Residents review patient charts and x-rays prior to the session. A prerequisite for having a resident participate actively in surgery on most private and ward patients is the successful justification of the rationale behind the treatment plan. Selected original articles are recommended and a review of the anatomical approaches is emphasized. At the present time, just over one-half of the services have formal Indications Conferences. This involves taking a history and performing a physical examination commensurate with the type of injury seen, as well as searching for other less obvious injuries.
Radiographs are reviewed as appropriate, then a treatment plan is rendered.
At all steps of this process, the junior resident has available a senior resident or chief resident, as well as an attending as needed to help during the decision making process. All patients admitted to the hospital, and those requiring emergent surgery, are discussed with the chief resident on the trauma service, as well as the attending covering the trauma service. In addition, the chief resident on call is available at all times for assistance in the emergency room for multiple trauma patients, difficult joint and fracture reductions, as well as advice regarding other less serious problems. The care of the multiply-injured trauma patient presenting to the emergency room is coordinated through a General Surgery Trauma Team with orthopaedic consultation as required. Thus, patients with both blunt and penetrating trauma which is in any way life-threatening is coordinated through the General Surgery Team.