Years 5 - 6
Orthopaedics Part of Clinical Rotations 65730 678
2014
MB, ChB
Phase IV – Late Clinical Rotations
MB, ChB Phase IV – Late Clinical Rotations
2014
ORTHOPAEDICS Part of Clinical Rotations 65730 678
2014
EDITOR:
Dr ICM Robertson
Phase IV: (Late) Clinical Rotations – 65730 678 DEPARTMENT OF ORTHOPAEDICS
© Faculty of Health Sciences, Stellenbosch University. 2014. All rights reserved.
1
ORTHOPAEDICS
INTRODUCTION
Welcome to this clinical rotation in Orthopaedics. The aim of this rotation is to give you the opportunity
to refresh and practice your clinical skills which you have learned in the Musculo-skeletal module of
Phase III. At the end of this module you should be able to do a clinical musculo-skeletal examination
of a patient and interpret X-rays meaningfully.
Furthermore you will have the opportunity to apply your theoretical knowledge in the field of
orthopaedics. After completion of this module, you should be able to confidently diagnose and
appropriately manage the common clinical problems with which you will be confronted in practice. In
addition. you will gain skills in interventions such as the reduction of closed fractures as well as the
applying of Plaster Of Paris casts to all routine fractures.
Some students will attend the Rural Clinical School in Worcester and have the opportunity to rotate
through the Department of Orthopaedic Surgery at Worcester Hospital. The duty roster of the students
allocated to district hospitals will be issued once they arrive at their respective hospitals. Please refer
to the description of the Longitudinal Model of the Rural Clinical School. As there are no separate
Orthopaedic Department or clinics in these centres, use will be made of portfolios of musculoskeletal
patients. The student will be required to compile a portfolio of short and long term Orthopaedic cases.
The portfolio will consist of a recording in the form of clinical notes of patients whom you have
examined and in which management you were actively involved in, or have followed up. These patient
studies may also be used for further questioning in your oral exams.
Students rotating at Tygerberg will also be rotating through the Division of Rheumatology. They will
attend Rheumatology outpatients where they will have the opportunity to see some of the more
common rheumatological conditions. They will also receive tutorials and have interactive sessions
focussing on the rheumatological aspects of the musculoskeletal examination as well as the most
important rheumatological conditions.
Students attending the Rural Clinical School in Worcester will have access to tutorials via the web
(see below). They will also have the opportunity to attend the Medical outpatients where they will get
exposure to rheumatology patients (Dr Cathy Nash)
You must also pay attention to the profile of the Stellenbosch doctor as introduced in the manual.
The aim of the final two years of your course is to train to become a knowledgeable and competent
interns
REFERENCES AND TEXTBOOKS
The following are recommended:
1. Concise System Of Orthopaedics And Fractures
AG Apley /L Solomons ISBN 0750617675 (Butterworth And Heindmann Ltd.)
2. Apleys System Of Orthopaedics And Fractures, Apley
3. Clinical Orthopaedic Examination, Ronald McCrae-Churchill Livingstone, 1983
4. Practical Fracture Treatment, Ronald McCrae
5. Physical Examination Of The Spine And Extremities, Stanley Hoppenfeld
ISBN 0-8385-7853
Phase IV: (Late) Clinical Rotations – 65730 678 DEPARTMENT OF ORTHOPAEDICS
© Faculty of Health Sciences, Stellenbosch University. 2014. All rights reserved.
2
6. Kumar and Clarke (Chapter on Rheumatology)
7. Rheumatology notes, 3rd
year lectures
Websites:
1. Departmental Website: http://www0.sun.ac.za/ortho
2. Webstudies: http://webct.sun.ac.za – Module: Late Clinical Rotations 541 and 687 (MS02363).
If you have trouble logging into this site, or the module is not listed please contact.
3. Orthopaedic Department: http://www.sun.ac.za/orthopaedics
4. Orthogate: http://www.orthogate.org/
5. Wheeless Textbook: http://www.wheelessonline.com/
6. Orthoteers: http://www.orthoteers.com/ (Subscription required)
7. DVD: Rheumatological examination techniques (Dr Alan Tooke) and podcasts on tutorials:
https://fmhspod.sun.ac.za
Log in using : tyg\yourSUname as User Name; then enter your SU password and click on
LOGIN.
Go to Resources, Bachelor’s Degrees, Medicine. Click on the + next to Clinical Tutorials;
Scroll down to Rheumatology.
FULL-TIME LECTURERS
NAME OFFICE E-MAIL TEL
Dr J du Toit C6 B West, TBH [email protected] 021-938 5458
Dr ICM Robertson C6 B West, TBH [email protected] 021-938 5458
Dr A Ikram C6 B West, TBH [email protected] 021-938 5458
Dr H de Jongh C6 B West, TBH [email protected] 021-938 5458
Dr S Pretorius C6 B West, TBH [email protected] 021-938 5458
Dr I Terblanche C6 B West, TBH [email protected] 021-938 5458
Dr G du Preez C6 B West, TBH [email protected] 021-938 5458
Dr JH Davis C6 B West, TBH [email protected] 021-938 5458
Dr T Franken Worcester Hospital [email protected] 023-348 1100
Dr A Basson Worcester Hospital [email protected] 023-348 1100
Dr. A. Hess Caledon Hospital [email protected] 028-212 1070
RHEUMATOLOGY LECTURERS
NAME OFFICE E-MAIL TEL
Dr Mou Manie Room 3127, clin build [email protected] 021 938 5527 / 5731
Dr Riette du Toit Room 3071, clin build [email protected] 021 938 5527 / 5731
Dr Dave Whitlelaw Room 3062, clin build [email protected] 021 938 5527 / 5731
Dr Lisa du Plessis Room 721 , TBH [email protected] 021 938 5527 / 5731
Dr Robert Cooper Room 721 , TBH [email protected] 021 938 5527 / 5731
Dr Cathy Nash Worcester Hospital [email protected] 0213486424
Phase IV: (Late) Clinical Rotations – 65730 678 DEPARTMENT OF ORTHOPAEDICS
© Faculty of Health Sciences, Stellenbosch University. 2014. All rights reserved.
3
ASSESSMENT DURING CLINICAL ROTATION
A. Tygerberg Students
1) Assessment during the module
2) Knowledge/skills
3) Written test
4) OSKE on last day of rotation
CONTINOUS ASSESSMENT DURING THE MODULE COMPRISES THE
FOLLOWING:
An attendance logbook will be kept for all clinics, tutorials and other scheduled activities.
The student is expected to attend at least 90% of these. Merit points will be awarded for
exceptional diligence regarding theatre assistance and after hours help.
These will be assessed and contribute ± 10% of the class mark.
KNOWLEDGE/SKILLS
1. Written test paper consisting of short questions at the end of the 4th week (This contributes
40% of the class mark, only students at Tygerberg need write.). This will test the student’s
theoretical knowledge (Musculoskeletal lectures, including Rheumatology – Middle Clinical
Rotation given in 3rd year) as well as knowledge of plaster casts, splinting and traction, and
clinical problems such as prevention of deep venous thrombosis and pressure ulcers. Oral and
Clinical Tests (OSKE)
a) Tygerberg and Worcester Students: OSKE at the end of the rotation (usually the fifth week),
consisting of an oral which includes a long clinical case). This assessment contributes to 50%
of the class mark. (60% for the RCS students)
ASSESSMENT DURING CLINICAL ROTATION
B. Longitudinal Model Students
Assessment will include the following:
1. Continuous evaluation mark
2. Portfolio Evaluation.
3. OSKE
Portfolio evaluation mark
The portfolio exam accounts for this mark. It will count 40% towards the class mark.
Portfolio. Details of the portfolio are given on page 16.
Phase IV: (Late) Clinical Rotations – 65730 678 DEPARTMENT OF ORTHOPAEDICS
© Faculty of Health Sciences, Stellenbosch University. 2014. All rights reserved.
4
Written test
The Worcester and Longitudinal model students will not have to undergo the written test. The 40%
allocated to this test (presently written by the Tygerberg Students) will be used for the portfolio
assessment.
OSKE
Longitudinal model students are encouraged to attend Tygerberg Hospital and sit in at up to 2 OSKE
tests as practice- these (voluntary) assessments will not count for marks. Arrange with Tygerberg
Hospital (Helga -Tel 021-938-9266) at least 2 weeks before an OSKE scheduled for Tygerberg
students. Longitudinal Model students must partake in one OSKE at Worcester, to be held at least 2
months before the final examination. This assessment contributes 50% towards the class mark.
MARK ALLOCATION – TYGERBERG MARK ALLOCATION - RCS
Class Mark- TBH: Class Mark - RCS:
OSKE test 50% OSKE test 60%
Written Test or Portfolio 40% Portfolio 32%
Continuous Assessment 10% Intraining progress report 8%
Final Mark
Final Exam 50%*
Class Mark 50%
*It is essential to pass this final exam (OSKE). Students who fail to pass this OSKE will be
offered an additional OSKE within 48 hours of publication of the final mark. If this is
unsuccessful the rotation may have to be repeated the following year.
ROTATIONS
Each group will rotate through the Division of Orthopaedic Surgery for 5 weeks. Rheumatolgy clinic
visits and tutorials are scheduled for week 1-3, as per roster. (See information booklet for late clinical
rotations for details of groups.) As from August both 5th and 6
th year students will be in the group
rotating through the Division of Orthopaedic Surgery. The clinical assessment evaluation (OSKE) will
normally take place on the last Friday of the rotation. This evaluation will be scheduled 1 week earlier
in April (6th years) and November (both 5
th and 6
th years) to accommodate the exams.
Phase IV: (Late) Clinical Rotations – 65730 678 DEPARTMENT OF ORTHOPAEDICS
© Faculty of Health Sciences, Stellenbosch University. 2014. All rights reserved.
5
In 2014 the OSKE clinical exams will be 22 ,23 & 24 April 2014 and 24, 25 & 26 November 2014.
During the final OSKE, students may be given a rheumatological case / -oral examination as part of
their assessment.
OUTCOMES
The outcome is a student who can competently enter internship and he/she has mastered adequate
clinical and cognitive skills to manage emergencies they may encounter and, stabilise these before
referral. He/she must be able to competently diagnose/treat orthopaedic and rheumatology patients
that do not need referral. He / she must be able to recognise patients who may need referral for
elective orthopaedic surgery, and be aware of complications of musculoskeletal surgery. The student
should also be able to identify patients that need referral for specialised rheumatological workup and
care.
The student should be able to:
1. Perform musculo-skeletal examination of a patient and request appropriate special
investigations.
2. Recognise extra-articular and systemic manifestations of common rheumatological conditions
3. Be able to evaluate and systematically discuss X-rays of the musculo-skeletal system.
4. Apply different traction methods to treat a fracture.
5. Apply POP to a limb, take the necessary precautionary measures recognise the possible
complications.
6. Must know how to evaluate a fracture union.
7. Acquire the basic principles of pre-operative preparation and post-operative care.
8. Assist in theatre
9. Acquire skills which you can apply as general practitioner e.g. giving local and regional
anaesthesia to limbs. remove nails, treat in growing toe nails, managing wounds, reduction of
common fractures, e.g. Colle’s, forearm and ankle fractures, closed reduction of dislocations
e.g. shoulder, elbows, knee and hips.
Phase IV: (Late) Clinical Rotations – 65730 678 DEPARTMENT OF ORTHOPAEDICS
© Faculty of Health Sciences, Stellenbosch University. 2014. All rights reserved.
6
ESSENTIAL TOPICS
The following is a list of core knowledge and competencies required. This list is not exhaustive, but
constitutes the important topics and gives a guide as to whether the patient may be managed and
treated, or should have initial stabilisation followed by prompt referral.
Student Intern
Essential Musculoskeletal
Topics- Late Clinical Rotation
PATIENT PRESENTATION
MUST KNOW & manage
Own Management details
Must Recognise, emergency management and refer
SKILLS REQUIRED OTHER POINTERS
Examination of a patient
General principles in the examination of a patient with an orthopaedic or
rheumatological problem. Interpretation
of X-rays and recognition of
pathology requiring immediate management.
Recognize other systematic
problems in your differential diagnosis
Congenital &
Early developmental diseases
Spina Bifida Early referral, Recognise complications of shunts.
Screen of neonate
Developmental dysplasia hip
Ortolani and Barlow's tests
Club Foot Application of appropriate cast
Cerebral Palsy
Be able to identify case needing possible surgery
Blount's disease
Able to distinguish from bow legs which straightens as child develops.
Painful hip Perthes
Symptoms, signs and X-ray presentation
slipped epiphysis
Symptoms, signs and X-ray presentation
Backache
Mechanical backache
Sepsis : - TB, Pyogenic ; spondylitis Inflammatory back pain
X-rays, Lab tests Differentiate between radiological features of ankylosing spondylitis and osteoarthritis
Know criteria for surgical treatment Recognise extra-articular features of Spondylo-arthropathies
Tumour Early referral, acute management spinal neurology
Slipped Disc Cauda Equina Know criteria for
referral
Shoulder pain Frozen shoulder, rotator cuff syndrome
Exam of shoulder, Steroid injection
Phase IV: (Late) Clinical Rotations – 65730 678 DEPARTMENT OF ORTHOPAEDICS
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Soft tissue injury (acute and cold)
Degloving
Extensor tendon injuries
Flexor / deep tendons
Clinical examination. Know how to suture extensor tendons
Achilles
rupture examination and transfer
All major peripheral nerves
Peripheral nerve injury
Clinical examination. Principles of nerve suture, post operative care
Contaminated wound, open fracture
Know principles of wound debridement. Must assist at least 1 case.
Joint pain (general)
Approach to inflammatory arthritis including Rheumatoid arthritis, primary osteoarthritis, reactive arthritis
Chronic inflammatory arthritis (RA, chronic ReA etc) Refer appropriately to physio-, occupational therapists and social worker
Appropriate diagnostic workup; Know principles and complications of treatment
Must know how to examine patient with polyarthritis. How manage a preoperative case with polyarthritis.
Sepsis
Pyogenic arthritis
Know how to manage a patient with septic arthritis. How to aspirate synovial fluid from a superficial joint and do arthrotomy of the knee.
Bone / Joint TB
Know appropriate diagnostic tests. Know anti tuberculosis drugs and length of treatment.
Local Infiltration steroids
Indications and contraindications
Know how to inject steroid into shoulder region, hand and wrist.
Pelvic pain (non-trauma)
AVN/TB/Septic arthritis/osteomyelitis
causes examination, clinical and X-ray features and appropriate management. Know how to aspirate a shoulder, elbow and knee.
Operative skills
Be able to competently assist in theatre, know suture technique, how to debride a wound.
peripheral nerve blocks
Indication and able to perform: Brachial/hand/femoral/foot blocks
Post surgery
Pre and postoperative care
Know rehabilitation programs for different injuries.
Consult and append time with physio and occupational therapists.
Confused Patient
Recognising the causes of post injury confusion and how to manage them.
Role of physio therapy
When to refer to a physiotherapist
Role of occupational therapy.
Trauma
Resuscitation
ATLS principles, how to align fractures and backslab. Management of
Phase IV: (Late) Clinical Rotations – 65730 678 DEPARTMENT OF ORTHOPAEDICS
© Faculty of Health Sciences, Stellenbosch University. 2014. All rights reserved.
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hypovolaemic shock.
Reduction and traction methods of fractures
How to apply: Thomas/Bohler - Braun frame/ Dunlop/Halter traction/skin/Denham Pin/Gallows’
Transport
Be able to competently assist in theatre, know suture technique, how to debride a wound.
Fractures - must be able to treat conservatively all fractures not mentioned in "Must Recognise" column
Ankle Displaced fracture
How to reduce Importance of early reduction
Foot Displaced foot fractures
Recognise Liz Franc and subtalar dislocations.
Be able to treat undisplaced toe and metatarsal fractures.
Tibia shaft Unstable shaft fractures
Reduction and plaster cast
Care of exfix pins
Tibia plateau / Pylon
Respect for soft tissues, immobilisation
Patella (undisplaced)
Displaced Patella fractures
Early referral, what cases can be treated conservatively.
Femur shaft (child)
Adults with femur shaft
How to immobolize and early referral in adult. Conservative treatment of child.
Thomas traction, Gallows' traction.
Hip Importance of managing medical complications e.g. DVT, dehydration.
Recognising the occult fracture
Pelvis Open pelvic injuries, displaced acetabular #s
Stabilising pelvic ring fractures, recognising other soft tissue and visceral complications.
Recognise which fractures need referral.
Spine (stable) Spine (Unstable)
Interpretation of x rays. Acute management of the spinal injury. Principles of air evacuation.
Clavicle Distal 1/3 Conservative treatment, How to apply a figure of 8 bandage.
Humerus Proximal fractures, irreducible shaft fractures
Conservative treatment of shaft fractures. How to manage the supracondylar fracture in children.
Radius and ulna (child)
Displaced R&U, single bone #s
Conservative treatment in the child. Recognise fracture dislocations and other pitfalls such as Essex Loprezzi lesion with radial head fractures.
Know how to apply an above elbow cast and know the principles of three point pressure.
Wrist How to diagnose an occult schapoid fracture.
Hand (uncomplicated lacerations)
Complex open hand injuries
Principles of treatment of hand injuries. Know which injuries can be treated conservatively.
Limb reimplantation, criteria for referral, and how to preserve tissue you send with the patient.
Salter (1 & 2) Growth plate injuries (Salter Harris >2)
Importance of Salter Harris classification, prognosis
Dislocations Shoulder Know how to reduce it by
at least 1 method.
Phase IV: (Late) Clinical Rotations – 65730 678 DEPARTMENT OF ORTHOPAEDICS
© Faculty of Health Sciences, Stellenbosch University. 2014. All rights reserved.
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Hip Know how to reduce a posterior dislocation. Postoperative care and recognising acetabluar and other associated injury.
Recognise and refer recurrent dislocation.
Knee Early reduction and arteriogram for possible vascular injury.
Sterno-clavicular (anterior)
Posterior Sterno clavicular dislocation.
How to diagnose and refer the posterior dislocation.
Elbow Recognise importance of associated fractures causing instability.
Early referral of unstable dislocations...
Ligamentous instability
Knee Management of acute knee injuries
Recognise lipohaemarthrosis. Know which ACL deficient knees need surgery.
Ankle Displaced ankle fracture
Conservative treatment. How to immobilise.
Importance of early closed reduction by GP before referral
Traumatic amputations
Unsalvageable amputations
Amputations (for possible limb salvage)
Levels of amputations. Know when to amputate and when not to.
Plaster casts
Limb Casts Know how to apply a back slab, above and below knee plaster.
Instructions to a patient with newly applied cast. Early follow up of a cast. Recognising compartment syndrome and how to manage it.
Spica Spica syndrome.
reflex sympathetic dystrophy
recognize signs and symptoms and refer
Pin care Extra skeletal
fixation Prevention and treatment of pin tract sepsis.
Osteomyelitis
Acute Management of acute osteomyelitis.
Chronic
osteomyelitis Recognise complications such as Marjolin's ulcer.
Head Injury
Subdural haematoma
Head injury Importance of early
intubation
Bone Tumours
Benign Recognise these and as a cause of pathological fractures in children.
Primary malignant
Recognise on X ray. Know appropriate special investigations and be able to explain the management to patient.
Metastasis Know common tumours metastasising to bone e.g., prostate. Be able to ask for appropriate special investigations.
Know which metastases in long bones may benefit from internal fixation.
Phase IV: (Late) Clinical Rotations – 65730 678 DEPARTMENT OF ORTHOPAEDICS
© Faculty of Health Sciences, Stellenbosch University. 2014. All rights reserved.
10
Sport's injury
Recognise Tendon Achilles rupture, stress fractures.
Be able to diagnose / advise patients on common sport's injuries.
Overuse injuries
carpal tunnel, Tennis & golfer's elbow, De Quervain's, trigger finger
Special Investigations
Interpretation of
ESR, common blood tests,serological markers (Rheumatoid factor, ACPA / aCCP, HLA B27) interpretation and analysis of joint aspirate.
X Rays Systematic approach to
When to request stress views, and safely do them
Orthoses Be familiar with common orthoses
Shoe raises, ankle foot orthosis, crutches
Metabolic diseases
Crystal synovitis- causes, risk factors etc
osteoporosis Causes, complications, X-ray signs and appropriate referral.
how to treat acute and chronic gout.
EXAMINATIONS
There will be a final assessment during your sixth year. The exam consists of a clinical long case,
X-ray discussions and an oral by a panel of examiners comprising of consultants of the Department of
Orthopaedics and an external examiner. The final mark will be determined by adding up 50% of the
late rotation module class mark and 50% of the (final) exam mark during the final examination. The
student must obtain at least 50% in the final examination (final exam mark) to pass Orthopaedics.
A student can possibly qualify for re-examination if he/she gets between 40% and 50% for the final
examination.
To ensure a uniform standard, students studying at Worcester and other hospitals will be required to
travel to Tygerberg Hospital and be assessed together with the local students.
AWARD
An award for the best student in orthopaedics will be determined at the end of the 6th year by a panel
of examiners. The prize is donated by the firm Smith & Nephew (subject to availability).
TIMETABLES AND DUTY ROSTERS
Tygerberg Students
Students must report Dr. S. Pretorius in the AOTC – (Middle of C6B passage Tygerberg Hospital)
at 8 am, on the first day of their rotation. Students will be designated to participate in the activities of
the firm on call each day.
Every weekday morning at 7.30 am, a student from the previous night’s duty call, will be required to
present a trauma case of interest. In addition, a student will be required present a summary of a (peer
reviewed) journal article of Orthopaedic interest.
Phase IV: (Late) Clinical Rotations – 65730 678 DEPARTMENT OF ORTHOPAEDICS
© Faculty of Health Sciences, Stellenbosch University. 2014. All rights reserved.
11
TIMETABLE FOR LATE CLINICAL ROTATION – 2014 – TYGERBERG STUDENTS
WEEK 1
TIME MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY SATURDAY SUNDAY
08:00
to
08:30
AOTC
Dr HS Pretorius
Introduction:
AOTC
Dr Robertson
Discussion of
fracture
Case
presentation
Article review
AOTC
Dr K Jordaan
Discussion of
fracture
Case presentation
Article review
AOTC
Dr G du Preez
Discussion of
fracture
Case
presentation
Article review
AOTC
Dr R Smith/Dr J
Davis
Discussion of
fracture
Case presentation
Article review
On Call
and
Ward work
as per
timetable
On Call
and
Ward work
as per
timetable
09:00
to
10:30
Ward round
Paediatric
Dr J du Toit
G6 Ward 1 group
Group A - 6th yrs
Trauma Ward
Round
Group B – 5th yrs
Dr Robertson
Ward round F4 &
Tutorial 6 yrs /
Group A
C6B East O/P
C6B West O/P
Dr Davis /
Tuesday Firm
Spinal clinic
Group A 6th yrs
Spinal Clinic
Group B – 5th yrs
Other OPD
AOTC – 12:00
Dr HS Pretorius
Shoulder Exam
Dr J Davis /
Prof GJ Vlok
Ward round
Dr Whitelaw
Rheumatology 5
yrs Group B
10:30
to
13:00
C6B East
POP room
POP technique
C6B West
Hand clinic
C6B East O/P
C6B West O/P
C6B West O/P
Hip clinic /Group
A -6th yrs
Dr K Jordaan
C6B East O/P
Paediatric Clinic/
Group B – 5th yrs
Dr J du Toit
Registrar Tuesday
Firm Cold
C6B East O/P
POP room
AOTC – 12:00
Dr A Ikram or
Hand Registrar
Examination of
the elbow, hand
AOTC – 12:00
Dr K Jordaan
Examination of
the pelvis and
hip joint, knee
AOTC – 12:00
Dr IPS
Terblanche
Examination of
the foot and ankle
LUNCH
14:00
to
15:00
AOTC
Dr J Davis /
Tuesday Firm
Take clinical
history
Examine spine
and neck
AOTC
Rheumatology
Dr R Cooper
Starts 13:30
AOTC
AK Program
According to
timetable
16:00
On Call and ward
work
Per timetable
On Call and
ward work
Per timetable
On Call and ward
work
Per timetable
On Call and ward
work
Per timetable
On Call and ward
work
Per timetable
Phase IV: (Late) Clinical Rotations – 65730 678 DEPARTMENT OF ORTHOPAEDICS
© Faculty of Health Sciences, Stellenbosch University. 2014. All rights reserved.
12
WEEK 2
TIME MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY SATURDAY SUNDAY
07:30
to
08:30
AOTC
Dr HS Pretorius
Discussion of
fracture
Case
presentation
Article review
AOTC
Dr ICM
Robertson
Discussion of
fracture
Case
presentation
Article review
AOTC
Dr K Jordaan
Discussion of
fracture
Case presentation
Article review
AOTC
Dr G du Preez
Discussion of
fracture
Case
presentation
Article review
AOTC
Dr R Smith/Dr J
Davis
Discussion of
fracture
Case presentation
Article review
On Call
and
Ward work
as per
timetable
On Call
and
Ward work
as per
timetable
09:00
to
10:30
Dr J du Toit
Ward round
Ward G6
Group B – 6th yrs
Trauma Ward
Round
Group A – 5th yrs
Dr Robertson
Ward round F4
& Tutorial 6thyrs
Group A
C6B West O/P
Dr J Davis
Group B 6th yrs.–
Spine Clinic
Group B – 5th yrs
Other OPD
Dr J Davis /
Prof GJ Vlok
Ward round
Dr Whitelaw
Rheumatology 5th
yrs Group B
10:30
to
13:00
C6B East O/P
C6B West O/P
Hand clinic
C6B East O/P
C6B West O/P
Paediatrics
Amputation
Registrar Cold
On Call
C6B East O/P
Paediatric clinic
Dr J du Toit
Group A 6yrs
C6B West O/P
Hip clinic
Dr H de Jongh –
Group B -5th yrs
C6B East O/P
POP room
Registrar Tuesday
Firm Cold
10:30 - 12:00
Dr D Hugo
Plaster
Technique
Clinical Skills Lab
AOTC - 12:00
Dr A Ikram
Approach to
X-rays, local steroid
injections
AOTC - 12:00
Dr HS Pretorius
Open fracture
Resus,
emergency
LUNCH
14:00
to
15:00
AOTC
Rheumatology
Dr R L du
Plessis
Starts 13:30
AOTC
AK Program
According to
timetable
Mev L Arendse
(0369)
B5
Physiotherapy
Dr Robertson
POP’s, splints, Ex
fixators
Indication for
internal fixation
General
Orthopaedic
operations. Bone
transplants,
arthrodesis,
arthroplasty,
osteotomy
16:00
On Call and ward
work
Per timetable
On Call and ward
work
Per timetable
On Call and ward
work
Per timetable
On Call and
ward work
Per timetable
On Call and ward
work
Per timetable
Phase IV: (Late) Clinical Rotations – 65730 678 DEPARTMENT OF ORTHOPAEDICS
© Faculty of Health Sciences, Stellenbosch University. 2014. All rights reserved.
13
WEEK 3
TIME MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY SATURDAY SUNDAY
07:30
to
08:30
AOTC
Dr S Pretorius
Discussion of
fracture
Case presentation
Article review
AOTC
Dr ICM Robertson
Discussion of
fracture
Case presentation
Article review
AOTC
Dr K Jordaan
Discussion of
fracture
Case presentation
Article review
AOTC
Dr G du Preez
Discussion of
fracture
Case
presentation
Article review
AOTC
Dr R Smith/Dr J
Davis
Discussion of
fracture
Case presentation
Article review
On Call
and
Ward work
as per
timetable
On Call
and
Ward work
as per
timetable
09:00
to
10:30
Dr J du Toit
Ward round
Paediatrics
G6 Ward
Group A -6th yrs
Trauma Ward
Round
Group B – 5th yrs
Dr D Whitelaw
C7B East
Rheumatology
Group A 6th years
Dr D Whitelaw
C7B East
Rheumatology
Dr J Davis /
Prof GJ Vlok
Ward round
Dr Robertson
Ward round F4
& Tutorial 5thyrs
Group B
10:30
to
13:00
Dr J Davis
C6B East O/P
Dr Ikram
C6B West O/P
Hand clinic
C7B East
Rheumatology
C7B East
Rheumatology
C6B East O/P
Paediatric clinic
Dr J du Toit
Group A -6th yrs
C6B West O/P
Hip clinic
Dr K Jordaan
Group B – 5th
yrs
AOTC – 12:00
Dr A Ikram or
Hand Registrar
Approach to the
painful wrist, hand
infections, the hand
in Rheumatoid
arthritis
AOTC – 11:00
Dr ICM Robertson
Septic arthritis
Osteitis
Skills Lab - 12:00
Dr G du Preez
Joint injection /
aspiration
LUNCH
14:00
to
15:00
AOTC
Dr L du Plessis /
R Cooper
Ruma tutorial:
Clinical approach
to arthritis,
principles in
treatment
Starts 13:30
AOTC
AK Program
According to
timetable
AOTC
Dr J du Toit/ D
Hugo
Paediatric
Orthopaedics
(CTEV),SUFE
Perthes, DDH
Limping child
16:00
On Call and ward
work
Per timetable
On Call and ward
work
Per timetable
On Call and ward
work
Per timetable
On Call and
ward work
Per timetable
On Call and ward
work
Per timetable
Phase IV: (Late) Clinical Rotations – 65730 678 DEPARTMENT OF ORTHOPAEDICS
© Faculty of Health Sciences, Stellenbosch University. 2014. All rights reserved.
14
WEEK 4
TIME MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY SATURDAY SUNDAY
07:30
to
08:30
AOTC
Dr S Pretorius
Discussion of
fracture
Case
presentation
Article review
AOTC
Dr ICM Robertson
Discussion of
fracture
Case presentation
Article review
AOTC
Dr K Jordaan
Discussion of
fracture
Case presentation
Article review
AOTC
Dr G du Preez
Discussion of
fracture
Case
presentation
Article review
AOTC
Dr Smith/Dr J
Davis
Discussion of
fracture
Case presentation
Article review
On Call
and
Ward work
as per
timetable
On Call
and
Ward work
as per
timetable
08:30
to
09:30
Written Test -
AOTC
Dr N Terblanche
09:00
to
10:30
Dr J du Toit
Ward round
Paediatrics
G6 Ward
Group B 5th yrs
Trauma Ward
Round
Group A 6th yrs
Dr D Whitelaw
C7B East
Rheumatology
Group A 6th years
Dr D Whitelaw
Rheumatology
C7 B East
Dr HS Pretorius
Ward Round
F4
Dr J Davis /
Prof GJ Vlok
Ward round
Dr Robertson
Ward round F4
& Tutorial 5thyrs
Group B
10:30
to
13:00
Dr J Davis
C6B East O/P
Dr Ikram
C6B West O/P
Hand clinic
Rheumatology C7B
East
Rheumatology
C7 B East
C6B East O/P
Paediatric clinic
Dr J du Toit
Group B – 5yrs
C6B West O/P
Hip clinic
Dr K Jordaan
Group A - 6yrs
C6B East O/P
POP room
AOTC – 12:00
Dr K Jordaan
AVN of bone
myositis ossif.
Pagets
Osteoporosis/
osteomalacia/bursitis
tendinitis/tendinosis
AOTC – 12:00
Dr S Pretorius
Diff. Diagnosis
and approach to
shoulder pain
LUNCH
14:00
to
15:00
AOTC
Dr J Davis or
Registrar
Tuesday firm
Approach to low
back pain,
causes,
treatment
Starts 13:30
AOTC
AK Program
According to
timetable
16:00
On Call and
ward work
Per timetable
On Call and ward
work
Per timetable
On Call and ward
work
Per timetable
On Call and
ward work
Per timetable
On Call and ward
work
Per timetable
Phase IV: (Late) Clinical Rotations – 65730 678 DEPARTMENT OF ORTHOPAEDICS
© Faculty of Health Sciences, Stellenbosch University. 2014. All rights reserved.
15
WEEK 5
TIME MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY SATURDAY SUNDAY
07:30
to
08:30
AOTC
Dr S Pretorius
Discussion of
fracture
Case presentation
Article review
AOTC
Dr ICM
Robertson
Discussion of
fracture
Case
presentation
Article review
AOTC
Dr K Jordaan
Discussion of
fracture
Case presentation
Article review
AOTC
Dr G du Preez
Discussion of
fracture
Case presentation
Article review
OSKE
C6 B West,
Room 33
Long case, X-
rays
Per timetable
09:00
to
10:30
Dr J du Toit
Ward round
Paediatrics
G6 Ward
Group A 6th yrs
Trauma Ward
Round
Group B 5th yrs
Dr ICM
Robertson Ward
round F4
Group A & B
Prof Vlok or
Registrar
C6B East O/P
C6B West O/P
Spinal clinic
Group A & B
Other OPD
Group A& B
Other OPD
10:30
to
13:00
Dr J Davis
C6B East O/P
Dr Ikram and
Registrar
C6B West O/P
Hand clinic
Dr S Pretorius
C6B East O/P
C6B West
Paediatrics
POP room
C6B East O/P
C6B West O/P
Spinal clinic
Group A& B
Other OPD
C6B East O/P
Paediatric clinic
Dr J du Toit
C6B West O/P
Hip clinic
Dr K Jordaan
AOTC – 12:00
Dr N Terblanche
Case Study - Cold
LUNCH
14:00
to
15:00
AOTC
Dr G du Preez
Acute dislocation of
joints mechanism
complications and
demonstration of
reduction
AOTC
Dr ICM
Robertson
Case study
Trauma
Starts 13:30
AOTC
AK Program
AOTC
Dr N Terblanche
Case study
Cold
16:00
On Call and ward
work
Per timetable
On Call and ward
work
Per timetable
On Call and ward
work
Per timetable
On Call and ward
work
Per timetable
Phase IV: (Late) Clinical Rotations – 65730 678 DEPARTMENT OF ORTHOPAEDICS
© Faculty of Health Sciences, Stellenbosch University. 2014. All rights reserved.
16
TIMETABLE FOR LATE CLINICAL ROTATION – LONGITUDINAL MODEL STUDENTS
TIME TABLE FOR ACADEMIC DAY AT WORCESTER
HOSPITAL
THIS WILL BE PUBLISHED BY WORCSTER HOSPITAL PRIOR TO STARTING YOUR ROTATION.
Students allocated to the Longitudinal Model will be given the opportunity to attend the Academic Day at
Worcester Hospital.
The duty rosters of the students allocated to district hospitals will be issued once they arrive at their respective
hospitals.
Phase IV: (Late) Clinical Rotations – 65730 678 DEPARTMENT OF ORTHOPAEDICS
© Faculty of Health Sciences, Stellenbosch University. 2014. All rights reserved.
17
PORTFOLIO ASSESSMENT OF STUDENTS IN THE RCS
A portfolio of patients managed by students will form part of the discipline based assessment.
1. Number of patient in portfolio per discipline:
a. Worcester Hospital
Int Psyc O&G Paed Surg Orth Total
Duration of module in weeks 7 7 6 6 5 5
No of Patients in portfolio during
module
10 10 8 8 6 6 48
Chronic patients through year for
Family Medicine
6 patients 6
Total 54
b. Longitudinal model
Block 1 Block 2 Block 3 Total
3/1- 24/4- 8/8 -
Int 3 4 3 10
Psyc 3 4 3 10
O&G 3 3 2 8
Paed 3 3 2 8
Surg 2 2 2 6
Orth 2 2 2 6
Total 16 18 14 48
Chronic patients through year for
Family Medicine
6 patients 6
Total 54
2. Instructions to students for completing portfolio entries:
All case notes must be handwritten as a carbon copy of the original patient notes you place
in the patient’s folder
Once you have written a set of case notes you should edit the notes according to the
discussion you have with the doctor/registrar/consultant supervising you. The editing
should be done in red ink and should help improve the quality of the notes written
All hospital patients clerked by you must have daily patient notes in the SOAP (subjective,
objective, assessment, plan) format. We expect to discuss the patient during the portfolio
exam.
All results of investigations – FBC, CEUG, LFT, ABG, blood/sputum/urine cultures, ECG,
CxR must be written into portfolio notes. We expect to discuss these results during the
portfolio exam.
For the longitudinal module all portfolio entries are to be indexed according to
discipline..Portfolios that do not have an index will be penalised in the portfolio exam.
Phase IV: (Late) Clinical Rotations – 65730 678 DEPARTMENT OF ORTHOPAEDICS
© Faculty of Health Sciences, Stellenbosch University. 2014. All rights reserved.
18
Copying of case notes is forbidden. Students found copying notes will fail the portfolio
exam and will be subject to university disciplinary action.
3. Format of portfolio entries
a. Subjective (History)
b. Objective (Clinical findings, side room investigations, laboratory results, X-rays and
ultrasound investigations)
c. Assessment
i. Clinical (Problem list, chronic active problems)
ii. Individual (Patient’s ideas, fears and expectations)
iii. Contextual/ Cultural (Family, work/financial situation, living environment)
d. Plan
i. Non drug management
ii. Therapuetic management
iii. Health promotion and prevention
iv. Relevant Ethical issue(s)
v. Interdisciplinary management
e. Identify at least one learning needs as show evidence how the learning need has
been met.
You are required to formulate a clinical question relevant to each patient in
your portfolio. The questions should specifically address a personal learning
need i.e. some issue about the patient’s presentation, the diagnosis,
investigation or treatment of the patient’s condition that you would like to
know more about. The list of Core Clinical Problems should guide you in
formulating a question each week.
You should write a single A4 page response to the question, including your
reference source.
You will be required to present your Portfolio of Learning at an oral
examination at the end of the module. One or more of these learning needs
may form the basis of part of the oral examination.
4 Chronic patients: Your portfolio should have six patients with a chronic condition that you
will follow-up through the year. Preferably you should identify these patients as soon as
possible but definitely within the first two months of the year. Make arrangement to
follow this patient at regular intervals . Ideally you should be aware of any contact the
patient makes with the health service e.g. outpatient/clinic visit, emergency visit ,
admission to hospital and referral to specialists or allied health professionals. You can
choose 6 patients from the following categories but one patient must be a patient
receiving rehabilitation:
i. HIV/AIDS
ii. TB
iii. Obstetric patient – to be followed from early pregnancy to post partum care
iv. Paediatric patient with a chronic condition
v. Rehabilitation patient (compulsory)
vi. Chronic condition e.g. DM, HT, Asthma, COPD, Epilepsy
vii. Psychiatric patient
Phase IV: (Late) Clinical Rotations – 65730 678 DEPARTMENT OF ORTHOPAEDICS
© Faculty of Health Sciences, Stellenbosch University. 2014. All rights reserved.
19
viii. Terminally ill/ Palliative care patient
ix. Orthopaedic patient with a chronic condition
b. In one of these patients you should identify an ethical dilemma and discuss this. See
LO
c. In one of these patients you should identify a EBM question and discuss this for
your EBM task. see LO
d. We expect you to do at least one home visit on each of the six patients and reflect
on your experience.
5. Assessment of portfolio
The assessment of the portfolio of patients will be both formative (ongoing and used as a
learning opportunity) and summative i.e. at the end of the module or at the end of the year
for the longitudinal module.
a) Formative assessment
a. Worcester Hospital
1. On ward rounds
2. With your consultant
3. During academic days
b. Longitudinal module
1. On ward rounds with Family Physician tutor
2. On ward rounds/clinics with visiting specialists
3. During academic days
b) Summative assessment
i Worcester Hospital
1. Discipline specific portfolio: End of rotation in “portfolio” OSCE
2. Chronic patients (Family Medicine): End of year
b. Longitudinal module
1. Discipline specific portfolio: End of year in “portfolio” OSCE
2. Chronic patients: End of year in “portfolio” OSCE
b Format for OSCE assessment of portfolio (Summative) but can also be used as
template for formative discussion of portfolio
i. What diagnosis did you make?
ii. Justify the diagnosis you made?
iii. What other diagnoses did you consider?
iv. How did you confirm your diagnosis?
v. How did you manage the patient?
vi. A basic science principle relevant to the case
c The summative portfolio assessment will form part of the discipline end of the
rotation class/ward mark:
i Worcester hospital:
1. Internal medicine -35%
2. Psychiatry – 40%
3. O&G – 50% (25% each for obstetrics and gynaecology)
4. Paediatrics – 40%
Phase IV: (Late) Clinical Rotations – 65730 678 DEPARTMENT OF ORTHOPAEDICS
© Faculty of Health Sciences, Stellenbosch University. 2014. All rights reserved.
20
5. Surgery – 50% (oral simulated clinical case)
6. Orthopaedics – 40%
7. Family Medicine – 25%
x. Longitudinal model
1. The portfolio assessment will form 40% of the class mark.
2. The assessment of the portfolio will be done in the form of a OSCE where the
student will present his/her portfolio to a panel of examiners representing all
the relevant disciplines.
3. The examiners can choose any patient in the portfolio to discuss.
TIMETABLE FOR LATE CLINICAL ROTATION AT
WORCESTER HOSPITAL
Students allocated to Worcester Hospital are to present at ward C3 at 07h30 on the first
day of their rotation. A detailed timetable of ward rounds and tutorials will be supplied on
or before this date.