Department of Orthopedic Surgery: Non-operative Pediatric Fellowship
What is non-operative pediatric orthopaedics?
What is the need for a non-operative pediatric orthopaedic fellowship?
History of the fellowship
Faculty
The University of Wisconsin Department of Orthopedics and Rehabilitation
The University of Wisconsin Children 's Hospital and the Department of Pediatrics
Fellowship Responsibilities
Application Guidelines
Introduction
The University of Wisconsin is proud to cointinue our tradition as the first program to offer a formal fellowship in non-operative pediatric orthopedics. This one-year fellowship aims to develop pediatricians with the expertise in the care of children with musculoskeletal issues. Our graduates have succeeded in securing desired positions with pediatric orthopedic groups supportive of this model of care.
The fellowship lasts one year, beginning July 1 and ending June 30. Employment opportunities will be actively sought by the fellowship directors to assist the fellow in securing a faculty appointment with an academic institution or partnership in a pediatric orthopedic group.
What is non-operative pediatric orthopaedics?
Pediatric orthpaedics encompasses the range of musculoskeletal issues from birth to adulthood. Examples of commonly encountered issues include:
1. Congenital/neonatal disorders, such as developemental hip dysplasia, clubfoot, torticollis, metatarus
adductus and limb deficiencies.
2. Disorders of growth, including variations in gait (intoeing, outtoeing, toe-walking), genu varum/Blount
disease, genu valgum, leg length discrepancy, Legg-Calve-Perthes disease, slipped capital femoral
epiphysis and scoliosis.
3. Neuromuscular diseases such as cerebral palsy, spinal muscular atrophy, spina bifida, muscular dystrophy.
4. Trauma
5. Benign and malignant bone and soft tissues lesions
6. Infectious disease, especially septic arthritis and osteomyelitis.
7. Sports medicine is a small component of pediatric orthopaedics that encompasses its own specialty.
8. Diagnostic delemmas commonly present in the form of children with limp or unexplained pain,
developmental delays or joint swelling.
The majority of these issues presenting in children do not require surgery and may be appropriately managed by a primary care physician with sufficient training in musculoskeletal medicine and the principles of orthopedics, hence the role of the non-operative pedeatric orthopaedist. Most primary care residency programs dedicate little or no time to the education of their residents in regards to pediatric orthopaedics, providing ample referrals.
The fellows receive sufficient training to identify and manage the non-operative components of the aforementioned diseases, as well as many others. Procedural training includes the Ponseti management of clubfoot, joint aspiration and injection and fracture reduction/splinting/casting.
What is the need for a non-operative pediatric orthopaedic fellowship?
A recent survey of pediatric orthopaedic surgeons in the United States has revealed that the average age of the pediatric orthopaedists is 52. Thirteen fewer fellowship trained pediatric orthpaedic surgeons are produced annually than are needed to meet the workforce deficit generated by those retiring. The surgical demands placed on the remaining surgeons requires more than full-time attention. The remaining clinical demands add an additional workload that could be partially supplanted by non-surgical partners. Pediatric orthopaedic groups have chosen a variety of models to deal with this by using nurse practitioners and physician assistants. Defferent models work well for different groups.
We have found the role of the non-operative pediatric orthopedist to work well for our practice, as have other institutions who have hired our fellows. This model already exists for neatly every subspecialty (urology-nephrology, cardiothoracic surgery-cardiology/pulmonology, general surgery-gastroenterology), but the closest correlate is in the field of sports medicine, where primary car physicians work as partners with surgical specialists in the non-operative managementof sports - and recreational - related injuries in older children and adults. Additional benefits of a physician in the role of a non-operative partner include the ability to play a formal role in medical student and resident education, as well continuing medical education for physicians, especially those in primary care.
History of the fellowship
The University of Wisconsin Non-operative Pediatric Orthopaedics Fellowship was initiated in 2004 by Dr. Kenneth Noonan, funded by the Department of Orthopaedics and Rehabilitation and the Department of Pediatrics, training Dr. Blaise Nemith as the first fellow. Due to the success of the initial venture, funding to develop a formal fellowship was sought and secured through an unrestricted educational grant from EBI with additional support from the Department of Orthopaedics and Rehabilitation.
Past Fellows:
Year of Graduation |
Fellow |
Current Institution |
|---|---|---|
| 2007 | Becca Carl | Children's Memorial, Chicago |
| 2008 | Robert Montero | University of Virginia |
| 2009 | Sheila Chandran | Cincinnati Children's Faculty |
Faculty
Fellowship Directors:
Pediatric Orthopaedics:
Sports Medicine:
Greg Landry, MD
Kathleen Carr, MD
Spine Medicine:
Pediatric Rehabilitation:
The University of Wisconsin Department of Orthopedics and Rehabilitation
The Department includes surgical specialists in the fields of spinal surgery, sports medicine, hand surgery, foot and ankle surgery, joint replacement, oncological orthopaedics, orthopaedic trauma, in addition to pediatric orthopaedics. Additionally, the Department includes faculty in the specialty of adult and pediatric rehabilitation, primary care sports medicine and post-doctoral research specialists. There are five residents per year, 25 total, in addition to one surgical fellow in sports medicine and one in spine.
Currently, children with pediatric orthpaedic issues are evaluated and treated either in the pediatric orthopaedics clinic in the American Family Children's Hospital, the Spine Clinic at Research Park , the Middleton Rehabilitation clinic or the Waisman Center.
The American Family Children's Hospital and the Department of Pediatrics
The AFCH is a 60-bed free-standing children's hospital. As a tertiary care center, referrals are drawn from southern, central and northeastern Wisconsin , northern Illinois , the Upper Penninsula of Michigan and northeastern Iowa . The hospital also cares for children with medical illnesses common in the community setting.
The Department of Pediatrics includes specialists in all areas of pediatrics, as well as a large group of primary care pediatricians with both academic and community affiliations and all pediatric surgical subspecialties. There are thirteen residents per year and one chief resident. Fellowships include sports medicine, endocrinology, pulmonology and allergy, intensive care, and hematology/oncology.
Eligibility
Applicants must have finished, or be scheduled to finish, a pediatrics (or related) residency program from an ACGME-accredited institution prior to the anticipated fellowship start date.
Fellowship Responsibilities
Education
The fellow will gain knowledge in pediatric orthopaedics through patient care, faculty education, conference attendance, and directed self-education. The fellow will also attend 3 high-level conferences:
-The International Pediatric Orthopaedic Symposium
-The annual meeting of the Pediatric Orthopaedic Society of North America
Clinical care
The fellow will participate in patient care in the outpatient settings at the AFCH. Clinical responsibilities will consist primarily of those in pediatric orthopaedics, but will also include sports medicine, spine medicine, rheumatology and rehabilitation. Additionally, the fellow will gain experience in fracture reduction in the emergency room and inpatient consultations regarding pediatric orthopedic issues.
Teaching
The fellow will be responsible for presenting on pediatric orthopaedic issues to the orthopaedic residents on a quaterly basis. The fellow will be required to present one Grand Rounds to the Department of Orthopaedics and Rehabilitation. The fellow will also participate in medical student education in the musculoskeletal module during the second year medical school curriculum. Other medical school and community educational opportunities are available and left to the discretion of the Fellowship Directors and the participating fellow.
Research
Each fellow will be required to participate in a research project during the one-year fellowship. A number of projects are underway at any given time and available as opportunities. Additionally, new projects may be developed tailored to the incoming fellow's interests and expertise. The fellow's research will be presented at the Department of Orthopaedics Research Day and submission for publication will be expected.
Benefits
Salary and benefits will be the same as those offered at the PGY-4 level for all post-graduate trainees at the University of Wisconsin Hospital. Benefits include health insurance, disability insurance and liability insurance. Additional catastrophic, dental, disability and life insurance are available at group rates.
Leave
Each fellow is afforded 4 weeks of vacation/conference time and paid holiday time. The fellow will also be provided registration, transportation, room and board for the three required educational conferences (Ponseti, IPOS and POSNA).
Application
Completed applications may be submitted at any time throughout the year but must be received by August 31 in order to be considered for a position starting the following July. Applicants will be contacted the first week of September regarding interviews.
Additional questions may be directed to either :
Blaise Nemeth, MD, MS Kenneth Noonan, MD
K4/731 Clinical Science Center K4/731 Clinical Science Center
600 Highland Avenue 600 Highland Avenue
Madison, WI 53792-7375 Madison, WI 53792-7375
(608) 263-1344
(608) 263-1344
nemeth@ortho.wisc.edu noonan@ortho.wisc.edu
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First published: 07/15/02 Last updated: 11/07/09
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