Orthopaedics Clinical Posting: Life of a Year 3 Medical Student

Instead of doing a “Week in the Life” as for the Internal Medicine clinical rotations, I’ve switched to just sharing about the posting in general! And also ending off with thoughts on the specialty itself (in case you’re considering it or just want to find out more, haha).

What Orthopaedics Clinical Posting is Like

Generally, in an Ortho posting we have a mix of OT (operating theatre), clinics, ward rounds, and tutorials.

OT (Operating Theatre)

For surgical specialties such as Orthopaedics, we have the chance to watch surgeries in the operating theatre. It probably depends on your posting, but for us it was free and easy i.e. up to us to decide when we want to go.

Since this was my first ever surgical posting, in the first week I did go to the OT quite a few times. On the very first day we saw a patient who had been in a very bad road traffic accident with severe degloving injuries. The operation had been performed previously and we were there for the wound dressing. But it was still very cool to see the clinical photos and what the team had done. In the simplest terms just imagine taking a segment of blood vessel, nerve, and even a large piece of skin from another part of the patient’s body and grafting it onto the huge gaping wound.

Clinics

Ortho clinics are split into different subspecialties, like Adult Reconstruction, Sports, Foot & Ankle, etc. We were scheduled to each of these different clinics throughout the four weeks of our posting, and so had the opportunity to see the whole spectrum of Ortho.

Ward Rounds

Ward rounds for Ortho (at least for my team) are usually rather short. The rounding itself doesn’t take too long, and sometimes is followed up by wound dressing for a couple of patients.

Tutorials

We had scheduled teachings that covered the different areas of Ortho. Ortho is split quite intuitively into the different regions, so e.g., we’d have doctors come to teach us on Hip, Shoulder, Knee, Hand, etc. All these sessions are packed together in the week with everything else, so, as you can imagine, life is a hectic whirlwind. (But a very fun one.)

Clerking Patients

Okay this is an extra category I just added on. Essentially amidst all the things mentioned above, we somehow squeeze out some of our own time to talk to and examine patients. Especially when it comes to a new posting under a new specialty, this helps to bolster our learning.

The Highlights of Orthopaedics Posting

The highlights (for me, personally) were:

1. Being in the OT for the first time. Surgery has always been quite exciting to me; you’re actually doing stuff and making a tangible change to the patient’s outcome. The stereotypical Ortho OT is hammering a new hip/knee joint in (yes, they actually hammer, with all the jarring sound effects). Besides that, I was glad that I did get to watch a variety of other operations too, including hand surgery. (Note: Hand Surgery is actually a distinct specialty from Orthopaedics!)
2. Meeting inspiring Ortho doctors. There are some doctors that make you want to do Ortho just by sitting in their clinic. Like. Damn. (Not that I want to do Ortho, I think maybe not. But that’s exactly what I mean, these doctors just inspire you with how they perform the clinical exam, interact with patients, etc. It’s nothing mind-blowing or adrenaline-inducing. Not a complex surgical operation. Not a TV-worthy life-saving incident. Just a simple clinic encounter!)
3. Seeing patients and clinical signs. Patients are always our best teachers. I always think I haven’t really learnt about a condition until I’ve seen it in real life. I’m beyond grateful to the patients who very kindly let me pull on their knees, rotate their shoulders, and whatnot. They’ve really taught me the most.
4. Reading X-rays. (Random add-on) For some reason I love orthopaedic X-rays haha. Those almost-impossible-to-see fractures. Describing the radiograph systematically. Figuring out the diagnosis.

The Lowlights of Orthopaedics Posting

There weren’t really lowlights (overall I’d say it was a really fun/lit posting!). But here are some not-so-good parts, I guess? (Again, these are just what I think personally.)

1. The time crunch. It’s a four-week posting with way too much to learn. Plus in some weeks our schedule was fully packed with clinics or tutorials in both the morning and afternoon. And we somehow still have to find time to clerk patients and study on our own. Sounds almost impossible right? Not sure how we survived.
2. Okay I can’t really think of any others oops… Haha so let’s just leave it at that!

Overall Impressions of Orthopaedics as a Specialty

While I never really considered Ortho previously, during the posting there were definitely times I was seriously inspired and seriously thought of doing Ortho, haha.

I think what struck me the most was that Ortho doctors are a generally fun group of people. And of course as I mentioned I did meet some Ortho doctors who are truly great doctors and truly inspiring.

In terms of the specialty itself, some would remark that Ortho is quite “straightforward”. The layman’s stereotype is that in Ortho you don’t need to think much (vs e.g. Internal Medicine), Ortho is just bones, and so on. But there’s so much to Ortho, and you actually need to think and learn a lot. As medical students, we’ve barely scratched the surface. (E.g., at Hand Surgery CME teaching, every week they’d throw out some classification I’ve never heard of before.)

When I asked Ortho residents why they chose this specialty, one underlying theme stood out. One resident told me Ortho patients generally have good outcomes. Another said patients are truly grateful and thank you for what you do. (“It makes a huge difference to them to be pain-free.”) I think there’s this aspect of Ortho where you can really make a tangible change in the patient’s outcomes, and therefore a significant impact on their lives. Patients are less sick than in, say, Neurosurgery, and less likely to die on the table. This makes the work tremendously rewarding. Another Ortho resident told me that it’s “fun” and “eye-opening”. The training is undoubtedly tough, but it seems like quite an amazing specialty, and the people who do it genuinely love what they’re doing. 😊🦴

ONE Example of Something You Might See in Orthopaedics

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