Tips for Locuming in a New Specialty – Orthopaedics

You may have chosen to do an F3 year for lifestyle reasons, to try out different specialties you didn’t get during your Foundation rotations, or to gain more experience in a specialty you’re particularly interested in. Of course, if you’re a current F2 or F3, you might've missed out on rotating on to different specialties because of the coronavirus pandemic.

Whatever the reason, at some point you may find yourself working in Orthopaedics for the first time having no previous experience in it, which can be a daunting prospect!

So, to help you with that challenge, this article explains what your daily workload will be like, talk through common scenarios you’ll face, and share some tips to ensure you’re prepared for starting the job!

Where Will I Cover?

Most hospitals have a similar spread of clinical areas you may work in as an Orthopaedics SHO. In different units you may cover Paediatric Orthopaedics as well as adults, although this could be done in a specialist children’s hospital.

Emergency Department, where you will likely clerk most of your patients.

Orthopaedic Ward and Outliers.

Theatres, for elective and emergency procedures.

Clinics, where you may or may not spend time in clinic as an SHO. If you do, it will be well supported by senior colleagues.

What’s the Day-to-Day Like?

Daily Role

You'll usually be expected to attend the trauma meeting, where the consultants and registrars go through x-rays and histories of patients seen over the last 24 hours and discuss them to make plans.

You may lead ward rounds independently, or participate with the consultant or registrar.

During the day, you'll likely be either ward cover or assisting in theatre, but sometimes you'll be asked to attend fracture clinics as well to do some clerking. Ward cover can include requesting and chasing investigations, managing unwell patients on the ward, and discharge planning.

On-Call Shifts

Your main job will be clerking new patients in A&E. Examples of common cases are neck of femur (NOF) fractures, other fractures, and septic arthritis.

A&E will manage most manipulations and non-operative fractures independently, and will book them for fracture clinic, but if they're unsure then they may call you. This means you'll usually call your registrar, especially in the early days!

You'll also be tasked with reviewing unwell patients on the ward. Elderly patients with NOF fractures often have lots of other medical problems, so you'll likely be managing a wide variety of conditions.

Depending on where you work, Orthopaedics may also cover spinal injuries, although these might go directly to another hospital. It’s also worth checking whether Orthopaedics covers soft tissue injuries in your hospital or whether these go to Plastics.

Assisting in theatre with emergency cases will be another potential responsibility. This is uncommon overnight, as most things wait until the morning trauma meeting, but it can happen.

Finally, attending trauma emergencies, which will depend on the case. You may be asked to attend a trauma emergency in A&E, but you'll not be expected to provide a specific Orthopaedics opinion at SHO level.

Our Top Tips

    1. Try to get some taster experience to try it out beforehand.

    2. Practice reviewing x-rays and presenting cases with the information that the registrar will want to know. For example, is the fracture open or closed, is the limb neurovascularly intact, is the fracture displaced pre/post-backslab?

    3. Use the Trust guidelines to help you, including antibiotic guidelines for septic arthritis. There's also usually a comprehensive NOF pathway in most hospitals which is very useful.

    4. Read up on the common conditions you might manage. There are plenty of resources out there to help you, like TeachMeSurgery and Orthobullets.  

    5. Ask for help! The registrar is usually non-resident overnight, but they will expect you to need a lot of help and advice, especially at the beginning. Always ask if there’s anything you're unsure about. They may even ask for (anonymised!) WhatsApp pictures to review x-rays at home.

Following the above advice will make the process of starting work in Orthopaedics for the first time far less daunting, and if you take our tips on board you'll be able to hit the ground running when you start.

Best of luck!

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Specialty-Specific Guides

We're also working hard to provide you with a guide for each of the main specialties, giving you tips on how to settle into those departments. These will be especially useful if you haven’t rotated through that specialty in your Foundation Training rotations before.

Tips for Locuming in a New Specialty – Paediatrics

Tips for Locuming in a New Specialty – General Medicine

Tips for Locuming in a New Specialty – General Surgery

Tips for Locuming in a New Specialty – Obstetrics & Gynaecology

‍Tips for Locuming in a New Specialty – Emergency Medicine

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This article is part of a wider series, supporting doctors like yourself with a comprehensive set of guides to ensure your F3 year is a success. These guides cover everything from initial planning, options for moving abroad, help with finding work, and tips for making the most of the experience. Click here to visit our F3 Resource Hub to explore the full list of guides and articles.

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