| Overview
 The
Harvard Combined Orthopaedic Residency Program (HCORP) is a five
year ACGME approved residency program that fulfils all the criteria
for the successful graduate to sit for Part I of their Board examination
given by the American Board of Orthopaedic Surgery (ABOS). The education
takes place within four major Harvard affiliated major metropolitan
hospitals: The Massachusetts General Hospital (MGH), The Brigham
and Women’s Hospital (BWH), The Children’s Hospital
of Boston (CHB), and the Beth Israel Deaconess Medical Center (BIDMC).
Residents also have clinical experiences at the West Roxbury VAH,
the Faulkner Hospital and two outpatient surgical centers. The goal
of HCORP is to prepare the graduate to be able to practice excellent
orthopaedic surgery and to thoroughly understand the pathophysiology
of the musculoskeletal system. Graduate of HCORP are prepared to
go directly into practice, pursue additional educational opportunities,
or to become Academic Orthopaedist. Graduate of HCORP have done
all of these activities after finishing the program.
No program can provide better preparation for any activity within
Orthopaedics. As with all residencies the strength of the program
is a combination of its faculty and residents. HCORP is fortunate
to attract outstanding residents. There are residents from all sections
of the country, from many different medical schools, of varied social,
ethnic, and educational backgrounds. HCORP is proud to have a larger
percentage of women than most orthopaedic residency programs. HCORP
has over 70 faculty who are actively involved in the residency program
and more who play a lesser role. The HCORP faculty is a who’s
who of Orthopaedics with many internationally renowned experts all
of whom are busy clinical orthopaedic surgeons. More than 120,000
patients are seen annually by the faculty who perform more than
18,000 operative cases. In addition the faculty are extremely productive
academically. More than 150 papers are published each year, each
hospital has a large active research laboratory supported by federal
and non-federal grants as well as philanthropic donations. All areas
of research are being pursued and a resident interested to participate
is always invited to join one of the research groups.
Residents rotate through subspecialty services during the residency
once as a junior resident and again as a senior resident. The rotations
include: Joint Replacement/Adult Reconstructive Surgery, Hand/Upper
Extremity Surgery, Foot and Ankle Surgery, Orthopaedic Sports Medicine/Shoulder
Surgery, Orthopaedic Oncology, and eleven months of Orthopaedic
Trauma. In addition, the third year residents have a 6 month rotation
at The Children’s Hospital of Boston. The clinical experience
is vast and includes not only the routine aspects of orthopaedic
surgery but also some of the most “cutting edge” surgery
done.
There are 12 residents in each postgraduate year. The first year
consist of twelve month long rotations through General Surgery Multi-system
Trauma, ICU, Vascular Surgery, Emergency Medicine, Anesthesia, Pediatric
Surgery, MSK Radiology, General Surgery, and 3 Orthopaedic rotations.
These are done as four month blocks at MGH, BWH, and BIDMC. The
rotations during PGY-2 through PGY-5 are of varying lengths as shown
on the block diagram in Appendix 1. There are no electives in the
schedule and there is only one month designated as “research”
which is done as a PGY-4. During this time some call is required.
There are numerous subspecialty specific didactic conferences each
week and Grand Rounds on the Longwood Campus (BWH, BIDMC, and CHB)
on Wednesday and at MGH on Thursday. Each hospital has its own monthly
M&M conference. In July and August anatomic dissections are
done on cadavers at the Harvard Medical School under the direction
of the orthopaedic faculty.
The didactic underpinning of the Combined Residency Program is the
weekly Core Curriculum Conference Program. The Core Curriculum Conference
follows Grand Rounds at the Brigham & Women’s Hospital
lasting from 8am to 11am. They are normally held at the Carrie Hall
15 Francis Street unless otherwise mentioned. Core Curriculum is
split so that PGY 2 and 3 residents alternate with PGY4 and 5 residents.
There are occasions where all residents attend together.
HCORP residents have a strong track record of publications and each
residents is required to do at least one publishable academic project
that is presented during the last month of residency.
All patients seen by HCORP residents have a responsible Attending
Orthopaedic Surgeon and the resident and attending manage the patient
jointly. Many of the subspecialties have Fellows. As the resident
progresses through the program they are given more responsibility
but there are no “residents’ service” or “residents’
clinics.” All residents see patients in an outpatient setting
with an attending orthopaedic surgeon at least a half day a week
and usually more often. HCORP residents routinely log more than
450 CPT codes per year. This includes operative experiences in all
aspects of orthopaedic surgery. There are Harvard Medical Students
and numerous medical students from around the country who rotate
on Orthopaedics and the HCORP residents are expected to actively
participate in their education.
HCORP residents are evaluated using a computer based program (New
Innovations) at the end of each rotation. Faculty are asked to provide
frequent feedback and residents are asked to request this feedback
if it is not given. The Program Director has an individual meeting
with each resident twice a year. Residents are also evaluated by
nurses, secretaries, and other support staff. Residents anonymously
evaluate the faculty, all services, and the overall program.
HCORP does not have a formal “mentoring” program. Mentoring
programs in the past have not been successful because it was not
possible to align faculty and residents effectively, likely due
to the size of the program. As a PGY-3 resident they select the
faculty member of their own choice to be their mentor. The Program
Director assist residents in this selection, if necessary.
In early November all residents take the Orthopaedic In-Training
Examination (OITE). This is a computerized examination given to
all residents in the United States and takes between four and eight
hours. It allows individual residents an opportunity to judge themselves
against their peers and it allows the program to judge itself against
other residency programs. The performance on this examination is
one of the criteria used to evaluate a resident’s progress.
PGY-4 and PGY-5 are allowed to moonlight with the approval of the
Program Director.
Successful completion of the residency fulfills all criteria necessary
to take Part I of the American Board of Orthopaedic Surgery’s
examination. This is a two part board examination. To qualify to
take Part II and be Board “qualified” one must pass
Part I, practice in a single location for 22 consecutive months
and pass the Part II examination.
HCORP is an excellent orthopaedic residency program for the right
individual. It is a busy clinical residency program with a large
number of residents (60), large faculty (>120), and four major
academic medical centers. The successful resident needs to be a
self-starter who is capable of learning in a diverse setting. The
attending staff will present many methods of successfully managing
clinical problems and the resident will need to decide which method
works best for them. Conflicting opinions will be offered and the
residents will not be provided with a single simple method of practice.
It is HCORP goal to prepare the resident for the future so that
he or she will be able to make the necessary adjustments to their
practice as advances in orthopaedic surgery are made. In addition,
it is expected that many of those advances will be made by graduates
of HCORP.
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