The Educational Program
(A) Basic Science Program: The orthopaedic basic science program through the Seton Hall University School of Health & Medical Sciences is integrated throughout the five-year training period. A three-hour block of teaching time on Friday mornings is devoted mainly to the basic science program. Instruction includes biomechanics, physiology, microbiology/immunology, pharmacology, pathology and anatomy. Neuroanatomy, embryology, neurophysiology and biochemistry are also taught. Anatomy is divided into cadaveric dissection sessions with clinical correlation and didactic sessions dealing with the back, extremities and musculoskeletal embryology. All sessions are conducted at the St. Joseph’s Hospital and Medical Center campus. Residents are also required to attend basic science sessions at the Alfred I. duPont Institute during their pediatric orthopaedic rotation.
Weekly clinical conferences, including Tuesday morning X-ray/Indications Conference and Monday morning Indications/Fracture Conferences, are structured to emphasize pertinent basic science information. Conferences are conducted with a case presentation, identification of problems, description of the pertinent basic science factors related to the problem, formulation of the data base, description of the pathophysiologic processes involved and formulation of a treatment plan. Emphasis is placed on anatomy and biomechanics when applicable. Psychosocial factors are also discussed in relation to the patient’s overall treatment plan.
Daily patient rounds are conducted with an attending physician. Residents are expected to be knowledgeable in the biomechanics of fractures and implant arthroplasties, biology of fracture healing, rationale for usage and mechanism of action of antibiotics and other drugs, host-immune responses, and anatomy as applied to the patient’s problem. Rounds are a major educational tool and are not treated in a perfunctory manner. Every attempt is made to integrate the basic sciences into the everyday clinical practice of orthopaedic surgery. Infectious Disease Specialists M. Christine Reyelt, M.D., Michael Lange, M.D. and Mohamed Rabat, M.D., conduct monthly conferences with residents and stress the basic principles of wound healing and antibiotic usage. Current concepts of immunology, microbiology and pharmacology are reviewed. Residents are expected to have a full understanding of the pathophysiology of orthopaedic disorders and the basic principles of treatment starting with a thorough preoperative nutritional assessment and ending with successful resolution of the patient’s problem.
Surgical cases are discussed in detail with the residents prior to entering the operating room. Principles of biomechanical stability and factors related to bone and soft tissue healing are reviewed in detail. Residents are not permitted to participate in surgery unless they are knowledgeable and conversant with the anatomy, surgical approaches and pathology of specific operative cases. Monthly Mortality and Morbidity Conferences provide an additional method for in-depth analysis of complications and failures of treatment. The monthly Orthopaedic Pathology Conferences are specifically geared
toward an interpretative skills format with emphasis on arriving at a diagnosis through understanding of the pathophysiology of the disease process. Dr. Aquiles Villacin, a fellowship-trained orthopaedic pathologist and chairman of the Department of Pathology, conducts the Orthopaedic Pathology Conference with Dr. William Matarese and Dr. James Wittig, chief of orthopaedic oncology. Every attempt is made to incorporate the principles of biomechanics, biochemistry, physiology, microbiology and anatomy into the overall understanding of orthopaedic disease processes.
Quizzing during rounds is used to assess the residents’ ability to apply the basic science principles learned in the classroom to actual patient management. Evaluations at the end of each rotation and formal quarterly evaluations permit the faculty to assess the residents’ abilities to integrate basic science education fully into clinical patient care. Resident critiques of the teaching faculty are also valuable for feedback to the teaching faculty.
(B) Hours Free of Clinical Responsibilities: Residents are free of clinical responsibilities for a minimum of three hours per week, which is available to them for basic sciences and study. Friday morning block teaching times run from 7 a.m. until 11 a.m. First-year residents are usually given additional free time, at the discretion of the program director, to further their studies in basic sciences, especially anatomy. Additionally, residents participate in the basic science instruction program when they rotate to the Alfred I duPont Hospital for Children during their pediatric orthopaedic rotation and orthopaedic oncology rotations with Dr. James Wittig.
(C). Faculty Who Are Responsible for Basic Science Instruction: The faculty who are responsible for the basic science instruction are as follows:
1. Anatomy: Deepak Patel, M.D., conducts the embryology section of the
anatomy course along with the program director. Dr. Patel gives three 2-hour
lectures beginning with gametogenesis, progressing through organogenesis, to
the full development of the musculoskeletal system.
Cadaveric Dissection: This segment of the anatomy training is conducted
by Dr. Vincent McInerney, Dr. Fereydoon Ghobadi, Dr. John Ambrose and
Dr. Om Ghandi, (semi-retired orthopaedic surgeon). Other members of the
orthopaedic faculty conduct selected didactic and cadaveric sessions with the
residents. Dr. McInerney received the highest award in anatomy and was
honored as one of the top two students in the basic sciences as a medical
student at New Jersey Medical School. He served as a visiting anatomy
laboratory instructor at New Jersey Medical School from 1977-83.
Michael Baruch, M.D., director of the plastic surgical section of our Hand
Service, conducts the anatomy dissections of the hand and forearm along
with Dr. Napoleon Valdez and Dr. Fereydoon Ghobadi.
2. Pathology: Aquiles B. Villacin, M.D., orthopaedic pathologist and chairman
of the Department of Pathology, has extensive background in orthopaedic
pathology and is an excellent didactic and clinical instructor.
William Matarese, M.D., fellowship-trained in total joint surgery at the
Hospital for Joint Diseases, and has a particular interest and expertise in
James C. Wittig, M.D., director of orthopaedic oncology, lectures every
other week on basic science topics, especially orthopaedic pathology.
3. Physiology: Louis J. Ramazatto, Ph.D., director of research at Hackensack
University Medical Center, Hackensack, New Jersey, and former chairman of
the Department of Physiology at Fairleigh Dickinson University School of
James M. Manning, Ph.D., associate professor and director of the Human
Performance Laboratory at William Paterson University, Wayne, New Jersey,
has been instrumental in instructing the residents in basic principles of
physiology, especially as applied to various research projects.
4. Biochemistry: James M. Manning, Ph.D., and Dennis Todd, Ph.D., assist in
teaching biochemistry as applied to orthopaedic surgery. Dr. Vincent DeBari
is director of research at Seton Hall University.
5. Biomechanics: Robert Fernand, M.D., former associate chairman,
Department of Orthopaedic Surgery and director of the Spine/Scoliosis
Service at St. Joseph’s Hospital and Medical Center and Seton Hall
University. Dr. Fernand has had particular interest and expertise in
biomechanics, especially related spine and total joint arthroplasties.
Robert Narcessian, M.S., Director of Motion Analysis and Kinesiology, is a
mathematician and kinesiologist. He has served as a consultant to the U.S. Olympic Committee and has worked extensively with the U.S.
Fencing Federation and Team Handball Federation.
Michael Lacker, M.D., Ph.D., professor of mathematics and director of
Bioengineering at the New Jersey Institute of Technology, Newark, New Jersey, assists Robert Narcessian in teaching biomechanics and kinesiology.
6. Bacteriology/Pharmacology: M. Christine Reyelt, M.D., Michael Lange,
M.D., and Mohamed Rabbat, M.D., infectious disease consultants at St.
Joseph’s Hospital and Medical Center, conduct the microbiology and
pharmacology section of the basic science program.
(D). Facilities for Resident Education: The library facilities at St. Joseph’s Hospital and Seton Hall University provide one of the largest medical resources in New Jersey. The library facility alone at St. Joseph’s Hospital is one of the largest medical library resource centers in the state. Anatomy videotapes are used to supplement the didactic and cadaveric dissections during the anatomy course. The cadaver is housed in the morgue and adequate facilities are available for residents to dissect the cadavers during regular working hours or on evenings and weekends. The cadaver is kept in a specially vented metal container/table and preservation bag to maintain its viability for as long as possible. Full-size skeletons, complete sets of disarticulated bones, models of all major joints and extremities, and prosections are available. Slides and videotapes depicting surgical approaches are available. The cadaver is replaced yearly at St. Joseph’s Hospital. Residents rotating through the Alfred I duPont Hospital for Children also participate at that institution’s cadaveric dissection and didactic lecture series. A microscope is available in the residents’ conference room and several teaching microscopes are available in the Department of Pathology.
The Sports Medicine/Human Performance Center at St. Joseph’s Hospital and Medical Center is equipped with Gould CO2-O2 Analyzer which allows residents to obtain a
better understanding of the physiologic basis of exercise and rehabilitation. The Human Performance Center at nearby William Paterson University is the main site of the outpatient physiology testing and research. This facility, which is approximately a five-minute drive from St. Joseph’s Hospital and Medicine Center, is described fully in the research section. Residents who are performing research projects in conjunction with Dr. Vincent DeBari have access to all equipment and facilities described in the research section. The Gait Analysis Laboratory situated in Dr. Roy Nuzzo’s office is approximately a 20-minute drive from St. Joseph’s Hospital. The office-based Gait Analysis Laboratory allows residents to obtain a better understanding of the biomechanical principles of normal and abnormal gait. Applied biomechanics allows residents to appreciate better the information taught in their didactic biomechanics lecture series.
The Orthopaedic Learning Center provides residents with ready access to standard orthopaedic text and journals. The study center is housed in a quiet area of the hospital and is conducive to reading and use of audiovisual aids. Residents have the use of a
microscope for study pathology slides. Computers are housed in the learning center and provide easy access for independent learning.
PGY-5 orthopaedic residents are required to attend a two-week orthopaedic pathology course conducted by the University of Pennsylvania Affiliated Hospitals and takes place in Atlantic City in June of each year or the AFIP, Washington, D.C. In addition, PGY-4 residents attend the Maine Orthopaedic Review Course, which takes place yearly in June. The PGY-3 resident is required to attend the New York University Orthotics/Prosthetics Course, which incorporates a substantial amount of teaching biomechanics and gait analysis. All required courses are funded by the Department of Orthopaedic Surgery.
Residents rotate for two months on the orthopaedic oncology service with Dr. James Wittig. They attend the required weekly oncology conferences and receive didactic lectures every Friday morning. Rehabilitation of neurologic injury and disease and spinal cord injury and rehabilitation is carried at St. Joseph’s Regional Medical Center and the AIDI. Dr. Priscilla Kaszubski, chairman of the Department Rehab Medicine, conducts monthly seminars covering all aspects of rehabilitation medicine, including diagnosis and treatment of neurologically impaired patients. Senior residents cover the weekly clinic at New Jersey Development Center in Totowa, NEW JERSEY, one of the largest facilities in New Jersey for the mentally and physically handicapped. Orthotics and Prosthetics are taught by Dr. Priscilla Kaszubski, director of the rehabilitation service. PGY-2 residents are required to take the two-week New York University Orthotics/Prosthetics course conducted by Norman Berger at the New York University campus in New York City.
Resident Education in Ethics: All orthopaedic residents are required to attend a mandatory one-day course biannually sponsored by the Employee Assistance Program at St. Joseph’s Hospital and Medical Center and Seton Hall University. These two days per year of a mandatory retreat are utilized to educate residents in interpersonal skills with emphasis on ethics in medicine. Clinical ethics is taught in the form of didactic and breakout sessions. Formal lectures are presented by bioethicist, Dr. John Mitchell, who is skilled to teach at the resident level. In addition, principles of appropriate ethical behavior are reinforced by the program directors on rounds and in conferences, especially the Tuesday morning X-ray/Indications Conference. We are fortunate to have Dr. Walter Pedowitz as part of our teaching faculty, a member of the AAOS CPT Coding Committee. He frequently instructs the residents on the appropriate ethics in billing practices. During their private ambulatory rotations, residents are exposed to the appropriate ethics of conducting a private practice in orthopaedics as evidenced by their teaching faculty conducting their office practices. Residents are also exposed to the review of medical malpractice files (anonymous) and fee disputes brought forward to the New Jersey Orthopaedic Society Board of Directors, since the program director is the past president of the New Jersey Orthopaedic Society. One of the teaching faculty members, Dr. Ira Rochelle, instructs residents in a monthly seminar on ethical and legal issues in orthopaedic practice. Dr. Rochelle is semi-retired and has taken keen interest in exposing residents to his vast knowledge and experience in the medical, legal and ethical aspects of orthopaedic practice.
The teaching faculty is cognizant of and adheres to the principle of leadership by example. All members of our orthopaedic teaching faculty are highly respected members of the medical community.
Program Conference Schedule: Morning teaching rounds begin at either 6:30 or 7 a.m., depending on the day of the week, and conclude with a five-minute resident’s topic. At least two hours of clinical didactic conferences take place each day. A weekly X-ray/Indications Conference takes place on Tuesday mornings from 7-8:30 a.m., and is attended by the entire faculty and resident staffs and serves as a major teaching conference. An Indications/Fracture Conference takes places on Mondays starting at 6:30 a.m. and is conducted by an attending staff member. The attending physician carefully reviews the residents’ case presentations, indications, management, and treatment alternatives and makes appropriate reading assignments. A monthly Hand Conference is conducted starting at 7:30 a.m. and runs to 9:30 a.m. on the second Friday of the month. The first segment of the hand meeting is designated as a Hand Seminar and is conducted by Michael Baruch, M.D., senior plastic surgeon and director of the plastic surgery division of the hand service. Various topics are presented by the residents and Dr. Baruch, with a two-year lecture cycle established. The Hand Conference, conducted by Fereydoon Ghobadi, M.D, chief of hand service, is conducted as a joint orthopaedic and plastic surgical meeting and takes place for one hour from 8:30-9:30 a.m. Cases from the month before are presented for morbidity and follow-up. Selected topics are presented by the residents and the hand-teaching faculty.
A 60-minute Mortality and Morbidity Conference takes place on the second Tuesday of each month. Monthly Journal Clubs are conducted between 1-1 ½ hours on Thursday mornings and/or at an attending’s home on selected evenings. Thursday morning teaching conferences are scheduled between 7 and 8:30 a.m., except for the first Thursday of the month when Trauma Conference is conducted. The Thursday morning teaching conferences include faculty presentation and discussion regarding sports medicine, foot and ankle, total joint and spine sessions conducted by Drs. William Carney, Kenneth Levitsky, William Matarese, Mark Ruoff and Bryan Massoud. Hand Journal Club is also conducted monthly and is moderated by either a plastic surgical or orthopaedic faculty member. A one-hour pediatric orthopaedic seminar is conducted every other Friday by Dr. Ronald Snyder. Various topics are presented by Dr. Snyder and the senior orthopaedic resident in charge of the children’s service. As part of the Chairman’s Rounds on Thursday/Friday mornings, a 20-30 minute videotape is presented on various topics in orthopaedic surgery covering total joint arthroplasties, arthroscopies/sports medicine and trauma. A monthly combined Orthopaedic/ Rehabilitation Conference takes place on the second Friday of the month from 9:30-10:30 a.m. conducted by Priscilla Kaszubski, D.O., chairman of the Department of Rehabilitation Medicine. Topics include discussion of neuroanatomy, electromyography, somatosensory evoked potentials, normal and abnormal gait patterns, orthotics and prosthetics, and rehabilitation care of the neurologically and spinal cord injured patient. Basic principles of rehabilitation medicine and various modalities are discussed in detail. A monthly Trauma Conference is conducted on the first Thursday of the month from 7-8:30 a.m. and is combined with the Department of Surgery. Multiple trauma cases from the prior month are discussed in detail and analyzed as to the appropriateness and timeliness of care and final outcome of the patient’s condition. Representatives from the Department of Radiology, Department of Anesthesiology and Department of Pediatrics are also present at the Trauma Conference. Attending physicians are required to attend the Trauma Conferences and the Tuesday morning conferences from 7-8:30 a.m., which include the X-ray/Indications Conference, Mortality and Morbidity, Guest Lectures Series and monthly departmental business meetings. Residents are required to attend all previously mentioned conferences and meetings. The orthopaedic residents’ teaching block time is scheduled from 7-11 a.m. every Friday morning. Bone pathology, biomechanics, biochemistry, physiology and pharmacology/microbiology are discussed in detail. Lectures are given in nephrology, pulmonary medicine, hematology, neurology and urology. Monthly seminars are conducted by the Departments of Plastic Surgery (Hand), Physical Medicine and Pathology. Guest lecture series include talks on various clinical and basic science topics. Residents attend conferences at the University of Medicine and Dentistry of New Jersey (New Jersey Medical School), especially the Grand Rounds on the first Wednesday of the month in the evening. Residents also attend the monthly meetings of the New York Academy of Medicine (Orthopaedic section). During his/her training period, each resident is required to take courses in orthotic/prosthetics, biomechanics, orthopaedic pathology, Swiss A/O technique and pediatric orthopaedics. In addition, the senior resident takes the Maine Orthopaedic Review course, which takes place yearly in June.
All residents participate in running the Combined Annual New Jersey Orthopaedic Symposium/Northeastern Orthopaedic Residents’ Conference, which was founded, at St. Joseph’s Hospital in 1959. All residents involved in the planning and participation in this event find it an excellent learning experience. At least one of the graduating residents from each of the four New Jersey Orthopaedic Residency Training Programs presents his or her graduation theses before a panel of distinguished orthopaedic educators who have been invited to critique the papers. The residents also conduct a three-hour Complications Conference, during which each resident presents two or three patient complications to the visiting faculty. For three of the past five years, Seton Hall University/St. Joseph’s Hospital orthopaedic residents have won the Resident Essay Award at this meeting.
Residents also participate in the four yearly meetings of the Greater Metropolitan Sports Medicine Society of New York and New Jersey. This society was founded in 1986 and is based at St. Joseph’s Hospital in Paterson. The Greater Metropolitan Sports Medicine Society serves as an educational and research tool for fellowship-trained sports medicine specialists in the New York, New Jersey and southern Connecticut areas. St. Joseph’s Hospital residents regularly present cases and topics during these meetings.
Resident Opportunities to Gain Experience: Residents gain experience in the diagnosis and management of all aspects of orthopaedic medicine by their outpatient experience in the clinics and private offices, through operative experiences in the major teaching institutions and in same day surgical operating rooms. Close faculty supervision is carried out in all aspects of the diagnosis and management.
(A). Adult orthopaedics, including joint reconstruction: Residents rotate throughout their training program on the adult orthopaedic service, including the joint reconstructive service. All aspects of adult orthopaedics are carried out, including total joint replacements of the knee, hip, shoulder and elbow. Non-operative and operative experience in this area is conduced by Vincent K. McInerney, M.D., William A. Matarese, M.D., Aiman Rifai, D.O., Joseph Pizzurro, M.D., and Mark Hartzband, M.D. Senior and chief orthopaedic residents are focused on the total joint replacement service and are progressed in their experience until they can fully handle joint replacements with only minimal supervision as a chief resident.
(B). Pediatric orthopaedics, including pediatric trauma: Residents are assigned to the pediatric orthopaedic service for four months during their PGY-3 training. Residents are assigned to the weekly pediatric orthopaedic clinic (three-hour clinic on Fridays). Chief residents conduct the orthopaedic clinic at North Jersey Developmental Center in nearby Totowa, New Jersey. Residents assigned to the pediatric orthopaedic service rotate in the private offices and obtain the appropriate surgical exposure to all aspects of pediatric orthopaedics, including significant trauma. St. Joseph’s Regional Medical Center is a major trauma center in North Jersey and has a Children’s Hospital with a specifically designated children’s emergency room and trauma center.
(C). Trauma, including multisystem trauma, and surgery of the spine: The trauma service at St. Joseph’s Regional Medical Center is a state designated regional and trauma center with the busiest emergency room in the state of New Jersey. The services are combined with the Department of Surgery, and residents are exposed to multisystem trauma on a regular basis, especially during their assigned trauma rotations. During their on-call duties, residents are additionally exposed to extensive orthopaedic and multisystem trauma. Surgery of the spine, including disc surgery, spinal trauma and spinal deformities, is conducted by the Department of Orthopaedic Surgery under the spine division. Additionally, there are three board-certified neurosurgeons on the teaching staff who interact with the orthopaedic residents since there are no surgical residents or neurosurgical fellows who assist during these types of operative procedures involving the neurosurgical service. In addition, residents are exposed to additional multisystem trauma at their assigned pediatric orthopaedic rotation (four months). The majority of spine operative cases are conducted by three fellowship-trained orthopaedic spine surgeons.
(D). Hand surgery: Residents receive extensive experience in the diagnosis and management of hand abnormalities. The hand services directed by Fereydoon Ghobadi, M.D., is combined with the plastic surgical service, which does not have any residents or fellows of its own. All hand operative cases are evaluated and treated with orthopaedic residents involved. Microvascular/re-implantation service is conducted by Anthony Berlett, M.D., plastic surgeon, who has extensive knowledge and clinical expertise in all types of hand surgery and vascular/flap reconstructive surgery. Residents obtain extensive elective and trauma hand surgical experience.
(E). Foot surgery in adults and children: The foot and ankle service provides extensive experience for residents by three fellowship-trained foot and ankle surgeons. Dr. Walter Pedowitz, director of the foot and ankle service, has extensive experience with both adult and children’s foot and ankle surgery. The trauma aspect of this division is conducted by Kenneth Levitsky, M.D., and Stephen Massood, D.O. The podiatric service is a division of the orthopaedic department and also does extensive surgical reconstructions under the direction of Dr. Henry Slomowitz and Dr. Richard Braver. Additionally, foot and ankle surgery is conducted on the pediatric orthopaedic rotation at both St. Joseph’s Hospital and Medical Center and at the Alfred I duPont Hospital for Children.
(F). Athletic injuries, including arthroscopy: Residents are exposed to the diagnosis and management of athletic injuries, including arthroscopic surgery throughout their residency training program, especially during their PGY-2 year and PGY-5 year of training. Residents are exposed to athletes covered by our department at Seton Hall University, Montclair State University, the New Jersey Jackals professional baseball team (Yogi Berra Stadium), and various high school and Olympic athletes. All aspects of arthroscopic surgery are carried out by fellowship-trained sports medicine/arthroscopic attendings with state-of-the-art techniques employed. Residents obtain significant exposure and experience with arthroscopic surgery of the knee, shoulder, elbow and ankle.
(G). Metastatic disease: A large oncology division at St. Joseph’s Regional Medical Center and at the Alfred I duPont Hospital for Children allows for extensive exposure to primary and metastatic disease. The large aging population in northern New Jersey provides a significant population base for diagnosis and management of metastatic disease. The orthopaedic oncology service under the direction of Dr. James Wittig and Dr. Joseph Benevenia provide surgical expertise in treating metastatic disease. St. Joseph’s Regional Medical Center is one of the first institutions in the United States approved to carry out bone marrow transplants. The mandatory two-month orthopaedic oncology rotation in the PGY-4 year provides abundant exposure to metastatic disease.
(H). Orthopaedic rehabilitation, including amputations and post amputation care: Residents are exposed to orthopaedic rehabilitation at St. Joseph’s Regional Medical Center and at the Alfred I duPont Hospital for Children, which has an extensive pediatric orthopaedic rehabilitation program. The rehabilitation department at St. Joseph’s Regional Medical Center is active and aggressive with its rehabilitation of amputees due to the high incidence of diabetic peripheral vascular disease and uremic vascular disease seen in our North Jersey population. St. Joseph’s Regional Medical Center has the largest in-hospital dialysis unit in the United States and provides significant experience with amputees. Anthony Porcelli, Priscilla Kaszubski and Supriya Massood are the physicians in charge of the rehabilitation department and all have extensive experience with orthopaedic rehabilitation. The Sports Medicine/Human Performance Center provides a significant expertise level for rehabilitation of the majority of orthopaedic patients.
Resident Opportunity: Residents are provided with the opportunity to develop competence in the pre-admission care, hospital care, operative care and follow-up care (including rehabilitation of patients) throughout their residency training. The outpatient clinics at St. Joseph’s Regional Medical Center and the Alfred I duPont Hospital for Children are extensive and are supervised by the orthopaedic teaching faculty. The private ambulatory rotations that residents are required to attend provide additional opportunities to experience appropriate pre-admission care. Hospital care and operative care are monitored by the program directors and the teaching faculty. The nurse supervisor on the orthopaedic floor attends monthly departmental meetings and assists the orthopaedic department to improve patient care. Residents are exposed to all aspects of a patient’s care, including follow-up care and rehabilitation, since they are mandated to work with the case workers and ensure patients obtain the appropriate post-operative rehabilitation necessary for a successful outcome. St Joseph’s Regional Medical Center has purchased St. Joseph’s Wayne Hospital approximately 10 minutes from the main teaching campus. This institution now provides one of the largest and most effective orthopaedic rehabilitation facilities in New Jersey. Residents have the opportunity to participate in all aspects of care of the same patient through the extensive clinics at St. Joseph’s Regional Medical Center and on their pediatric orthopaedic rotations. The service and private patients that are treated in the clinic setting are cared for by the residents with an attending supervisor monitoring the resident’s care and progress. The private ambulatory rotation that residents are required to attend provides the complete care model from pre-admission through post-operative care of the same patient.
Resident experience in non-operative outpatient diagnosis and care: Residents are assigned to rotations that incorporate non-operative outpatient care, including the diagnosis and care of all anatomic areas and patients of all ages. Resident exposure to the non-operative outpatient setting both in the hospital clinics and on the private ambulatory rotations is reviewed weekly by the program directors. Division chiefs are responsible to the program directors for carrying out the proper monitoring of the residents experience in all operative and outpatient diagnosis and care. At St. Joseph’s Regional Medical Center, there are two clinics weekly, both of which are half-days, and all residents are assigned to those clinics (Tuesday mornings and Friday afternoons). Each resident sees a minimum of 20-25 patients on the Tuesday morning clinic and approximately 10-15 patients on the Friday pediatric orthopaedic/scoliosis clinic. Additionally, the chief resident sees at least 20-25 patients on the Tuesday afternoon half-day clinic at North Jersey Developmental Center. All residents have requirements to attend the private ambulatory rotations at our teaching faculty’s private offices at least one-half day per week. All assignments are made by the program directors and are monitored on a weekly basis.
Manner In Which Residents Are Supervised and Given the Opportunity to Assume Increasing Responsibilities:
(A) Outpatient: Clinics are supervised by at least two orthopaedic faculty members. In addition, scoliosis clinic is supervised by Dr. Arash Emami and Dr. Robert Fernand. Hand clinic is supervised by Dr. Fereydoon Ghobadi. Dr. Sanjeev Sabharwal and Dr. Ronald Snyder supervise the pediatric orthopaedic clinic. During the private ambulatory rotation, residents are directly supervised by the orthopaedic faculty member at whose office the resident is rotating. Residents are evaluated and assessed as to their diagnostic acumen and progressed accordingly to higher levels of responsibility on a graduated basis. Junior residents are closely supervised by the attending physician who will often demonstrate the appropriate history taking techniques and pertinent physical findings and then discuss the differential diagnosis and treatment options with the resident. By the time a resident has reached the PGY-4 level, he/she is allowed to formulate diagnostic and treatment plans and then reviews them with the attending physician for confirmation of the plans. As a chief resident, the resident has his/her own patients on the private ambulatory rotation and briefly reviews his/her findings and treatment options with the attending physician who serves more as a consultant. The chief resident books the operative cases and learns the mechanics of doing this in a private office setting.
(B) Inpatient: Rounds are conducted with the attending staff and include extensive discussion with the residents. The resident is required to discuss treatment options with each attending physician and formulate a plan of action, which is verified by the attending physician. Residents write daily progress notes and usually write the vast majority of patient orders on the chart. Individual rounds with the attending faculty, as well as grand rounds, occur on a regularly scheduled basis. The residents meet at 6:30 a.m. rounds with the chief resident and at 7 a.m. with the program director and one other attending on a daily basis. X-rays are reviewed from cases admitted through the Emergency Room and all admissions are discussed in detail. Weekly, Grand Rounds take place on Friday morning and include detailed discussions and treatment options for all patients currently in the hospital. As stated earlier, junior residents are focused more on fracture care during their first year of training along with the basics of pre-operative and post-operative patient care. The junior residents are then progressed to higher levels of responsibility as judged by their faculty evaluations.
(C) Operative: The chief resident discusses all operating room resident assignments
with the program director on a weekly basis. Operative cases are assigned appropriately
according to the degree of difficulty and are based on the resident’s surgical maturity.
Attending faculty members are required to be present in the operating room suite on all
orthopaedic operative cases. Faculty evaluations are particularly important in deciding
when to progress a resident to the next surgical skills level.
(D) Emergency: Junior residents are supervised by a senior resident during their Emergency Room on-call assignments. Teaching faculty are assigned to Emergency Room call duty on a rotating basis and directly supervise the orthopaedic resident along with the Emergency Room attending physician. For the first six months of their training, first-year residents are required to review all x-rays with the chief resident on the next day, 6:30 a.m. morning rounds. All x-rays of importance are presented at the X-Ray/Indications Conference which takes place every Tuesday morning from 7-8:30 a.m. Residents are progressed to less overall supervision as evidenced by the chief resident and faculty member’s evaluation of their performance.
Senior residents administer the service that they are assigned to and instruct the junior residents regarding medical work-ups, treatment regimens and surgical skills. The program offers an abundance and variety of surgical and emergency outpatient material. Each resident is given progressive surgical and non-surgical responsibilities depending on his/her level of training. The senior resident and attending staff are responsible for supervising and training of junior residents.
Basic Motor Skills: The psychomotor skills teaching is conducted on a monthly basis in the Psychomotor Skills Laboratory located at St. Joseph’s Hospital and Medical Center. This laboratory houses the sawbones work station equipment and a fully functional arthroscopy and total joint and trauma laboratory. Attending physicians are assigned to cover specific areas of psychomotor skills teaching throughout the year. Fereydoon Ghobadi, M.D., coordinates the psychomotor skills teaching. The Psychomotor Skills Laboratory was fully developed in September 1982 and has provided residents with the facilities and instruction to learn and improve their skills. This has been a valuable addition to the teaching program and has been especially useful for teaching Swiss AO techniques, total joint arthroplasties and arthroscopic surgical procedures. Bioskills utilizing the operating microscope are taught and perfected in the Animal Research Laboratory where rats are anesthetized and surgical procedures are performed beginning with the most basic suturing techniques and progressing to more difficult anastamoses.
Basic Motor Skills are taught in the Psychomotor Skills Laboratory and in the operating rooms. The proper use of instruments and proper surgical techniques are instructed by the teaching faculty. New techniques and biomaterials are evaluated in a critical and analytical fashion. Basic motor skills application is integrated throughout daily activities and is emphasized in the operating room area.
Program Activity Summary: Research activity is concentrated in the area of sports medicine (motion and gait analysis) and spine research. We have recently concluded a 12-year project, which has resulted in the establishment of the Boundary Method of Motion Analysis, jointly developed by Seton Hall University and the New Jersey Institute of Technology. Preliminary results were presented in Gait and Posture volume 5 (2) in April 1997, and revealed the basic concepts of a new mathematical model of human gait dynamics. From this process, performance enhancement activities have expanded and have resulted in dramatic improvements in the performance aspects of several sports including tennis, golf, weight training and basketball foul shooting techniques. This process resulted in the awarding of the 2000 Best Exhibit Award at the 55th Annual Meeting of the American Society of Surgery of the Hand in Seattle, Washington (the diagonal grip, a modified grip designed to prevent dorsal wrist pain in athletes). A new tennis serve has been devised, which incorporates new concepts developed by the Boundary Method Analysis. This work was presented at the Annual Meeting of the Tennis Medicine and Research Society in September 2003 (Hilton Head, South Carolina). Spine research in the areas of the effectiveness of kyphoplasty for compression fractures of the thoracolumbar spine, as well as the effect of alendronate on posterolateral spine fusion (rabbit model), has been ongoing in the program. Dr. J. Lee Berger has patented his balloon carpal tunnelplasty device and is currently working on patents for balloon treatment of fractures in the forearm.
Since our last site visit, we have tripled our abstracts and presentations. The overall scholarly activity has dramatically increased with the addition of four new full-time faculty and 12 part-time faculty. The addition of Joseph Pizzurrro, M.D., and Mark Hartzband, M.D., have brought us into the era of robotic surgery and minimally invasive surgery that is cutting edge. Significant publications emanating from the work of Dr. Pizzurro and Dr. Hartzband are anticipated.
Orthopaedic residents participate fully in the development of these new areas of orthopaedic knowledge. They are becoming better critical thinkers and are able to evaluate research activities in a more thorough fashion. Our teaching faculty and residents participate in clinical discussions, rounds and conferences in a way that stimulates further guided inquiry. Active attempts are made to apply the basic science and clinical research information into the daily activities of orthopaedic practice. Our staff has increased their participation in regional and national orthopaedic meetings, and have presented an increasing number of scientific presentations. Through the efforts of Dr. Vincent DeBari, director of research at St. Joseph’s Regional Medical Center and Seton Hall University, our residents and attending staff have a better understanding of research design and statistical analysis. Dr. DeBari conducts two courses yearly at Seton Hall University and at St. Joseph’s Regional Medical Center specifically designed to improve resident and faculty research capabilities. Areas of instruction include the development of proper experimental design, hypothesis testing and review of current research methodology.
Clinical and laboratory research are integrated into the education program during the five years of training. Residents are given at least one project yearly and must complete a graduation thesis paper upon completion of their training. Residents are encouraged to investigate orthopaedic disorders that present a particular interest to them during their training. Seton Hall University sponsors a one-day research colloquium, which has been held since 1989. Since the inception of this research colloquium, the orthopaedic department has been represented every year and presented original papers. Each resident is encouraged to complete one project during their four-month pediatric orthopaedic rotation at the Alfred I duPont Hospital for Children.
Monthly research meetings are conducted with the program directors to discuss and facilitate both clinical and basic science research. Residents update their progress and review future goals and objectives. Attempts are made throughout the entire training program to develop the residents into critical, analytic thinkers who will be able to read the orthopaedic literature with close scrutiny and adopt those conclusions that are appropriate. Faculty supervisors and mentors are assigned to each resident to stimulate their interest in research and guide them in the process of developing proper research protocols and papers.
(A) Staff who Provides Research Stimulation: The following teaching staff faculty provides most of the stimulation/supervision of clinical and laboratory resident research.
1. Vincent K. McInerney, M.D. — Expertise in sports medicine
2. Fereydoon Ghobadi, M.D. — Expertise in hand and trauma
3. J. Lee Berger, M.D. — Expertise in hand and trauma
4. Joseph Benevenia, M.D. — Expertise in orthopaedic oncology
5. Arash Emami, M.D. — Expertise in orthopaedic spine
6. Ramin Ghobadi, M.D. — Expertise in hand and trauma
7. Roy M. Nuzzo, M.D. — Expertise in pediatric orthopaedics, gait analysis and computer-generated graphics
8. Walter J. Pedowitz, M.D. — Expertise in foot and ankle
9. Deepak Patel, M.D. — Expertise in sports medicine and research
10. Aiman Rifai, D.O. — Expertise in total joint replacements and avascular
11. Mark J. Ruoff, M.D. — Expertise in spine
12. James C. Wittig, M.D. — Expertise in orthopaedic oncology
13. Robert Narcessian, MS — Expertise in kinesiology and motion analysis
14. H. Michael Lacker, M.D., Ph.D. — Expertise in bioengineering and
15. Vincent DeBari, Ph.D. — Expertise in biochemistry, physiology, rheumatology and immunology
(B) Time Free of Clinical Duties for Resident Research:
Residents are free of clinical responsibilities approximately 2 to 3 hours per week at the discretion of the program directors, residents are given additional blocks of time monthly, amounting to approximately four to five hours for additional research projects and study.
(C) Facilities and Resources Utilized to Support Resident Research:
The following clinical and laboratory research facilities are available to our residents:
Rheumatology Laboratory and Laboratory for Experimental Medicine, Sports Medicine/Human Performance Center (all at St. Joseph’s Hospital and Medical Center); Human Performance Center at William Paterson University, Wayne, NJ; Office-based Gait Analysis Laboratory at the office of pediatric orthopaedist Roy M. Nuzzo, M.D.,
Human Performance Center at Seton Hall University; New Jersey Institute of Technology, Newark, NJ; Kessler Institute for Rehabilitation, West Orange, New Jersey.
The Sports Medicine/Human Performance Center is housed in approximately 800-square feet and is staffed by two full-time sports medicine physical therapists. One full-time secretary staffs the facility. The Sports Medicine Research Fund is presently endowed at $280,000 solely for orthopaedic research programs. St. Joseph’s Hospital and Medical Center supports all the salaried positions. Equipment includes the Biodex and Cybex isokinetic systems, a Gould CO2-O2 analyzer ($52,000) and various bicycle ergometers, treadmills, total gym, and other modalities.
The Human Performance Center at William Paterson University, Wayne, NEW JERSEY, is housed in approximately 800 square feet with a large gymnasium utilized for the cardiac rehabilitation program. James M. Manning, Ph.D., is director of this facility. Undergraduate students and secretarial staff assist Dr. Manning in his research efforts.
Equipment includes a Beckman Oxygen-CO2 Open Circuit Spirometer, two computers (IBM), two treadmills, four bicycles, two arm ergometers, one rowing machine and a lactate analyzer. EKG monitoring equipment and telemetry are also available. Lung volume measuring devices, hydrostatic weighing machine, skin fold calipers and dynamometers are available. Additionally, a full professor, Dr. Samuel Silas, has actively contributed to the laboratory and is involved in ongoing epidemiologic study regarding injuries to National Football League players. Funding is through the education budget at William Paterson University and with grants from the Sports Medicine/Human Performance Center Research Fund at St. Joseph’s Hospital and Medical Center.
The office-based Gait Analysis and Gait Laboratory, which was completely rebuilt in March 1993 by Dr. Roy Nuzzo, pediatric orthopaedic surgeon, allows for biomechanical
evaluations and gait analysis. This sophisticated office-based motion analysis system was presented at the Pediatric Orthopaedic Society of North America and published in their transactions in May 1989.
Robert Narcessian, M.S., kinesiologist, serves as director of motion analysis and kinesiology in the resident research program. The resources of the Sports Medicine Research Fund and Seton Hall University support his work, including grants. The Human Performance Laboratory at Seton Hall University supports a staff of three full-time individuals. Force plates are in place and a new gait lab is being installed.
H. Michael Lacker, M.D., Ph. D., directs the Biomechanics Laboratory at the New Jersey Institute of Technology in Newark. Dr. Lacker has a special interest in teaching residents and is one of the creators of the Boundary Method of Motion Analysis.
William Roman, Ph.D., PT, directs the research efforts at Kessler Institute for Rehabilitation in West Orange, New Jersey. The facilities have been utilized by residents in conjunction with research efforts by Robert Narcessian and H. Michael Lacker. The Christopher Reeve Foundation has been helpful in funding much of Kessler’s research.
Deepak Patel, M.D., is director of institutional research at St. Joseph’s Regional Medical Center and coordinates all research efforts of the Orthopaedic Department and institution.
Stuart Hirsch, M.D., serves as assistant residency program director and assists with research coordination.
(D) Methods to Promote Resident Ability to Evaluate Medical Literature and Research:
Vincent DeBari, Ph.D., director of research at St. Joseph’s Regional Medical Center and Seton Hall University, conducts yearly courses for residents regarding experimental design, hypothesis testing and research methodology. Journal Clubs are conducted in a fashion to stimulate critical thinking and evaluation of the literature. One of the orthopaedic residents is assigned, on a yearly basis, to be a member of the Institutional Review Board at St. Joseph’s Regional Medical Center. Vincent K. McInerney, M.D., and Roy M. Nuzzo, M.D., are on the Editorial Boards of the American Journal of Orthopaedics and Orthopaedics Today, and Joseph Benevenia, M.D., and Deepak Patel, M.D., are reviewers for peer-reviewed journals. This experience helps further develop the residents’ abilities to evaluate appropriate experimental designs and methodology. Additionally, Paul J. Hirsch, M.D., past chairman of JBJS Board of Trustees, began conducting Journal Clubs starting in July 2004.
Resident Duty Hours and Working Environment
Exceptions Granted: The program has not been granted an exception to the program requirement regarding the 80-hour per week duty limits for residents.
Program Ensurance of One Day in Seven Free: The program directors carefully monitor on-call schedules and review, on a daily basis, resident work duties and hours. All residents have at least one day in seven free from all educational and clinical responsibilities.
Program Ensurance of 10-Hour Time Period: Residents have a minimum of a 10-hour time period between daily duty periods and after in-house call duties. Daily consultation of the program directors with the chief resident ensures that the appropriate institutional resident duty hour policies are carried out. Documentation by residents is required and reviewed on a weekly basis to ensure that the duty hour policies are enforced.
Manner in Which the Program Ensures the Residents’ Call Schedule is Compliant: Resident call schedules are reviewed by the program directors on a monthly basis to ensure compliance with the program requirements. Any changes in the call schedule must be approved by the chief resident and the program directors. In-house call does not occur more frequently than every third night averaged over a four-week period. Continuous on-call duty does not exceed 24 consecutive hours. No new patients are accepted after 24 hours of continuous on-call duty. At-home call is not performed in the residency training program.
Policies Regarding Moonlighting: Moonlighting is not allowed in the residency training program. The orthopaedic residency education is considered a full-time activity, and moonlighting is not allowed. The program complies with the institutional written policies and procedures regarding moonlighting.
Manner in Which Residents Are Evaluated: Written quarterly resident evaluations are conducted and summarized at quarterly departmental meeting that are devoted to the evaluation process. Assessment of residents’ competence in patient care, medical knowledge, practice-base learning and improvement, interpersonal and communication skills, professionalism, and systems-base practice are carried out. Regular and timely feedback to the residents is carried out on a quarterly basis. The residents’ written quarterly evaluation is reviewed with the resident in a timely fashion and maintained as a record in the resident’s permanent file. Residents have access to their file to review their evaluations. The resident evaluations are utilized to assess progressive improvement and the residents’ competence and performance. Also taken into consideration in the residents’ evaluation are other sources, including patients and other professional staff members. Final evaluations for each resident completing the program are carried out and include a review of the resident’s performance during the final period of education and verify whether or not the resident has demonstrated sufficient professional ability to practice competently and independently. This final evaluation is part of the residents’ permanent record maintained by our institution.
Manner in Which Faculty Are Evaluated: Faculty evaluations are carried out on a yearly basis by the program directors with input from the written resident evaluations. The program directors also meet with the residents for a conference twice per year regarding overall faculty evaluations and ways to improve their teaching. Evaluations include assessment of teaching abilities, commitment to the educational program, clinical knowledge and scholarly activities.
Manner in Which Program Personnel Review Program Effectiveness: The program directors, division chiefs, and a senior resident meet annually to review the program goals and objectives and to assess the effectiveness of the program in achieving those. All areas of input, including written and verbal resident and faculty evaluations, in-training exam scores, results of ABOS certifying exams, and research productivity and presentations, are discussed and plans are formulated for corrective action and/or expansion of programs. The GMEC and dean of Seton Hall University’s School of Health & Medical Sciences also review our program effectiveness on a yearly basis.