Mission

Our mission is to train, educate and produce board-certified Army orthopaedic surgeons, who are prepared for independent practice and provide world-class musculoskeletal care from the battlefield to the military tertiary care medical center, and after military service to provide high-quality, high-value orthopaedic care to the community. We will produce orthopaedic surgeons of the highest quality with the knowledge, clinical acumen, and surgical skills to care for the entire spectrum of orthopaedic diseases. We believe in a rigorous academic training program with a strong didactic schedule, busy and comprehensive surgical caseload, and a broad research experience. Emphasis will be placed on instructing the residents on the importance of a strong physician–patient relationship and delivering care with compassion.

Vision

We are the premier orthopaedic education platform within the DHA, producing the highest quality military Orthopaedic Surgeons, with a strong service ethic and patient centered care. Madigan-trained Orthopaedic Surgeons will be ready to deliver evidence-based, expert orthopaedic care with compassion.

Aims

1. Upon graduation, will demonstrate superior competence for independent clinical practice.
2. Well-rounded training and education, with optimized case mix and volume (trauma center, large academic practice, local community practice, sub-specialty and generalist practices).
3. Prepared for a military orthopaedic practice and trauma/on-call emergencies (MTF and deployed).
4. Life-long learners, able to evaluate current literature and assimilate evidence-based practice.
5. Self-reflection to assess and improve clinical practice, practice habits, and personal strengths/weakness.

Our weekly schedule is as follows:

• Monday through Friday the day normally begins at 6:45 a.m. with morning report. During morning report all call cases from the previous twenty-four hours are presented.
• On Monday all cases from the weekend are presented. Cases are reviewed and discussed with all staff and residents present. Residents are expected to present pertinent information from the literature as well as answer questions demonstrating their understanding of the case and appropriate treatment.
• Every 3rd Thursday is our Journal Club and Friday mornings are devoted to academics which includes morning report, pre-op and post operative conference, Grand Rounds, lectures given by staff and residents, as well as cadaveric dissections focusing on specific anatomic regions and the pertinent surgical, review of various orthopaedic knowledge updates and fracture texts.

Our program has 12 block rotations for PGY2-PGY5 and 13 block rotations for PGY1.

During a typical week, residents will spend two days in clinic. One half-day in clinic is generally devoted to pre-op visits and one half-day in the cast room performing continuity care for on-call patients. The remainder of clinic time is spent working directly with their subspecialty staff. The resident works with staff in the operating room two other days per week. Most residents perform 1400-1600 surgical cases throughout their residency. All residents are required to participate in research. Residents receive at least two months of time for dedicated research over their residency.

At Madigan, residents are often one-on-one with staff in clinic and in the operating room. On each team, we strive for a minimum ratio of 1.5 staff per resident (typically three faculty for two residents), but in some instances there is a two staff per resident ratio (four faculty for two residents). We also benefit from the team model with senior resident oversight for junior residents assigned to their team, with near-peer learning/teaching occurring in the clinic and operating room. Staff surgeons are heavily invested in resident mentoring and development.

There are no elective rotations inherent to the Orthopaedic Surgery residency training program. Case-by-case approvals for unique learning opportunities may be approved through the Madigan DIO and GME Committee.

On-call is taken from home and averages every third to fourth night.

Orthopaedic Junior Residents (PGY1-3) at Madigan perform junior call. Madigan is a Level 2 Trauma Center. Residents are required to perform the initial evaluation of patients with musculoskeletal trauma in the Emergency Department as well as the initial evaluation for in-house urgent consultations. Orthopaedic PGY3 residents on rotation at Harborview Medical Center and Seattle Children’s Hospital, both Level 1 Trauma Centers, perform in-hospital overnight call every third to fourth night.

Orthopaedic Senior Residents (PGY4-5) residents perform senior call. They provide supervision for the primary junior resident on-call and take responsibility for the evaluation, treatment and appropriate disposition of patients seen in the Emergency Room or in-hospital consultations. They are responsible to inform and consult with the staff on call as appropriate. Staff is always immediately available, band based on the supervision policy will be immediately available (indirect) or provide direct supervision of all consultations and surgical cases.

Participation in the Combat Casualty Care Course (C4)

• PGY1: Combat Casualty Care Course (C4)
• PGY2: Orthopaedic Resident Workshop and AO Basic Principles & Techniques of Operative Fracture Management Course
• PGY4: University of Florida Enneking Musculoskeletal Pathology Seminar
• PGY5: Miller Review Course
• PGY1-5: Margo Johnsen Orthopaedic Pathology Course
• Additional courses: Microvascular Surgery Course, AO Spine Basic Course

Monthly hands-on cadaveric sessions or sawbones labs at the Andersen Simulation Center.

Our program includes a quarterly Officer Professional Development hour in which both on and off-site speakers are invited to Madigan to discuss topics such as leadership, professional development, or career enhancement. PGY-5 residents perform duties as the Academic Chief Resident during a four-month leadership position, and are directly responsible for the planning and execution of the resident didactic program, and oversee the daily operations of the orthopaedic clinic and ORs. The Academic Chief interfaces almost daily with the Residency Program Director and Orthopaedic Surgery Department Chief and gain broadening experience in the administration and leadership of a MTF residency program and department.

The Orthopaedic Research Director conducts the orthopaedic research conference quarterly. At this conference updates on ongoing research projects are presented, difficulties encountered in research projects are discussed and new ideas are examined. In addition, announcements are made regarding possible presentation forums for research projects and regarding resident research paper competitions.

Our quality assurance/quality improvement conference (QA/QI) is held monthly. During this conference all morbidities and mortalities (M&Ms) from the previous month are reviewed. Residents and staff present cases, which are then thoroughly discussed. Where appropriate, issues for ongoing review are identified or areas in which process or technical changes could be expected to benefit patients are explored. This conference provides another opportunity to discuss both medical/ethical and risk management issues.

Our program includes a quarterly Officer Professional Development hour in which both on and off-site speakers are invited to Madigan to discuss topics such as leadership, professional development, or career enhancement. PGY-5 residents perform duties as the Academic Chief Resident during a four-month leadership position, and are directly responsible for the planning and execution of the resident didactic program, and oversee the daily operations of the orthopaedic clinic and ORs. The Academic Chief interfaces almost daily with the Residency Program Director and Orthopaedic Surgery Department Chief and gain broadening experience in the administration and leadership of a MTF residency program and department.

• Shriners Hospitals for Children
• Seattle Children's Hospital
• Harborview Medical Center
• Puget Sound Orthopaedics
• Olympia Orthopedic Associates
• University of Washington Medical Center – Northwest
• Proliance Orthopaedics & Sports Medicine
• MultiCare Orthopedic and Sports Medicine - Tacoma General

We encourage all medical students to perform an in-person sub-internship rotation if interested in pursuing an Army Orthopaedic Surgery Residency position. Most sub-internship rotations will be four-weeks in length, and the minimum rotation length is two-weeks. We only allow third-year rotations for USUHS students.

During a Sub-Internship rotation, medical students will participate actively in clinical interaction in both the inpatient and outpatient setting. During their rotation, students are assigned to one of several orthopaedic subspecialty teams. They will participate with the Staff Orthopaedic surgeon and residents in clinic, operating room environment and the post-operative inpatient and outpatient care of orthopaedic patients. Fourth year medical students will take at least one day of call with residents per week (with at least one weekend day during the rotation) to experience the daytime, after hours and weekend orthopaedic consult process, management of acute orthopaedic injuries and inpatient management of elective post-operative patients.

Applicants will be interviewed in-person during a rotation scheduled between July and mid-October in the MS4 year. Phone interviews are conducted during the third or fourth week of September if applicants are unable to do a rotation.

Each staff and resident have an equal vote during residency selection. It is important to interview with all the staff if possible but are expected to interview with the Department Chair, Program Director, Associate Program Director and each surgeon with whom you have rotated. Applicants should provide a copy of their Curriculum Vitae when interviews are scheduled. Due to the fluid nature of the clinic and operating room environment you will just want to arrange times relatively early during your rotation to ensure as much opportunity as possible.

Program graduates take the American Board of Orthopaedic Surgery (ABOS).

The certifying examination is divided into two parts:

• Part I is a written examination which may be taken after the completion of the educational requirements.
• Part II is an oral examination which may be taken after passing Part I, completion of the 22-month practice requirement, evaluation of the applicant’s practice, and admission to the examination.

A candidate must pass both parts of the certifying examination to be certified. This exam is offered annually. In order to be admitted to the examination, the candidate must complete the full 60 months of required education by June 30th of the year of the exam. Requirements for postgraduate year one include a minimum of six months of structured education in surgery to include multisystem trauma, plastic surgery/burn care, intensive care, and vascular surgery. A minimum of one month of structured education in at least three of the following—emergency medicine, medical/cardiac intensive care, internal medicine, neurology, neurological surgery, rheumatology, anesthesiology, musculoskeletal imaging, and rehabilitation. A maximum of three months of orthopaedic surgery. Orthopaedic requirements beyond the PGY-1 must be broadly representative of the entire field of orthopaedic surgery. The minimum distribution of educational experience must include: (1) 12 months of adult orthopaedics, (2) 12 months of fractures/trauma, (3) Six months of children’s orthopaedics, (4) Six months of basic and/or clinical specialties.

PGY-5 residents perform duties as the Academic Chief Resident during a four-month leadership position and are directly responsible for the planning and execution of the resident didactic program, and oversee the daily operations of the orthopaedic clinic and ORs.

All Orthopaedic Residents (PGY1-PGY5) perform near peer teaching, and these occur daily on rounds, in the clinic setting, and the operating room. Residents are assigned a grand rounds or sub-specialty didactic lecture during each rotation and provide education to their peers.

• Total Joints-Adult Reconstruction
• Musculoskeletal Oncology-Tumor
• Hand Surgery
• Foot-Ankle Surgery
• Spine Surgery
• Shoulder-Elbow Surgery
• Sports Medicine

Our residents are paired with a faculty member who serves as their mentor for the academic year. Our program has dedicated monthly mentorship time scheduled into our didactic schedule.

The program promotes a wellness day that faculty and residents participate in quarterly (fifth Friday). Typical wellness day activities including, skiing/snowboarding, hiking, paintball.

Every Friday after didactics, residents and available faculty perform physical training or sports (ex. frisbee, soccer, basketball).

Each academic year, the program and department have several events to improve esprit de corps and team building, these include:

• Madigan Orthopaedic Research and Alumni Day
• Tacoma Rainier’s Baseball Game
• Hail-Farewell BBQ
• End-of-Year/Graduation Dinner
• Resident Retreat (recent locations include Lake Chelan and Ocean Shores)
• Participation in Madigan O-Day
• Participation in JBLM intramural leagues (softball/basketball)

The program is fortunate to have a faculty to resident ratio of 1:1 that allows for close interaction and monitoring of each other’s psychological, emotional, and physical well-being to include signs and symptoms of burnout and depression.