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Harvard Orthopaedics Residents during a surgical anatomy dissection at Harvard Medical School.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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