Orthopaedic Trauma Fellowship

Program Leadership:
Theodore Miclau, MD, Program Director
Saam Morshed, MD, Program Co-Director

Program Contact:
Whitney Milyard, Program Coordinator

Address:
Orthopaedic Trauma Institute
2540 23rd Street, Building 7, 3rd Floor
San Francisco, CA  94110

Phone:
(415) 476-2124

Program Description

The goal of the Orthopaedic Trauma Fellowship is to produce well-rounded leaders in orthopaedic trauma. The combination of highly skilled faculty and state-of-the-art facilities, all collocated, provide a solid framework to balance surgical skills, clinical training, and research experience for our trauma fellows. The program is housed at Zuckerberg San Francisco General Hospital, the only Level I Trauma Center in San Francisco, which also serves as the safety net hospital for over 1.5 million people.

The faculty include 12 orthopaedic trauma (over half of which have done a trauma and one other subspecialty fellowship), 2 hand, and 3 physical medicine and rehabilitation faculty. Other clinical resources include 2 podiatry faculty, and a robust orthotics and prosthetics program. The facilities include 4 research laboratories (molecular biology, biomechanics, clinical research, and a cadaver facility for tissue based research), which are directed by faculty that include 4 full-time PhD scientists. The fellows also have the unique opportunity to engage in International Orthopaedics through the Institute for Global Orthopaedics and Traumatology group at UCSF.

There are 2 clinical trauma fellowship positions, who can perform cases with the full-time, UCSF faculty at several different institutions and hospital systems, which include the city public hospital, Zuckerberg San Francisco Hospital, UCSF hospital, and a private hospital south of the City, Regional Medical Center of San Jose. These opportunities not only provide a wide array of emergent, urgent, and elective trauma, but also an exposure to a diversity of faculty, patients, practices, implants, and hospital systems.

The educational program is robust, with daily conferences that include the review of all trauma case pre-and post-operatively, didactics, cadaver-based surgical dissections, and extramural conferences. The fellowship has produced a diverse group of practitioners, with approximately half entering academics and half community or military practices.

Schedule

The fellow is expected to spend his/her time in research one day per week and the other split between the operating room and clinics. Call will be, on average, one weekday per week and every fourth weekend. Each fellow will have four weeks of vacation.

Each fellow rotates six months on the gold service, and six months on the blue service and are outlined below:

Gold Service Rotation – Main Educational Focus: General trauma (all aspects), foot and ankle (including post-traumatic foot and ankle reconstruction), upper extremity/hand (including all upper extremity and hand injuries and post-traumatic reconstruction—Gold Service hand surgeons alternate every-other night hand call with the plastic surgery service), and sports medicine (including post-traumatic soft tissue reconstruction of the shoulder and knee). The Gold service also assists the Blue service in on-call coverage, which alternates every-other week with the neurosurgery service.

Blue Service Rotation - Main Educational Focus: General trauma (all aspects), adult joint reconstruction (including post-traumatic reconstruction), and spine surgery (including spinal injuries with and without neurologic compromise).

Throughout the week, the trauma fellows are credentialed at three regional health care systems covered by the full-time faculty (City and County, University, and private hospitals) and have the opportunity to select from a variety of urgent and elective orthopaedic trauma cases. These facilities provide an expanded trauma base and enhanced opportunity to receive additional clinical experiences in different health care environments. The Gold Fellow’s rotation is primarily based at the only level 1 trauma center in a major city (L1) and the Blue Fellow’s rotation includes regular operative and clinical experience at a Level 2 trauma center south of the city (L2). This level 2 center is located near the intersection of three major highways in a major metropolitan area and receives significant volumes of high velocity trauma. Additionally, it has an active helipad, receiving regional trauma referrals.

                            Mon                    Tues                    Wed                    Thurs                  Fri
South    AM        OR (L2)               OR (L2)               OR (L1)               Clinic (L2)          OR (L2)
              PM        OR (L2)               OR (L2)               OR (L1)               Research           Research
North    AM        OR (L1)               Research            OR (L1)                OR (L1)              OR (L1)
              PM        OR (L1)               Research            OR (L1)               OR (L1)               Clinic(L1)

Board Rounds

  • Morning X-ray rounds begin at 6:45 a.m.
  • Monday, Tuesday, Thursday, and Friday.
  • During X-ray board rounds, the on-call resident presents the cases that were treated during the previous 24 hours. The fellow will be encouraged to comment on treatment options, reduction methods, and relevant literature related to these cases.

Conference Schedule

Morning conferences begin at the conclusion of X-ray board rounds.

Monday:            Pre-operative case conference

Tuesday:            Interdisciplinary case presentation / M&M conferences

Wednesday:      Grand rounds / Basic Science conference (Departmental)

Thursday:           Foot and ankle / radiology conferences

Friday:                Trauma conference is conducted by the fellow and fellowship director.

Residents present a specific topic in trauma and fracture care. The fellow is responsible for current literature review. Other conferences will include monthly cadaver and/or bio-skills labs on a monthly basis. There is a teaching conference on each of these days, which include trauma, spine, foot and ankle, radiology, morbidity and mortality, indications and interdisciplinary case presentation conferences.

Orthopaedic Journal Club

The orthopedic trauma fellow and attending staff are responsible for topic selection, review, and reading assignment on a monthly basis. The trauma fellow and attending will read every article to be presented by a resident during journal club.

Research

Fellows are required to complete a research project suitable for publication in a peer-reviewed journal. An assigned faculty research mentor supports the fellows’ research interests for each fellow and academically by PhD scientists who direct the organization’s four laboratories: the Laboratory for Skeletal Regeneration (molecular biology), the Biomechanical Testing Facility (biomechanics), the Clinical Research Center (clinical research), and the Surgical Training Facility (procedure-based research). Each facility is run by its own PhD director and is supported by extramural funding agencies, including NIH and DOD. Collectively these labs provide a framework for “bench-to-bedside” investigations. These research labs are networked with other University affiliated laboratories and clinical investigators in the greater Department of Orthopaedic Surgery and throughout the University, which consistently ranks in the top three in the US in annual NIH funding. The in-house clinical research group includes 2 full-time clinical research staff, and the faculty is currently engaged in over 25 clinical research projects, including multiple multi-national/multi-center prospective clinical research trials, any of which the fellows can actively engage. The site participated in the SPRINT and BESTT studies, and continues to be a core site for the Department of Defense funded Orthopaedic Extremity Trauma Research Program (OETRP) and Major Trauma Extremity Research Consortium (METRC), and an active member of the Orthopaedic Trauma Research and Southeast Fracture Consortiums. Additionally, the fellows are given the opportunity to participate in review articles and other projects, such as book chapters, throughout the year. Given the abundance of research areas available for study at the institution, most fellows exceed the minimum requirement, particularly those interested in academic careers.

Meetings

The fellows are able to attend a variety of national and regional courses to supplement their fellowship curriculum. They are required to attend the Orthopaedic Trauma Association Annual Meeting, the OTA Fellows Course, and the San Francisco International Trauma Course. The AO supported fellow is required to attend an AO Course. They also have the option of choosing between two other course choices, including the American Academy of Orthopaedic Surgeons Annual Meeting, AO Courses, or other specialty courses. Over the past several years, both fellows have chosen to attend an AO Course. Regional courses that the fellow attends includes the annual alumni meeting and visiting professor grand rounds (related to trauma topics).

Instructors and Resources

The UCSF OEM Residency Program has a wealth of clinical and research faculty distributed throughout UCSF and its associated hospitals listed below. Education within the program and supervision of trainees are the focus of the majority of the faculty.

Teaching Staff

  • Theodore Miclau III, MD (Fellowship Director)
  • Saam Morshed, MD (Fellowship Co-Director)
  • Curt Comstock, MD
  • Tony Ding, MD
  • Ashraf El Naga, MD
  • David Gendelberg, MD
  • Utku Kandemir, MD
  • Nicolas Lee, MD
  • Meir Marmor, MD
  • Amir Matityahu, MD
  • David Shearer, MD
  • Paul Toogood, MD
  • Kudret Usmani, MD
  • Mark Xu, MD