawaii and Japan.
Residents
Each resident class comprises 4 residents, with 20 total. The residents are a dedicated and driven group, who enjoy being in each other’s company even outside of work. More than half are married. Spouses find an instant support system and form strong friendships with each other. Despite a busy work schedule, we have also managed to grow our families, with several newborns delivered in the last year, and more on the way.
Resident morale events are arranged regularly and the department provides financial support for these activities. Past events have included tailgating, bar-b-ques, and kayaking trips. Families are encouraged to attend.
Most residents choose to pursue fellowship training. However, residents interested in a career in general orthopaedics will be well-prepared. Our residents have pursued sub-specialty training in all fields, and at institutions throughout the US. The graduating PGY-5 class will be training at Indiana Hand to Shoulder Center, Andrews Sports Medicine, and Emory University for adult reconstruction. Graduating residents have joined our faculty as well as faculty of other institutions. We have also developed a reputation as producing well-respected and successful private-practice surgeons.
Lifestyle
Call responsibilities are more lifestyle friendly than most programs. With the trauma service on a night float schedule, call responsibilities are limited to the weekends as a junior resident. For this reason, abiding by duty hour restrictions have not been a problem for our program. Senior residents average 1:8 weekday call and 1:4 weekend call, which is divided into a Friday/Sunday block and a Saturday block. Senior call is home call. Our institution is a Level I trauma center, with the majority of patient being victims of blunt trauma. All of our coverage hospitals are located on the same campus.
Location / Housing
Historically, Gainesville has been regarded as a medium sized college town, but it is emerging into a growing city. An emerging young professional scene has developed for recent recruitment of tech and start-up companies. Gainesville is now the home of numerous tech and software companies. The university and hospital system has also shown tremendous growth in the last decade.
Despite this recent growth, Gainesville remains relaxed, quiet (except on game day) and very livable city. Housing options are plentiful and very affordable, whether you choose to rent or buy a home. Traffic is minimal, making commutes to and from work very manageable regardless of how far residents choose to live from the hospital.
Limitations
In general, residents would agree that UF is a very well rounded program with great operative experience, excellent mentorship with a well-balanced lifestyle. Previous reviews have noted the following weaknesses of our program. While some still exist, the department is actively making an effort to address each of the concerns.
Foot/Ankle Experience: Currently (as of August 2016) only one faculty member within this division. Clinical (1.5 days/week) and operative (1-2 days/week) remains limited. However, the attending (Dr. Vander Griend) is one of the most dedicated in our department to resident education and makes considerable effort outside of these days to further our education. Dr. Reb will be joining our Department in September 2016 to further bolster the service.
Spine Experience: Our department continues to not take trauma call, which may or may not be a weakness depending on one’s clinical interest. Our spine experience is led by Dr. Decker, our program director. Dr. Molinari will be joining our department in September 2016 as the second adult spine surgeon. Our spine experience is currently supplemented by our Pediatrics rotation during which we see a considerable amount of pediatric spinal deformity due to Dr. Blakemore’s expertise.
Peds Experience: Is now a strength of the department. We currently have two pediatric orthopaedic faculty and the department is actively recruiting a 3rd. Both the junior and senior on service have 2-3 OR and 2-3 clinical days per week during which they work one-on-one with an attending.
Research: Has been a variable experience for residents. Some divisions are well staffed and organized with numerous ongoing projects and available databases to facilitate resident involvement in research. Faculty interest and mentorship of resident research is quite variable. Dedicated time for research is currently limited in the early years of residency. However, based on the recent research-focused initiatives by our leadership, we expect many of these issues to be addressed in the near future.
Overall Rotation Experience / Conclusion
Given the opportunity again, I would rank this program first without hesitation. I’ve formed lifelong relationships with faculty mentors and future colleagues. I’ve received an outstanding surgical education. I’ve developed into an orthopaedic leader. And most importantly, through the example set by those around me, I’ve learned to keep the patient central to everything we do.
