Orthopaedic Traumatology Advanced Clinical Experience (OTACE) Program
(Trauma Fellowship ACE)
The Orthopaedic Traumatology Advanced Clinical Experience (OTACE) is a 12 month program designed for board eligible orthopaedic surgeons, after their residency training. The OTACE curriculum satisfies the developing criteria for a Certificate for Specific Expertise in Orthopaedic Traumatology. This experience exposes the orthopaedist to the organization and management of a trauma center, and to the function of the orthopaedic traumatologist in this setting.
The Advanced Clinical Experience in Orthopaedic Traumatology goal is to facilitate the development of an outstanding orthopaedic trauma surgeon. The OTACE can organize a trauma team that adequately manages problems of polytraumatized patients, in academic or non-academic settings. The OTACE possesses a solid clinical foundation, as well as advanced traumatology skills.
Duration: One year (August 1-July 31).
Locations: Harborview Medical Center, University of Washington Medical Center
The twelve month Advanced Clinical Experience in Orthopaedic Traumatology is a complete experience involving patient care, teaching, and opportunities for basic and clinical research. The Orthopaedic Trauma ACE rotates through three individual clinical services. The clinical rotations are 3 months in duration. Each service or team consists of the OTACE, a chief resident, two junior residents, and medical students. Fourteen full-time experienced faculty members are divided among the teams. Each team has subspecialty emphasis and dedication. Trauma related team subspecialty areas include spine, foot/ankle, complex articular, pelvic/acetabular, amputation, soft tissue reconstruction, upper extremity, deformity reconstruction, among others.
Clinical experience and teaching are profuse. The clinical component of the OTACE introduces the orthopaedist to many operative and nonoperative techniques used in polytrauma with special emphasis on stable internal fixation. Advanced and innovative techniques of internal fixation are emphasized.
The OTACE takes call on average every third night for 9 months. The primary on-call responsibilities in the hospital belong to the junior and senior UW HMC orthopaedic residents. One junior resident is assigned to the ward, and one to the Emergency Department. The OTACE may take call from home, or in the hospital with the team. An attending faculty member participates on call with the team each night.
The OTACE works in the assigned team's orthopaedic clinic one day per week. The OTACEs clinical responsibilities include operative procedures as surgeon and assistant, daily ward rounds, and emergency patient care along with the chief or junior resident. The average ward census for an ACE is fifteen to twenty patients covered primarily by the junior orthopaedic resident, supervised by the chief resident. One elective operating day per attending is assigned, and other operative procedures are scheduled throughout the week.
The fourth three months rotation is dedicated to research. At least one basic science or clinical project is required during the year. Ideally, a clinical project is a prospective clinical trial. A trauma data base facilitates other clinical projects. The facilities for basic science research are located in the new Research Building at Harborview. Biomechanical studies related to internal fixation of numerous fractures have been designed and implemented by former OTACEs. Similarly, almost any investigation can be developed.
The orthopaedic conference schedule includes a Monday morning resident education conference from 7:00 a.m. to 10:00 a.m. at the University of Washington. Most OTACEs do not attend these mandatory conferences for residents. Grand Rounds occur the first Monday of each month at the Virginia Mason Clinic, located adjacent to Harborview. On site Wednesday morning teaching sessions, held at Harborview from 7:00 a.m to 9:00 a.m., involve case presentations by the ACE and/or chief resident. In addition, weekly traumatology teaching rounds occur every Thursday at 5:00 p.m. Each Friday morning, a one hour pelvic/acetabular teaching session emphasizes these difficult injuries. Monthly spine conferences are held in conjunction with the Neurosurgical department. An annual pelvic and acetabular cadaveric lab and skills workshop for OTACEs, senior residents, and AO fellows is held.
In 1966, the University of Washington assumed control of the King County Medical Center, which then became Harborview Medical Center. Donald Gunn, M.D. was the Chief of Orthopaedics at Harborview Medical Center in 1968-9, and Sigvard T. Hansen Jr., M.D. was the Chief Resident in Orthopaedic Surgery. D. Kay Clawson, M.D. was the Chief of Orthopaedics for the University of Washington, of which Harborview Medical Center was a major component.
In 1971, Dr. Hansen visited Gerhardt Kuntscher and learned advanced techniques of medullary nailing. He was involved in the early North American AO/ASIF development and, in particular, worked with Hans Willenegger.
In 1972, Dr. Hansen became chief of Orthopaedics at Harborview Medical Center and established the roots of aggressive management of long bone and pelvic fractures. In 1973 Drs. Clawson and Hansen attended the AO Course in Davos, Switzerland. Thereafter, stable fixation became the treatment of choice at Harborview. Dr. Robert A. Winquist began his six years Harborview tenure in 1974. He gained extensive clinical experience with closed medullary nailing of femur fractures, as well as open reduction and internal fixation of metaphyseal and articular fractures.
The first Advanced Clinical Experience (ACE) in Orthopaedics was obtained by Dr. Jos Stuyck of Belgium in 1979. Since that time, there have been over 100 orthopaedists trained in traumatology at Harborview Medical Center through the ACE and AO Fellowship programs. AO Fellowships are 1-3 months scholarships administered through Harborview Medical Center and funded by AO International.