Clinical Student Attachment - Year 4: Orthopaedics

Throughout your med school career, there are only 4 weeks of formal orthopaedics.
This was probably my most enjoyable surgical-half run, because I liked the people I worked with, and was able to get more hands-on experience.

The assessments are:
1) 1 CSR
2) Case History
3) OSCE (formative - so it counts!)
4) CAT - rheumatology topic
5) Checklist

There are four orthopaedic teams at Tauranga, with 3 consultants, 2-3 registrars and 1-2 house officers per team. The teams are split into focussing on upper limb, lower limb, back, and arthroscopy, but you will most likely see a bit of everything due to having acute days.

The day starts like most other surgical specialities at 7.30am.
At Tauranga Hospital, there is weekly teaching for registrars on Mondays from 7.30 to 9.30, which all consultants and members of the team attend. It's interesting and usually, the consultants arrange for a couple patients to be present so you can actually observe a brief history taking session and examination (which is helpful for your learning and the OSCE).

Orthopaedics was a lot more integrated than General Surgery, meaning that you often interacted with members of other teams, rather than just your own team. There were fracture clinics in mornings which is when registrars see patients who need follow up, either referred from ED for a fracture previously, or from a patient who has been discharged from orthopaedics. Often, the registrar will let you see patients first and present to them. I particularly enjoyed this because I felt it was a good opportunity to develop history taking and examination skills. These were often rushed because of the sheer number of patients that needed to be seen, but it gives you a good overview of presentations to orthopaedics. You could also have opportunities to dictate notes, which gives you an indication to what your job will be like.

There were also elective clinics, where consultants would see GP referred patients. Despite often being time pressured, this was a good learning experience to see various conditions and also learn how doctors and patients interacted. Since many of these patients needed an operation, I was also able to learn about the surgical referral system.

Otherwise, there was theatre. This was either elective (which are pre-scheduled procedures, where the patient was seen by the consultant previously) or acute, typically fractures needing open reduction internal fixation (ORIF), such as ankle fractures. Hip fractures, needing either a dynamic hip screw or hip replacement, were also common. Scrubbing in even allowed me to insert a hip screw (under guidance, over course!) which was exciting because I hadn't done much in theatre under General Surgery.

On call days were good opportunities to find a case history, because you are with your registrar seeing patients in ED who either self-presented or were acutely referred by the GP. This day is also when you do your long day, so it's a good way to gain insight into the long-day-in-the-life-of-a-registrar.

You also have to go to 2 rheumatology clinics during your 4 weeks. Rheumatology is a medical sub-speciality that typically sees patients with rheumatic/osteo-arthritis, ankylosing spondylitis, SLE, or rheumatology-associated conditions. I only saw patients with rheumatoid arthritis, osteoarthritis and ankylosing spondylitis, so my CAT was based on rheumatoid arthritis treatment. It's a good idea to try find a RCT. Unlike General Surgery where you had to present your CAT, this is just filled out on the excel template.

A brief overview of Orthopaedics at Tauranga, I hope it's been insightful and/or helpful! :)