Responsibilities: Clinical Fellow

As an extension of the faculty, fellows will be responsible for patient care, resident education, and participation in weekly basic science and clinical conferences. Participation in attending staff clinics will provide exposure to patient clinical care and office management.

Research opportunities exist in either the one-year fellowship or in the dedicated research year of the two-year fellowship. University facilities include two PhD-staffed, fully equipped research laboratories in areas of biomechanics and cell biology under the supervision of the Department of Orthopaedic Surgery. Opportunities for both in-house and external grant funding exist for collaboration in valid clinical or basic science research projects.

The goal of the fellowship is to produce a well-rounded spinal surgeon interactive within the medical community. Applicants committed to an academic career will be favored.

The main priorities are:

• Surgery and Patient Care
• Clinic
• Research and Education

Surgery and Patient Care

During the clinical year the fellow will be the primary assistant to the attending physician during surgery. The fellows will not operate independently except under extenuating circumstances (i.e., emergency situations and only if directed to do so by the attending physician).

At UCSF, the fellow will function as a junior consultant and guide the residents running the spinal service ensuring adequate communication with the attending physician. Fellows will be responsible for knowledge of and involvement with patient care on an ongoing basis. Daily patient rounds are a must and should always be made with both the residents and the attending physician when possible. At the very least, the fellow should contact the staff every other day or at any time that a significant change of treatment is entertained, or if a significant medical complication arises.

The fellow may be consulted by the orthopaedic service at San Francisco General Hospital (SFGH). Depending on the urgency of the situation, it may be appropriate to examine the patient and review radiographic studies prior to or with the attending surgeon. Patients being followed by the UCSF spine service while they are inpatients at SFGH should be personally seen by the fellow on Pod #1 or 2 as well as the SFGH residents and then on a qod or daily basis as indicated thereafter.

Admission history and physicals are the ultimate responsibility of the resident on the spine service. The fellow may be required to handle this depending upon the needs and workload of a specific day. The fellow will examine all new patients at the time of admission or, if the resident has done the history and physical, the fellow should provide a note to the chart. The fellow will be responsible for ordering appropriate x-rays, the accuracy of measurements made on the x-rays, and ensuring that x-ray summary folders are completed.

History and physical examination on readmission for treatment is likewise the ultimate responsibility of the resident, however, the fellow is responsible for assuring that the history and physical is done properly. He/she should see these patients, review important data with the resident, and be certain that appropriate x-rays are obtained and measured.

Notes shall be written on the patient’s chart the night of surgery and each day following. Post-operative follow-ups are the absolute responsibility of the fellow. At UCSF, the fellow functions as a consultant and should allow the resident to make many of the primary decisions, but guide him/her appropriately.

At the UCSF/Moffit/Long hospital, the discharge summaries are the responsibility of the chief resident.

Clinic

Fellows will be expected to be at all clinic sessions with the attending physicians if they are not in surgery. This is an excellent opportunity for learning and teaching; it particularly provides a unique opportunity to develop judgment skills.

Research and Education Projects

All fellows are expected to participate in at least one research project, which should be supervised by an attending spine surgeon. The fellow is encouraged to start early in order to prepare abstracts for submission by March or early April. The first draft of the paper should be completed prior to the end of the fellowship. The fellow is given first authorship on these papers if he completes at least the first written draft prior to the conclusion of the fellowship. If however, the attending physician has to complete the paper, or a major rewrite is needed, the fellow will forgo the privilege of being first author.

Conferences

Fellows will be expected to attend and participate in the scheduled conferences at UCSF.

UCSF/Moffit-Long Hospital

Monday 7:00 Spine lecture series – every other week 5:00 pm spine conference – Inman resident’s room

Wednesday 7:00 Grand Rounds

Thursday 7:00 Attending rounds/orthopaedic service – HSW 303

At the weekly Monday spine conference, fellows are responsible for presenting or guiding the residents in presenting concise patient histories, including relevant radiographs using these guidelines:

• Surgery recommendations (from the previous week of clinics)
• Post-operative cases (all those scheduled by Saturday the weekend prior)
• Interesting cases and follow-ups
• The x-ray summary folder should be complete prior to conference and is the responsibility of the fellow.

Fellows are encouraged to attend weekly university functions and are particularly expected to attend conferences that are on a spine related subject.

Spine Journal Club

The fellow will run a monthly spine journal club with the cooperation of one of the spine attendings on a rotating basis. Spine, Journal of Spinal Disorders, JBJS, or other appropriate material may be discussed.

Teaching

Fellows are basically junior consultants and have the responsibility for supervising and assisting the university orthopaedic residents as necessary. They are expected to make rounds with them and teach and assist them in the day-to-day decision making process.