Intern year as an orthopaedic surgery resident
Updated: Jun 30, 2021
First off, congratulations! You're going to be an orthopaedic surgeon.
Intern year can simultaneously consist of some of the hardest and most enjoyable moments of your life. The biggest advice I can give is to remind yourself of this every day: I chose this specialty and I deserve to be here.
Depending on the program, we will all have different expectations, duties as residents, particular protocols to follow, and unique patient populations that we serve. During intern year, the majority of programs will have 6 months of orthopaedic rotations and 6 months of other rotations including surgical ICU, anesthesia, plastic surgery, MSK radiology, trauma/general surgery, among others, depending on the program. I will focus on what I find to be the most widely applicable advice, regardless of your residency program or geographic location.
Most orthopaedic interns will rotate through trauma over the course of their first year. This will likely be the rotation where you get the most reps in the ED in terms of placing splints, reductions, and performing bedside procedures. It is crucial to collaborate with your team and glean as much advice from them as you can. As new interns, it's our job to learn and absorb large amounts of new information while learning how to be efficient. If you need help or don't know something, ASK. One of the most helpful resources I have found is Orthobullets (not sponsored), which gave me great guidance when responding to consults. I would also recommend going through the questions prior to your OITE (orthopaedic in-training exam) during your intern year and subsequent years. I think it will be the most useful to talk about my experience by focusing on the following areas of the hospital:
In the beginning when taking a consult, record as much as possible about the patient while you have the consulting service on the phone. This includes age, sex, and mechanism of injury as well as more specific information including if the injury is open vs. closed, if the patient is neurovascularly intact, etc. based on the particular injury and situation. Learn how your program likes to splint, follow those guidelines, and learn how to be efficient and precise. Listen to your colleagues in the ED, as they can guide you and give you tips when you're first starting out. Keep track of what works and what doesn’t work. Specific types of digital blocks may work better and different reduction techniques may better suit your style. Each person has their own way of doing things but there are certain methods that you may adopt from others that prove to be helpful. Intern year is about learning how to be efficient with consults and figuring out how to manage different injuries.
The way I work up a patient is similar to any other specialty. First I go through the HPI, past medical history (especially surgical history), and then finally the physical exam. You should be able to write your own H&P with the information. Surgical history is very important and knowing the patient’s NPO status is key if planning to go to the OR. Your physical exam is arguably the most important aspect of seeing a patient. Be systematic and have the same approach each time. I usually do a full “spine” style exam for every patient, which is particularly helpful in trauma situations where the full extent of their injuries is still being investigated. You may be the first person to discover an injury, so trust your exam and if something is off or concerning, image it. Trust your gut.
Get your hands ready! Focus on studying anatomy, as this is usually what you'll be asked about during a case. Be prepared to cut skin, put in screws, and close up. This is what you came to learn so get excited and don't be shy. You will make mistakes but learning from them is what will make you a good resident. Talk to your upper level resident about what approach will be used in the case. Hoppenfelds is the book of choice for surgical exposures. I would practice both instrument ties and hand ties. Closing is often where you get to show your skills and if the closure looks good, you might be able to put in some screws. Don’t be concerned about the amount you are in the OR during intern year, as you will get more time as you advance in your residency. Follow your upper level residents' lead and most of all keep learning. It's your responsibility to read and further your learning so make sure to keep up.
Many residents want to jump into research right away and this may even be a requirement in your program. Before you hit the ground running, focus on becoming acquainted with being a resident, and an orthopaedic resident at that, so you don't find yourself overwhelmed. I would recommend speaking with upper level residents and determine which attendings are good communicators, enjoy teaching, and provide helpful guidance with research projects.
Life outside of the hospital:
Your mental health is not something to neglect. Intern year is new and exciting but it’s going to be stressful and discourage you at times. There will be many hours of call, sleepless nights, and days where you may not even see your significant other (especially when one of you is on days and the other is on nights!) Having a good support system is critical, so be proactive with talking to your family, friends, significant others, even pets. Find an outlet or hobby outside of the hospital you enjoy. Whether it's going to happy hour, running, golfing, going to the gym, painting, or watching movies, find the time to do whatever it is that you enjoy. You are an orthopaedic surgery resident, but you need to maintain the other aspects of yourself too.
Intern year is tough, there's no doubt about it. There will be growing pains and you may look at your upper level residents and wonder if you'll ever get there. BUT if you work hard, study, ask questions, and always strive to get better, you'll be a great resident.
I hope this helps! If you take only one thing from this post remember this: You earned the spot you’re in, and you deserve to be here.