Gregory P. Nicholson, MD, Fellowship Director
Grant E. Garrigues, MD
Nikhil Verma, MD
Brian J. Cole, MD
Chicago, IL 60612
Fellowship Description:
The fellow will be provided with an extensive clinical, surgical and academic experience related to the care and treatment of all aspects of Shoulder and Elbow Surgery. This includes advanced arthroscopic techniques for the management of all soft-tissue and traumatic injuries of the shoulder and elbow, as well as open reconstructive surgeries for arthritis, trauma, as well as soft tissue and bone deficiency. The fellow can anticipate an experience that includes more than 500 shoulder and elbow cases, extensive office evaluation of complex shoulder and elbow problems, and complimentary translational and basic science research projects during the fellowship year. Due to the support staff and activities of the faculty, the fellow can also expect participation and completion in no less than 6 exciting research projects per year. The staff is also involved in an accredited Sports Medicine fellowship. There are 4 sports fellows, but 7 staff physicians who are often “uncovered” in their clinical and surgical endeavors. The shoulder/elbow fellow will be able to participate in our care and treatment of athletes at all levels of competition, including the Chicago White Sox, Chicago Bulls, and Depaul University. In addition to the athletic component, the fellow can expect extensive experience managing arthritic conditions of the shoulder and elbow with more than 200 shoulder arthroplasties per year among the faculty.
Candidates must be eligible for employment in the USA and eligible for a medical license prior to training. International fellow applicants who meet these criteria will also be strongly considered. Interviews will be conducted in February Positions will be offered at the end of March 2019 according to the SF Shoulder & Elbow match process.
Goals and Objectives / Rotations
PROGRAM DESCRIPTION
The Rush Shoulder and Elbow Fellowship is based at Rush University Medical Center in Chicago, Illinois, providing hands on learning from an institution committed to excellent professional development, research, clinical skills and outstanding patient care. The fellow will have access to a wide variety of physicians during his/her training as well as state-of-the art equipment and resources.
The ultimate goal of our program is to develop a well-rounded Shoulder and Elbow expert who is comfortable with the evaluation and management of all shoulder and elbow problems. The fellow will be provided with an extensive clinical, surgical and academic experience related to the care and treatment of all aspects of Shoulder and Elbow Surgery. This includes advanced arthroscopic techniques for the management of all soft-tissue and traumatic injuries of the shoulder and elbow, as well as open reconstructive surgeries for arthritis, trauma, as well as soft tissue and bone deficiency. The fellow can anticipate an experience that includes more than 500 shoulder and elbow cases, extensive office evaluation of complex shoulder and elbow problems, and complimentary translational basic science research projects as well as clinical outcome studies during the fellowship year. Due to the support staff and activities of the faculty, the fellow can also expect participation and completion in no less than 6 exciting research projects per year. The shoulder/elbow fellow will also be able to participate in our care and treatment of athletes at all levels of competition, including the Chicago White Sox.
We anticipate that our mentorship-based program will result in an life-long collaboration and friendship!
Knowledge Skills
Integration of basic science incorporated • History and physical examination techniques
through daily patient care and teaching, labs, • Management of general shoulder and elbow
lectures, rotations and self-learning. problems affecting all ages
Patient Care: Patient evaluation in a variety of • Pre-operative evaluation
settings, i.e., office, operating room, etc. • Rehabilitation and injury prevention
Shoulder and Elbow Health promotion and prevention .• Multiple in office procedures: joint/soft tissue injections.
Sport-specific issues • Advanced surgical procedures, arthroscopic and open
Medical legal and ethical aspects • Communication skills
ROTATIONS
The Fellow will be with Dr. Nicholson for 5 or 10 week blocks, alternating throughout the year. This block time will be alternated with the Sports Fellow. On the alternating blocks, the fellow will rotate with Dr Garrigues, Dr. Cole, and Dr. Verma. This will provide a variety of pathology, surgical approaches and techniques, and clinic experience. There will also be dedicated research time.
Shoulder and Elbow Fellow: An Integral Resource
The fellows have historically had an excellent working relationship with our residents. One of our criteria for selecting fellows is based on whether the fellow will be a “team player”. Currently there are three residents (PGY-5, PGY-3, PGY-2) on the service. There is minimal overlap in the office between the residents and fellows. In the operating room, each attending has a different level resident assigned from the service. The high volume nature of the practices allows for little overlap between multiple residents and a fellow. Usually, a fellow and a resident will cover a surgical case. The delegation of surgical responsibilities/opportunities is base on experience, abilities and preparation. The attending surgeon who is present for the entirety of all elective surgical cases determines of intraoperative responsibilities. The attendings’ surgical schedules are extremely busy and each attending operates on multiple days during the week. Most days there are several attendings operating so that there is direct one on one experience with the resident or fellow as one of the residents is either in the office or has floor responsibilities on any given day. The fellow has been an integral resource to our residency-training program. All residents have “grown up” with the concept of fellowship programs at our institution. The fellows are involved daily in the education of our residents and medical students. Historically, we have tried to recruit fellows from different programs throughout the country as each fellow brings different educational experiences that contribute to the educational exchange between residents and fellows, as well as fellows and attendings. Our residents have appreciated the continued influx of varied training program experiences. Within our own residency program, we encourage our residents to seek shoulder and elbow, and sports medicine fellowship training outside of our program.
Salary/Benefits
The fellow’s salary is based on a PGY-6 level. Although the fellow is paid through the Medical Center, the fellow’s salary is funded by the faculty of the Shoulder/Elbow Fellowship. Medical malpractice is paid by Midwest Orthopaedics at Rush and an umbrella policy of the Medical Center. Medical, disability, dental and life insurance benefits are included in the benefits package and are subject to a premium contribution. The fellow is provided with lab coats and parking. Contingent upon appropriate academic productivity, the fellow is sent to multiple Meetings (expenses paid).
Most fellows have attended courses throughout the year including courses occurring at the Rosemont OLC, as well as industry sponsored courses. If a fellow makes a podium presentation at a national meeting, we pay expenses for the course/presentation. In addition, we strongly encourage and support our fellows’ application for ASES Candidate Membership immediately following the completion of the fellowship. We have a $1,000 stipend for our fellows that can be used at their discretion for books and/or electronics (i.e., computer, digital camera, etc.) that will enhance their learning experience. We ask that these funds be used and/or earmarked for use by October 31st. All fees for the fellow’s Illinois license, Illinois Controlled Substance License and Federal DEA are paid through Midwest Orthopaedics at Rush.
Educational Process / Resources in Conjunction with the Sports Medicine Fellowship
The fellow’s educational process is a balance of direct discussion and didactic teaching methods. On Monday evenings, there is a regular sports conference, which often includes topics related to the shoulder and elbow. As exemplified by the listing of conferences, the attendings have a commitment to fellow and resident education and present the majority of these teaching conferences. At the conclusion of the conference, we leave time for questions and discussion.
Ongoing education occurs in the operating room via discussions germane to the procedure being performed; education includes indications, contraindications, results, anatomy, biomechanics, surgical “pearls”, preop and postop management strategies, and literature reviews. The fellows are expected to be prepared prior to the operative procedure. The fellow receives the attendings surgical schedule in advance to allow him/her to read and prepare beforehand.
Multiple times throughout the year a sports medicine and shoulder journal club is organized by one of the fellows; selected papers are provided to the fellows and residents and these papers are discussed at our Monday evening sports conference once monthly.
Every 2 – 3 months a fresh-frozen cadaver sports medicine surgical skills workshop is conducted for our orthopedic residents in which the fellows are lab instructors, thus further honing their teaching skills. These workshops include shoulder, knee lab session which are moderated/facilitated by a faculty member.
We developed a computer media library in 2000-2001. This computer is a repository for Power Point lectures, intraoperative video images (jpeg and mpeg), clinical photos and radiographs. Fellows have access to this resource. We encourage our fellows to download onto an external hard drive any material within the media library.
Clinical Environment
We are fortunate to have free-standing outpatient facilitates such as, Rush Surgicenter, Ltd. in our professional office building, which opened in March 1993 and Gold Coast Surgical Center in downtown Chicago on Michigan Ave in Water Tower Place.
Outpatient surgeries are performed in the Rush Surgicenter, Oak Park Hospital and Gold Coast Surgicenter. The main OR at both Rush University Medical Center and Oak Park Hospital are used for complex inpatient shoulder cases. A brand new clinic and outpatient surgery center in Oak Brook will open in 2019. It is a state of the art facility with a sports performance center within the therapy area.
The fellow will participate in >500 surgeries during the fellowship year. Cases are usually scheduled in 2 rooms, with the procedures staggered throughout the day.
In general, all attendings dictate their own operative reports; this allows for a consistency and accurate documentation of the actual procedure in the operative reports, which is not found in some programs. A single consistent dictation method optimally allows data retrieval (eg. examination under anesthesia, pathologies, operative findings) for our clinical follow-up studies. All attendings maintain a surgical database for clinical research. Operative reports are digitally transcribed so they are archived and retrievable for research purposes through EMDAT.
Program Goals
In summary, the educational goals of this program include the following:
- To train board eligible/certified orthopedic surgeons to become experts in the care of Shoulder and Elbow patients and train the next generation of leaders
- To increase the knowledge of the epidemiology, pathophysiology, and nonoperative treatment of Shoulder and Elbow problems.
- To develop and improve surgical skills for the surgical treatment of both common as well as unusual conditions. Our approach integrates our latest knowledge of the pathophysiology of Shoulder and elbow conditions and the use of modern open and arthroscopic techniques to treat these conditions.
- To advance arthroscopic skills of the fellow. This includes arthroscopic treatment of shoulder instability, rotator cuff disease, elbow tendonitis, elbow stiffness, neurologic compression, arthritis.
- To develop and teach practical guidelines for the evaluation and management of shoulder and elbow injuries.
- To work with and develop research skills necessary to advance our understanding of a variety of shoulder and elbow conditions, particularly the management of complex shoulder and elbow injuries.
- Our ultimate educational goal is to develop a well-rounded Shoulder and Elbow physician who can progress through non-operative as well as surgical treatment, and proceeding with advanced rehabilitation protocols to maximize the opportunity for the patient to return back to the preinjury level of function.
In 2004, we were appointed the team physicians for the Chicago White Sox. Each year the fellows travel to Tucson, Arizona to briefly attend spring training. They also participate in game coverage at Guaranteed Rate Field. Team physician coverage is provided by multiple attendings.
In 2005, we were also appointed team physicians for the Chicago Bulls basketball team. Team physician coverage is provided by multiple attendings.
Most recently we have been appointed as the team physicians for the DePaul University Athletic Department (Division I) along with multiple minor league teams and high schools in the Chicagoland area.
The other attributes of the fellows and assignment of education has been discussed with respect to the on-the-field evaluation of athletes and their participation with a variety of other health care workers concerned with musculoskeletal injuries.
Questions or application requests can be directed to Vanessa Marquez at the address above.
