Department of Orthopaedic Surgery

Orthopaedic Hand and Upper Extremity

Fellowship Handbook

February 2014

Table of Contents
INTRODUCTION AND WELCOME ...................................................................... 1
MESSAGE FROM THE CHAIR .................................................................................. 1
MESSAGE FROM THE VICE CHAIR & FELLOWSHIP DIRECTOR ................................... 1
INTRODUCTION TO UVA ORTHOPAEDIC SURGERY .................................................. 1
A BRIEF HISTORY OF UVA ORTHOPAEDICS ........................................................... 2
THE SERVICES OFFERED BY UVA ORTHOPAEDICS ................................................. 3
OUR PROGRAM STRENGTHS ................................................................................. 4
Orthopaedic Faculty ....................................................................................... 4
Research ........................................................................................................ 4
Medical Library Facilities ................................................................................ 4
Outpatient Facilities ....................................................................................... 5
Inpatient and Surgical Facilities ..................................................................... 5
Medical School Affiliation ............................................................................... 6
Patient Population .......................................................................................... 6
SPECIAL NOTICE TO ALL EMPLOYEES .................................................................... 6
CONTACT INFORMATION ....................................................................................... 6
Direct Dial Paging .......................................................................................... 6
Direct Retrieval of Messages and Status/Location Changes ......................... 7
Staff ................................................................................................................ 7
Faculty ........................................................................................................... 8
Graduate Medical Education Office (GMEO) Housestaff............................... 9
DUTY HOUR REQUIREMENTS ......................................................................... 10
UVA POLICY ..................................................................................................... 10
Duty Hour Logging and Monitoring .............................................................. 10
ORTHOPAEDICS POLICY...................................................................................... 11
RECORDING DUTY HOURS AND CASE LOGS ......................................................... 13
FELLOW RESPONSIBILITIES ........................................................................... 14
HAND FELLOW EXPECTATIONS ............................................................................ 14
ATTENDING EDUCATIONAL RESPONSIBILITIES ....................................................... 14
CLINICAL RESPONSIBILITIES ................................................................................ 15
HAND SURGERY FELLOW BLOCK SCHEDULE ............................................ 16
OTHER GENERAL FELLOW RESPONSIBILITIES ....................................................... 17
MOONLIGHTING .................................................................................................. 17
SUPERVISION .................................................................................................... 18
ORTHOPAEDIC SURGERY ESCALATION OF CARE POLICY ....................................... 19
OPERATING ROOM SCHEDULES .......................................................................... 19
Posting Cases .............................................................................................. 20
DOCUMENTING AN ORTHOPAEDIC CONSULTATION IN DICTATION: A GUIDELINE ....... 20
Dictation Tips ............................................................................................... 21
i

MAIN OR AND OPSC SCHEDULING ..................................................................... 21

MEDICAL DOCUMENTATION ................................................................................. 22
Documentation/Completion Standards ........................................................ 23
PATIENT INFORMATION SIGN-OUT POLICY ........................................................... 25
EXTERNAL TRANSFER REQUESTS ....................................................................... 26
PROGRAM OVERVIEW AND COMMON GOALS & OBJECTIVES ................. 27
OVERVIEW ......................................................................................................... 27
DESCRIPTION OF EDUCATIONAL EXPERIENCE ....................................................... 27
COMMON CORE COMPETENCY GOALS AND OBJECTIVES ....................................... 28
DETAILED EDUCATIONAL GOALS AND OBJECTIVES ................................. 31
PATIENT CARE ................................................................................................... 31
MEDICAL KNOWLEDGE........................................................................................ 32
PRACTICE-BASED LEARNING AND IMPROVEMENT.................................................. 34
SYSTEMS-BASED PRACTICE ............................................................................... 35
PROFESSIONALISM ............................................................................................. 36
INTERPERSONAL AND COMMUNICATION SKILLS..................................................... 37
CORE CURRICULUM TOPICS .......................................................................... 38
CURRICULUM GOALS .......................................................................................... 39
Basic Sciences ............................................................................................. 39
Traumatic Conditions ................................................................................... 39
Degenerative and Inflammatory Arthropathies, Osteonecroses .................. 40
Tendinitis and Other Soft Tissue Inflammatory Conditions .......................... 40
Congenital Differences ................................................................................. 40
Arthroscopy and Endoscopy ........................................................................ 41
Metabolic and Infectious Processes ............................................................ 41
Neurovascular Pathologies and Microsurgical Applications ........................ 41
Neoplastic Processes .................................................................................. 42
Pressure-related Phenomena and Thermal Injury ....................................... 42
Miscellaneous Disorders .............................................................................. 42
Hand and Upper Extremity Rehabilitation .................................................... 42
CONFERENCE REQUIREMENTS ..................................................................... 43
CONTINUING MEDICAL EDUCATION / LECTURE SERIES .......................................... 43
Conference Schedule .................................................................................. 44
Fracture Conference .................................................................................... 44
Core Curriculum Conference ....................................................................... 45
Grand Rounds .............................................................................................. 45
Quality Assurance (Morbidity and Mortality) Conference............................. 45
Ethics & Professionalism Conference .......................................................... 46
Journal Club ................................................................................................. 46
Basic Science & Anatomy Conference ........................................................ 47
Visiting Professorship .................................................................................. 47
Multi-disciplinary Core Competency Lecture Series .................................... 47
PORTFOLIO ....................................................................................................... 47
ii

ASSESSMENT OF PERFORMANCE ................................................................ 48

UVA Policy ................................................................................................... 48
ACGME Policy ............................................................................................. 48
Department Policy ........................................................................................ 48
LEAVES OF ABSENCE / TIME AWAY FROM THE PROGRAM ...................... 49
VACATION POLICY .............................................................................................. 49
Allotted Vacation and Terms ........................................................................ 49
TRAVEL POLICY ................................................................................................. 50
UVA POLICY ..................................................................................................... 51
Maternity Leave ........................................................................................... 51
Paternity Leave ............................................................................................ 52
GENERAL INFORMATION ................................................................................ 52
MEDICAL LICENSE AND MALPRACTICE INSURANCE ................................................ 52
LAB SUPPORT .................................................................................................... 52
Microvascular Laboratory ............................................................................. 52
Research Expenses ..................................................................................... 52
COMPUTER SUPPORT ......................................................................................... 53
PRINTING AND COPYING SERVICES...................................................................... 53
LAB COATS ........................................................................................................ 53
PERSONNEL RECORDS ....................................................................................... 53
POLICIES AND PRACTICES ............................................................................. 53
EMPLOYEE WARNINGS ....................................................................................... 53
UVA GRIEVANCE PROCEDURE ............................................................................ 54
REIMBURSEMENT OF EXPENSES .......................................................................... 54
FELLOW FUNDS ................................................................................................. 54
GME OFFICE FAQ AND INFORMATION .......................................................... 54
ADVOCACY ........................................................................................................ 55
BENEFITS .......................................................................................................... 55
CALL SUITE ....................................................................................................... 55
CASH BENEFIT ................................................................................................... 55
EMAIL ................................................................................................................ 55
EPIC ................................................................................................................ 55
FAC (LONG DISTANCE CODE) .............................................................................. 55
ID BADGES ........................................................................................................ 56
LOAN FORBEARANCE.......................................................................................... 56
MEAL MONEY .................................................................................................... 56
NEW INNOVATIONS ............................................................................................. 56
PARKING POLICY................................................................................................ 56
PAYDAY ............................................................................................................. 56
PERSONAL INFORMATION CHANGES .................................................................... 56
TB TESTS AND MASK FITTING ............................................................................. 57
WEBSITE ........................................................................................................... 57
COMPUTER, AV EQUIPMENT AND THE RESIDENT LIBRARY..................................... 57
iii

COUNSELING SERVICES...................................................................................... 57
RESIDENT CALL AND COVERAGE ................................................................. 57
CALL SCHEDULE AND RESPONSIBILITIES .............................................................. 57
Night Float .................................................................................................... 58
DETAILED CALL SCHEDULE ................................................................................. 58
Pager #1206 (Ortho In-House Resident on call) .......................................... 58
Pager #1251 (Ortho ER Resident on call) ................................................... 58
Pager #1218 (Ortho Chief Resident on call) ................................................ 59
CALL COVERAGE DURING SPECIAL EVENTS ......................................................... 59
HIGH SCHOOL FOOTBALL COVERAGE .................................................................. 60
EMERGENCY DEPARTMENT HOLIDAY & WEEKEND NIGHT CALL ............................. 61

iv

Appendices
A.
External Transfer Request Procedure
B.
Joint Commission Surgery Safety Admission Ticket Sample
C
UVA Graduate Medical Education Committee Policy No. 10: Duty Hours
D.
New Innovations, How to Log Duty Hours
E.
UVA Graduate Medical Education Committee Policy No. 23: New
Innovations
F.
UVA Graduate Medical Education Committee Policy No. 12: Levels of
Supervision for Graduate Medical Trainees
G.
Quality Assurance Conference Form
H.
Case Logs for Hand Procedures

Introduction and Welcome

Message from the Chair
You have chosen the University of Virginia for your Orthopaedic Surgery
Fellowship and we are delighted to have you. Our faculty is committed to
ensuring that your training will be challenging yet rewarding, and that you will
have the experiences needed to be an outstanding orthopaedic surgeon.
Furthermore, the opportunities which will be available to you should prepare you
well for any setting, private or academic, and any specialty. My expectation is
that all interactions, whether between resident colleagues, faculty, or patients, be
based on mutual respect and cooperation. Ideally, your education will be an
active and interactive process of professional exchanges including information
gathering and implementation of care pathways with increasing levels of
responsibility. With that in mind, please recognize that we will be working
together to achieve excellence in patient care, orthopaedic education and
research.
This handbook is designed to furnish you with information about the Department
of Orthopaedic Surgery and to answer questions you may have concerning our
everyday operations. If you have any questions that this handbook doesnt
answer, do not hesitate to ask any member of the faculty.

Message from the Fellowship Director

With great pleasure I welcome you to the University of Virginia, Department of
Orthopaedic Surgery Hand and Upper Extremity Fellowship Training Program.
Our mission is to be a national and international leader in patient care, medical
student, resident and fellow education, and musculoskeletal regenerative
research. The strength of our program includes our dedicated faculty and our
outstanding trainees.
In 2013, the Orthopaedic Residency Review Committee granted the Orthopaedic
Hand Fellowship a 5-year accreditation status. This is the maximum period of
accreditation that can be obtained. Our commitment to Orthopaedic education
and patient care, cutting edge research, and diversity were noted in the
reaccreditation report.
Our mission requires commitment to teamwork. This is essential for optimizing
patient care and your education. I look forward to getting to know you and
working closely with you to help you achieve your personal and academic goals.

Introduction to UVA Orthopaedic Surgery

The Department of Orthopaedic Surgery is a national leader in musculoskeletal
academics in the areas of patient care, orthopaedic education, and
musculoskeletal research. We provide state-of-the-art comprehensive care for all
musculoskeletal disorders, treatment by responsive physicians in the highest
1

quality facilities, and broad based primary and tertiary care. The department
treats patients without regard to their ability to pay. We also provide quality
graduate orthopaedic education through an intensive teaching and evaluation
process and participate in national, international, professional and educational
activities.
The University of Virginia Medical Center serves as the home institution for
residents during the five years of the Orthopaedic Surgery Residency Program.
All but 40 weeks of training are spent in Charlottesville at the University of
Virginia Medical Center, the Kluge Childrens Rehabilitation Center, the
University of Virginia Outpatient Surgery Center (VASC), the Fontaine
Orthopaedic Center, the UVA Hand Center, and the UVA Spine Center. The
hospital, a Level-One Trauma Center, and the associated facilities provide the
core clinical experience for the orthopaedic resident. Full-time University of
Virginia Professors in the Department of Orthopaedic Surgery represent all
Orthopaedic subspecialties. The formal educational program includes structured
Orthopaedic teaching conferences in fracture management, subspecialty core
conferences, Grand Rounds, Quality Assurance conferences, small group
service-specific conferences, and Basic Science and Anatomy conferences to
provide a comprehensive curriculum of fundamental Orthopaedic knowledge.
Involvement with research is required and encouraged for all orthopaedic
residents. With opportunities for research activity, residents gain invaluable
experience in all facets of research: from proposal preparation and experimental
design to podium presentations and manuscript submission.

A Brief History of UVA Orthopaedics

The Department of Orthopaedic Surgery at the University of Virginia is one of the
oldest in the country and dates back to 1932. From that year until 1949, Dr.
Robert Funsten chaired the department. He was followed by Dr. J. Hamilton
Allen, who in turn was succeeded by Dr. Warren G. Stamp in 1968. Dr. Funsten
and Dr. Allen were excellent orthopaedic surgeons who by all accounts had an
outstanding department. Dr. Stamp brought the department into the modern era
a department that not only excelled in clinical orthopaedics, but also in
research and medical education, especially residency and fellowship training. At
the time Dr. Stamp took the helm, the department consisted of two orthopaedic
surgeons. Dr. Stamp successfully recruited a wide variety of excellent
orthopaedic surgeons and research personnel and established an active and
productive research lab. Several orthopaedic surgeons, who served either as
faculty or as residents in the Stamp era, have served as chairmen of orthopaedic
surgery departments across the country. Two have been presidents of the
American Academy of Orthopaedic Surgery, the organization that represents
orthopaedic surgeons in this country, and many others have held similar
positions in other regional, national and international organizations.
Dr. Gwo-Jaw Wang took over as chair in 1992. Dr. Wang expanded to thirteen
full-time orthopaedic surgeons and upgraded the Division of Prosthetics and

Orthotics. The Department expanded its divisions by adding Foot and Ankle and
Orthopaedic Oncology. Dr. Wang also added two additional fellowships Adult
Reconstruction and Spine to the Department.
Dr. Cato T. Laurencin became the fifth Chair of the department in 2003. Clinically
trained at Harvard, and Sports Medicine and Shoulder Fellowship trained, Dr.
Laurencin brought a large research group with him from Drexel University in
Philadelphia. The Department expanded a number of clinical divisions, including
Adult Reconstruction and Sports Medicine. In addition, Dr. Laurencin created a
University Research Center for Musculoskeletal Repair.
Dr. Mark Abel served as the sixth permanent Chair of the department, named in
2008. Dr. Abels training included a surgical internship at Barnes Hospital,
Washington University in St. Louis, MO, followed by residency training at the
University of California San Diego (UCSD), which included a year of orthopaedic
research. A fellowship year in Pediatric Orthopaedics and Scoliosis Surgery
followed at the Childrens Hospital of San Diego. Here he developed his
expertise in Motion Analysis for use as a clinical and research tool. Dr. Abel
entered the United States Navy following fellowship and worked at the
Portsmouth Naval Hospital. He joined the faculty of the University of Virginia in
1993. He has served on numerous medical school and hospital committees
during his tenure, including the promotions and tenure committee, faculty search
committees, Health Services Foundation Physician Advisory Committee, and the
Childrens Medical Center Leadership Committee. He is an international expert
in clinical management of pediatric neuromuscular and spinal disorders.
Dr. A. Bobby Chhabra became Chair of Orthopaedics in August 2013 after
serving as Vice-Chair for Dr. Abel since 2008. He has been a faculty member
since 2002, and was instrumental in the creation of the University of Virginia
Hand Center. Dr. Chhabras strength has been in Orthopaedic education for
which he is nationally recognized. He has also served in a variety of committees
and positions within the University of Virginia Health System and School of
Medicine including a two-year term as the Associate Chief Medical Officer for
Surgical Services. His advocacy skills created significant changes in the OR with
regard to patient centric care, resource utilization, efficiency, quality, work place
environment improvement, as well as employee satisfaction and accountability.
Dr. Chhabra takes over a department that has grown to 23 faculty members and
13 physician assistants. His priority is to respond to the changing health care
landscape which is moving toward a value-based care system. In addition, his
objectives include improving the educational curriculum for our residents and
fellows while incorporating the ACGME milestones and surgical simulation and
enhancing musculoskeletal research and clinical trial productivity.

The Services Offered by UVA Orthopaedics

Adult Reconstruction
Orthopaedic Trauma

Hand, Upper Extremity and Microvascular Surgery

Sports Medicine
Spine Surgery
Pediatric Orthopaedics
Orthopaedic Oncology
Ambulatory Orthopaedics
Foot and Ankle Surgery
Prosthetics and Orthotics

Our Program Strengths

Orthopaedic Faculty
The department prides itself on having a very approachable and proactive
faculty. Any trainee is free to address individual issues with the program director
or Chair at any time. Each subspecialty that has a fellowship program (Sports
Medicine, Hand/Upper Extremity, Adult Reconstruction, Foot & Ankle Surgery,
and Spine Surgery) has multiple attending physicians participating in the
subspecialty, in order to avoid diluting resident experience. Since this is a group
practice, other staff members provide coverage for staff members that are called
away from their practices. This facilitates continuity of patient care and fellow
training.

Research
The departments research has gained national and international recognition.
Both the research faculty and facilities have markedly expanded. The department
has several Ph.D. primary and joint faculty members. The influx of research
funding and a recently awarded N.I.H. Training grant provide multiple
opportunities for trainees to actively contribute and participate in cutting-edge
research. During their training here all residents and fellows are exposed to
experimental design and are taught the process of producing scientifically sound
research, from drafting proposals to presenting their data at national meetings.
All trainees are provided opportunities for research, and are required to produce
one peer-reviewed publication prior to graduation. Basic science research
emphasizes musculoskeletal tissue repair and research translation with
biomaterial and tissue engineering approaches.

Medical Library Facilities

The main medical library is staffed with experienced employees and is well
stocked with current orthopaedic textbooks and journals. A vast array of journals,
textbooks, computers, and databases are available from 7:00am to 12:00am in
the library. Additional computers are available in the residents call room, ED,
inpatient floor, and departmental offices. The Orthopaedic Department has its
own orthopaedic library, with current journals and textbooks, which can be used
for quick reference work. Additionally, there are work cubicles available for fellow
in the departmental office space. A collection of Academy OKU and self-

assessment CDs are available for checkout. The department has also invested
in online book collections for resident use.

Outpatient Facilities
The UVA Hand Center and The UVA Spine Center opened their doors in 2010 at
the 415 Building at Fontaine Research Park. These state-of-the-art clinics
provide convenient specialty specific care with all ancillary services located in
clinic.
The main clinic is on the first floor of the Fontaine Orthopaedic Center, adjacent
to the 50-bed inpatient HealthSouth Rehabilitation hospital. The clinic features
free patient parking; physician workstations with computers and online clinical
archive and radiograph access in each pod; four orthopaedic clinic pods with four
exam rooms each and a cast room; a minor surgical treatment room; in-house
dedicated orthopaedic radiology technicians with four x-ray pods, onsite MRI,
ultrasound, and fluoroscopy; in-house radiologists; and handicapped patient
parking and access.
Prosthetics and Orthotics (P&O) is located at the Townside Shopping Center on
250 West near Kluge Childrens Rehabilitation Center (KCRC). This facility
fabricates artificial limbs and braces on site for both UVA patients and other
patients of Central Virginia physicians. Because P&O is a division of
Orthopaedics, it is important to properly order and medically document P&O
services. All P&O prescriptions and Letters of Medical Necessity must be signed
and dated by the ordering physician. Please make certain that the Letter of
Medical Necessity has been correctly and fully completed with an appropriate
diagnosis for the ordered service. Also, UVA Compliance requires that all P&O
prescriptions for Medicare/Medicaid patients that are signed by residents be
documented by the attending physician within his/her clinic note.
KCRC is where the Pediatric Orthopaedic Division is located. Drs. Abel,
Romness, and Lather see all of their UVA outpatients at this site. In addition to
these clinic services, Dr. Abel has a Motion Analysis and Motor Performance
Laboratory for both clinical and research purposes. This laboratory is just one of
four on the East Coast.

Inpatient and Surgical Facilities

The UVA Medical Center, opened in 1990, remains a state-of-the-art facility,
providing the residents with the latest in technology and resources. There is a
dedicated Orthopaedic inpatient unit, with a full-time nursing staff, Physical &
Occupational Therapy staff, and a social worker. This was the first hospital in the
country with the capability to perform 3-D computer-guided and Virtual
Fluoroscopic pelvic and extremity surgery. The adjacent Outpatient Surgery
Center (OPSC) provides six operating rooms for outpatient surgery, and houses
our Bioskills lab with state-of-the-art endoscopic and internal fixation practical
stations. The University Hospital has 27 state-of-the-art operating rooms.

Medical School Affiliation

Being a part of the University and the Health Sciences Foundation provides
numerous financial and academic benefits. Ready access to the Medical School
faculty and facilities provides the residents with excellent research and academic
opportunities. The University, through its Research and Development Fund,
provides startup funding up to $20,000 for junior faculty to initiate research
projects with the residents. Most of the faculty have funded clinical and basic
science research programs.

Patient Population
UVA is the major referral center for a large area in Central Virginia and the
Appalachians to the West. The next closest level-one trauma center is 75 miles
to the East, with a much larger radius extending to the North, West, and South. A
high percentage of difficult and challenging cases are referred in from outside
sources as far away as West Virginia, Tennessee, and North Carolina. This
referral base complements the more routine cases available from the local
community. The departments share of local orthopaedic care has increased
commensurate with the improved facilities in the last decade, and we now control
well over 70% of the local orthopaedic care.

Special Notice to All Employees

The personal pronoun he as used in this handbook is used for convenience and
refers to people of both sexes. It is not to be considered a reflection of superiority
or inferiority of either sex.

Contact Information
Fellows are responsible for updating their Status/Location codes in the Registry
System on a regular basis. Access to the Registry System is made by dialing 511
from within the hospital or by dialing 982-3501 from outside the hospital.
The system Status/Location codes are:
10 Available for Radio Paging
16 Calls are being taken by (PIC/Name)
17 Can be reached at (telephone number)
18 Unavailable until (date or time)
19 Not on Call
20 Not available, Messages being stored
21 Available on outside pager

Direct Dial Paging

(500 plus PIC)
To place a direct page to medical staff and employees without operator
assistance, dial 500 plus the users PIC from any University telephone. The
system will prompt you through each transaction. Once familiar with the system,
you can overdial any prompt to speed your transaction.

Use a # at the end of your call back number (message) or just hang up.
From outside the University dial 982-3500 plus the users PIC.

Direct Retrieval of Messages and Status/Location Changes

(Dial 511 plus PIC)
The UVA Registry System allows users to directly retrieve their messages and
change their status/location codes. From any University telephone dial 511 plus
your PIC. If you have an optional Security Code, you will be prompted to enter it
before proceeding further.
From outside the University dial 982-3501 plus your PIC.

Staff
Orthopaedics Business Office, Fax 3-0230
Mike Boblitz, Administrative Director, Phone 3-0225
Mary-Leigh Thacker, Accounting and Billing Manager, Phone 3-0226
Rose Herndon, Accounts Payable, Phone 3-0220
Orthopaedics Office
Laura Simmons, Dr. Abels and Chhabras Office, Phone 3-5647
Mindy Franke, Educational Programs Coordinator, (Fellowship,
Residency, Student, and Observer Liaison), Phone 3-0265, PIC 4667
Diane Sullivan, Orthopaedic Reception, Phone 3-0270
Laura Simmons, Orthopaedics Grants Administrator, Phone 3-5647
Amy Radigan, PA (Hand), Phone 2-6195, PIC 6355
Kelsey Parente, PA (Hand), Phone 2-6195, PIC 6480
Joe Hart, PhD, Research Faculty (Sports), Phone 3-0256
Wendy Novicoff, PhD, Research Faculty (Adult Recon), Phone 3-0296
Vasantha Reddi, PhD, Research Staff (Spine), Phone 3-5382

Faculty
Physician
Abel, Mark (clinical)
Abel, Mark (admin)
Brockmeier, Steve
Brown, Thomas
Browne, James
Carson, Eric
Chhabra, A. Bobby
Cui, Quanjun
Dacus, A. Rashard
Deal, D. Nicole
Diduch, David
Domson, Gregory
Freilich, Aaron
Gwathmey, Winston
Kahler, David
Lather, Leigh Ann
Miller, Mark
Park, Joseph
Perumal, Venkat
Romness, Mark
Shen, Frank
Shimer, Adam
Weiss, David
Yarboro, Seth

Ofc
Phone
4-2364
3-0250
3-0273
3-0293
3-0279
2-6539
3-0268
3-0236
2-6704
3-0282
3-0275
3-0266
4-1796
4-2375
3-0237
2-4832
2-4801
3-5381
3-0825
4-2301
3-0276
3-0258
3-0292
3-0267

PIC
3076
3076
3574
3795
3512
6467
3637
3725
3317
6134
4137
3324
3062
2434
6004
4073
3947
3984
3392
3007
6278
3148
6843

Secretary

Secy
Phone
Brenda Lawson
2-4215
Marla Langdon
3-0218
Vickie Blackwell
3-0067
Vallerie Staton-Bickley 3-0278
Vallerie Staton-Bickley 3-0278
Kathy Johnson
2-4832
Marla Langdon
3-0218
Susan Fitzgerald
3-0266
Diane Sullivan
3-0270
Vickie Blackwell
3-0067
Lora Everly
3-0291
Susan Fitzgerald
3-0266
Vickie Blackwell
3-0067
Debbie Handy
3-0245
Diane Sullivan
3-0270
Sarah Dellinger
2-4832
Vallerie Staton-Bickley 3-0278
Debbie Handy
3-0245
Debbie Handy
3-0245
Tammy Brown
2-4214
Lora Everly
3-0291
Susan Fitzgerald
3-0289
Kathy Johnson
3-0274
Kathy Johnson
3-0274

Fax
2-1727
3-0290
3-0242
3-0290
3-0290
3-0290
3-0290
3-0242
3-0242
3-0242
3-0242
3-0242
3-0242
3-0242
3-0242
3-0290
3-0290
3-0242
3-0242
2-1727
3-0242
3-0242
3-0290
3-0290

Musculoskeletal Radiology Faculty

Mark Anderson, Chief of Service, Phone 2-0275, PIC 4132
Bennett Alford, Phone 4-9377, PIC 4138
Michelle Barr, Phone 3-9974, PIC 2210
Michael Fox, Phone 4-9377, PIC 6729
Christopher Gaskin, Phone 3-6410, PIC 3088
MSK Reading Room 545 Building, Fontaine, Phone 2-6382
UVA HAND CENTER
Appointments 982- HAND (4263)
Fax 924-1124
Surgery Scheduling (Vickie Musselman), Phone 2-6233
Fontaine Clinic, Fax 3-5460
Main Line Appointments, Phone 3-5432, Fax 3-0382
Authorization/Referrals, Phone 3-9167

Return Appointments, Phone 3-5433

Staff Notes/Supply Orders, Phone 3-5436
Registration, Phone 3-5428 or 3-5427
HSF Patient Accounts, Phone 3-0388, Fax 3-5612
Cast Technician, Phone 3-5444, Fax 3-5486
Surgery Scheduling, Phone 3-5435, Fax 3-0295
Triage Nurses, Phone 3-5440, Fax 3-5486
UVA SPINE CENTER
Front Desk 243-1531
Internal Scheduling Phone 3-3633
Surgery Scheduling (Kim Vest), Phone 243-1537
UVA SPORTS CENTER
Front Desk 243-7778
Internal Scheduling Phone 3-7778
Surgery Scheduling (Amanda Davis), Phone 243-5066
Primary Care Center, Fax 3-0235
Medical Record Requests/Forms, Phone 3-0233
Patient Lists, Phone 3-0234
X-Rays 3-6700
OPSC 2-6100
6East 4-2485

Graduate Medical Education Office (GMEO) Housestaff

GMEO Office 243-6297
GMEO Fax Number 244-9438
Risk Management (Malpractice/Claims History) 924-5595

Duty Hour Requirements

UVA Policy
The Office of Graduate Medical Education shall require all ACGME and nonACGME residency and fellowship programs to participate in the documentation
of duty hours in New Innovations, to ensure graduate medical trainees are not
being placed at risk for fatigue, and to document compliance with each programs
individual Residency Review Committee (RRC) and the Accreditation Council for
Graduate Medical Education (ACGME) regulations.
Duty hours are defined as all clinical and academic activities required for the
educational program; i.e., patient care (direct patient care: both inpatient and
outpatient), administrative duties relative to patient care, the provision for transfer
of patient care; time spent in-house during call activities, and scheduled activities
such as required conferences. Duty hours do not include reading and preparation
time spent away from the duty site. Duty hours restrictions are based upon the
ACGME Duty Hour rules as found in the Common Program Requirements on the
ACGME website: http://www.acgme.org/acWebsite/home/home.asp.
1. Faculty and fellows must be educated to recognize the signs of fatigue
and sleep deprivation and must adopt and apply policies to prevent and
counteract its potential negative effects on patient care and learning. This
information is contained on a LIFE curriculum course on DVD which is
shown to residents/fellows/faculty once annually. The DVD is kept in
Mindy Frankes office as a resident/fellow/faculty resource.
2. The Institution mandates that all graduate medical programs comply with
their individual RRC regulations regarding duty hours restrictions.
3. The Institution mandates that all non-ACGME accredited programs comply
with the ACGME Duty Hour rules as found in the Common Program
Requirements on the ACGME website:
http://www.acgme.org/acWebsite/home/home.asp and the Specialtyspecific Duty Hours Definitions (4/29/2011) located at:
http://www.acgme.org/acWebsite/dutyHours/DH_Definitions.pdf.
4. The Institution does not allow exceptions to the 80 hour weekly limit on
duty hours.

Duty Hour Logging and Monitoring

Program Directors will complete and submit a duty hours tracking report to the
GMEC Subcommittee on Duty Hours Compliance on the following schedule:
Programs at low risk for violations will complete one survey for the one
month period of their choosing and will submit to the GMEO the second
Friday after the end of that rotation. Low risk is having no risk of true duty

10

hour violations and absence of any of the additional measures noted to

designate it high risk.
All fellows are responsible for recording their own hours in New Innovations. Any
trainee wishing to discuss a duty hour concern may do so confidentially with their
program director, GMEO staff, or the DIO. Trainees are encouraged to utilize the
anonymous incident reporting line at 434-806-9521.
To see complete text of this policy, please see Appendix C, Graduate Medical
Education Committee Policy No. 10, Duty Hours, effective date November 16,
2011.

Orthopaedics Policy
The Orthopaedic Hand & Upper Extremity Fellowship program schedules fellow
assignments to be in compliance with all applicable ACGME requirements.
Faculty members know, honor, and assist in implementing the applicable duty
hour limitations. Fellows comply with those limitations, accurately report duty
hours, and cooperate with duty hour monitoring procedures. All involved identify
and report sources of potential duty hour violations, and collaborate to devise
appropriate corrective action.
Duty hours are defined as all clinical and academic activities related to the
program. This includes patient care, administrative duties relative to patient care
(including those, if any, conducted from home), provision of transfer of patient
care, on-call time spent in-house, and scheduled activities such as conferences.
Duty hours do not include reading and preparation time spent away from the duty
site.
Scheduled duty periods are defined as assigned duty at this hospital or other
training site encompassing hours which may be within the normal work day,
beyond the normal work day, or a combination of both. Fellow Duty Hours are to
be recorded for a one-month period during the year, in the New Innovations
Software system. See Appendix D for directions on how to log Duty Hours. The
following delineates our policies on duty hours for Orthopaedic Surgery Trainees.
1. Weekly limit: Duty hours are limited to 80 hours per week, averaged over
a four-week period, inclusive of all in-house call activities.
2. Days off: Fellows have one day (24 hour period) every week free of all
duty (including at-home call), when averaged over a four-week period.
3. Maximum duty period length
a. Duty periods are limited to 24 hours of continuous duty in the
hospital. The fellow may remain on-site for transition of care and/or
to attend an educational conference when that transition is
completed, but may not perform additional clinical duties (including
continuity clinic) during those additional 4 hours.
11

b. After 16 hours of continuous duty, fellows are encouraged to

engage in strategic napping, especially when the 16 hour mark
occurs between 10pm and 8am.
4. Individual exceptions to maximum duty hour period: In unusual
circumstances, a fellow may remain beyond their scheduled period of duty
to continue to provide care to a single patient. These policies apply:
a. The extension of the duty hour period must be initiated voluntarily
by the fellow never assigned, or suggested, by a faculty member.
b. Possible justifications for this extension of the duty hour period
include: required continuity of care for a severely ill or unstable
patient, or a complex patient with whom the fellow has been
involved; events of exceptional educational value; or humanistic
attention to the needs of a patient or family.
c. The fellow must transfer the care of all other patients to the resident
team responsible for their continuing care.
d. The fellow will text or page the Program Director within 12 hours to
notify him that continuous care over 24 hours was provided,
including the name of the patient, the date, and the specific reason
for remaining on duty.
e. The Program Director will review each submission of additional
service.
5. Time off between scheduled duty periods: Fellows are in their final year of
education and therefore have flexibility in their duty hour assignments,
which might be irregular or extended. It is desirable that these fellows
have eight hours free of duty between scheduled duty hour periods, but
there will be circumstances when they must stay on duty to care for their
patients or return to the hospital with fewer than eight hours free of duty.
Those circumstances may include required continuity of care for a
severely ill or unstable patient, or a complex patient with whom the fellow
has been involved; events of exceptional educational value; or, humanistic
attention to the needs of a patient or family. Such instances of fewer than
eight hours away from the hospital must be reported to, and will be
monitored by, the Program Director.
6. At-Home call: At-home call must satisfy the requirement for one-day-inseven free of duty. Time spent in the hospital by a fellow on at-home call
must be reported in, and count toward, the 80-hour maximum weekly hour
limit. Return to the hospital for episodic care whole on at-home call does
not initiate a new off-duty period.

12

Saturday Elective Time

Saturday elective cases will be preferentially covered by the on-call team. For
complex cases to be done on the weekend the staffing attending will determine if
fellow coverage will be needed. The fellows must remain compliant with all duty
hour regulations.

Recording Duty Hours and Case Logs

All trainees are required to log their time into the New Innovations system. See
the Graduate Medical Education Manual for GME Policy No. 23, New
Innovations Appendix E, and Appendix D for instruction on how to enter your
time.
Case Logs must be entered each week. This is an ACGME requirement. See
Appendix H for instruction on how to enter your cases in the ACGME Case Log
System. Failure to comply with this requirement may result in a probationary
status for lack of professionalism and this will become a permanent part of the
trainees file. Random checks of compliance will be performed by the coordinator
and director.

13

Fellow Responsibilities
Hand Fellow Expectations
The fellow should:
1. Make every attempt to see as many initial visits in clinic as possible
2. See as many patients they have operated on post-operatively for follow-up
care as possible
3. Be responsible for the coordination of all Wednesday conferences and
Journal Clubs which means coordinating and attending lectures
4. Be familiar with all patients on the Orthopaedics Hand Service, rounding
on patients they operate on and coordinating with the residents on service,
during the months they are on Ortho. They should do the same for Plastic
Surgery Hand Service during their Plastics months.
5. Be available for all evening cases during the week regardless on which
service they are on call with
6. Complete the microsurgery course within the first three months of arrival
(Basic Microsurgery Certificate from Randy Amiss)
7. Complete the Sterns Bibliography, reading all articles by the end of the
year. This is a self-study and should be done on their own. Dr. Deal has a
recent version of this resource.
8. Read JHS every month from cover to cover
9. Immerse themselves in Hand Surgery during the course of the year
including ER involvement, aggressive clinic involvement, and being
available for OR cases
10. When the assigned attending is out of town, the fellow is required to notify
the other attending to make sure they are kept busy working with the other
attending
11. Complete at least one manuscript by the end of the year that should be
submitted for publication
12. Become comfortable with the use of hand therapy in both non-operative
and post-operative management of common hand problems and should
spend one-half day per quarter with the hand therapy clinic
13. Photo document index cases, and should prepare pre-, intra- and postoperative pictures of the event
14. Sit for the Certificate of Added Qualifications in Hand Surgery upon
completion of the fellowship

Attending Educational Responsibilities

While all six Hand faculty are involved with educating the Hand fellow on a daily
basis, participate in all conferences, actively participate in emergency Hand and
Upper Extremity call, and jointly are involved in the education of all Hand
Fellows, Plastics, and Orthopaedic Surgery residents on the Hand service, each
faculty member has an area of expertise for which they are responsible in
educating the fellows.

14

1. Dr. Bobby Chhabra, Chair of Orthopaedic Surgery, has a diverse practice

but his special areas of interest are athletic injuries of the upper extremity,
arthroscopy, elbow trauma, and reconstruction, congenital hand surgery,
and brachial plexus injuries. He also has a vast experience in wrist
reconstruction and microvascular free fibular transfer for large segmental
bony defects. His basic science area of research is zone II flexor tendon
repairs. His experience and knowledge in this area gives him the
responsibility of being the primary educator for the fellows in these areas.
2. Dr. Rashard Dacus has a diverse hand practice but his main areas of
interest are upper extremity sports injuries as well as shoulder fractures
and arthritis reconstruction. He also has experience in upper extremity
trauma including the hand and wrist. He is the primary educator for
shoulder pathology in the fellowship.
3. Dr. Nicole Deal, Fellowship Program Director, has a diverse practice that
includes upper extremity trauma. She has extensive experience with
microvascular reconstruction including nerve injury and repair. Her basic
science area of interest is tissue engineering techniques for nerve repair.
She is the primary educator for nerve injury and repair for our fellows.
4. Dr. Aaron Freilich has experience in upper extremity trauma and
reconstruction. His main area of focus is in microvascular reconstruction
and this is his primary area of education for our fellows.
5. Dr. Raymond Morgan, Chair, Plastic Surgery, is our senior faculty member
with a very diverse practice in Plastics Hand Surgery. He has extensive
experience in congenital hand surgery as well as soft tissue reconstruction
and rheumatoid arthritis. These are his main areas of focus for fellow
education.
6. Dr. David Drake, the Plastics Hand Fellowship Director, has vast
experience in free tissue transfer for limb reconstruction. This is his area
of expertise and focus for fellow education.
The six faculty members above provide an extremely comprehensive scope of
hand and upper extremity surgery for all ages. The combination of their unique
interests and skills allow for a comprehensive fellow education program.

Clinical Responsibilities
The fellow will participate in the pre- and post-operative care of patients in both
inpatient and outpatient settings. The fellow will be expected to develop a
detailed understanding of the diagnostic work-up of common and complex hand
problems, including the use and interpretation of appropriate musculoskeletal
imaging studies, electrodiagnostic studies, vascular studies, and selective
injections. The fellow will become comfortable with the application of hand
therapy in both non-operative and post-operative management of common hand

15

problems, and will have the opportunity to work directly with the therapist to
ensure in-depth understanding of the techniques of splinting and the use of
various modalities. The fellow will also participate in the daily rounds on
inpatients on service.
In addition to outpatient and inpatient clinical responsibilities, the fellow will spend
a minimum of two full days each week in the operating room developing surgical
skills. Over the course of the year, the fellow should become comfortable with the
technical aspects of all areas of hand surgery, including adult and pediatric
reconstruction, adult and pediatric trauma, peripheral nerve surgery, hand burns,
and wrist arthroscopy. The fellow will be expected to become facile in the
performance of these procedures and will also be involved in overseeing both
Plastic Surgery and Orthopaedic Surgery residents in the operating room.

Hand Surgery Fellow Block Schedule

Orange Fellow
Monday

Tuesday

Chhabra

Athletic
Clinic

Clinic (am) Clinic (am)

OR (am)

Morgan

OPSC

Clinic

Clinic (pm) Admin

Deal

OR

Clinic (pm) Admin

Research

Wednesday Thursday

Main OR

OR (am)

Friday
OR

Clinic

PM

Orange fellow is first call for Orthopaedic Hand Consults

Yellow indicates the primary assignment
Blue Fellow
Monday

Tuesday

Wednesday Thursday

Friday

Drake

OPSC/Clinic Main OR

Non-Hand

AM Clinic

Admin

Dacus

Clinic

Admin/OR

Clinic (am)

OR

OR

Freilich

AM Clinic

OR

Trauma Rm Clinic

Research

OR

PM

Blue fellow is first call for Plastics Hand Consults

Yellow indicates the primary assignment

16

We realize that the clinical experience will vary with the fellows background and
may be tailored to the individuals needs. For example, first call responsibilities to
the ER may be arranged if the fellow has not had this experience. We will also
arrange protected time for research if the fellow has an approved project.

Other General Fellow Responsibilities

1. New Innovations time entry is not optional. Trainees are reminded of the
Universitys Honor Code when entering time into the New Innovations
System.
Fellowship work hours are monitored by the Program Directors, the
Program Coordinator, and the GME Office. The New Innovations system
records and monitors work hours and reports any violations to the
Residency Coordinator and Program Directors. Duty hours are entered
weekly for a one-month period during the academic year.
2. Case Logs The fellow case logs are currently maintained within the New
Innovations Procedure Logger. Additional references including procedure
(CPT) codes are available at the ACGME website http://www.acgme.org

Moonlighting
No moonlighting is allowed in the Department of Orthopaedic Surgery.
Educational and service activity that UVA Orthopaedic Surgery Trainees provide
for local varsity sports activity (physical exams, presence at games, etc) will
count toward duty hours and any stipends will be placed in the Resident & Fellow
Education fund within the UVA Alumni Association account. All money received
will be shared by trainees in the form of books, subscriptions, or the year-end
visiting professor activity.

17

Supervision
The Orthopaedic Hand and Upper Extremity Fellowship Program recognizes and
supports the importance of graded and progressive responsibility in graduate
medical education. The goal is to promote assurance of safe patient care, and
the fellows maximum development of the skills, knowledge, and attitudes
needed to enter the unsupervised practice of medicine.
Supervising Physician is defined as a faculty physician, or a licensed
independent practitioner, including non-physician faculty working in conjunction
with the orthopaedic surgery department.
Four levels of supervision are recognized. They are:
1. Direct: The supervising physician is physically present with the fellow and
the patient and prepared to take over the provision of patient care if/as
needed.
2. Indirect: there are two types of indirect supervision:
a. Indirect supervision with direct supervision immediately available:
the supervising physician is present in the hospital (or other site of
patient care) and is immediately available to provide Direct
supervision. The supervisor may not be engaged in any activities
(such as a patient care procedure) which would delay his/her
response to a fellow requiring direct supervision.
b. Indirect supervision with direct supervision available: the
supervising physician is not required to be present in the hospital or
site of patient care, or may be in-house but engaged in other
patient care activities, but is immediately available through
telephone or other electronic modalities, and can be summoned to
provide Direct Supervision.
3. Oversight: The supervising physician is available to provide review of
procedures/encounters with feedback provided after care is delivered
The Orthopaedic Hand and Upper Extremity Fellowship program establishes
schedules which assign qualified faculty physicians, or appropriate other licensed
independent practitioners, to supervise at all times and in all settings in which
fellows of the Orthopaedic Hand and Upper Extremity Fellowship program
provide any type of patient care.
The minimum amount/type of supervision required in each situation is
determined by the definition of the type of supervision specified, but is tailored
specifically to the demonstrated skills, knowledge, and ability of the individual
fellow. In all cases, the faculty member functioning as a supervising physician
should delegate portions of the patients care to the fellow, based on the needs of
the patient and the skills of the fellow.
18

In every level of supervision, the supervising faculty member must review

progress notes, sign procedural and operative notes, and discharge summaries.
Faculty members must be continuously present to provide supervision in
ambulatory settings, and be actively involved in the provision of care, as
assigned.

Orthopaedic Surgery Escalation of Care Policy

All fellows must communicate with the appropriate supervising faculty member,
according to these guidelines: the fellow shall notify the responsible Attending
Physician within 90 minutes of any of the following events:
1. Patient admission to hospital
2. Transfer of patient to or from the intensive care unit or to a higher level of
care
3. Need for intubation or ventilator support
4. Cardiac arrest or significant changes in hemodynamic status (i.e., Code
12 or MET team activation)
5. Development of significant neurological changes
6. Development of major wound complications
7. Medication errors requiring clinical intervention
8. Any significant clinical problem that will require an invasive procedure or
operation
9. Patient death
10. Notification of patient representative that family wishes to lodge a formal
complaint
11. Activation of IRPA for anything other than routine procedures
12. Patient and/or family request to speak to the attending
Please see Appendix F for Graduate Medical Education Committee Policy No.
12, Graduate Medical Trainee Supervision Policy, effective date March 21,
2012, Protocol for Implementation of Policy No. 12: Graduate Medical Education
Supervision, and Orthopaedic Hand and Upper Extremity Fellowship Program
Policy, Fellowship Supervision Policy.

Operating Room Schedules

Surgery is to be scheduled through each services surgery schedulers. The Chief
Resident on each service is responsible for the sequence of cases, for any
additions or subtractions, and for the appropriate equipment and positioning. The
information required includes a realistic appraisal of the amount of time
necessary to complete the procedure, use of the intensive care unit
postoperatively, and estimated blood loss. The physician section of the Surgical
Safety Admission Ticket should be filled out completely and checked with the
attending, see sample in Appendix B
.

19

The Orthopaedic residents responsible for first cases at OPSC or the main OR
will be in the operating room and changed into OR attire by 7:10am (9:10am on
Wednesdays).
Emergent cases should be booked with the OR Staff and the Anesthesia
Department only after all pertinent workups have been completed. The
information provided should be detailed.

Posting Cases
All trainees should be familiar with the logistics of posting cases for the main
operating room for both elective and emergent cases. It is the Chief Residents
responsibility to notify the Attending on call when a patient is sent for as well as
when the patient enters the operating room.

Documenting an Orthopaedic Consultation in Dictation: A

Guideline
This is a guideline and not a template. You need to ask the specific attending or
the Chief Resident on call what the individual attending would like to see included
in a consult.
1. Getting started: all consults should be dictated on the Medquest system or
typed into EPIC as a Consult Note / H&P with the name of the orthopaedic
attending of record and, if known, the name of the faculty orthopaedist
who will take care of the patient on a follow-up appointment. Specifically
state the attending on call and the follow-up attending in the dictation.
2. All consults begin after establishing who the consulting team is and what
they wish to know or what need as a procedure for the patient. All
dictations should begin with I was consulted by Dr. {insert name} of the
{name of service} to evaluate OR and treat .
3. Dont document unnecessary, irrelevant and speculative information, i.e.,
The patient was injured in an MVA not This drunken, unrestrained driver
of a stolen Hummer missed a curve on an unfinished stretch of State
Road 39 and crashed into a bridge piling. Unless you were riding in the
vehicle and witnessed it, it is just hearsay and best left off the record.
4. Pertinent positives and negatives in both history and physical findings. Not
a complete head-to-toe review of systems and exam. But focus your
questions and exam to the injured or pathologic systems and body parts.
5. Before formulating an opinion and plan, discuss with a senior level
resident and document that residents level of participation if they
examined the patient with you or helped with a reduction or helped
determine if surgery or MSK procedure was indicated.
6. If the patient needs surgery or an invasive procedure, be certain to
mention that the senior level resident and attending orthopaedist were
informed and agreed with this plan.
7. Formulating a plan: these are suggestions and you are to be as specific as
you can about who will be following up on these suggestions. If there is
urgency to anything be sure to document that you made that fact clear to a
20

named person on the consulting team. Do not provide treatment

suggestions if you were asked to make a diagnosis only.
8. For outpatient follow-up for ED and in-patient consults always give a
narrow range of possible return dates and communicate this to the
receiving service in as many ways as possible, particularly if the problem
has urgency (i.e. needs to be seen in 1-2 days). If youve discussed the
situation with the ultimate receiving service, it is acceptable to say that the
patient may be contacted with a follow-up appointment by the resident or
the attending (or someone designated by that attending to make
appointments) of that service.
9. If you are being asked to accept the patient and have Orthopaedics be the
responsible service, be certain to speak with the accepting attending or his
resident and document that. Always mention that the attending is aware of
what is happening. In the event that the faculty orthopaedist does his or
her own evaluation, try to make the evaluation and treatment plan you
dictate coincide with that of the attending.
10. The dictated consultation should include: Why you were consulted, who
the patient was, what the problem was you were asked to solve, who
helped you solve the problem, what you believed the situation was
(diagnosis), what needed to be done, how your suggestions were to be
implemented, and when the service was or can be provided.

Dictation Tips
1.
2.
3.
4.
5.

Push button BEFORE beginning to speak

Do not speak like an auctioneer; normal speaking tempo
Enunciate and speak clearly
Do not put your mouth too close to the recording device
Please organize your thoughts BEFORE beginning to dictate. Order is the
Presentation of the patient, the Medical History, the Physical Exam, and
the Assessment & Plan
6. Keep notes brief and succinct while conveying all necessary pertinent
information
7. Remember to dictate an attending of record for each ED encounter at the
START of your dictation (NOT the subspecialty attending the patient was
referred to for follow-up unless previously arranged with said subspecialty
attending)
Please see Attachment E for a copy of Dictating Instructions and Guidelines for
the automated system.

Main OR and OPSC Scheduling

Add-ons:

For OPSC: If a case is an add on (a case posted within 3 business days of

the DOS) you must call and ask permission and the posting slip must be
faxed (817-8470) with the pre-auth written on it.

21

For Main: If a case is a late post (added on or after noon the day before
the DOS) it must be faxed (2-3972) or be turned into the Control Desk.
The resident must also page 1311 and speak to the Anesthesia resident.
All add-ons for the day of must go through the Control Desk.

Change in DOS:

For OPSC: If a case that has already been posted is rescheduled, the
resident/attending must notify the scheduling office by email of the new
DOS. Please dont send another posting slip.
For Main: If a case that has already been posted is rescheduled, the
resident/attending must notify the scheduling office either by email or in
person. If the resident chooses to notify the scheduling office by phone or
in person, a follow-up email will be required to confirm. The resident will
be notified if a new posting slip is needed.

Change in Procedure / Other Information:

For OPSC: If a case that is already posted is changed, i.e., different or

additional procedure/CPT code, the resident must notify the scheduling
office by email. Please dont send another posting slip.
For Main: If a case that is already posted is changed, i.e., different or
additional procedure/CPT code, the resident must notify the scheduling
office either by phone or in person, a follow-up email will be required to
confirm. The resident will be notified if a new posting slip is needed.

Holding Time / 3rd Discretionary Time:

For OPSC: Please remember if you hold time at OPSC, that the hold only
lasts five business days starting the day after the OPSC is notified. After
that point in time, if posting slips have not been submitted, the time will be
released to the general public.
For Main: Holds may be put on the 3rd discretionary room or open time by
emailing CL SchedulingMain OR and they dont expire, but should be
patient-specific and followed up by posting slips as soon as possible.

Medical Documentation
Adapted from the March 5, 2008 Medical Documentation Message, from Dr.
Susan Kirk, DIO.
A complete legible medical record is the permanent way to document a patients
condition, plan of care and response to treatment. Patient safety depends on
clear communication both verbal and written.
Please remember the following:
Include time and date on all medical record documentation
Sign every note in legible format with your credentials (MD, DO, etc)
Always include your PIC number to further clarify the author of the note
At each contact point make sure the medications match up. This is
medication reconciliation. Medication list must be complete and do not use
the phrase resume home meds. The complete list of medications

22

should be in the discharge summary with name, dose, route and

duration if it is limited. Medication reconciliation is done more efficiently
now through the EPIC electronic medical record.
Never use these abbreviations:
U, write out units
IU, write out international units
QD, write out daily
QOD, write out every other day
MS or MSO4, write out morphine sulphate
Dont use a trailing zero, 1.0 can be mistaken for 10
Always
Use a leading zero if the amount is less than one, e.g., 0.25 mg of
Digoxin. Even better would be 250 micrograms
Indicate your plan of care in the admission or clinic note

Documentation/Completion Standards
General Documentation Guidelines:
Include the patient name, medical record #, service, and date of service
Hand-written documentation, such as consent forms, must be legible
All medical records are legal documents
Sign, date, and write PIC # on all documents
If not documented, it is as though it did not happen
Record Completion:
Timely Completion of Medical Records is needed for continuity of patient care;
JCAHO, HCFA, and PRO compliance; third party payment; and, legal protection
for the patient, physician, and hospital.
Discharge Summary:
Dictation delinquency: 5 days post discharge
Signature deficiency: 14 days post discharge
Responsibility: Attending physician
Note: "Transfers" of patients between inpatient units and Psychiatric Medicine,
Physical Medicine/Rehabilitation, or KCRC are treated as discharges and readmissions. A final Discharge Summary must be dictated when a patient is
discharged from the current unit. Contact the Admissions Office (4-2264) for
assistance with questions.
Operative Reports:
Dictation delinquency: 24 hours after surgery
A brief operative note is required to be present in the medical records
immediately post-op.

23

Signature deficiency: 14 days post surgery

Responsibility: Attending physician

History and Physical:

Completion time frame: Performed no more than 7 days prior to admission or
within 24 hours of admission.
Verbal Orders:
Completion time frame: Within 24 hours of order.
Designated Resident:
The responsible Resident shall ensure that information regarding the correct
responsible Attending and designated Resident is kept current in EPIC.
Medical Record Requests:
Patient Care Requests:
Emergency Room: Call 4-5283 to have medical records delivered
immediately.
Inpatient: HIS is notified of all admissions. Record deliveries are made to the
nursing units every two hours.
Outpatient: The Resource Scheduling System provides the opportunity to
request medical records upon scheduling. Other requests must be submitted
to HIS at least 3 days prior to the patient's visit. The medical records are
made available to the clinic one-day prior to the patient's appointment date.
Most medical records will be available on EPIC.
Clinical Studies/Non-Patient Care:
Contact 4-2196
Record Management/Chart Control:
Responsibilities for Ensuring Timely & Confidential Provision of
Information:
Medical records are NOT TO BE REMOVED from the patient care units,
except by HIS staff after patient discharge.
Medical records must be "CHARGED OUT" to the location in which they are
being used. Notify HIS (4-5283) immediately of any changes in the medical
record's location, destination or requestor.
Returning the record:
Inpatient Admission: 24 hours post discharge
Emergency Room: 24 hour following patient's visit
Outpatient Clinics: 48 hours following patient's visit
Studies and Research: Within 7 working days after they are made available

24

Release of Medical Information:

Original records are never to be given to external requestors or removed from
the hospital complex.
Medical information cannot be released to individuals without the written
consent of the patient, subpoena, a court order or statute.
Access to patient care and financial data shall be strictly controlled and given
to an individual only on a job function NEED-TO-KNOW basis.

Patient Information Sign-Out Policy

SERVICES
Joints/Adult Reconstruction/Oncology
Trauma
Spine
Pediatrics
Foot and Ankle
Hand
Sports
MORNING SIGN-OUT (Sunday Saturday) MOST IMPORTANT
The primary resident from each service and/or team must place a copy of their
service EPIC patient list on the 6-East workroom board after morning rounds
(these lists will be for the floor NPs information). Communication should also be
reinforced through the EPIC system and verbally at minimum. When necessary,
additional sign-out details over email should be provided. The list should include
(in brief) the following for each primary orthopaedic patient:
1. Surgery and POD
2. Activity: WB status/Restrictions
3. Anticoagulation plan/restrictions (if applicable)
4. Discharge status (if applicable)
a. NP will assist with Final D/C medically cleared orders, and D/C
orders ONLY when asked and/or notified to do so by primary
team). This request may be placed on EPIC list.
b. Each team remains responsible for completing its own patients
discharge instructions, summaries, and follow-up appointments.
5. Pertinent and/or active critical issues over past 24hrs (low BP, SOB, AMS,
etc.) that could possibly alter hospital course and need follow-up by the
primary team at the close of each day.
6. The NP will call to clarify any major floor issues/questions that she is
unsure about.
EVENING SIGN-OUT(Monday Friday)
The primary resident on each service should update their services patient
information as follows at the close of each day.
1. Newly Admitted Patients - Should be added to that teams EPIC patient list
(with the same information required in the morning) and a copy of that list
placed in 6-East workroom or on the electronic board. This is for main OR
and new ER/clinic/direct admits. (Note: Residents should NOT have to
come back from VASI or Fontaine for sign-out purposes after morning
sign-out unless they have admitted a patient and/or deem it necessary.)
25

2. Old Patients - Pertinent issues/changes that occurred throughout the day

should be communicated to the night float/overnight resident as
necessary.
NIGHT FLOAT/OVERNIGHT RESIDENT
1. The NF/ON resident coming on each evening will be provided with copies
of the EPIC patient lists used during the day or will have direct
communication from the daytime call residents. This will be left in the 6East workroom by the NP upon her leaving each evening. This
information will be supplemented by emails, pages, and/or phone calls
regarding any issues handled by the resident(s) on call during the day.
Communication is important both by phone and by email, and the night
float resident should be paged if important tasks are pending.
2. Each morning following the NF/ON resident(s) shift, they will be
responsible for relaying patient care information to the resident(s) coming
on call for that day. This will include, but not be limited to:
a. Cases on call to the OR
b. Active/outstanding/pending inpatient/ER consultations
c. Orthopaedic inpatient issues overnight

External Transfer Requests

When an outside referring physician calls in through the page operator or call
center they are asked if the call is about a potential patient transfer or for a
consult. If for a potential transfer, then the call is immediately linked into the Bed
Center; if for a consult then the resident and/or attending would be paged. Please
see Appendix A for the hospitals External Transfer Request Procedures
document.

26

Program Overview and Common Goals & Objectives

Overview
The University of Virginia Orthopaedic Hand Fellowship is designed to provide
comprehensive training in all aspects of surgery of the hand. The Department of
Orthopaedic Surgery and the Department of Plastic Surgery jointly provide
clinical and didactic training, as well as exposure to the opportunities for
research. The fellowship year is divided between six full-time faculty physicians.
Dr. Chhabra is the Director and Drs. Drake, Morgan, Dacus, Deal and Freilich
are the Hand Faculty. Please contact Dr. Chhabra if there are any issues that we
can address to make this fellowship a truly exceptional experience for you.
The Fellowship Program at the University of Virginia requires that all trainees
obtain competence in the six areas listed below. The six competencies will be
taught and evaluated through a variety of techniques: didactic presentations,
clinical experience, teaching rounds, attending observation, Journal Club
discussion, individual study and review, 360 degree evaluations, In-Training
examinations, and successful completion of web-based training modules
(NetLearning).
1. Patient Care: Effective, appropriate and compassionate evaluation and
treatment of patients. This includes information gathering, decisionmaking, safe and effective performance of procedures, and
communication with other members of the health care team.
2. Medical Knowledge: The acquisition and integration of medical
knowledge pertinent to Orthopaedic Surgery. The ability to utilize and
analyze basic and clinical scientific literature in support of appropriate
treatment decisions.
3. Practice-Based Learning and Improvement: The ability to objectively
appraise ones own ability (as well as the specialtys) to evaluate patient
care with regards to scientific literature and information technology as well
as the teaching of other health care professionals and trainees.
4. Interpersonal and Communication Skills: The ability to effectively listen
and communicate with patients, families and health care professionals via
written communication, verbal and non-verbal methods.
5. Professionalism: Develop respect, compassion and integrity for gender,
age, and cultural differences in the patient population as well as in the
health care workforce. A commitment to ethical principles and practice,
continued professional education and development of selflessness in the
providing of medical care.
6. Systems-Based Practice: Develop an awareness and understanding of
health care delivery systems and the interaction of health care with society
with respect to health care cost, access to care, and optimal patient care.

Description of Educational Experience

The Hand Fellow has rotating schedules each three months of the year. The
educational experience is consistent, and the fellow will work with both
27

Orthopaedic Surgery and Plastic Surgery faculty physicians each week. Time in
each department is shared with surgery days and clinics divided evenly and
research time respected. Individual and shared group learning experiences are
available on a daily basis. Education in surgery is designed to simultaneously
develop cognitive knowledge, judgment, technical ability, and teaching skills. The
practice of surgery requires the application of clinical data and technical skills to
sure disease. Surgical judgment is that combination of knowledge, confidence,
ability, and compassion that leads to the successful practice of our specialty. It is
attained through consistent mentoring and professional development. It is
essential to participate in the entire patient interaction from initial evaluation
through the surgical process to final discharge. Our program is designed to
facilitate that experience for the entire fellowship program, with intense one-onone interaction on a daily basis between the attending and the fellow.

Common Core Competency Goals and Objectives

Patient Care that is compassionate, appropriate, and effective for the treatment
of health problems and the promotion of health.
Communicate effectively and demonstrate caring and respectful behaviors
when interacting with patients and their families;
Gather essential and accurate information about their patients;
Make informed decisions about diagnostic and therapeutic interventions
based on patient information and preferences, up-to-date scientific
evidence, and clinical judgment;
Develop and carry out patient management plans;
Counsel and educate patients and their families;
Demonstrate the ability to practice culturally competent medicine;
Use information technology to support patient care decisions and patient
education;
Perform competently all medical and invasive procedures considered
essential for the area of practice;
Provide health care services aimed at preventing health problems or
maintaining health;
Work with health care professionals, including those from other
disciplines, to provide patient-focused care.
Medical Knowledge about established and evolving biomedical, clinical, and
cognate sciences, as well as the application of this knowledge to patient care.
Demonstrate an investigatory and analytic thinking approach to clinical
situations;
Know and apply the basic and clinically supportive sciences which are
appropriate to orthopaedic surgery.
Practice-based Learning & Improvement that involves the investigation and
evaluation of care for their patients, the appraisal and assimilation of scientific
evidence, and improvements in patient care based on constant self-evaluation
and life-long learning.

28

Identify strengths, deficiencies, and limits in ones knowledge and

expertise;
Set learning and improvement goals;
Identify and perform appropriate learning activities;
Systematically analyze practice using quality improvement methods, and
implement changes with the goal of practice improvement;
Incorporate formative evaluation feedback into daily practice;
Locate, appraise, and assimilate evidence from scientific studies related to
their patients health problems;
Use information technology to optimize learning;
Participate in the education of patients, families, students, residents and
other health professionals;
Analyze practice experience and perform practice-based improvement
activities using a systematic methodology;
Locate, appraise, and assimilate evidence from scientific studies related to
their patients health problems;
Obtain and use information about their own population of patients and the
larger population from which their patients are drawn;
Apply knowledge of study designs and statistical methods to the appraisal
of clinical studies and other information on diagnostic and therapeutic
effectiveness;
Use information technology to manage information, access online medical
information, and support their own education;
Facilitate the learning of students and other health care professionals.
Interpersonal & Communication Skills that result in the effective exchange of
information and collaboration with patients, their families, and other health
professionals.
Communicate effectively with patients, families, and the public, as
appropriate, across a broad range of socioeconomic and cultural
backgrounds;
Communicate effectively with physicians, other health professionals, and
health related agencies;
Act in a consultative role to other physicians and health professionals;
Maintain comprehensive, timely, and legible medical records;
Create and sustain a therapeutic and ethically sound relationship with
patients;
Use effective listening skills and elicit and provide information using
effective nonverbal, explanatory, questioning, and writing skills;
Work effectively with others as a member or leader of a healthcare team
or other professional group.
Professionalism, as manifested through a commitment to carrying out
professional responsibilities, adherence to ethical principles, and sensitivity to
patients of diverse backgrounds.
Respect for patient privacy and autonomy;

29

Demonstrate respect, compassion, and integrity; a responsiveness to the

needs of patients and society that supersedes self-interest; accountability
to patients, society and the profession; and a commitment to excellence
and ongoing professional development;
Demonstrate a commitment to ethical principles pertaining to provision or
withholding of clinical care, confidentiality of patient information, informed
consent, and business practices;
Demonstrate sensitivity and responsiveness to patients culture, age,
gender, and disabilities;
Demonstrate sensitivity and responsiveness to fellow health care
professionals culture, age, gender, and disabilities.
Systems-based Practice, as manifested by actions that demonstrate an
awareness of and responsiveness to the larger context and system of health
care, as well as the ability to call effectively on other resources in the system to
provide optimal health care.
Work effectively in various health care delivery settings and systems
relevant to orthopaedic surgery;
Coordinate patient care within the health care system relevant to
orthopaedic surgery;
Incorporate considerations of cost awareness and risk-benefit analysis in
patient and/or population-based care as appropriate;
Advocate for quality patient care and optimal patient care systems;
Work in inter-professional teams to enhance patient safety and improve
patient care quality;
Participate in identifying system errors and implementing potential
systems solutions;
Understand how their patient care and other professional practices affect
other healthcare professionals, the healthcare organization, and the larger
society and how these elements of the system affect their own practice;
Know how types of medical practice and delivery systems differ from one
another, including methods of controlling healthcare costs and allocating
resources;
Practice cost-effective health care and resources allocation that does not
compromise quality of care;
Advocate for quality patient care and assist patients in dealing with system
complexities;
Know how to partner with health care managers and healthcare
procedures to assess, coordinate, and improve health care and know how
these activities can affect system performance.

30

Detailed Educational Goals and Objectives

Patient Care
Goals
The Hand Fellow must be able to provide patient care that is compassionate,
appropriate, and effective for the treatment of health problems and the promotion
of health.
Competencies
1. Communicate effectively and demonstrate caring and respectful behaviors
when interacting with patients and their families
2. Develop and carry out patient management plans
3. Gather essential and accurate information about patients
4. Counsel and educate patients and their families
5. Demonstrate the ability to practice culturally competent medicine
6. Make informed decisions about diagnostic and therapeutic interventions
based on patient information and preferences
7. Use information technology to support patient management plans
8. Perform competently all medical surgical invasive procedures considered
essential to hand surgery
9. Provide healthcare services aimed at preventing health problems or
maintaining health
10. Work with other health care professionals to provide patient focused care
Objectives
Upon completion of this training program, the Hand Fellow will demonstrate
proficiency in the following areas:
1. Evaluate and surgically treat patients with tendon injuries requiring the use
of primary and secondary tennorrhaphy techniques (including tendon
grafting, implantation of a tendon spacer, tenolysis, and tenodesis).
Included in this experience would be experience with tendon transfer and
tendon balancing
2. Evaluate and surgically treat patients with nerve injuries of the upper
extremity requiring repair and reconstruction, including upper-extremity
peripheral nerves, nerve graft, neurolysis, neuroma management, nerve
decompression and transposition
3. Evaluate and surgically treat patients requiring restoration of functional
cutaneous coverage of the hands and fingers (including flaps, grafts, and
microvascular free tissue transfer)
4. Evaluate and surgically treat patients requiring musculotendon transfer or
substitution techniques
5. Evaluate and surgically treat patients requiring restoration of digital
function from the manifestations of arthritis, including synovectomy,
arthroplasty, arthrodesis, joint repair and reconstruction, including
contracture release and management of stiff joints
31

6. Evaluate and surgically treat patients with fractures and dislocations

including phalangeal and metacarpal with and without internal fixation,
carpus, radius, and ulna with and without internal fixation and injuries to
joints and ligaments
7. Evaluate and treat patients with established brachial plexus injuries
including tendon and nerve transfers
8. Evaluate and manage patients with benign and malignant tumors of the
upper extremity
9. Evaluate and treat patients with acute and chronic ischemia of the upper
extremity
10. Understand the application of hand therapy and rehabilitation to the
practice of hand surgery including upper extremity pain management
11. Effectively demonstrate competency in the management techniques of
tendon repair; fracture fixation of the hand, wrist, and forearm; nerve
repair; nerve decompression; and arthroscopy of the wrist
12. Effectively demonstrate competency in the performance of arthroscopy of
the wrist
13. Evaluate patients with disorders of the wrist, small joints of the hand, and
treat with arthroscopic management
14. Demonstrate familiarity with the diagnosis and management of congenital
anomalies including syndactyly, polydactyly, and radial aplasia
15. Evaluate and manage patients with Dupuytrens Disease
16. Demonstrate efficiency with foreign body and implant removal
17. Evaluate and manage patients with osteonecrosis, including Kienbocks
Disease
18. Evaluate and manage patients needing thumb reconstruction including
pollicization, toe to hand transfer, and thumb metacarpal lengthening
19. Demonstrate competency in bone graft techniques with autogenous and
synthetic material, including corrective osteotomies of long bones
20. Evaluate and treat patients needing replantation or revascularization
21. Manage and provide coverage for burns of the upper extremity

Medical Knowledge
Goals
The Hand Fellow must demonstrate knowledge of established and evolving
biomedical, clinical, epidemiological, and social-behavioral sciences, as well as
the application of this knowledge to patient care.
Competencies
1. Demonstrate an investigatory and analytic approach to clinical situations
2. Know and apply the basic clinically supportive sciences that are
appropriate to hand surgery

32

Objectives
1. Know the principles, indications and techniques of tendon reconstruction
in the hand including:
a. Tendon grafting sources, methods, indications
b. Tendon transfers
c. Use of prosthetics indications, timing, techniques
2. Develop a thorough understanding of functional deficits resulting from loss
of segments of the anatomic system
3. Develop an understanding of the diagnostic techniques for evaluation of
functional loss, including EMG and conduction studies, arteriography,
conventional radiographs, CT scan, and MRI evaluation
4. Develop an understanding of the management of nerve injuries of the
upper extremity including primary, delayed primary and secondary repair
5. Demonstrate knowledge of the techniques of grouped interfascicular nerve
grafting and of nerve-graft harvesting (including use of vascularized nerve
grafts)
6. Demonstrate knowledge of the indications and techniques for
reconstruction of the amputated thumb, including lengthening,
pollicization, free whole toe transfer, and free wrap-around techniques
7. Develop knowledge of the indications for and specific technical methods of
skin and soft tissue coverage including skin grafts, local flaps, distant
flaps, and free tissue transfers
8. Demonstrate knowledge of the specific requirements and resurfacing
techniques for areas of critical innervations in the hand
9. Demonstrate understanding of the use of tendon transfer and pedicle
muscle/tendon substitution (including use of free muscle transfer) to
redistribute functional activities in the upper extremity
10. Demonstrate knowledge of the indications and techniques (including joint
replacement) for treatment of hand and wrist dysfunction and joint
deformities secondary to trauma or non-traumatic disorders
11. Demonstrate an understanding of the consequences of derangement of
the bony architecture of the hand and wrist and the methods and
techniques for bone stabilization and reconstruction
12. Develop understanding of the indications and techniques for correction of
bony deficits of the hand including lengthening, free non-vascularized
bone grafting, and free microvascular bone transfer techniques
13. Demonstrate understanding of the principles of management of patients
with brachial plexus injuries including radiologic and electrical evaluation
and surgical treatment (early and late)
14. Demonstrate knowledge of the vascular, boney, and ligamentous
structures of the wrist and understand the principles and techniques of
intracarpal fusion, arthrodesis, tendon interposition, fracture management,
joint replacement, and proximal row carpectomy
15. Demonstrate proficiency in discussions of the pathophysiology of
sympathetic mediated pain syndromes (RSD) and knowledge of the perioperative diagnosis and management of a patient with this disorder

33

16. Develop efficiency in the evaluation and management of benign and

malignant tumors of the upper extremity
17. Demonstrate experience in dealing with the acute and chronic
management, both operatively and non-operatively, of the burned upper
extremity
18. Learn to synthesize a management plan for patients with hand problems
by conducting a thorough and efficient clinical history and physical
examination and have an understanding of:
a. Implications of systemic, emotional, and situational factors for the
treatment of hand disorders
b. Relevant basic science and anatomy (gross and arthroscopic)
related to the hand and wrist
c. Presenting basic treatment options, including home exercises,
medications and surgery, along with the alternatives and risks of
each
19. Develop an understanding of the diagnosis and treatment of:
a. A core group of traumatic lesions (including fractures, tendon
injuries, dislocations and instability problems, nerve injuries, soft
tissue loss, reflex sympathetic dystrophy and amputations)
b. Non-traumatic disorders (including arthrosis, compression
neuropathies, tendonitis, contractures, ganglions, tumors, and
palsies
20. Learn the elements of efficient and safe hand surgery, including:
a. Preoperative planning
b. Positioning and preparation
c. Surgical approaches

Practice-Based Learning and Improvement

Goals
The Hand Fellow, using an individual critique of patient care practice outcomes,
will be able to demonstrate methods of improvement in patient care through the
recognition and practice of lifelong learning skills in the surgical field as judged
against applicable standards of patient care. The Hand Fellow must also
demonstrate the ability to investigate and evaluate their care of patients, to
appraise and assimilate scientific evidence, and to continuously improve patient
care based on constant self-evaluation and lifelong learning.
Competencies
1. Identify strengths, deficiencies and limits in ones knowledge and expertise
2. Set learning and improvement goals
3. Identify and perform appropriate learning activities
4. Systematically analyze practice, using quality improvement methods, and
implement changes with the goal of practice improvement
5. Incorporate formative evaluation feedback into daily practice

34

6. Locate, appraise and assimilate evidence from scientific studies related to

the patients health problems
7. Use information technology to optimize learning
8. Participate in the education of patients, families, students, residents, and
other health professionals as documented by evaluations of the Hand
Fellows teaching abilities by faculty and/or other learners
9. Analyze practice experience and perform practice-based improvement
activities using a systematic methodology
10. Obtain and use information about their own population of patients and the
larger population from which their patients are drawn
11. Apply knowledge of study designs and statistical methods to the appraisal
of clinical studies and other information on diagnostic and therapeutic
effectiveness
Objectives
1. Evaluate patient care through a personal QA program
2. Review personal portfolio for patient safety issues
3. Appraise scientific evidence as to correctness of data
4. Appraise scientific evidence as to applicability in patient are
5. Assimilate new scientific knowledge to improve patient care
The measurable objective for this area will be the graded review of the
evaluations by faculty of this specific goal. This will be performed on a quarterly
basis and be based on direct daily evaluation, evaluation of an ongoing portfolio,
and of performance at journal club activities.

Systems-Based Practice
Goals
Upon completion the Hand Fellow will understand the role of Systems-Based
Practice in the management of their patients and recognize the importance of this
as a lifelong process for optimal health care. Specifically, the Hand Fellow will
gain understanding of how the specialty is utilized in the context of maximizing
results and minimizing expenditures. The Fellow will also be able to recognize
inefficient resource allocation and how this impacts the total health care system.
Competencies
1. Work effectively in various health care delivery settings and systems
relevant to the clinical specialty
2. Coordinate patient care within the health care system relevant to hand
surgery
3. Incorporate considerations of cost awareness and risk-benefit analysis in
patient care
4. Participate in identifying systems errors and in implementing potential
systems solutions
5. Advocate for quality patient care and optimal patient care systems

35

6. Work in inter-professional teams to enhance patient safety and improve

patient care quality
7. Understand how their patient care and other professional practices affect
other healthcare professionals, the healthcare organization, and the larger
society and how these elements of the system affect their own practice
8. Know how types of medical practice and delivery systems differ from one
another, including methods of controlling healthcare costs and allocating
resources
9. Practice cost-effective health care and resource allocation that does not
compromise quality of care
10. Advocate for quality patient care and assist patients in dealing with system
complexity
11. Know how to partner with healthcare manager and healthcare procedures
to assess, coordinate, and improve healthcare and know how these
activities can affect system performance.
Objectives
The Hand Fellow will be able to demonstrate an awareness of the health care
system, respond to the larger context of the health care system and manage
health care system resources to provide optimal care as judged against
applicable standards of patient care.
1. Define cost-effective patient care
2. Describe how to meld together both high-quality and cost-effective care
methods in providing health care
3. Demonstrate risk-benefit analysis in day-to-day patient care
4. Describe the appropriate use of specialists in health care
5. Describe the use of non-physician health care team members in daily care
of the patient
6. Demonstrate the role of the individual physician in the development of the
overall health care system at the local, state, national and international
level
7. Describe the importance of using the political process to enhance the
medical health care system
This will be assessed through the competency-based clinical reports as well as
through learning modules provided through the Institutional GME Office.

Professionalism
Goals
The Hand Fellow will demonstrate understanding, manifest a commitment to
carrying out professional responsibilities, adherence to ethical practices and
sensitivity to diverse patient populations. He will present himself in a respectful,
professional, honest and congenial manner in all interactions with patients,
colleagues, and other health care professionals and ancillary staff.

36

Competencies
1. Compassion, integrity, and respect for others
2. Responsiveness to patient needs that supersedes self-interest
3. Respect for patient privacy and autonomy
4. Accountability to patients, society, and the profession
5. Commitment to excellence and ongoing professional development
6. Sensitivity and responsiveness to a diverse patient population, including
but not limited to diversity in gender, age, culture, race, religion,
disabilities, and sexual orientation
7. Commitment to ethical principles pertaining to provision of withholding of
clinical care, confidentiality of patient information, informed consent, and
business practices
8. Sensitivity and responsiveness to fellow health care professionals culture,
age, gender, and disabilities
Objectives
1. Demonstrate a commitment to professional responsibilities
2. Perform patient care in an ethical manner
3. Display sensitivity to the needs of a diverse patient population
4. Demonstrate the principles of the highest standard of patient care
5. Demonstrate commitment to continuity fo patient care
6. Demonstrate sensitivity to patient age, gender, and culture
Frequent feedback of professionalism will be given through the clinical
evaluation.

Interpersonal and Communication Skills

Goals
The Hand Fellow must demonstrate interpersonal and communication skills that
result in the effective exchange of information and teaming with patients, their
families, and professional associates. Upon completion, the Hand Fellow will be
able to communicate in a collaborative and collegial model with patients, patients
families, and members of the health care team relevant and important
information.
Competencies
1. Communicate effectively with patients and families across a broad range
of socio-economic and cultural backgrounds
2. Communicate effectively with physicians, other health professionals, and
health-related agencies
3. Work effectively as a member or leader of a health care team or other
professional group
4. Act in a consultative role to other physicians and health care professionals
5. Maintain comprehensive, timely, and legible medical records
37

6. Create and sustain a therapeutic and ethically sound relationship with

patients
7. Use effective listening skills and elicit and provide information using
effective nonverbal, explanatory, questioning, and writing skills
Objectives
1. Discuss the patient/s medical condition, progress and outcome with the
patient and patients family (if requested) to assure complete
understanding
2. Team with the patient, their family, and other health care providers to
optimize the patients recovery
3. Demonstrate effective communication with other health care professionals
4. Demonstrate education of the patients family
5. Demonstrate counsel of the patients family
6. Document patient education and counseling
7. Document development of patient care plan
8. Demonstrate ability to obtain informed consent, including the components
of condition, proposed treatment, alternative treatment, complications,
risk, benefits, outcomes of treatment and alternatives
9. Demonstrate maintenance of patient confidentiality in communication with
family, friends, and other health care workers
10. Demonstrate integration and understanding in how professionalism and
communication are critical and essential in overall optimal patient care and
equally crucial in risk management and therefore effective Systems-Based
Practice

Core Curriculum Topics

The following topics should be covered in conferences over the course of the
fellows year:
1. Skin Repair/Flaps/Grafts
2. Fingertip/Nailbed Injuries/Amputations
3. Tendon Repair
4. Nerve Repair/Compression neuropathy
5. Fractures/Bone Grafts/Wrist Arthroscopy
6. Inflammatory Joint Disease/Rheumatoid Arthritis
7. Hand Tumors/Dupuytrens
8. Replantation/Microsurgery/Toe-Hand Transfers
9. Congenital Disorders
10. Vascular Disorders
11. Thermal Injuries
12. Upper Extremity Pain Management
13. Hand Therapy/Rehabilitation/Prosthetics

38

Curriculum Goals
Basic Sciences
1. Appreciation for basic and advanced surgical anatomy of the bones, soft
tissues, nerves and vessels associated with the hand, wrist, forearm,
elbow and shoulder. Additionally, facility with the anatomy of other
selected regions of the body utilized in microsurgical reconstruction is
required.
2. Familiarity with the science of healing tissue, including bone, nerve,
tendon, ligament and vessel.
3. Understanding of the pertinent biomechanics of normal and pathologic
bone, and the relationship of force transmission to creation of osseous
injury.
4. Knowledge of the length-tension relationships of musculotendinous units
and their expression in normal and pathologic states.
5. Awareness of metabolic and autoimmune balance that affects the tissues
of the upper extremity.
6. Knowledge of macroscopic and microscopic anatomy and physiology of
nerves and vessels as they relate to the normal and pathologic status of
the hand and upper extremity.
7. Appreciation of hydraulics and fluid flow sciences as they relate to the
vascular system and its disturbances or pressure-related pathologies.
8. Familiarity with basic pharmacology as it relates to the drugs and agents
utilized in the practice of Hand Surgery.
9. Knowledge of the embryology, especially as it relates to upper extremity
development, teratogenesis and basic genetics.

Traumatic Conditions
1. Fractures and/or dislocations of the bones and joints of the hand and
upper extremity, including open and closed injuries of the tubular bones
and dislocations of all elements of the osteoarticular column (simple and
complex).
2. Specific fractures and nonunions of the carpus, in addition to treatment of
acute and chronic wrist instability patterns.
3. Role of arthroplasty and/or arthrodesis in management of acute trauma to
the bones and joints of the hand and upper extremity.
4. Eponymous fractures and dislocations of the forearm axis (Galeazzi,
Monteggia, Essex-LoPresti).
5. Lacerations or injuries associated with tissue loss, including those
requiring advanced coverage options.

39

6. Logical and systematic treatment of combined injuries that present with

soft tissue, bony and neurovascular involvement.
7. Knowledge of ballistic injury and other foreign body management of the
hand and upper extremity.
8. Management of tendon laceration of the hand and upper extremity (flexor
and extensor tendons of the hand and wrist, biceps and triceps tendons).

Degenerative and Inflammatory Arthropathies, Osteonecroses

1. Degenerative or inflammatory arthritis of the small joints treated with
debridement (mucous cyst), arthrodesis or arthroplasty.
2. Degenerative or inflammatory arthritis of the wrist treated by proximal row
carpectomy, partial fusion, denervation, total wrist fusion or wrist
arthroplasty.
3. Degenerative or inflammatory conditions of the elbow treated by
arthroscopic debridement, interposition biologic arthroplasty or total elbow
replacement arthroplasty.
4. Degenerative arthritis of the shoulder treated with shoulder arthroplasty.
5. Recognition and treatment of Kienbocks and Pressiers disease.
6. Post-traumatic or developmental pathologies that may accelerate the
development of degenerative arthrosis (ex., Radius malunion,
Madelungs).

Tendinitis and Other Soft Tissue Inflammatory Conditions

1.
2.
3.
4.
5.
6.
7.

Trigger finger and trigger thumb.

DeQuervains stenosing tenosynovitis.
Intersection syndrome
Synovitis and tenosynovitis associated with inflammatory arthritis.
Medial and lateral epicondylitis.
Rotator cuff tendinitis.
Cumulative trauma disorders.

Congenital Differences
1. Hypoplastic or absent thumb and radial club hand (pollicization,
augmentation, microsurgical reconstruction, non-microsurgical
reconstruction including metacarpal lengthening).
2. Central and ulnar deficiency.
3. Syndactyly and polydactyly.
4. Duplicate thumb.
5. Role of extraperiosteal toe phalanx transfers for terminal deficiency.
6. Madelungs Deformity.
7. Polands Syndrome.
40

8. Other syndromes with manual manifestations (Cornelia DeLange, NailPatella, etc.).

9. Understanding of basic genetics, embryology and collaborative
approaches with other professionals dealing with pediatric patients
(Pediatrician, Therapists, Geneticists, Social Workers, Parental Support
Groups, etc.).

Arthroscopy and Endoscopy

1. Understanding of the indications for and performance of upper extremity
arthroscopy for diagnosis and treatment (elbow, wrist, selected small joints
of the hand).
2. Use of endoscopic visualization for upper extremity nerve decompression
(ex., Carpal tunnel release).

Metabolic and Infectious Processes

1. Diagnosis and management of crystalline arthropathy (gout, pseudogout)
specifically as it is in contradistinction to suppurative processes.
2. Decompression of suppurative tenosynovitis, hand space abscesses or
suppurative arthritis of the hand, wrist, elbow and shoulder, paronychia
and felons.
3. Management of postoperative infectious complications of the hand and
upper extremity, including those with in-dwelling hardware or joint
implants.
4. Basic knowledge of microbiology, including common pathogens.
Additional knowledge of atypical infections seen and treated by hand
surgeons (HIV, TB, mycobacterial infections, etc.).
5. Appreciation for the management of metabolic bone disease and
osteoporosis as it relates to the practice of hand surgery.

Neurovascular Pathologies and Microsurgical Applications

1. Management of compressive or polyneuropathy (carpal tunnel, cubital
tunnel, radial tunnel, sensory nerve disturbances).
2. Treatment of brachial plexus lesions, including direct repair, necrotization
and transfers to restore function after brachial plexus injury.
3. Management of neuromata and adhesive neuritis.
4. Management of acute nerve and vessel lacerations (isolated or
combined).
5. Non-microsurgical tissue coverage options, including skin grafting,
complex flap closures and pedicled transfers.
6. Microsurgical capabilities for employment in acute and elective
circumstances for wound coverage (free tissue transfer).
41

7. Revascularization or replantation of upper (and selected lower) extremity

amputations.
8. Tendon transfers for isolated or combined nerve palsies (radial, median,
ulnar) or brachial plexus palsy.
9. Vasospastic, embolic and vascular insufficiency disorders (Raynauds,
hypothenar hammer syndrome, etc.).

Neoplastic Processes
1. Ganglion cysts, and other benign tumors including inclusion cyst, giant cell
tumor, nerve-associated tumors, vessel-associated tumors.
2. Malignant melanoma, including integrated approaches in collaboration
with Oncologists.
3. Squamous cell carcinoma.
4. Metastatic Cancer with manual/upper extremity manifestation.
5. Dupuytrens Contracture diagnosis and treatment.
6. Enchondroma, osteoid osteoma and other bone-associated tumors.

Pressure-related Phenomena and Thermal Injury

1. Diagnosis and treatment of evolving compartment syndrome.
2. Management of first, second, and third-degree burns.
3. Indications for and performance of hand and forearm fasciotomies and
digital escharatomies.
4. Management of frostbite.
5. High-pressure injection injuries.

Miscellaneous Disorders
1. Sympathetically-mediated pain-dysfunction syndromes.
2. Conversion reaction and Munchausens Syndrome.
3. Child Abuse.

Hand and Upper Extremity Rehabilitation

1. Knowledge of the indications for and collaborative employment of
contemporary protocols for upper extremity rehabilitation in nonsurgicallymanaged and postoperative patients.
2. Appreciation for advanced concepts of hand rehabilitation, including work
hardening, vocational evaluation and workplace ergonomics.
3. Appropriate consultation with additional professionals (Social Work,
Psychology, etc.) in the treatment of patients for hand and upper extremity
pathologies.

42

Conference Requirements
Continuing Medical Education / Lecture Series
A minimum of one hour each week is devoted to Orthopaedic didactic
presentations in the basic sciences. A formal lecture is presented weekly, either
by a resident, basic science faculty member, staff orthopedist, or visiting
consultant. All resident lectures are supervised and backed-up by one or more
designated attending physicians. Additional Orthopaedic Pathology lectures are
given one to two times per month by our orthopaedic oncologist. While these
lectures are often clinical topics, the basic science issues relevant to these topics
are incorporated into each didactic lecture. Additional basic science
presentations are integrated into the Grand Rounds and Chairmans conference
schedules. An annual conference evaluation form is filled out by the trainees at
the end of each academic year to ensure improvement and enhancement of the
Orthopaedic learning experience. Hand Fellows should plan to attend those
conferences in Orthopaedics that are pertinent to their education. Each month
there are six required upper-extremity conference for the Hand Fellow.
A combined-service Hand Journal Club is held every two to three months to
review the latest issue of the Journal of the American Society for Surgery of the
Hand. Each quarter, a Monday evening conference will be devoted to Continuing
Quality Improvement. A record of all conferences given and attended should be
recorded by the fellow for documentation.
Every Thursday at 7:00am, an Upper-Extremity Conference is held in the
Conference Room at the outpatient surgery center. One Tuesday per month at
6:30am, Orthopaedic Surgery Competency Lectures is devoted to Hand and
Upper Extremity Surgery.
One Thursday every 2 months at 6:30 am, a combined MSK radiology/ortho
hand conference is held to review interesting and educational radiology findings
and correlate with surgical findings. This conference is held in the conference
room on the 2nd floor of the 545 building at Fontaine.
The Morgan-McCue Lectureship in Hand Surgery is presented in the spring of
each year. A noteworthy Hand Surgeon is invited to visit in honor of the founders
of the fellowship program at the University of Virginia. In addition, two or three
visiting professor lectures will be arranged, and the fellow will help the fellowship
program directors for Plastics (Drs. Drake and Dacus) to organize topics and
case presentations.
A written log of all conferences attended should be maintained for the year.
Please keep this up to date, as accuracy improves greatly when this log is
completed at the event.

43

Conference Schedule
Skeleton weekly conference schedule for Orthopaedics:
Monday
06:15-06:30 Fracture conference didactic session
06:30-07:15 Fracture conference cases
Tuesday

06:15-07:15 Core Curriculum conference

Wednesday 07:00-0800 Early conference on a rotating schedule

OITE Review (Pathology Conference)
08:00-09:00 Grand Rounds (2x/month)
Quality Assurance (Morbidity and Mortality) 1x/month
Friday

06:30-07:30 Basic Science/Anatomy (didactic/dissection) Lecture

Journal Club

One Thursday evening each month at the home of an

attending

Visiting Professor

Held at the end of year in conjunction with resident

graduation
Multi-disciplinary Core Competency Lecture Series
Held once a month on the
second Wednesday from 7-8am

Fracture Conference
Monday mornings, 06:15-07:15, Moss Amphitheater (1st floor main hospital)
Over the course of each academic year, we attempt to cover all major topics
relating to adult and pediatric fractures. We use a discussion of the previous
weeks fractures following a scheduled didactic presentation with representative
cases. It is expected that the junior residents will have read the assigned topic in
Rockwood and Green (reading assignments are on the conference schedule).
Assigned residents will present a lecture on the scheduled topic. The lecture
should last no more than 15 minutes, and should include detailed discussion of at
least one recent or classic paper from the literature. The speakers should try to
concentrate on the current concepts and controversial aspects of the specific
fracture being discussed, so as to supplement, rather than reiterate, the assigned
reading. A slide presentation with a handout is required. One of the Trauma
attendings will then present either a short didactic lecture or a case-based
interactive exercise for the junior residents. There will be significant interaction
with the junior residents, and adequate preparation for the scheduled topic is
expected.
One to two Mondays each month will be devoted to pediatric fractures. The first
30 minutes of conference will be topic specific, followed by presentation of the
weeks cases.
44

The junior residents will be responsible for presenting x-rays of all the previous
weeks surgical and non-surgical cases to each conference. Junior residents who
have initially seen the patients should be prepared to present and discuss the
management of these cases at every fracture conference.

Core Curriculum Conference

Tuesday mornings, 06:15-07:15, Operating Room Classroom (2nd floor main
hospital)
The subspecialty conference ensures that all residents are exposed to a core
curriculum covering all orthopaedic subspecialties. All conferences are given by
an appropriate attending and resident, with the format of the lecture left to the
discretion of the attending (case review, slide presentation, article review, etc).
Assigned readings are provided to the residents one week in advance to
reinforce the presented materials. The subspecialty conference rotates services
and topics on a 2-year schedule.

Grand Rounds
Wednesday mornings, 07:00-09:00, Fontaine Conference Room, 3rd Floor
Wednesday morning is an institution-wide dedicated conference time; surgical
cases start at 9:30am. The Wednesday Orthopaedic conference schedule is
divided into two lectures.
Grand Rounds conferences are held two times per month. Each chief resident
and fellow is required to present one grand rounds presentation during the
academic year. Throughout the year, the department also hosts several visiting
lecturers during the Grand Rounds schedule. These are invited speakers from
within the University community, as well as eminent National and International
speakers. Many of these presenters are funded by industry, and some are invited
by the senior residents and paid for with departmental funds. Topics include
clinical orthopaedics, osteoporosis, medical ethics, systems-based practice, and
other related topics.

Quality Assurance (Morbidity and Mortality) Conference

During this conference, held the first Wednesday of the month, residents present
complications to all residents and faculty. Complications are documented for
departmental Continuous Quality Improvement, including the nature of the
complication, the root cause, contributing factors, and strategies for future
prevention. Chief or Senior residents are required to submit a report for each
service including the number of surgical procedures, number of admissions and
the number of complications for the previous month. This information as well as a
description of the complication and action taken must be submitted on the
appropriate form (Appendix G) to Dr. Mark Romness. One case of good

45

educational value should be presented (with x-rays) to the department from each
service.

Ethics & Professionalism Conference

The University of Virginia School of Medicine is fortunate to have a very active inhouse Department of Medical Ethics. This department provides a 24-hour ethics
consultation service for inpatients. Residents are encouraged to consult the
Ethics service for any questions regarding difficult decisions with informed
consent and refusal of care. This service has responded with rapid input in
issues regarding informed consent, competency, and withdrawal of support for
orthopaedic patients in the past year. For obtunded patients without an
identifiable surrogate, the Ethics service has helped to arrange court-appointed
surrogates with medical power of attorney in short order.
All of the faculty strive to provide ethical and cost-effective care to patients,
without regard to ability to pay for care, and in doing so teach by example.
According to institutional policy, clinics are not separated or stratified with regard
to the patients socioeconomic status, and all care is provided without regard to
the patients insurance status or ability to pay.
Since the inception of the bi-monthly Ethics feature in the Journal of Bone and
Joint Surgery in 2000, and the inception of the AMAs Virtual Mentor, we have
included these features in our monthly Journal Club discussions.
Lectures in medical ethics are integrated into the Grand Rounds and Basic
Science Conferences. Past topics have been thought provoking supplements to
the journal club reviews and clinical teaching.
In addition, residents in the research laboratory attend eight hours (four sessions,
two hours each) of meetings during the research year or during the ten-week lab
rotation. Each session consists of a lecture followed by a discussion group that
includes postdoctoral fellows and graduate students in the Health Sciences and
the Graduate School of Arts and Sciences Research Training Programs. The
ethics mini-course is designed to emphasize the ethical standards practiced at
the University of Virginia in Medicine and Research.

Journal Club
One of the senior residents selects articles from the current edition of the JBJS
for discussion each month at the home of one of the orthopaedic attendings. The
attendings are also asked to suggest seminal articles from the subspecialty
journals and the British journal for inclusion in the journal club schedule. The
Ethics features in JBJS and AMAs Virtual Mentor are discussed bi-monthly as
part of the ethics curriculum. Approximately two hours per month are devoted to
journal club.

46

Basic Science & Anatomy Conference

Friday mornings, 06:30-07:30, Jordan Hall 1-17
A weekly conference offers comprehensive coverage of Orthopaedic Basic
Science and Applied Surgical Anatomy over the course of each academic year.
Attending physicians with appropriate subspecialty interest are designated to
participate in each weekly conference. Basic science topics are covered twice
monthly, one session is devoted to didactic anatomy presentations or radiology
correlates presented by the musculoskeletal radiologists. The final session
monthly is devoted to a cadaveric prosection (prepared by the research resident)
to review the important anatomical material for the particular body region.
Attending physicians are assigned to the sessions with which they have the most
expertise.

Visiting Professorship
A formal visiting professorship is sponsored each year in conjunction with the
graduation banquet for the senior residents. The Chief Residents choose an
eminent speaker for a one-day lectureship. The visiting professor generally gives
two to three hours of didactic lectures, followed by two to three hours of case
presentations by the residents. Chief Residents join the visiting professor for
breakfast, lunch, and dinner on the Friday of the Professorship. The end of year
banquet and awards ceremony is traditionally held at the Rotunda, a central
campus structure designed by Thomas Jefferson, where all doctorates have
been granted since the Universitys founding in 1825.

Multi-disciplinary Core Competency Lecture Series

These monthly conferences are held in Jordan Hall Amphitheater on the second
Wednesday of the month from 7-8am. Two residents (intern on service and 1
second year) are assigned to attend each meeting and are therefore excused
from participation in that Wednesdays Orthopaedics Grand Rounds lectures.
These residents are responsible for signing-in for the lecture and taking enough
notes to present the topic to their fellow residents in the form of a 1-page report,
due to the Directors and Coordinator within a week of the conference.

Portfolio
The Hand Fellow will be required to assimilate ongoing experience in an
organized portfolio. The outline for the portfolio is given below, and will be
discussed in detail during orientation. This document is extremely important, as it
serves as confirmation of the fellows experience and maturation as a hand
surgeon. Contents should be organized as follows:
Curriculum Vitae & Personal Statement
Patient Care/Experience
o Case Log
o Microsurgery Course Certification
o Patient Letters

47

Medical Knowledge
o Hand Self-Assessment Scores
Professionalism Documentation/Development
o Lectures Attended
o Lectures Presented
o Visiting Professor Presentations
Interpersonal and Communication Skills
o Teaching Evaluations
Evidence of Systems-Based Practice
o Faculty Evaluations
o Evaluation from Head of OR Service
o NetLearning Modules Completed
Practice-Based Learning and Improvement
o Index Case Documentation
o Quality Assurance Presentations
Scholarly Activity
o Research Project
o Abstracts Submitted
o Papers Submitted/Presented
o Awards

Assessment of Performance
UVA Policy
POLICY AND PROCEDURES FOR
THE ASSESSMENT OF PERFORMANCE OF RESIDENTS
This document is maintained on UVAs Graduate Medical Education Office
website at
http://www.healthsystem.virginia.edu/internet/housestaff/housestaff.cfm

ACGME Policy
Documents for program requirements are housed on the ACGME website at
http://www.acgme.org/acWebsite/downloads/RRC_progReq/260orthopaedicsurg
ery07012007.pdf

Department Policy
Quarterly Evaluations
At the end of each quarter, standardized evaluations are completed by the
supervising faculty member(s) of the fellow, by the fellow of the faculty
member(s), peer review by the residents, PAs and fellows, and nurses
evaluations on the fellow. Additionally, twice annually the fellow and faculty are
asked to evaluate the program. These evaluations reflect the six competencies
identified by the ACGME. These evaluations are completed within the New
48

Innovations Software system. The faculty evaluation of the fellow should be

discussed directly with the fellow prior to submission to the Residency
Coordinator for filing in the trainees records. Fellow evaluations of the faculty are
kept confidential and are blinded and randomized with resident evaluations
before comments are shared with the faculty during their annual review. Rotation
evaluations are blinded and randomized and are reviewed annually by the
Education & Curriculum Committee for resident and fellow education
improvement.
Any significant deficiencies are discussed at the next Orthopaedic Faculty
meeting. Significant or recurring deficiencies in performance warrant a referral to
the Resident Advocacy & Remediation Committee. This committee has the
authority to act on these identified deficiencies. Sanctions may include assigning
a faculty mentor for more frequent evaluations; remediation with committee
recommendations for improvement in performance and review after each
rotation; and in extreme cases, termination. All sanctions are subject to
institutional (UVA Health System) Grievance policies.

Assessment of Training Program

Program effectiveness is critically evaluated twice annually at the Education &
Curriculum Committee Meetings. The quality and content of the conferences are
reviewed and recommendations are made concerning positive changes. Clinical
evaluations of fellow performance are not specifically reviewed during these
meetings. Fellow input regarding conferences are sought by faculty and resident
members of the committee. As the Program Director has an open door policy,
trainees often voice concerns or complaints regarding conferences and faculty,
and these are taken into consideration when scheduling the upcoming academic
conference calendar.

Leaves of Absence / Time Away from the Program

Vacation Policy
Allotted Vacation and Terms
Fellows will have the following vacation allowance during an academic year
(August 1 July 31):
1. Two weeks of personal time off (14 days including 10 business days
and two weekends)
2. One week of conference time (5 business days) with conference
preapproved by the fellowship director
3. Five days off during the Holiday Season of Christmas-New Years
If time off is used inappropriately or without prior approval, probation will
automatically be instituted and the trainee involved will lose the remainder of their
vacation time for the year.

49

Travel Policy
Fellows traveling to conference on educational funds should consult with the
Program Director and Program Coordinator for pre-approval submission
guidelines. A pre-travel authorization workbook will need to be completed as
early as possible that includes flight, mileage, hotel, registration fees, parking,
and per diem for the destination location. No travel outside of the continental US
are supported. Exceptions may be made in the case of research presentations at
international conference, where the resident is the primary podium presenter,
and should be discussed with the Program Director. Please fill out any
associated attachments out completely and accurately, using UVAs Travel
website for guidance on Per Diem rates and current Travel Workbook forms.
http://www.procurement.virginia.edu/main/travel/TravelBasics.html.
Fellows are responsible for keeping all travel receipts and should submit a signed
and completed travel workbook within seven (7) days of return. Receipts include
credit card statements showing charges for registration, air fare, and hotel. An
itemized, zero balance receipt must be obtained from the hotel, and all nonreimbursable items must be deducted. Items not reimbursed include
entertainment, some room service, and bar/courtesy charges. Receipts for
parking, taxis/shuttles, luggage fees, and boarding passes must be submitted.
Failure to keep boarding passes or other required receipts may result in the
residents travel reimbursement being reduced or rejected.
Travel must be submitted, approved by the department, and keyed within 30
days of travel or the traveler risks non-reimbursement of their traveling expenses.
In the unlikely event that a trainee is absent for more than twenty (20) working
days without approval or extenuating circumstances, he risks being denied
residency certification.
Accurate expense accounts and receipts of activities must be returned by the
fellow to the Program Coordinator within 7 days of travel to comply with IRS and
University regulations. Please see the web for current directions and forms to
complete www.healthsystem.virginia.edu/internet/orthopaedics/travel.cfm
In addition to the above, fellows will be allowed to attend legitimate national
meetings at which they are presenting papers for the first time (not posters),
which have been accepted. Examples of this type of meeting are:
AOA Residents Conference
AAOS Annual Meeting
ORS Annual Meeting
Funding for other meeting presentations are to be provided by the PI of the
study. Supplemental funding by the Department will be considered on a case by
case basis.

50

Funding for these meetings is in addition to each fellows individual allotment,

and MUST be done in advance to ensure reimbursement. Receipts need to be
turned in within 5 working days and need to be submitted to the Business Office
within 10 working days. All questions regarding travel funding should be directed
to the Departments Business Office.

UVA Policy
Please see the Housestaff webpage regarding leaves and request for absence
included
in
the
Graduate
Medical
Trainee
Manual
at
http://www.healthsystem.virginia.edu/internet/housestaff/housestaff.cfm.
Scroll
down to the Policies and Manuals section and click on the link to Graduate
Medical Trainee Manual for the most current policies for Housestaff.
The department of Orthopaedic Surgery seeks to provide all trainees with
appropriate time off to ensure well-being and to conform to both the ACGME and
ABOS regulations. Any time away from the training program must adhere to
university and department policy, and board requirements. All orthopaedic
department fellows may take up to four weeks of paid medical leave per year
without extending the length of their training if they have an unexpected medical
problem (i.e., broken leg) separate from vacation leave.

Maternity Leave
The trainee must inform the department chair, vice chair, and program director
and coordinator of their pregnancy or adoption date as soon as this information is
confirmed in order to facilitate appropriate planning, which may include a revised
education plan for the remainder of the trainees training and must be sent to the
board. Under normal circumstances, the trainee should expect to take six weeks
of maternity leave without extending her training period. Four weeks would be
paid as medical leave with the addition of up to two weeks being allowed to be
taken as vacation leave if the trainee has this leave available to them. Additional
time taken away from the program due to medical necessity will need to be made
up at the end of the trainees program in order to fulfill all requirements for sitting
for the specialty board. It will be the programs responsibility to create an
appropriate makeup program for the additional time.
The trainees obstetrician will determine the date of return to duty. It is
recommended that the trainee try to schedule less demanding rotations during
her third trimester and for the first month post partum. Decisions about call during
the third trimester and the first month post partum will be made in conjunction
with the trainees obstetrician. Fellows will not be expected to make up call
nights missed while away on maternity leave. Loss of time from training for
maternity leave will not be reason for termination from the program. The fellow
must comply with all OSHA and safety regulations as they apply. The trainee will
make every attempt to schedule elective tests and appointments outside of
working hours. In no case will a fellow be not allowed to attend or be forced to

51

reschedule her appointments or tests simply because they occur within the
normal working day.
The trainee may take full benefit of the Family Medical Leave Act of 1993, which
states that an employee has up to 12 weeks of job-protected unpaid leave during
any 12 month period, if the fellow is eligible to do so.

Paternity Leave
One week paid vacation around the time of birth, in addition to other vacation
time is allowed by the department.

General Information
Medical License and Malpractice Insurance
The Code of Virginia requires each resident or fellow to obtain a Virginia Medical
License to practice medicine for bonafide hospital patients who are being seen
as an official part of this departments approved training programs.
The malpractice insurance, which the hospital has purchased for trainees,
provides coverage only while the fellow is acting within the scope of his
employment.

Lab Support
Microvascular Laboratory
The department will pay the expenses for the trainees time spent in the
Microvascular Laboratory. Randy Amiss, R.N., is the Plastics Microsurgery
technician and runs the microsurgery lab (4-2016) in the Department of Plastic
Surgery. Randy is accessible at all times to assist with developing the fellows
microsurgical skills. We strongly urge fellows to complete the microsurgical
training experience early in the year, then practice with him frequently; this will
enhance overall microsurgery experience. A certificate of completion will be
given at the completion of the course and should be included in the fellows
Portfolio.

Research Expenses
The fellow will have ready access to the research laboratories of both
departments, including cellular biology labs, the microvascular lab of the Plastic
Surgery department, the biomechanics lab of the Orthopaedics department, and
the anatomy lab of the medical school Each of these labs has full-time basic
science researchers available to the fellow. Additionally, the trainee will have
ample opportunity to do clinical research, including clinical trials, chart reviews, or
case studies.

52

All research projects will have a faculty member as the senior investigator, and
presentation of publishable research will be supported by the department of the
faculty investigator. The fellow will have up to a full day each week to conduct
research activities. The fellow is required to participate in a clinical research
project and to complete a paper for a peer-reviewed publication. Faculty
members will present their current research at a conference in August or
September, and the fellow should commit to a project at that time. A timeline for
completion of the project will be formulated to assure completion.

Computer Support
The Department maintains computers with a variety of peripherals for trainees
use in the Departmental office, the Department Library, and the call room. These
computers are loaded with a variety of software that includes MS Office, Internet
Explorer, and various medical online search engines. In addition to the available
software, trainees have access to a number of AAOS CD-ROM educational
materials. The computers allow the fellow to perform patient order entry for their
assigned inpatients. EPIC Super Users are also available by phone to help with
the EPIC medical record system.
According to Section 117 of the Copyright Act, copying of computer software is
prohibited except for the purpose of making an archival copy. Blank CDs and
jewel cases are available from the Fellowship Coordinator to store data.

Printing and Copying Services

All photocopies should be made using the copiers at the Orthopaedic Offices or
clinics. Trainees may obtain copy cards from the GME Office to make copies
elsewhere on grounds.

Lab Coats
Each trainee receives two (2) monogrammed laboratory coats upon arrival with
the University to be worn during patient-care activities.

Personnel Records
Personnel records are kept in a locked filing cabinet within the Residency Office,
and are continually updated. Access to your file is granted with the coordination
of the Fellowship Coordinator.

Policies and Practices

Employee Warnings
Initial intervention for trainee difficulties with respect to performance, behavior
and conduct are handled with face-to-face conference with the Program Director.
If the conference does not resolve the problem, the Resident Advocacy &
Remediation Committee is convened to discuss the issue and to formulate an
action plan. If remediation is recommended, the trainee is notified in writing.
53

Remediation is continued until satisfactory information is available for the

committee to recommend removal of remediation status. If remediation status
has not been lifted, and it is apparent that behaviors or problems resulting in
remediation have not changed despite specific recommendations from the
Committee, the trainee will be notified in writing of suspension of clinical activities
or termination, depending on the problem.
All policies regarding remediation, suspension, termination and the appeals
process are described in detail below and in the Universitys GME Manual at
http://www.healthsystem.virginia.edu/internet/housestaff/housestaff.cfm

UVA Grievance Procedure

GME GRIEVANCE POLICY AND PROCEDURE
This policy is kept electronically and is available on the web on the GME Current
Housestaff Page under Policies and Manuals at
http://www.healthsystem.virginia.edu/internet/housestaff/housestaff.cfm.

Reimbursement of Expenses
Please refer to the following websites for information and processes regarding
resident travel and reimbursement policy:
Travel Policy and all forms
http://www.procurement.virginia.edu/pagetravelbasics

Fellow Funds
Fellows are allotted monies each year for travel to conference as follows:
Fellows $2,000

GME Office FAQ and Information

Dr. Susan Kirk
Susan Oh, PhD

Designated Institutional PIC 2558

Official
ACGME Educational
243-7346

Diane Farineau
Linda White

243-6297
924-8145

Ranithra Chelliah
Joe Boelsche

Requirements, Internal
Reviews, Away Rotations
GME Operations Manager
Credentialing Coordinator,
Notary
Pay actions
New Innovations, Meal
Money, Cash Benefit

243-6297
924-2315

The GME Office is located in the Barringer Building, 2nd Floor, Room 2461. The
fax number is 424-244-9438.

54

Advocacy
Everyone in the GME Office is available to the trainees to assist or direct you
towards the resources you need. The office maintains an anonymous hotline that
you may call at any time for any reason. (434) 806-9521.

Benefits
Benefit enrollment forms must be turned in within 31 days of payroll start date.
Trainees may speak to a benefits counselor any time between 8:00am and
5:00pm by calling (434) 243-3344. Health insurance and retirement benefits are
detailed fully on the GME Current Housestaff Page under the Benefits and Work
Life section.

Call Suite
The GME maintains a call suite in the zero level (northeast corner) of the main
hospital that has program-designated call rooms, float rooms (for use by any
trainee called in overnight), a lactation room, a gym, a lounge, and shower
facilities. This space is reserved exclusively for the GME trainees and can be
accessed using your ID badge.

Cash Benefit
In addition to the trainees base salary, each trainee receives a cash benefit of
approximately $1040. This is designated to offset the cost of parking. If you elect
NOT to have parking, you will still receive this money, distributed over each of
the 24 pay periods, to use however you would like.

Email
Your email ID can be found in New Innovations. Logging in the first time you will
use that ID + the last 4 digits of your social security number as the password.
Logging into email remotely can be done at www.healthsystem.virginia.edu. If
you have issues, please call the helpdesk at (434) 924-5334.

EPIC
Trainees are granted access to EPIC once theyve completed the required CBLs
and classes. The trainee should receive an email asking them to agree to the
user permission statement. If you have trouble accessing EPIC or for any EPIC
related questions please call (434) 982-EPIC.

FAC (long distance code)

Each trainee is given a forced access code that will allow you to make patientrelated long distance calls (not international). This can be found in New
Innovations. To use, please dial an 8 first. You will hear two beeps, then enter
the FAC number. Once you hear a dial tone, dial your long distance number as
normal, including the 1 at the beginning.

55

ID Badges
ID badges must be worn at all times above the waist. If you have a problem with
your card not giving you proper access to a building or area, please call the GME
Office at 243-6297.

Loan Forbearance
Both the GME Office and your Coordinator can complete these forms.

Meal Money
Some services with a heavy inpatient presence receive a monthly meal
allowance. This process is driven by the Housestaff Council. If you are on a
service that does get meal money, this is loaded onto your ID badge on the first
of every month. The Orthopaedic Hand Fellow does not take overnight call, and
therefore does not receive these funds.

New Innovations
All of the trainees personal information, including relevant identification numbers
(NPI, DEA, SMS, Virginia Medical License, etc) can be found in New Innovations.
In the event that you forget your password or need to have it reset, your
Coordinator can help you.

Parking Policy
If you elect not to get parking and change your mind during the year, please
contact Diane Farineau in the GME Office. Please know that the University has a
ZERO TOLERANCE POLICY concerning staff, faculty, or trainee parking in
patient parking areas. Also, please be aware that your parking will need to be
renewed in May, prior to your departure, that will cover your final months. You
will be notified by email when it is due. Please see the Housestaff Policy
webpage at
http://www.healthsystem.virginia.edu/internet/housestaff/benefits.cfm#parking for
current parking information.

Payday
Payday for GME members is bi-weekly. The first two paychecks must be picked
up in person, by you, at the Payroll Office, 1222 Jefferson Park Avenue, 2nd floor,
between 8:00am and 5:00pm. After the first two pays, your check will be
automatically deposited to the bank account designated by you on the Direct
Deposit form submitted during orientation.

Personal Information Changes

Please alert the GME Office and your coordinator if you move, get married, have
children, etc, so that your records can be appropriately updated.

56

TB Tests and Mask Fitting

These happen annually. They are conditions of continued employment. Failure to
meet these requirements may result in your suspension without pay. Directions
will be sent to you from Employee Health.

Website
Please familiarize yourself with the GME website for information about
educational programming and opportunities, such as the GME Certificate
Program, and the GME Institutional Curriculum series, the Housestaff Council,
and
other
resources
for
trainees.
http://www.healthsystem.virginia.edu/internet/housestaff/housestaff.cfm.

Computer, AV Equipment and the Resident Library

The main medical library is staffed with exceptional employees and is well
stocked with current orthopaedic textbooks and journals. A vast array of journals,
textbooks, computes, and databases are available from 7am to midnight daily in
the library. Additional computers are available in the call room, ER, inpatient
floor, and department offices.
The Orthopaedic Department has its own orthopaedic library, with current
journals and textbooks, which can be used for quick reference work. Additionally,
there are work cubicles available for trainee use. A collection of Academy OKU
and self-assessment CDs are available for checkout. Computer terminals with
internet access are available in all clinical settings.

Counseling Services
The pressures and demands of medical training can be stressful both to the
individual and to relationships. Confidential evaluation and treatment services are
available through a number of resources. Should service be desired, contact the
GME Office and/or the Faculty and Employee Assistance Program (FEAP).

Resident Call and Coverage

The following policies are in effect regarding resident call and coverage.

Call Schedule and Responsibilities

The objective of on-call activities is to provide residents with continuity of patient
care experiences throughout a 24-hour period. In-house call is defined as those
duty hours beyond the normal workday when residents are required to be
immediately available in the assigned institution.
PGY-2 and PGY-4 residents rotate on the Night Float service which covers 7pm
to 7am Sunday through Thursday each week. Daytime Trauma residents take
over during the weekdays. Friday 7am through Sunday 7pm the PGY-2 residents

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take in-house call every third weekend on average. PGY-3 through PGY-5
residents take no in-house call. The PGY-3 and PGY-4 residents take pager call
every third weekend on average. Chief (PGY-5) residents take second call from
home every third weekend on average, and are responsible for all patients seen
in the ER and all consults and must be available to immediately assist junior
residents with difficult patients in the ED or on the floor.

Night Float

Night float residents (PGY-2 and PGY-4) rotate on in-house call from 7pm
7am Sunday through Thursday and are allowed to operate until noon on
Fridays ONLY.
The remaining residents take call from Friday night through Sunday at
7pm when the night float residents return.
Conference attendance is required for all residents on the night float
rotation.

Detailed Call Schedule

Pager #1206 (Ortho In-House Resident on call)

Monday Thursday 7am to 7pm, Friday 7am to 4pm: Day call junior
resident
Sunday Thursday nights 7pm to 7am: Night float junior resident
Friday 4pm to Saturday 6am: Weekend Friday/Sunday junior resident on
call
Saturday 6am to Sunday 6am: Weekend Saturday junior resident on call
Sunday 6am to 7pm: Weekend Friday/Sunday junior resident on call
The junior resident is required to talk to the Chief on call about all
consults. The Chief Resident should be involved in all decisions regarding
in-patient and out-patient consults and is to direct triage and patient
management of all consults. The Chief Resident on call is to review all
fracture and joint reductions, particularly before a patient is
discharged from the ER.

Pager #1251 (Ortho ER Resident on call)

Monday Thursday 7am to 7pm, Friday 7am to 4pm: Day call junior
resident
Sunday Thursday nights 7pm to 7am: Night float junior resident
Friday 4pm to 11pm: Weekend Friday/Sunday mid-level resident on call
Friday 11pm to Saturday 6am: Weekend Friday/Sunday junior resident on
call
Saturday 6am to 11pm: Weekend Saturday mid-level resident on call
Saturday 11pm to Sunday 6am: Weekend Saturday junior resident on call
Sunday 6am to 7pm: Weekend Friday/Sunday mid-level resident on call

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The PGY-3 and 4 resident covering E.R. calls on Friday and Saturday
must be available even after 11 pm to assist in operative cases and to
assist the in-house junior resident who takes over primary call at 11 pm.
While the senior may not get direct E.R. consults after 11 pm they must be
available to assist the junior resident and provide guidance and be
involved in all operative cases that go to the O.R. on Friday and Saturday
nights.

Pager #1218 (Ortho Chief Resident on call)

Monday Thursday 6am to 6pm, Friday 6am to 4pm: Day call chief
resident
Sunday Thursday nights 6pm to 6am: Night float chief resident
Friday 4pm to Saturday 6am: Weekend Friday/Sunday chief resident on
call
Saturday 6am to Sunday 6am: Weekend Saturday chief resident on call
Sunday 6am to 7pm: Weekend Friday/Sunday chief resident on call
The night float chief and the chief resident covering weekend call is
required to be involved in every consult that is seen during call
coverage and be the direct contact to the faculty on call for all
operative cases and admissions. The chief residents are required to
provide guidance for posting all surgical cases so that appropriate
equipment and positioning is on the posting slip so that there are no
delays during surgical intervention. The Chief Resident or Night
Float Chief is required to see all admissions, operative cases, and
patients with a change in status (transfer to unit).

Call Coverage During Special Events

1. OITE Examination (November) Two fellows take call (Friday 8pm
Saturday 6pm), covering floor and ER call. All residents are off call from
Friday 8pm through Saturday 6pm when normal call resumes.
2. ORS/AAOS (Winter/Early Spring) R-4 assumes role of Chief resident
Friday through Sunday as follows:
Tuesday Thursday Night Float Residents (normal)
Friday Saturday PGY-4 (Chief), PGY-3 (ER), PGY-2 (In-House)
Sunday until 7pm PGY-4 (Chief), PGY-3 (ER), PGY-2 (In-House)
Sunday after 7pm Night Float Residents (normal)

3. Visiting Professor Lectureship (Graduation Weekend, May/June)

Visiting Professor arrives in Charlottesville on Thursday afternoon
for dinner with the Chiefs residents
Friday is educational day culminating in the graduation banquet
Leisure activities end by 3pm on Saturday
All Chiefs will make 15-20 minute presentation to the Visiting
Professor, suitable for publication but not necessarily submitted. An
outline or manuscript is required to be delivered 2 4 weeks prior
to lectureship to the Program Director for review and approval

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Chiefs are excused from call from Thursday evening until Sunday
7am; all services to be managed by other residents during this time
Thursday Night Float Residents (normal)
Friday PGY-4/3 (Chief), AOTP/PGY-2(ER-In House/24hr), PGY-1 (InHouse-16hr)
Saturday 7am-3pm PGY-4/3 (Chief), AOTP/PGY-2 (ER-In House/24 hr),
PGY-1 (In-House-16hr)
Saturday 3pm Sunday PGY-4/3 (Chief), AOTP/PGY-2 (ER-In House/24
hr), PGY-1 (In-House-16hr)
Sunday 7am 7pm Fellow (Chief), ER and In-house/1251 and 1206
Regular Call Schedule

Roanoke call All residents will work through Thursday, with the
on-call resident being released Thursday evening at 10pm so they
can make it back to Charlottesville for Friday mornings lectureship
start. All residents are free of clinical duties on Friday and Saturday
until 3pm when the on-call resident is to return for call by 5pm in
Roanoke Saturday night.

High School Football Coverage

Resident physicians in the department of Orthopaedic Surgery at the University
of Virginia may elect to cover high school football games in the city of
Charlottesville, Albemarle County, and other neighboring counties. This is an
elective outreach program sponsored by the Department of Orthopaedics that will
abide by the following guidelines:
1. Each resident will be linked to an attending physician. Prior to each
session each resident physician will be assigned to an attending physician
for supervision, call, etc.
2. Resident coverage of high school sports is not required as a part of the
residency curriculum; this is an elective. Those who desire this
educational experience provide coverage on a strictly volunteer basis.
Goals and objectives of this elective will be reviewed with the resident
prior to the elective.
3. Each resident who covers a high school sports team will be required to
attend the annual athletic team coverage orientation which is held
annually during the first week of August. UVA attending physicians provide
current information regarding athletic injury recognition, management, and
return-to-play guidelines. CPR training/certification is also offered during
this orientation course.
4. Resident physicians will not directly receive payment or compensation in
any form from the high schools they are covering. Travel cost
reimbursement of no more than $10 per game covered may be paid
directly to the resident by the school. All other monetary contributions from
high schools will be paid directly to the University of Virginia, Department
of Orthopaedic Surgery Alumni Fund. This money will be earmarked for
use by residents providing coverage to purchase books, fund additional
conference travel/registration fees, etc. Funds from this source may also
be used to support the annual athletic team coverage orientation.

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5. The residents will be covered by their University of Virginia liability

insurance when providing coverage of these games.
6. As this is a recognized elective educational activity, time spent covering
sporting events does count against duty hour work requirements. It is not
considered moonlighting as resident physicians do not receive direct
payment for their services.
7. Since this is an elective, all residents participating will be evaluated by the
attending providing supervision.

Emergency Department Holiday & Weekend Night Call

1. The PGY3/4 resident on ER call (1251 pager) will handle all emergency
room consults between 4pm to 11pm (Fridays), 6am to 11pm (Saturdays),
and 6am to 7pm (Sundays). The resident will evaluate and present each
patient to the chief resident and attending physician on-call, and will
accompany all surgical cases to the operating room regardless of the time
of the case during that 24 hour period.
2. The In-House PGY2 resident (1206 pager) will handle emergency room
calls while the ER resident is in the operating room, and will handle all
calls from the floor, all inpatient consults, and all ER consults between the
hours of 11pm and 6am with the PGY3/4 resident on call providing
backup.
3. The resident is to inform the Chief Resident on call of all emergency
admissions to the individual service before admission is arranged. It is the
chief residents responsibility to ensure that the attending orthopaedic
surgeon has seen the patient pre-operatively and is present for the
operative procedure.
4. Before leaving each day, the resident should sign out to the resident on InHouse call and provide complete information about existing or anticipated
problems on the service. It is necessary to check the EPIC service specific
list and electronic board the first thing each morning for admissions and
messages for each particular service.
All patient encounters in the Emergency Department must be discussed with the
attending on call. PGY-1 or PGY-2 residents must also communicate with the
Chief Resident on call and the Chief Resident is required to be present for the
performance of procedures with which the junior resident is not yet proficient or
experienced. Documentation of Emergency Room encounters must reflect that
the case was discussed with the Attending on call. In addition, if follow-up care is
to be provided by another attending based on subspecialty, this must be so noted
in the dictation, with the name of the particular attending with whom the patient
will follow-up.

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