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Intern year is comprised of 6 months of ‘on-service’ orthopedic rotations and six months of ‘off-service’ non-orthopedic rotations. There are three orthopedic rotations you complete twice each per year, but six different off-service rotations to increase your exposure to various hospital systems and enhance your broad patient management skills. 

Ben Taub
Ben Taub provides an opportunity to work at one of the busiest Level 1 trauma hospitals in the nation. This rotation is widely regarded as one of the most intense but also most valuable rotations of the intern year. Expect to see virtually every manifestation of every orthopedic injury. As the intern, you hold the pager from 6 a.m. to 6 p.m. and are responsible for all consults and floor pages within this time frame. This is an excellent rotation to learn how to acutely manage and triage orthopedic traumas. You often show up close to 5 a.m. to round on your patients and prepare for sign-out before consults start flowing in. After presenting the consults from the day before and updating your progress notes, you spend the day attending to consults and making sure there are no issues with floor patients. You will reduce and splint countless fractures, place multiple traction pins, perform revision amputations and nail bed laceration repairs, and develop and execute treatment plans under the guidance of senior residents and attendings. Most days, the work takes past 6 p.m. to finish up, but the experience gained is unparalleled. 

Texas Children's Hospital
TCH is one of the premier pediatric hospitals in the U.S., and as such, it draws orthopedic patients from all over the world. Similar to Ben Taub, the intern holds the pager from 6 a.m. to 6 p.m., with daily sign-out at these hours. After morning sign-out, days will often start with an education-based conference to learn about topics ranging from the management of pediatric MSK tumors to neuromuscular scoliosis. After the conference, your daily responsibilities include rounding and managing consults and floor pages. This is an excellent opportunity to learn how to treat common acute pediatric injuries. The consult volume is very manageable, so there is also adequate time to scrub into the OR to assist on cases treating virtually every pediatric orthopedic condition imaginable. Sign out to the overnight resident at 6 p.m. and head home for the day. 

VA
The VA rotation is the busiest orthopedic VA in the United States. This rotation provides an excellent opportunity to hone your clinical exams across various orthopedic subspecialties with supervision from senior residents and attendings. Daily responsibilities include holding the pager from 6 a.m. to 6 p.m., seeing patients in the subspecialty clinic of the day, and attending consults and floor pages. Generally, you will arrive between 4:30 a.m. and 6 a.m. to round on patients and get everything squared away, with patients heading to the OR before heading to the conference and/or clinic. Each day of the week covers a different clinic, including sports, joints, upper extremity, hand, foot and ankle, and spine. Clinics are very busy, but the rotation serves as a staple for clinical skills development early in residency.

Off service: Off service rotations include ER, neurosurgery, plastic surgery, vascular surgery, radiology, and SICU. Each rotation has different sets of rotation expectations and will provide different opportunities to work on orthopedic adjacent and broad patient management skills alike. You will operate a lot and learn wound management on plastics, work in the neuro ICU and see spines on neurosurgery, triage emergency patients in the EC, work on surgical skills and vascular anatomy on VA vascular, learn the ins and outs of SICU management, and study for step 3 and work on imaging interpretation during radiology.

The PGY-2 year as an orthopedic surgery resident carries several responsibilities, including ensuring patients are receiving excellent care, preparing patients for the operating room, seeing consults, managing the orthopedics service when taking overnight call, and starting your leadership development. The PGY-2 year carries an increase in responsibility, notably ensuring the interns develop their treatment plans appropriately for consults in the daytime. We work at Texas Children’s Hospital, Ben Taub Hospital, the VA, McNair, and Kelsey Seybold. Most days start at 4:30 a.m. with rounding on your inpatients followed by preparing to see patients in the clinic or the operating room. During the daytime, we have the great opportunity to help the interns work through consults and offer advice that aids both our and the interns' education. The typical day in the clinic may end at 5 p.m., and the last surgical case may end at 6 p.m. 

For days when you are taking overnight call, you will pick up the pager from the intern at 6 p.m. A typical night on call can yield anywhere from zero to eight consults that must be ready for team sign-out at 6 a.m. Overnight call may be daunting; however, a great aspect of our program is the availability of help in the form of different levels of upper-level residents and ultimately the attendings. On days that you are not on call overnight, the afternoon is used to prepare for the next day’s operative cases. 

The PGY-2 year is regarded as one of the toughest years in orthopedic surgery residency, and for good reason—your knowledge base and confidence grow exponentially, which is invaluable in your development as an orthopedic surgeon. During my free time, I enjoy being at home with my wife and dogs as well as going hiking. Many of my colleagues use the time to travel, raise a family, and spend time with friends. It is often said that “the days are long, but the years are short” in regard to residency. I feel that the PGY-2 year is the start of appreciating that statement—the year goes by exceptionally fast.

Texas Children’s Hospital 
The drive from the Medical Center to Texas Children West Campus is about thirty minutes but well worth it. It runs as an ambulatory surgery center with great turnover time. The nurses/scrub techs you work with have tons of experience with orthopedic cases, and most of the attendings have their own physician assistants to help with notes, orders, consents, and more. You'll mostly work with three peds sports attendings and the peds hand attending physician. There are no fellows, so you are always one-on-one with the attendings. There's lots of ACL tears and patella instability cases, with the occasional trauma case. You will receive a lot of experience. You're usually operating every day and occasionally go to the clinic. There is no rounding. You still take in-house call at the Medical Center, but everyone is good about letting you leave early enough to make it there. There's a weekly morning conference on Thursdays. 

Sports 
You get to work with one of the Baylor sports attendings for the entire rotation. It's great because he is extremely experienced, and you get to learn a very consistent/reproducible way to do knee/shoulder diagnostic scopes and simple arthroscopic procedures. He's an excellent educator who really takes his time to make sure you understand everything and teaches you how to avoid common pitfalls. He has a PA who does all the periop notes, orders, and closes skin, and in clinic he does all the joint injections. The clinic and OR time are mostly at Baylor McNair next to the VA, but he also has a Friday clinic at the St. Luke's San Felipe clinic about thirty minutes away. There's a weekly morning conference on Monday mornings and also a monthly sports journal club at night, usually at a nice restaurant. There's also a sports fellow with you. There is no rounding. 

Joints 
You get to work with three of the arthroplasty attendings. This is a very operative heavy rotation. You will round on post-ops at McNair, but most of our patients go home on the same day of surgery. You will work with the adult reconstruction fellows. There are two nurse practitioners who help out with the clinic. You're going to get lots of experience with primary total knees and also anterior hips. 

Upper extremity 
The upper extremity rotation offers a comprehensive learning experience with a strong focus on both the specialties of shoulder, elbow, and hand. The rotation seamlessly integrates experiences from both the VA and the private side at Baylor McNair, with a higher ratio of elective cases. We have a balanced allocation of two and a half days in both the operating room and clinic. A notable feature is the deliberate scheduling to avoid any overlapping with the four hand fellows. Exclusive OR days for residents and fellows ensure one-on-one interactions for our residents with attendings. Additionally, the dedicated week for a microsurgery course adds a valuable dimension to the rotation, allowing residents to focus on honing microsurgical skills. 

Ben Taub 
Our level 1 trauma hospital offers an unparalleled trauma experience, involving four days in the operating room and one in the clinic. This recent schedule adjustment, based on resident feedback, allows a day for reflection and much-needed rest, conveniently placed midweek on Wednesdays. Since there are no trauma fellows, the three spend significant time with the attending during complex cases. The trauma service operates entirely under resident management and coverage. Some days, the three may be paired with a chief who guides them through routine fracture cases. Call is home call unless there are operative cases to cover. Typically, we are on call for two weekends a month, as well as once a week for a midweek day. 
 
MD Anderson 
Exciting opportunities await at the world's premier cancer institution, providing exposure to a diverse range of pathologies and surgeries. While oncology may not suit everyone, the experience is unparalleled. Typically, you are in the operating room twice a week, clinic twice a week, and spend the last day on consults, unless there is a specific need in clinic/OR. Night call once a week, usually as home call, with rare in-person requirements. Weekend on-call duty extends from Friday night to Sunday night once a month, with minimal OR cases, primarily involving morning rounds and occasional post-round consults. Additionally, you are part of the Ben Taub call pool for two extra weekends per month to cover operative cases.

The PGY-4 year at Baylor is one of the best, if not the best! One of our busiest, but best, rotations is trauma at Ben Taub General Hospital. The day usually begins around 5 AM–5:15 a.m., We have fracture rounds where consults from overnight and the day before are presented by our PGY-2 and intern, respectively. We run the list of patients, of which I have a few to several depending on how the service looks. Our chiefs, with the attendings, are generally in charge of helping staff consults from overnight, but I do participate in helping juniors make plans and plan for the cases that day. 

At 7:30 a.m., I am off to the operating room. We generally run three to five rooms a day at Ben Taub. We have two chiefs, a PGY-4 and a PGY-3/PGY-2, in the operating room depending on the day. This means that I ‘run’ my own room. Prior to the start of the cases, I will have run through the plans for the three to four cases with the attending on that day. 

The day is then off! Depending on the complexity of my cases or how the other cases are going, I am generally left to work through the case on my own, calling as needed for help. Straightforward ankle and femur fractures are great cases at my level, and I get the experience of making intraoperative decisions on my own. The attending pops their head in at the end of the case to review and give the ‘thumbs up’ or the ‘I’m going to scrub in and show you something’. The latter is helpful, and the learning as a PGY-4 is excellent. 

Between cases, I complete rounds on patients I had previously operated on, handle their orders, or discharges. Back to the operating room where we are working on a complex patella fracture, where the attending scrubs in with me to show his technique while I execute the steps with him watching and providing feedback. It's now time to go home after a solid day of three to four cases where I was either by myself, walking a junior through a simple case, or being shown the nuances of complex cases by an attending. I drive home, and just when I pull into the garage, I'm called by the on-call PGY-2 about a stat mangled extremity with thigh compartment syndrome! I rush back to the hospital and meet Dr. Atassi there. Together we perform emergent fasciotomies and a rescue femoral nail. I walk the patient to the ICU, complete my notes, and say goodnight to our in-house PGY-2 at 10 p.m. I get home, greet my wife, and try not to wake up our kids. I fall asleep and wake up to do it all again the next day. 

The day wraps up at variable times, and when I'm not on call, I'm often home by 5:30-6:30 p.m. When I am on call, it's a backup operative call. Usually, I come in 1 out of every four to five times on call, so it's not too burdensome. Our other PGY-4 rotations include sports, foot and ankle, the VA (mostly joints with similar autonomy to Ben Taub), spine, and Texas Childrens as the rotation chief. Hours vary, with 8 a.m. to 4 p.m. on foot and ankle and sports to the longer hours of trauma and everything in between. PGY-4 is the year, and things start to click; confidence and knowledge grow exponentially, and the attendings start to really trust you.

The Chief year at Baylor is the best year overall. It is the year where everything comes together, and we really get to hone our craft and knowledge. Our rotations are broken up into elective, private trauma (at St. Luke’s Hospital), Ben Taub trauma chief, Ben Taub flex (sports) chief, VA chief, and VA sports chief, each for two months. 

While at Ben Taub and the VA, we are responsible for leading the team in rounds, running consults, and even scheduling surgeries. We run our own room with an attending backup and walk junior residents through cases. Administrative work also gives us insight into working with hospitals and surgery schedulers and also working with medical device representatives and learning different systems and what differences/advantages they offer for a given case. At Ben Taub, the day often begins around 5:45-6 a.m. with rounds, includes administrative duties, and often 3-4 cases. At the VA, the day may start a little later, 6:30 a.m., with similar responsibilities. The case load at Ben Taub is largely trauma with some basic sports cases mixed in. The case load at the VA is heavy arthroplasty and sports, with some basic trauma. It is a great eight months between the two for us as chiefs to make clinical and operative decisions while running our own room and the team, with attending backup. It is a learning curve but quite rewarding and really builds confidence going forward into fellowship and practice. 

I recently just returned home from my two-month elective rotation in which I performed a visiting Shoulder-Elbow Fellowship in Munich, Germany. We all have the opportunity as chiefs to perform 2 months of elective time anywhere we would like. The department gives one grant to a PGY-4 each year for this purpose, but there are other funding sources that can be obtained. It is a clear advantage that our program offers. I will be forever grateful for the two months in Munich, the connections I made, and the incredible learning experience. I was a part of more than 100 shoulder/elbow procedures, attended a German Shoulder Conference, and participated in a shoulder arthroplasty course at Arthrex in Munich. 

Currently, I am rotating on the private trauma rotation at Baylor St. Luke’s Medical Center. There are no administrative responsibilities and very minimal rounding work. It is all operating. Unlike Ben Taub or the VA, it is one-on-one with our spectacular trauma attendings (the same with which we work at Ben Taub). This has been my favorite rotation of residency, as it is a place where I feel my understanding of indications and the nuances of surgery have been expanded. Having the opportunity to have operated on my own as a PGY-4 and other rotations as a chief prior to this rotation has enhanced the experience. It is a slower-paced rotation where I’ve learned about billing and coding, how to start and run a practice, what to expect when first in practice, contracts, and particularly indications and tips and tricks in trauma surgery. The day begins around 7:15 a.m. and is usually finished by 4 p.m. at the latest. 

Lastly, as chiefs, we each have an additional responsibility in the residency, such as administrative chief, academic, journal club, etc. My responsibility is the academic chief, which involves coordinating the residency didactic experiences on Wednesday mornings, leading our OITE review sessions, and meeting with residents and medical students to coordinate research opportunities. Chief year is the year it all comes together. The best year of residency!