Mission

Provide each resident the opportunity to become a competent orthopaedic surgeon of the highest character through excellence in didactic and clinic teaching and exposure to the entire spectrum of orthopaedic pathology.

Vision

Military Medicine Most Trusted Healthcare Providers

Aims

Graduates of this program must be competent and innovative orthopaedic surgeons and leaders. To that end, graduate surgeons must be:

• Capable of general orthopaedic practice.
• Able to practice in a deployed/austere environment.
• Competitive for subspecialty fellowships.
• Well-versed in ongoing research efforts to save lives and limbs on the battlefield.
• Able to preserve and optimize function for servicemembers.
• Active in promoting orthopaedic advances.
• Pioneers in improving orthopaedic education.

The program's objective is to cultivate leaders in military medicine and encourage involvement in advocacy, research, and national committee work.

Didactics

The majority of formal education is provided during protected academics held each Wednesday, typically at the Texas Tech University Health Sciences Center (TTUHSC) El Paso Foster School of Medicine. Clinics and operating room time are limited to allow both resident and staff participation. Academic activities during these days fall under several categories: staff lectures, resident lectures, anatomy presentations, Orthopaedics In-Training Exam (OITE) review, and practical skills labs.  

Between July and November, the academic calendar is focused on core orthopaedic knowledge with emphasis on resident and staff lectures, anatomy dissections, and OITE review. The second half of the academic year features more specific resident and staff lectures with an emphasis on practical cadaver skills labs. 

Staff Lectures

Attendings participate in a rotating schedule of specialty-specific core lectures in the fields of trauma, sports medicine, adult reconstruction, spine, hand, pediatrics, tumor, and foot and ankle. 

Anatomy

Between July and November, the core anatomy program is central to resident education. Each Wednesday, a senior resident leads a team of residents for a given anatomic region (e.g. Pelvis/Acetabulum, Hip/Thigh, Knee, etc.). Staff supervision is provided for each of these sessions as appropriate. The PGY-1 will perform a cadaveric dissection, highlighting all relevant anatomy of the region of focus. The PGY-2 resident will demonstrate common surgical approaches in the specified region. The residents then attend a practical session in the state-of-the-art Foster School of Medicine anatomy lab, where there are 2-3 cadavers dedicated to orthopaedics each year.  

Resident Core Review Lectures

Between July and August, there are two resident-lead lectures each week. The residents will  present a formal lecture based on high yield orthopaedic topics, while interns are usually responsible for basic science lectures. Whenever possible, these lectures correlate to the anatomic region of the week (e.g. osteoarthritis core lecture and biomaterials/septic loosening basic science lecture during hip anatomy week).

Cadaver / Sawbones Practical Skills Labs

Incorporation of frequent practical labs using both cadavers and sawbones is extremely beneficial in solidifying knowledge base and developing technical skills. These are incorporated throughout the year, usually with 2-3 labs prior to the OITE and 1-2 labs monthly thereafter. Cadaver labs are typically held at the medical school. Dedicated orthopaedic department cadavers as well as cadaver specimens provided by industry support allow residents to practice both surgical approach and instrumentation in an anatomically realistic model. These labs cover many topics, for example: upper extremity fracture fixation, joint arthroplasty, circular frame placement, and arthroscopy. 

PGY-1

Off-Service Rotations

• General Surgery Nights
• Plastic Surgery
• Vascular Surgery
• Emergency Medicine
• Musculoskeletal Radiology
• Physical Medicine and Rehabilitation

Ortho Rotations

Adult Reconstruction x 2-3

This is a fast-paced and busy rotation with a fellowship trained arthroplasty surgeon and a senior resident. You will work with the chief on the service, with a mix of clinic and operating room experience. As the intern, you will begin to learn the basics of inpatient management and patient optimization for elective procedures. In the operating room, you will be guided through the basics of hip and knee reconstruction and begin learning tangible surgical skills. Interns typically rotate once or twice on this rotation.

General

During the general orthopaedics rotation, you will work with one of our generalist orthopaedic surgeons and be exposed to a broad spectrum of pathology representative of a community practice, through both clinic and operative experience.

Trauma x 2-3

This rotation, on the team-based trauma service at University Medical Center of El Paso, exposes you to the perioperative management of trauma patients at our Level I facility. From initial management and stabilization in the emergency department, through indicating for operative or non-operative treatment, surgical treatment, and the post-operative care of patients, this rotation has a lot of hands-on learning opportunities. You’ll also get the opportunity to see patients in clinic. The intern is an important component of the team, and works under the direct supervision of the PGY-2 or PGY-3. Interns typically rotate two or three times on this rotation.

Research

We offer a dedicated research month for orthopaedics.

PGY-2

Hand

Second year residents complete a 10-week rotation with one of our fellowship-trained hand surgeons. This block is a true mentorship style with one-on-one training in the operating room and clinic. As a PGY-2, you begin to gain autonomy in the operating room as you are guided through common and complex upper extremity pathology.

Trauma x 2

The PGY-2 rotates for two blocks on the trauma service. They are responsible for consult management, either directly or by supervising the intern as appropriate. About half of the block is spent on nights, a formative process where you are entrusted with in-house call responsibility at the Level I. Oversight is provided by the senior residents on call and the attending surgeons. Senior residents are approachable and happy to answer questions or assist on a difficult reduction. The PGY-2s while they are on the day team are expected to help teach the interns and other learners on the team (rotating emergency medicine residents, medical students, physician extenders). They also get into the operating room. It may seem impossible now, but the growth and confidence that is gained in your orthopaedic knowledge while on this rotation is exponential.

General

You’ll be the only resident on this general orthopaedics rotation. A wide variety of pathology comes in through clinic, and it is a great window into how a generalist practice works. You may perform a total knee arthroplasty, carpal tunnel release, and shoulder arthroscopy on any given operating room day.

Sports

Working with a senior resident, usually a chief, this rotation is on a very busy service, with excellent exposure to pediatrics and sports injuries in young athletes. This service features a heavy operative case load. You’ll get exposure to primary anterior cruciate ligament (ACL) reconstruction, Periacetabular Osteotomy (PAO), hip arthroscopy, as well as operative pediatric trauma during your rotation. 

PGY-3

Pediatrics – Utah

This is the first of two off-site rotations. We have the opportunity to rotate at Shriners and Primary Children’s hospital, associated with the University of Utah in Salt Lake City. We are exposed to rare pediatric pathology, the opportunity to see another excellent residency program through their pediatrics rotation, and a heavy dose of closed reductions while on call. Their staff attendings are also enthusiastic about teaching residents. This rotation augments the exposure to pediatrics that we receive longitudinally in our other rotations in El Paso, through a mix of clinic and operating room..

Oncology

This rotation provides one-on-one training with our department chair, in orthopaedic oncology. This rotation is located at TTUHSC El Paso, so most of your time is at University Medical Center of El Paso in the OR or clinic, learning the intricacies of tumor surgery. You’ll occasionally have an opportunity to jump in on other cases at University Medical Center of El Paso as well.

Sports Reconstruction

This mentorship model rotation, focused on the shoulder and its treatment and/or a generalist practice with a strong preference for arthroplasty procedures, is an excellent opportunity to continue to advance your clinical acumen and surgical skills with one-on-one teaching from our staff. 

Hand/Oncology

This is a rotation with our dual-fellowship trained hand and oncology program director. This block is another mentorship style rotation, with one-on-one training in the operating room and clinic. As a PGY-3, you continue to gain autonomy in the operating room as you are guided through common and complex upper extremity and tumor pathology.

Sports

On this rotation, you will work with a senior resident, typically a chief, and have excellent exposure to varied sports pathology.  Get ready for plenty of arthroscopy as well as the opportunity for trauma cases. You’ll get shoulder instability, multi-ligament knee injuries, meniscus transplant, hip arthroscopy, and the more bread-and-butter cases, like primary ACL reconstruction.

PGY-4

Adult Reconstruction – Chicago

Fourth year residents have the privilege to train at Rush Orthopaedics in Chicago. They work with a pioneer in the field of arthroplasty with an emphasis on minimally invasive total hip and knee replacements. As a resident on service, you will be participating in surgical cases and clinical duties. Residents from TTUHSC El Paso/WBAMC are provided with an apartment within walking distance to the hospital while in Chicago. A sub-rotation occurs in Munster, Indiana which is also included in this rotation.

Trauma x 2

As a senior resident on service, you will continue to progress with your surgical decision-making and operative skills. Expect to help provide teaching and guidance to junior residents, while honing your operative skills. You’ll also typically be in clinic once a week. Autonomy is granted according to individual ability as well as surgeon preference. 

Foot and Ankle

On the foot and ankle service, you will be working one-on-one with a highly trained foot and ankle surgeon in a true mentorship model. The goal of this rotation is for senior residents to become confident and competent in common and uncommon foot and ankle disorders. Surgical skills will be sharpened under the guidance of a skilled mentor in the field. Pathology ranging from lower extremity trauma to complex congenital disorders will be encountered.

Spine

During the spine surgery rotation, you will work with a fellowship-trained orthopaedic spine surgeon and an orthopaedic intern. You will learn the management of both adult and pediatric spinal disorders in the clinic and operating room setting. 

PGY-5

Peds/Sports

Chief residents will have the opportunity to rotate with our dual fellowship-trained sports and pediatrics department chair on a pediatrics and sports rotation, typically with the assistance of a junior resident. The service features a heavy operative case load of sports cases and pediatric cases. In this mentorship-model rotation, you will be guided through common and complex sports and pediatric cases.

Trauma

As the trauma chief, you will run the University Medical Center of El Paso service administratively. At this point, it is expected that you will be walking junior residents through cases as appropriate. You will typically spend one day a week in clinic, usually with our senior orthopaedic traumatologist. The rest of the time, you will have the opportunity for honing your operative skills with the wide variety of injury patterns that we take care of, including a high number of periarticular fractures of the lower extremity.

Sports

On this rotation, you will work under a fellowship-trained sports surgeon and supervise a junior resident. Get ready for plenty of arthroscopy as well as the opportunity for trauma cases.  You’ll get shoulder instability, multi-ligament knee injuries, meniscus transplant, hip arthroscopy, and the more bread-and-butter cases, like primary ACL reconstruction.

Adult Reconstruction

As a senior on this rotation, you’ll have a junior resident, typically an intern, who you’ll help guide in the basics of adult reconstruction. This rotation is with our Hospital for Special Surgery (HSS) fellowship-trained arthroplasty staff surgeon and consists of primary and revision total hip and knee reconstruction. This is a fast-paced and busy practice.

Elective Rotation

An opportunity to carve out a rotation according to your interests. In the past, we have rotated with local community orthopaedic surgeons, getting excellent exposure to a general orthopaedic practice. If you have other ideas, start planning early, especially if you want to go out-of-state, as you’ll need to get your affairs and paperwork in order.

There is opportunity for residents to select a desired subspeciality in orthopaedics. Some of the recent elective rotations include: Sun City Orthopaedics, additional Rush University rotation and Maine Orthopaedics.

Junior call varies based on where you are assigned. When at University Medical Center of El Paso, a night float system is used, where a PGY-2 takes in-house night call for approximately 8-10 weeks, evenly split over two blocks. On the weekend, a PGY-2 or PGY-3 will have a 24-hour shift on Saturday, and a different junior resident will have the day call on Sunday. These weekend residents may be on or off-service at University Medical Center of El Paso.

When at WBAMC, juniors (PGY-2 and PGY-3) take nightly home call, roughly every 5 days. Junior residents will usually have one “power weekend” per month, where they are on call over the weekend at WBAMC.

Service members need musculoskeletal care to prepare for deployment. Orthopedic injuries are some of the most common seen on deployment. We teach residents how to treat deployed servicemembers, especially those who are injured during war. We teach our residents lessons regarding definitive Musculoskeletal (MSK) care and the proper evaluation and transfer prior to arrival at a center such as ours. As one of few “critical wartime specialties” the military relevance of orthopaedic care is inherent. We cover damage control orthopedics with a cadaver lab focused on those critical skills with external fixation, fasciotomies, debridement principles, and vascular approaches. Several of our faculty are instructors in the Combat Orthopaedic Trauma Surgery Plus (COTS+) pre-deployment course. We also have our faculty share lessons learned during deployment during a military focused day of didactics in July. This covers different deployment experiences including conventional and special operations, humanitarian, and covers everything from preparation to reintegration. We also hold a quarterly leadership journal club.

In order to augment the resident’s education in orthopaedic surgery and rehabilitation, participation in several courses is integrated into residency. Residents typically will attend one to two supported courses per year after internship. In years with only one supported course, residents are encouraged to take advantage of additional industry-sponsored courses. 

Courses:

• PGY-1: Southwest Orthopaedic Trauma Association (SWOTA) Basic Fracture Care (typically attended by the entire class)
• PGY-2: AO Basic
• PGY-3: Orthopaedic Oncology Course (Enneking)
• PGY-4: AO Advanced
• PGY-5: Board Review Course (Miller Review)

The program utilizes the following simulation activities:

• Dedicated simulation labs for incoming interns that cover all American Board of Orthopaedic Surgery (ABOS) Basic Skills Modules (“Drill Camp” and “Boot Camp”)
• Dedicated Arthroscopy and Arthroplasty skills lab that each require one day of instruction in May of intern year
• Microscope for suture skills
• Focused Microvascular Training (MAYO Microvascular Course) is available based on interest during PGY-3/4 year
• Monthly cadaver labs*
• Local arthroscopy simulation program
• "Sawbones" labs to work on fracture treatment
• Simulation Curriculum - the Director of Surgical Simulation has developed a curriculum to foster planned, well-curated subspecialty instruction along with enough support for senior residents to mentor junior residents through simulated surgical cases
• *The department chair makes sure to excuse residents from clinical duties when the monthly labs are scheduled on “non-academic” days.

Our program requires that residents have one publish manuscript prior to graduation. WBAMC has won the Society of Military Orthopaedic Surgeons (SOMOS) Research Award the last 5 years.

All residents participate with quality and process improvement throughout all five years of residency. These include regular scheduled monthly Morbidity & Mortality as well as quarterly quality improvement (QI) and process improvement (PI) functions. Courses for additional training in the QI/PI process are available, as are opportunities to participate in root cause analysis (RCA) and other military specific processes throughout residency.

Professional Development is a process that is seamlessly incorporated throughout the curriculum. Our job as physicians is only part of our responsibility. Officership and professional military education are important to understanding the patients we serve and the system through which we care for them. Throughout residency, there are numerous opportunities for formal education such as Captain’s Career Course (CCC), Tactical Combat Casualty Care (TC3 if needed), etc...

• University Medical Center
• University of Utah/Shriner (Salt Lake City)
• Rush University Medical Center

Medical students are encouraged to rotate with us! Uniformed Services University of the Health Sciences (USUHS) 3rd year medical students may rotate with us as part of their elective option during their surgery clerkship. Sub-intern and elective rotations are available for 4th year medical students. If you are interviewing, please join us between June and September. Please email us at dha.bliss.william-beaumont-amc.list.wbamc-ortho@health.mil to request an interview and follow our Medical Student Rotation Guidance.

Prior to interviews, we ask for a copy of your Curriculum Vitae (CV) and personal statement. Interviews are conducted during your rotation with us, but we can coordinate a telephone interview/ zoom if you cannot visit us. At a minimum, you will interview with the Program Director, Associate Program Director, and core faculty members. We look for a variety of characteristics in our applicants, including fund of knowledge, scholarship, and professional citizenship. We also listen closely to our residents’ experience with each applicant, especially their ability to work well within the team.

Program graduates take the American Board of Orthoapedic Surgery (ABOS) exams after graduation. During residency, the Orthopaedic In-Training Examination (OITE) is part of the preparation for this process. This ABOS exam is two parts. The first part is a written exam, offered annually, and performed within a few weeks of successful residency graduation. To become fully board certified, successful part 1 applicants then proceed to step 2. Step 2 is an oral in-person examination completed after a period of case collection (typically 6 months) and submission. This exam is completed approximately two years into practice. After successful completion of step 1 and 2, fully trained surgeons are ABOS board certified orthopaedic surgeons.

William Beaumont is a clerkship site for Uniformed Services University (USU), so we frequently have 3rd year medical students rotating with us as an elective option during their surgery clerkship; our residents are their primary teachers. In addition, throughout June – September, we have several 4th year medical students present for audition rotations. Physician Assistant (PA) students and transitional, anesthesia, and internal medicine interns/residents also rotate through our department and provide opportunities for near peer teaching.

• Adult Reconstruction
• Trauma
• Hand, Upper Extremity and Microvascular Surgery
• Shoulder/ Elbow
• Musculoskeletal Oncology
• Pediatric Orthopaedics
• Spine
• Sport Medicine
• Foot and Ankle

Our program strongly believes in the importance of strong mentorship throughout the residency process as well as throughout practice as a lifelong learner. Mentorship is a personal decision and based on an individual fit. Mentor-mentee relationships are encouraged and formalized throughout residency for program participants (residents and teaching faculty). Additional outside mentor-mentee relationships are also highly encouraged.

Residents meet regularly for program sponsored morale events (minor league baseball, lake activities, pickleball, bowling) and for department journal clubs. We have had visiting professors to discuss well-being, leadership, and balance. We have given lectures and readings on recognizing signs of burnout and are vigilant in watching out for our residents. We have a quarterly morale day when residents can participate in team activities.