Related posts:
- First Posting (Orthopaedics)
- I Started My Housemanship – 1 Month Check In
- Do I Regret Choosing Medicine? – Why Did I Pursue Medicine?
- A Personal Trait That I’m Most Proud Of
- Recharging Myself During Slow Days
- Something I Remind Myself Constantly, Especially On Bad Days As A Junior Doctor
“Orthopaedic surgery or orthopaedics is the branch of surgery concerned with conditions involving the musculoskeletal system.”
– Wikipedia
In short, it is concerning the bones and soft tissue involvement, should there be a trauma, causing even a simple laceration to a fracture or an infection of the superficial tissues up till the bone.
The Orthopaedics Posting is my first posting during my housemanship journey. According to many, it is considered a “chill posting” where the patients are mostly stable and the procedures are less and the people or our bosses are one of the nicest.
Chill? I beg to differ. Perhaps because it is my first posting to begin with.
1. Teams / Subspecialties
Depending on the hospital, the system may vary slightly. Where I’m at, the posting is divided into General Team and subspecialties such as “Peri”, “POW”, “Artho”, “STT / Advance Trauma”, “Tumour”, “Spine”, “SFAT & DFU Clinic”, “Hand” and “RCBM”.
Each of the subspecialties only has one houseman except the Spine Team which has 3 house officers. The rest are in General which is then divided into two main wards, the Male Orthopaedic Ward (MOW) and Female Orthopaedic Ward (FOW). Throughout my whole time in Ortho, I was in the General Team all throughout. I started of in Female Ortho Ward for a month before they shifted me into Male Ortho Ward, thankfully.
2. Shifts
In the General Team, we have a variety of shifts which makes the whole experience “wholesome”, which are “Tag”, “SD”, “LD”, “ON”, “ETD AM”, “ETD PM”, “EMOT AM” and “EMOT PM”.
What are all these abbreviations?
“Tag” or “Tagging” is something all of us have to go through when we first enter the department. It is a compulsory 2-week period starting from 7am-10pm (on paper) with only one day of break in a week. It is the most tiring period that all of us have to go through and it challenges us both physically and mentally.
After we have “off-tag”, meaning we have completed our “off tag assessment” with our respective mentors or completed the two-week period (whichever comes first) is when we begin to experience the rest of the shifts.
“SD” or “Short Day” starts from 7am-5pm (on paper) and that basically means that we will be in our respective ward placement. We will not be in charge of the acute beds (usually).
“LD” or “Long Day” starts from 7am-7pm and they are usually in charge of the acute beds. Acute beds are beds situated in front of the nursing counter. They are usually kept under strict observation because they are quite unstable.
“ON” or “On Night” starts from 7pm-8am and they take care of the ward at night, basically taking over the duties from the person who is “LD”. Other than being in charge of the ward alone at night, they are responsible for updating the patient master-list and are in charge of allocating the beds to the housemen the following day. Meaning, they have to have the allocations ready by 6am and have it sent in the ward WhatsApp group, so the “SD” and “LD” will know of which bed to take care for the day. In addition to that, they are also in charge of “cm bloods” or “coming morning bloods”. Yes, it’s not centimetre bloods. Usually there will be a list sent in the WhatsApp group and the forms and tubes will be prepared by “SD” and “LD”.
The cm tubes and forms prepared will be stored and the bloods will be taken after midnight and sent to the respective labs by morning. Besides this, the “ON” has to trace the bloods sent and chart them.
Lastly, not forgetting, the “ON” person is also responsible for post-operative review and has to attend to any acute issues or active complaints in the ward.
Sounds like a lot of responsibility for one person, doesn’t it? Especially if you have just started, it can seem rather overwhelming. However, fear not, it’s actually quite fun.
“ETD AM / ETD PM” is short for “Emergency & Trauma Department AM shift and PM shift”. The AM shift is from 7am-7pm while the PM shift is from 7pm-7am. However, both are required to attend the morning handover which is in the “Old Ortho Clinic” on weekdays or the “level 6 Handover Room” during weekends and public holidays. Prior to the morning handover, we are required to create a WhatsApp group, in which, we have to add the medical officer on call for that day, the ward call, registrar as well as the other house officers in General Team who are “EMOT AM / EMOT PM”, “SD” or “LD” for the day as well as the “Peri house officer” and the house officer in charge of “Paeds Ortho Ward, POW”. Whenever, the “ETD Call” or “Ward Call” receives a call for a new referral of patient, the list gets updated and the “ETD houseman” has to look for the patient either from Green Zone, Yellow Zone or Red Zone, update the name and ID as well as to upload the x-rays and clinical photos onto the group. If there is time, to clerk the patient as well while awaiting the medical officer to arrive.
At the end of the day, if the patient gets admitted, be it under Ortho or for Ortho to review as Peri Team, we are required to make the presentation slides.
The presentation slides will include the patients’ information, any co-morbidities, history of presenting complaint, vitals, physical examination, clinical pictures, x-rays, any important investigations, diagnosis and also the plan (management).
Being the “ETD PM” houseman, it is important to complete the slides before the handover. So yes, if there were to be a total of 10+ admissions during your shift, then there would be a lot of slides to make and apart from being the first responders and assisting, we’ve got a plateful of duties.
“EMOT AM / EMOT PM” is short for “Emergency Operating Theatre AM / PM” meaning any case posted under emergency, not elective surgery. The EMOT AM shift starts from 7am-7pm and the EMOT PM shift starts from 7pm-7am.
Basically, being an “EMOT houseman”, you are the surgeon’s assistant. The surgeon might be the “OT Call” which is a medical officer, a registrar or the specialist.
When there is a case that is going to be called, the nurse will alert the EMOT house officer first (provided that you have left the phone number with them), then it is our duty to alert the surgeon and prepare the necessary equipments, call the radiographer if needed and to alert the surgeon upon the patients’ arrival to the airlock.
Once the patient has arrived at the airlock, the EMOT houseman has to inform the surgeon, prepare the antibiotics and write the patient’s details on the whiteboard in the OT while the patient is being assessed by the nurse and the anaesthetists.
After the patient has been pushed to the OT, the EMOT houseman has to help arrange the patient according to the position needed by the surgeon, which is most of the time supine, insert urinary catheter if needed and finally, to scrub in!
This is the best part. After we have scrubbed in, the patient will be prepped for operation, meaning the limb that will be operated on will be painted and draped with green towels. Once the patient is set, it is time to “Time Out”. “Time Out” basically means that we have to read the patient’s details, op planned, nurses and doctors involved by the EMOT houseman on the whiteboard earlier.
3. Rounds
Rounds during weekdays is three times per day, early in the morning (AM rounds), in the afternoon (PM rounds) and at night (On-call rounds). However, on-call rounds are only for the patients in acute beds or for any newly admitted patients from the emergency department.
On weekends or public holidays, rounds are only in the morning (AM rounds), usually without a specialist and also on-call rounds (with the specialist).
4. Must-Know Procedures
Apart from the regular blood taking, ordering scans, carrying out the job-lists, attending to the patients’ issues and being a surgeon’s assistant, there are a few important procedures that an Orthopaedic House Officer should be aware of as they’re frequently being carried out in the wards, emergency department and also in the operating theatre.
Here is a list of a few procedures that I can remember off-hand:
- Wound desloughing
- How to prepare POP slabs (Backslabs / Casts)
- Vacuum dressing
- Closed Manual Reduction (Usually doen with a medical officer / registrar / specialist but it is good to know)
- Applying skin traction
- Toilet and suturing
This basically covers the short introduction to the Orthopaedic Posting in the General Team. I’ve yet to experience being in subspecialties and hence, I am unable to share my experience for the others.
Personally, I love hands on procedures and the Orthopaedic posting is a very hands on as well as houseman dependent posting.
If you have yet to begin or have just started your rotation in the Orthopaedics posting, I bid you “good luck”. Albeit it being a tiring posting, it is nonetheless a fun one once you are familiar with the order and the system.
Till then, stay amazing, stay strong and always have faith!
Related posts:
- First Posting (Orthopaedics)
- I Started My Housemanship – 1 Month Check In
- Do I Regret Choosing Medicine? – Why Did I Pursue Medicine?
- A Personal Trait That I’m Most Proud Of
- Recharging Myself During Slow Days
- Something I Remind Myself Constantly, Especially On Bad Days As A Junior Doctor
The Theoretical Doctor 