Review Detail

8.1 7 10
Alabama August 12, 2007 19461
UAB Review from current resident
(Updated: December 10, 2011)
Overall rating
 
8.0
Staff Surgeons
 
8.0
Didactics/Teaching
 
8.0
Operating Experience
 
10.0
Clinical Experience
 
9.0
Research
 
6.0
Residents
 
8.0
Lifestyle
 
6.0
Location
 
9.0
Overall Experience
 
8.0

Program Review

Staff / Faculty / Chairman
We have depth in our faculty with at least two or more faculty in every major field (spine2, hand2, foot/ankle2, joints2, upper extremity2, trauma3, peds4). We also have tumor with a lot of joints on that rotation.


We changed program directors beginning of 2008 and Dr. Theiss, one our spine surgeons, now is program director. In the past, the 80 hour work week was not well enforced. He has taken it very seriously and made a great effort at getting us into compliance. The good news is you won't be working 80 hours a week on every service. Many of our tertiary services like foot/ankle and hand are 40-60 hour a week rotations.

Dr. Hunt is our chairman and took over around 4 years ago. He has gradually been making changes to the program and has things headed in the right direction. It appears that he plans to stay at UAB for the long haul.
Didactics / Teaching
We have didactics with lectures 3 days a week as well as Grand Rounds with speakers brought in.
Operating Experience
We have a strong operative experience with graduating residents having 1800-2200 cases. We are consistently in the top 20th percentile for volume in the country. I don't feel like I have been lacking for cases.

As a junior, your primary responsibilities are covering the ED, taking call, covering clinics, etc. There is certainly an operative experience as a junior, but we do many more cases as upper level residents. For example on trauma, the 2nd year resident goes to the OR 2-3 days a week. That resident will be doing hardware removals, washouts, basic knee scopes, both bone forearms, ankles. At the end of your 3rd year here, you should be comfrotable handling community trauma independently (nailing a tibia or femur, ORIF ankle, ORIF BBFA, etc.) The 4th and 5th year residents usually spend 4-5 days a week in the OR. Most of the cases at this level are going to be complex. For trauma, you will be doing acetabulums, tibial plateaus, etc. The level of independence also increases as you go where the juniors are purposely placed with more "hands-on" attendings and the upper levels working much more independently. Upper level residents frequently run a room independently depending on the level of complexity of the case.

Most rotations (hand, foot/ankle, peds, tumor, joints, spine, trauma) are set up so you are one on one with a faculty member. If there is a fellow on that service, on OR days the fellow will be in one room and the resident in another room with the attending spending his/her time in the more complex cases but usually bouncing back and forth. Upper level residents rarely operate in the same room with a fellow and it is rare to lose a case of interest to a fellow. We didn't have fellows when I started here which I saw as a plus. We now have foot/ankle, hand and trauma fellows. The negatives I was worried about (holding hook for a fellow, etc.) haven't happened. If anything, they have helped disperse a fairly heavy work load.

The other review mentioned surgical nurses who are RN first assists. They do help educate us , primarily at a younger age on proper suture technique, reduction techniques. They technically are very skilled and can be quite helpful. I have never seen an RNFA take over a case. We have strong faculty supervision with education provided. As an upper level, the RNFA is there to assist you with holding a reduction, etc. while you lead the case. It is nice because when you are done, you can break scrub to do orders, op note, etc. while they close. I personally have become friends with all of them and dont see them as an issue of concern.
Clinic Experience
Our intern year is designed to provide optimal exposure to other areas that will help you later in ortho.
One month plastics - working on suturing technique, a good amount of hand surgery if you set it up right
One month vascular at VA
One month rehab/PM and R
Personally didn't do either of the two above so don't know much about the experience.
One month radiology (Musculoskeletal. Read MRIs with our MSK guys)
One month Burns - I have never had to think twice since this about how to do skin grafts. Once he knows you can do them, lets you do them while he watches.
Two months Trauma (gen surg trauma). Busy, learn a great deal, quickly get comfortable taking care of crumping patients, triage incoming patients.
One month Trauma Burn ICU - learn basic ICU management skills, putting in lines, etc.
Two months ortho trauma - Take two days of day call a week, one night a week of call. Busy with clinic, floor work, day call. Learn a lot with long hours. Can get to the OR if motivated. On my trauma rotation this past year, I got my intern in to plate a both bone forearm fracture, do some washouts, etc. when they were done with floor work.
One Month Children's (pedi surgery). Basically learn how to manage the kids with fluids, narcotics, etc. Not a meaningful operative experience, much more about how to take care of the kids later while on ortho.
One month Neurosurgery - Monday through Friday, minimal rounding responsibilities. Work exclusively with a NSGY spine guy. No call. Excellent chance to see some spine and how NSGY guys differ from ortho spine guys. Also quite entertaining at times.

Our 2-5 years are set up so you see every rotation once as a junior and once as a senior. The exceptions are Tumor which you do once, children's you do three times and trauma which you do every year. It is a nice balance. Each rotation is 2 months
2nd Year - Hand / Cooper Green (charity hospital, gen practice ortho) / Joints / Children's / Spine / Trauma
3rd Year - Andrews Sports Medicine (Jimmy Andrews and partners, excellent opportunity) / Garth sports (covers UAB) / Children's / VA (gen ortho) / Trauma / Foot,ankle
4th Year - Spine / Trauma / Tumor / Cooper Green / Children's / Research
5th Year - Upper extremity (shoulder, elbow) / Hand / Trauma / VA / Foot,ankle / Joints

Our fourth year we have a two month research rotation. One month of that is used to tidy up any outstanding projects, do some reading/writing, etc. The other month is used for an outside rotation. Working with someone in private practice, etc. This has recently been used for a month at HSS for sports, Boston to work with the guys in their peds/sports program, Switzerland to work with the hip guys in Bern, Steadman Hawkins in Vail, etc. This is an excellent opportunity and the possibilities are wide open.You basically get out what you put into this program. The opportunities to learn orthopaedics both inside and outside the OR are there. There is sufficient time to read, you just have to take advantage of it. Nobody can be spoon fed Orthopaedics to develop into a competent, independent surgeon. You have to take the education for yourself. There are plenty of lectures but you have to build off of those and read independently, prepare for your cases, etc. All faculty are willing and available to pre-op and I have learned as much or more from book reading as I have from pre-op sessions.

We have a large amount of clinical experience and get to do a large volume of patient contact with phyiscal exams, etc.
Research Opportunities
Traditionally, most of the residents have been clinically focused without a large interest in research. We have an active research faculty, most of us have chosen not to take full advantage of it. If you are interested in bench top or clinical research and want to publish, there are plenty of chances to do so. We have 4 faculty members heavily involved in benchtop and clinical research who will get you published.
Residents
We take 6 residents a year. Every year has taken non-rotators except for the upcoming 5 class. Rotating at our program is by no means a pre-requisite to coming here. We are fairly selective about offering interviews, interviewing roughly 40 for 6 spots. We have one interview day and when we leave the room, the rank order is decided. If you get an invitation and did not rotate here, we are very interested in you. Last year I think only 2 or 3 rotated with us but don't quote me on that. We do have a majority of people from the South but definitely are not closed to Southern people only as should be apparent looking through our residents (Argentina, Canada, Michigan which I think is close to Canada?, Oklahoma, Texas, etc.). The residents certainly have a say in who comes to this program and as you might expect, we are looking for residents who will fit in well, work hard, all the usual expectations. Rotating with us can help you a great deal if you are somewhat of an average ortho candidate on paper but can excel clinically.


For the most part, we all get along well with each other, get beers together after work, etc. We also are self-regulated for the most part where chiefs handle all issues that arise between residents and then they bump it up to faculty if needed. With six residents a year, some classes are tighter than others. I have been very happy with the guys I work with.
Lifestyle
We work hard and play hard. Everyone gets adequate time off and life has gotten much better for the junior residents since we began enforcing the 80 hour work week.

You will take call on certain intern services - vascular, ortho trauma, the gen surg trauma services. The other services are VERY nice with regular working hours (radiology, PM and R, etc.).
Second year is our toughest call year, covering 8 months of first call Q4at University in house. You take 2 months of home call at Children's when on that rotation and 2 months of home call at Cooper Green / Highlands when at Cooper Green.
Third year you take 6 months of home call at Children's and 6 months of Cooper Green Highland home call which is all q 4 due to the 2nd year being in the call pool.
Fourth year is second call at University backing up the 2nd year. It is home call. Q5-6
Fifth year is chief call backing up the fourth year. Q6.
The second year guy is in house seeing all consults, fielding patient phone calls, taking floor calls, etc. The fourth year guy comes in for anything that gets admitted and to provide direction to the 2. "Put a traction pin in that, etc". The fourth year also should provide education on reductions, classifications, etc. and are there to ease the load if you get rocked. The chief comes in for anything operative and is the link between the residents on call and the faculty on call.
Location / Housing
Birmingham is a very liveable city with hiking, lakes, mountain/road biking, etc. You can easily get a house at or under $200,000. Most of us live either in one area that is 5 minutes away or another area a little farther out (10-20 minutes) that is more like the burbs with big yards, etc. Most of the older guys/gals are married, there is a good blend of single/married in the first, second year classes. It snows here once every other year, gets into the 30s in the winter and gets hotter than hell in the summer (95-102).
Limitations
We have moved from four residents a year to six residents a year 5 years ago, which means a bigger program.

Scheduling has become more of a hassle with the 80 hour work week and it does require some coordination, but I imagine this is now a problem at a lot of programs.
Overall Rotation Experience / Conclusion
Traditionally, we were more of a working program with academics taking a back seat. There has been a push over the past 3-4 years to move more towards an academic program and we are well balanced right now.

UAB bought a community hospital about half a mile away from the main hospital campus 4 years ago and is called UAB Highlands. It used to be Healthsouth where Jimmy Andrews and crew operated until Healtsouth got into trouble with the law man. It has been set up to primarily serve the Orthopaedics division and all of our tertiary care is given here (joints, hand, tumor, foot/ankle, shoulder). Some trauma elective cases are also done here. All hot trauma and spine is done at University. The nice thing about Highlands is that it functions like a community hospital but as residents we spend a lot of time here. You park right out front, there is free breakfast and lunch for doctors (including us), we have resident offices here, the clinics are all in the building, etc. We have a good number of ortho beds as well, not sure of the exact number but we usually have a census of anywhere from 5-25 ortho patients in house on various services at any given time. As a resident, this gives you a chance to get away from the big University setting. You get to know all of the circulators, scrubs, clinic staff and it is just much more pleasant.

We are the only level I trauma center in Alabama and we do have a high trauma volume. We get transfers from Pensacola FL, West GA, East MS, and throughout Alabama. Complex ortho trauma is also treated in Huntsville, AL and Mobile, AL. I would guess our trauma service fluctuates between a total of 30-60 cases a week between 3 attendings. This is a great operative experience where you are doing the majority of the cases with direct supervision or an attending close at hand if needed. UAB has a very well developed gen surg trauma service that at any given time has 60-120 patients on their service with 28 TBICU beds and over 50 trauma floor beds. The nice thing is they take care of a lot of our patients. The patients are on their trauma service and we get to operate on them. As a student, I rotated at an away program where the ortho guys were managing everything because their gen surg program wasn't very strong. That is not the case with us. The other nice thing about the way our rotations are set up is that you do trauma in little spurts and are able to get away from it for long periods of time. Some probably see a high trauma volume as a detractor, I saw it as a plus as a student and still do.

Our residents have matched well into fellowships the past several years and everyone that I know has ended up in their top 3. A large part of that is due to having influential faculty who can pick up the phone and make calls for placement. Getting a fellowship is a much different process than getting a residency and is not something you should be concerned too much with at this level. Suffice it to say you will have nice fellowship options if that is what you want. We are moving more and more towards fellowships. Traditionally, we have had half go out into practice, half do fellowships. The current 5s have 5/6 doing fellowships, the current 4s have all 6 doing fellowships. I can't speak for everyone, but I personally am doing a fellowship out of my specific interests and not because I feel like I need to. I feel comfortable that I could leave this program and practice general ortho. The guys who have been out in practice that did not do fellowships who were my chiefs when I was a junior had no difficulty transitioning into private practice.

Our web site is quite dated http://www.ortho.uab.edu/ and isn't a whole lot of help. Our residency coordinator is probably your best point of contact for away rotations Vicki Allen 205-930-8494. vicki.allen@ortho.uab.edu. Her number is outdated on the website.

Qualification

I am a current resident of this program.
Date of Rotation
2005-2010
B
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