Welcome to your musculoskeletal attachment in phase 3. During your six week attachment, a pair of you would be attached to a lower limb orthopaedic consultant. It would be expected that you attend clinics and theatre sessions with your named consultant. You would be informed of the details of the named consultant prior to the attachment. Please contact the named consultant’s secretary and obtain his/ her timetable, so that you can attend the clinic/ theatre sessions. We have covered clinical examination of some of the joints in phase 2. The key feature in phase 3 is to become proficient in history taking and examination by attending clinics. I have attached the learning objectives for the six week block. If there are any topics that you feel are not being covered, please speak to your named consultant.
You may have noticed that we did not concentrate on musculoskeletal trauma and other emergencies in phase 2. This was intentional.
In phase 3, we would like to introduce you to the “hot” side of musculoskeletal conditions. You would have had lectures and small group discussions on fractures and other emergencies as a part of AC2. We would like you to use that core knowledge and build on it during these six weeks. It will be useful to revise AC2 prior to you starting the block.
During your six weeks in the musculoskeletal block, you would be expected to attend the following (in addition to the clinic and theatre sessions with your named consultant):
2 trauma meetings
2 trauma theatre sessions (1 session= ½ day list)
2 fracture clinics including the plaster room
1 shoulder and elbow clinic/ upper limb clinic (when 1 CEX should be completed)
1 all day combined teaching session at UHCW where the following topics would be covered:
Limping child and bone tumours
Hand and wrist examination
Shoulder and elbow examination
Acute knee injuries
There would also be a rheumatology teaching session every week. The topics that would be covered would be:
Metabolic bone disease
Soft tissue disorders/fibromyalgia
Besides these sessions, I would upload few online power-point presentations on:
Surgical management of hip and knee arthritis
Shoulder and elbow examination
Hip and knee examination
The formative assessment during this block would include MCQs and SAQs. In addition, you would be expected to complete 2 OSLERS, one OSLER session will be conducted on the last Wednesday afternoon in the fracture clinic area. The aim is for students to be assessed by consultants other than their named consultant. The second OSLER should be with a Rheumatology Consultant.
2 Mini-Cexs (at least 1 on upper limb/ shoulder and elbow cases) and 2CBDs (on trauma/ orthopaedic emergencies). Although the bare minimum number of formative assessments required for the curriculum is 1 CBD, 1 OSLER and 1MiniCEX, I would recommend that you undertake at least 2 of each. This would help you improve your knowledge and examination skills.
Besides the clinics and teaching sessions mentioned above, there would be ample opportunity for you to attend other clinics, such as foot and ankle, hand and wrist etc.
May I suggest you shadow an SHO all day and then attend the Trauma meeting the following day, this will be an excellent experience for when you become and FY1.
Here are lists of books you may reference:
Crash course in rheumatology and orthopaedics
Orthopaedics and Rheumatology on the Move (MOTM)
Churchill's Pocketbook of Orthopaedics, Trauma and Rheumatology, 2e (Churchill Pocketbooks)
It would be a good experience to revise the AC2 on fracture.
You will be informed of your Rheumatology Consultant partnership on Induction.
Here are useful tips from your colleagues who have completed the Musculoskeletal block which you may find useful.
- Take advantage of as many opportunities to talk to patients as you can. This can be fracture clinics, rheumatology clinics or any kind of teaching that involves patient contact. We are going to be assessed on our ability to speak with patients, and we need to take as much advantage of this as possible. Pass up the temptation to have a lie-in, turn up to a random fracture clinic for the morning and spend three or four hours talking to patients. It's the best way to practice histories and examinations and to learn about investigations and management. And to be blunt: there is no substitute. The more you do it, the better you will be at it.
- Go to as many different clinics/teaching sessions as possible. On call with the orthopaedic SHO is a very good learning opportunity.
- If you're at UHCW all you have to do is introduce yourself and be there willing to get involved.
- Even if going to the same clinics (# clinic) try to go with different consultants, as they see patients with different problems, and what you get involved in varies. New patient clinics allow for more opportunities to practice than follow ups.
- Make the most of all the clinics (orthopaedic / fracture / rheumatology) - there's really good opportunities to practice histories and examinations. Clinics at Rugby St Cross are good to attend, they're much quieter and so more scope to get involved.
- Don’t just stick with your consultant, arrange placements with all subspecialties within each placement to have a varied experience and cover more of your learning objectives.
- Be outgoing and don’t be afraid to get things wrong.
- Attend everything you can and keep up to date with your work at home.
- Go to fracture and elective clinics to get some hands on practice
- Go to Dr Perkins' Monday teaching at UHCW - so worth it.
- Attend fracture clinics and organise teaching clinics
- Try and swap around with other students so that you get to see clinics etc. for all the do to fracture clinics as often as you can and in the mornings rather than afternoon read up on your examinations and if possible slight practice before going to fracture clinics
- Learn about hip/knee replacements before attending surgery as this makes it more useful different sub-specialties within orthopaedics.
Mr. Sunit Patil
Consultant Trauma and Orthopaedic Surgeon
University Hospitals Coventry and Warwickshire