Penn offers a one week clinical clerkship in orthopaedic surgery, Orthopaedic Sugery 200, in its Module 4 (corresponding to the third year in most schools). This course is required of all students.
The course is organized as follows:
- clinical experience in the morning;
- didactic session in the afternoon; and
- self-study in the evening.
An examination (discussed below) is given and a grade of 90 is required for passing.
The clinical assignments are made to ensure that the students receive a distributed experience. Of the five days, at least two are spent in the out-patient clinics and two in the operating room. Each student is assigned to the Children’s Hospital at least one day; and almost all students are assigned to a sessions covering the spine.
The topics of the didactic sessions are chosen primarily according to faculty interest (that is, somewhat randomly). Currently, the sessions include: knee anatomy and physical exam; basic science and clinical management of fractures; radiology of musculoskeletal medicine; and arthritis. The fifth didactic session is dedicated to the examination and its review.
Self study has two components: completion of Evidence Based Medicine Educational Prescriptions and mastery of a set of Self Study Questions
The goal of the Evidence Based Medicine Educational Prescription (EP) is to improve students’ ability to use evidence for clinical care. Students are asked to identify a single clinical question in musculoskeletal medicine; acquire, appraise and apply relevant medical evidence to answer it. The EP is evaluated as “Competent” or “Not Yet Competent”; with agrade of “Competent” is required to pass Ortho 200. Students are also asked to be prepared to discuss their EP on the exam and at the Friday post-exam review session.
The Self Study Questions are a set of approximately 50 basic questions in musculoskeletal medicine. A printed copy of the questions, with answers, is provided on the first day of the clerkship. On the fifth (final) day of the course, an open response test, comprising 9 somewhat-randomly selected (ie, if the roll of the dice produces 6 pediatric questions, the dice are ignored and the test is rebalanced) questions from this set, plus one other question related to the EP, is given. Students are given one hour to complete the test, and then its is reviewed as a group, with students grading their own papers (which are then handed in for audit). At this review sessions, additional (tangential?) material is discussed.
The strengths of this course are that students are given a broad exposure to orthopaedic surgery and musculoskeletal medicine; and most, if not all, leave the week with good mastery of the basic material. The major deficit of this course is the lack of student responsibility for patient care: students are more tourists than clinical clerks. Also, to ensure a broad experience, students work with the same attending at most two times during the week, at the expense of continuity.