Orthopaedics Residents Put Through Paces at ‘Boot Camp’

The department currently accepts five incoming trainees to its residency program each year.

The boot camp is taught by Jacobs School of Medicine and Biomedical Sciences faculty members and aims to make sure all the interns are proficient with the basic surgical skills and nonoperative skills needed to function in the training hospitals.

The four-week program is conducted inside the Jacobs School’s Gross Anatomy Lab and UB RISE (Research, Innovation, Structure, Simulation, Education, Engineering) surgical skills suite, as well as the clinical training sites for the orthopaedics residency program — Buffalo General Hospital, Erie County Medical Center and the Tim Horton Orthopedics & Sports Medicine Center at Oishei Children’s Hospital.

“It’s not just about the operating room. They are also getting detailed lectures on physical exams, patient evaluation and splinting and casting,” says Susan M. Daoust, MD, clinical assistant professor of orthopaedics, who coordinated the boot camp.

“Interns never practice medicine unsupervised. They are always under the guidance of senior residents and attendings,” she says. “In their first year, they perfect these skills through guided experiences.”

“Unfortunately, not everyone starts out at the same level because of the variability in medical school training,” Daoust adds. “This will help to standardize them to a level we feel is appropriate for surgical training. I think this will give them the skills to perform with more confidence and allow them to progress at an accelerated rate throughout the year.”

Daoust notes that a secondary benefit is the new residents will have an opportunity to meet and interact directly with many faculty members right away.

“All of the residents work directly with the attendings, however a large bulk of their work is carried out with their senior residents,” she says. “The senior residents are usually the first line in evaluating and perfecting certain skills such as cast and splint application and initial assessment of trauma patients.”

“This leaves a lot of variability from year to year,” Daoust says. “With boot camp, the interns will initially train every year directly with the attending staff. This will help standardize where the interns start every year.”

Facilities such as the Gross Anatomy Lab and UB RISE surgical skills suite are critical components in the training.

John M. Marzo, MD, clinical professor of orthopaedics and director of the Ralph C. Wilson Jr. Center of Excellence in Sports Medicine Skills Lab in the UB RISE surgical suite, points out the residents will gain experience in the lab on models and simulators a full two years earlier than they would have in the past.

“The skills lab and anatomy lab are more important than ever in modern training. Training is no longer straight apprenticeship. There is just too much specialization and so much more needed to learn in a shorter period of time,” Daoust says.

“Prior modes of training would allow residents to acquire their competency while actually managing patients in the facility. Now, the trend is that they should already be reasonably proficient before getting into the OR,” she adds.

“Our facilities are exceptional in that they offer all facets of training throughout all levels. There is a lot more than just the basic space where someone can come and practice suturing and knot tying,” Daoust says. “There are X-ray capabilities to practice fluoroscopic skills. There are multiple arthroscopic stimulators for all areas of the body.”

The facilities are readily available and open for the residents to use after their boot camp training as well.

Giving first-year residents a head start like this boot camp does will pay dividends throughout their training, Daoust says.

“The first thing that any resident has to be able to master is the basic surgical skills. It’s like learning to crawl before they can walk,” she says. “If they are still concentrating on basic surgical skills, it is hard to start to appreciate the nuances and finer details in any surgery.”

“Combine that with the increasing complexity of cases that they are expected to see. For example, 10 years ago there might have been two ways to deal with a complex shoulder fracture. Now, there are at least six,” Daoust says.

“We have to be more efficient in teaching them more content in less time. By fast-tracking them where we can, any resident graduating from our program will be able to spend a larger amount of their training at a more complex level of thinking.”