Clinical Rotations

Overall Strategy

Welcome to our Program!

The overarching priority of the clinical training at the U of M/St Joe’s residency program is to produce technically skilled surgeons who will provide exceptional care to their future patients. We aim to give our residents experience in all subspecialties early in their training in order to allow for polishing of skills and focusing on specific aspects of orthopedics during their more senior years. The structure of the clinical rotations underwent a major revision for the 2020-2021 academic year. 

The goals of the rotation schedule are to:

  1. Allow for experiences in all subspecialties prior to finishing the PGY-3 year.
  2. Provide adequate time on service to learn more about diagnosis and treatment of orthopedic conditions and work to improve surgical technique. We have found 2 month blocks to be ideal for this purpose
  3. Allow for elective time in the PGY-3 and PGY-5 years to explore specific areas of training and progress towards career goals.
  4. Flexibility in rotation options to adequately cover all services while putting residents in areas to maximize training opportunities.
  5. Junior residents and senior residents working together as much as possible.
Where We Train

Clinical rotations are completed at University Hospital, Mott Hospital, Ann Arbor VA and St Joseph Mercy Hospital, all of which are in Ann Arbor. We also run multiple ambulatory surgery centers around the Ann Arbor area. No one location is more than a 30 minute drive from University Hospital. All subspecialties other than pediatric orthopedics and orthopedic oncology are represented at St Joseph Mercy Hospital.

Structure of Rotations

PGY-1 year

Our intern year is designed to provide first-year residents with the foundation they will need to become orthopedic surgeons. Rotations provide early exposure to orthopedic subspecialties while working alongside more senior residents. Organizational and interpersonal skills are developed along with significant knowledge and experience growth within orthopedic surgery. Experience in non-orthopedic patient care is gained by completing five off-service rotations. Intern rotations are 1-month in length. The orthopedic rotations include trauma, foot and ankle, spine, sports, and night float at UH, and a month on one of the St Joe’s orthopedic services. The interns also participate in a dedicated orthopedic skills month. The remaining five months include rotations in vascular surgery, pediatric general surgery, Trauma-Burn ICU, and microvascular plastic surgery at UH, as well as SICU at St Joe’s.

PGY-2 through PGY-5 years

Rotations during the PGY-2 through PGY-5 years are two months in length and span multiple practice locations and types. Residents are able to tailor their time in such a way to allow for a broad experience in all areas of orthopedics while focusing on certain subspecialty areas to build on career-focused goals. 

Residents will spend between two and four months at St. Joe’s each year with rotations on trauma, arthroplasty, foot and ankle, spine or sports. Two, two-month blocks at the Ann Arbor VA are completed as PGY-2 and PGY-5 years. The remainder of training is done at University of Michigan based locations. There is a two-month block of protected time for research during the PGY-3 year. During the PGY-4 year, each resident will rotate on an “operative orthopedics” rotation that provides for a broad operative experience that spans multiple subspecialties. Residents are able to choose an elective two-month block during the PGY-3 year and again during the PGY-5 year. This allows each resident to get a more in-depth experience prior to choosing a fellowship direction and then to get additional experience in an area of resident choosing prior to graduation.

Each resident’s time is balance between the clinic and operating room. We feel strongly that a significant part of becoming an exceptional orthopedic surgeon requires developing skills outside of the OR. Clinic time is spent seeing patients, understanding the physical exam, developing indications for surgical intervention and learning how to manage complications. Time in clinic varies between one and two days per week on all services. Most of the services have advance practice providers (either a physician assistants or nurse practitioners) who assist on the care of both inpatients and outpatients. 

Call is handled differently at each institution. UH coverage is done by a PGY-3 resident on a night-float specific rotation. Mott coverage is divided between PGY 2-4 residents who take turns covering nights one week at a time. St Joe’s coverage is divided between PGY 2-4 residents who take nightly call with the following post-call day free. With 40 residents in the program, the call burden is manageable.

Details about each subspecialty are below:

Trauma

Time spent during training: 7 months

Levels of rotation: PGY 1, 2, 4 and 5

Locations of rotation: U of M and St Joe’s

Faculty cover both U of M and St Joe’s.

Goals of the Rotation: Residents will gain experience in managing all types of orthopedic trauma, from basic hip and ankle fractures to complex peri-articular fractures, pelvis and acetabular fractures and post-traumatic conditions. The trauma program at the University Hospital cares for patients with an average ISS score higher than any other in the state of Michigan. St Joe’s is a level 1 trauma center as well with a volume of trauma higher than UH, but with lower acuity. Dr. Ahn leads the trauma division at U of M. Dr. Hake and Dr. Perdue cover orthopedic trauma at both hospitals.  The volume of orthopedic trauma seen between U of M and St Joe’s provides a busy, well rounded trauma experience. Our residents become highly skilled at managing both simple and complex fractures as the level of autonomy is typically higher on the trauma service.

Joint Reconstruction

Time spend during training: 6 months

Levels of rotation: PGY 2, 4 and 5

Locations of rotation: U of M and St Joe’s

U of M Faculty:

St Joe’s Faculty:

Goals of the Rotation: The goal of the adult reconstructive rotation is to provide a broad educational base for orthopedic residents in order to prepare them to be competent general orthopedic surgeons, to include certification by the American Board of Orthopaedic Surgery. Training in adult reconstruction is based primarily at the University of Michigan, although residents get a significant experience at St Joe’s as well. Residents see a wide range of reconstructive procedures including primary total hip and knee replacements as well as many complex revision procedures. Opportunities to gain experience in partial knee replacements, anterior total hip arthroplasty and outpatient joint replacement are plentiful. 

Sports Medicine

Time spend during training: 7 months

Levels of rotation: PGY 1, 2, 3 or 4 and 5

Locations of rotation: U of M and St Joe’s

U of M Faculty:

St Joe’s Faculty:

Goals of the Rotation: The goal of the orthopedic sports medicine rotation is to provide a broad educational base for orthopedic residents in order to prepare them to be competent orthopedic surgeons, including certification by the American Board of Orthopaedic Surgery. The Sports Medicine experience within our program is fantastic. Residents get to see both academic and private-practice sports medicine with opportunities for coverage of multiple University of Michigan and Eastern Michigan University sports. The faculty at both U of M and St Joe’s are focused on teaching and provide a wide variety of cases to learn from. Residents will have high exposure to general sports medicine problems of the knee, shoulder, hip, and elbow. A unique feature of our program is a robust volume of hip arthroscopy, complex knee surgery (e.g., cartilage, multi-ligamentous reconstructions, pediatric sports), as well as complex open shoulder reconstruction and replacement surgeries. The sports medicine division provides a robust academic curriculum with dedicated weekly sports medicine journal club and case conferences.

Spine

Time spend during training: 3 months

Levels of rotation:  PGY1 and PGY3

Locations of rotation: U of M and St Joe’s.

U of M Faculty:

St Joe’s Faculty:

Goals of the Rotation: The goal of the orthopedic Spine Rotation is to provide a broad educational base for orthopedic residents in order to prepare them to be competent orthopedic Surgeons and to prepare them for the American Board of Orthopaedic Surgery certification. The Spine Service will educate and provide high quality learning in spinal care. During the rotation residents will be exposed to complex cervical and thoracolumbar cases.  They will gain experience in using navigation, a microscope as well as robotics.  Residents rotate on the spine service during their 1st and 3rd year. Additional experiences in spine surgery are available as electives.    

Foot and Ankle

Time spend during training: 3 months

Levels of rotation: PGY 1 and 3

Locations of rotation: U of M and St Joe’s

U of M Faculty:

St Joe’s Faculty:

Goals of the Rotation: The goal of the orthopedic foot and ankle rotation is to provide a broad educational base for orthopedic residents in order to prepare them to be competent orthopedic surgeons, to include certification by the American Board of Orthopaedic Surgery.  During the Foot and Ankle rotation residents will become competent in the management of the disease processes and mechanical problems related to the foot and ankle to provide them with the comprehensive knowledge and surgical skills to successfully recognize and treat orthopedic foot and ankle problems.

Hand

Time spend during training: 4 months

Levels of rotation:  PGY-2 and PGY-3

Locations of rotation: U of M and St Joe’s

U of M Faculty:

St Joe’s Faculty:

Goals of the Rotation: The goal of the orthopedic hand rotation is to provide a broad educational base for orthopedic residents in order to prepare them to be competent orthopedic surgeons, to include certification by the American Board of Orthopaedic Surgery.  During the rotation residents will develop a core knowledge of elbow and hand surgery. To understand the indications for non-operative and operative treatment of a broad range of clinical conditions involving the hand, wrist, forearm and elbow regions. To develop surgical skills, experience, and judgment related to a broad range of hand, wrist, forearm, and elbow disorders/conditions.

Orthopedic Oncology

Time spend during training: 2 months

Levels of rotation: PGY-4

Locations of rotation: U of M

U of M Faculty:

St Joe’s Faculty: none

Goals of the Rotation: The goal of the Orthopedic Tumor Oncology Rotation is to provide a broad educational base for orthopedic residents in order to prepare them to be competent Orthopedic Surgeons and to prepare them for the American Board of Orthopaedic Surgery certification. The goal of the musculoskeletal tumor rotation is to provide a broad education in caring for patients with musculoskeletal tumors. The tumor service has two attending’s - Drs. Sybil Biermann and Geoff Siegel. Residents rotate on the oncology service as a 4th year. The Tumor service manages benign and malignant primary bone and soft tissue tumors, as well as bone metastasis. This service does large limb salvage procedures using implants and/or allograft and teaches residents how to care for the critically ill cancer patient as well as communicate in a multidisciplinary approach with our colleagues in the Medical and Radiation Oncology services”

Pediatric Orthopedics

Time spend during training: 6 months

Levels of rotation: PGY 2, 4 and 5

Locations of rotation: Mott Children’s Hospital

U of M Faculty:

St Joe’s Faculty: none

Goals of the Rotation: The goal of the pediatric orthopedic rotation is to provide a broad educational base for orthopedic residents in order to prepare them to be competent orthopedic surgeons, to include certification by the American Board of Orthopaedic Surgery. The pediatric orthopedic service has a large impact on resident training in general orthopedics as well as the coordination of many competencies. The service consists of a 2nd, 3rd and 5th year resident. There is also a nurse practitioner who helps with clinic and inpatient responsibilities as well as two physician assistants who help out with some operative cases. On this service, you will take care of the entire spectrum of pediatric orthopedics, including scoliosis (idiopathic, congenital, neuromuscular), developmental dysplasia of the hip, trauma, lower extremity deformity, clubfoot and other pediatric foot conditions

VAMC

VA

Time spend during training: 4 months

Levels of rotation:  PGY2 and 5

Locations of rotation: Ann Arbor VA

Faculty:

Goals of the Rotation: The orthopaedic service at the Ann Arbor VA is directed by Dr. David Patterson, with additional faculty coverage from Drs. Siegel and Lien. Other UM orthopaedic faculty are available for special cases and clinics as needed. Residents rotate at the VA during their 2nd and 5th year.  The goal of the VA orthopaedic rotation is to provide a comprehensive resident-directed clinical. The VA service provides resident training in community trauma, routine hip, knee and shoulder arthroplasty, general and complex hand, as well as sports medicine and joint preservation.  At every level of education, the goal is for there to be an increase in knowledge, skill, judgment, and independence.  

Operative Orthopedics

Time spend during training: 2 months

Levels of rotation: PGY-4

Locations of rotation: U of M

U of M Faculty: All

Goals of the Rotation: The goal of the Operative Orthopedics rotation is to allow senior level residents to gain knowledge and experience in a variety of different subspecialty areas prior to their PGY5 year. This rotation will allow residents to focus on preoperative planning, communication and honing technical skills in the operating room. Since residents rotate through all services except orthopedic oncology prior to their PGY-4 year, they will have some experience working with all faculty. The possibility of operating on doing an ACDF one day, a revision total hip the next followed by fixing a scaphoid fracture the next will be an experience that will require a new set of skills and preparation. 

Elective Rotation

Time spend during training: 4 months

Levels of rotation: PGY 3 and 5

Locations of rotation: Any

U of M Faculty: Any                      

St Joe’s Faculty: Any

Goals of the Rotation: We recognize that each resident has their own career goals and expectations. A main goal of our program is to help our residents prepare for whatever career path they are on. The goal of the Elective rotation during the 3rd and 5th year is to gain focused knowledge and competence in an orthopedic subspecialty of the resident’s choosing. Residents are free to choose rotations in any of the subspecialty areas, in all practice locations and are even free to choose additional research time as long as all standards for graduation are on track to be met. We also encourage residents to plan off-site rotations if they would like in order to enhance their experience. 

A&R (Anatomy and Research)

Time spend during training: 2 months

Levels of rotation: PGY-3

Locations of rotation: U of M

Goals of the Rotation: Prior to graduation, residents are required to complete a publishable quality research project, which can be either a clinical or basic science project. Residents in their 3rd year are given two months to work on clinical or bench research, or an anatomy project may be completed. This fits in with our overall research curriculum where dedicated time during the PGY-2 year is spent designing and starting a project. Some residents choose to use this time in the lab, in data preparation or even in writing and submitting their manuscript. This resident does not have clinical responsibilities during this time, but are responsible for assisting in our anatomy curriculum.