Fellowship

Length: 1 year
Type of Fellowship: Clinical Fellowship
Fellowship Supervisor: Dr. Paul Kim
Fellowship Attending/Affiliated Surgeons: Drs. Abdelbary, Beaulé, Feibel, Garceau, Grammatopoulos, and Gofton
Hospital Affiliation: The Ottawa Hospital; Hawkesbury and District General Hospital; Kemptville District hospital

Overview:

The adult joint reconstruction fellowship is a twelve-month program in primary and revision hip and knee arthroplasty. In addition to general and revision arthroplasty exposure, the fellowship will be tailored to the fellows’ interest according to two streams: 1) Hip preservation, or 2) Periprosthetic joint infection management. Although fellows will have the opportunity to work will all supervising surgeons, the experience will be tailored to the fellows’ goals and interests. The fellowship will see significant involvement of the fellow in both clinical and surgical work to prepare them for independent practice. Responsibilities will be delegated based on demonstration of the individual’s ability.

Objectives:

• To develop an approach to patient problems and decision-making skills in management.
• To attain surgical skills required in primary and revision arthroplasty for competence in independent practice
• To develop a systematic approach to the management of periprosthetic joint infections as part of a multidisciplinary team.
• To develop a systematic approach to hip preservation surgery.
• To obtain experience in scientific data collection, analysis and interpretation, and publication.

• Hip Arthroplasty:
  • Total Hip arthroplasty
    • Cemented and Uncemented
    • Direct anterior approach, Posterior Approach, and Direct Lateral Approach.
  • Revision Hip Arthroplasty
  • Hip Periprosthetic joint infection surgical management and care
  • Periarticular Osteotomies
  • Hip arthroscopy
• Knee Arthroplasty:
  • Total Knee Arthroplasty
    • Cemented and Cementless
  • Revision Total Knee Arthroplasty
  • Knee periprosthetic joint infection surgical management and care
  • Unicompartmental Knee Arthroplasty
  • Computer-assisted adjunctive technology

Research and Academic Career Training:

Involvement in research and academic-related activities during the fellowship are mandatory. In addition to clinical duties, dedicated time will be allotted for research endeavors related to both periprosthetic joint infection and general arthroplasty. Dedicated research support is available including research coordinators and a dedicated statistician. The fellow will also have the opportunity to collaborate with other trainees, surgeons, and centers in pursuit of their research endeavors. A minimum of two projects that will be presented, and published in a peer-reviewed journal will be required.

Length: 6 months to 1 year
Number of Positions: 1
Type of Fellowship: Clinical Fellowship
Fellowship Supervisors: Drs Paul E. Beaulé (Director), Sasha Carsen, George Grammatopoulos, Kevin Smit and Geoffrey Wilkin.
Hospital Affiliation: The Ottawa Hospital (TOH), Children’s Hospital of Eastern Ontario (CHEO) and Hawkesbury District and General Hospital (HGH).

Overview:

The hip preservation is a six to twelve-month program in hip preservation surgery covering both arthroscopic techniques and open techniques. The fellowship will see significant involvement of the fellow in both clinical and surgical work to prepare them for independent orthopaedic practice with a subspecialty in hip preservation. Responsibilities will be delegated based on demonstration of the individual’s ability.

The program will emphasize the evaluation and treatment of pre-arthritic hip disease including dysplasia, labral tears, femoro-acetabular impingement, sequelae from childhood hip disorders as well as failed hip preservation surgery. As part of this team, the fellow will also participate in monthly hip preservation clinical case reviews and research projects in optimizing the care for these patients.

Duration of Fellowship:

This is no specific start date with the fellowship requiring a minimum of six months to up to 12 months. During this time, the fellow will be immersed in all aspects of the program and have the opportunity to work with multiple providers in the clinical practice unit of hip preservation.

Objectives:

• To develop an approach to the pre-arthritic hip conditions from teenage years to adulthood emphasizing decision-making skills in diagnosis and management.
• To attain surgical skills required in hip arthroscopy for management of labral tears i.e. repair/debridement/reconstruction and cam type femoro-acetabular impingement.
• To develop a systematic approach to the management of pre-arthritic hip disease using advanced imaging techniques such as low dose 3D CT, 3T MRI and MRI cartilage mapping i.e. T1Rho.
• To obtain experience in scientific data collection, analysis and interpretation, and publication.

Clinical and Surgical Training:

The fellow will be involved in a highly specialized tertiary care referral center with care being provided at CHEO, TOH and HGH managing both labral pathology and bony deformities of the femur and the acetabulum. In addition, the fellow will be engaged in providing level 2 orthopedic trauma care. The fellow will have additional surgical experience via dedicated operative time for the primary and revision hip arthroplasty and post-traumatic reconstruction. At the end of the fellowship, the fellow is expected to demonstrate the skills required in the independent treatment of both arthroscopic and open surgical techniques.

The fellow will work be based with two primary preceptors, but will also be involved in cases and clinics with other hip preservation surgeons. A heavy emphasis will be placed on optimizing operative experience. The fellow can expect significant exposure to a wide range of procedures:

• Hip Arthroscopy:
  • Latest techniques in labral tear management including repair and reconstruction
  • CAM resection using fluoroscopy control
  • Rim Ossification débridement
• Peri-Acetabular Osteotomy:
  • Correction of mutli-planar deformities based on the Ottawa Classification for hip dysplasia including anterior wall deficiencies and retroversion.
  • Latest techniques including less invasive “bikini Incisions” and outpatient
• Surgical Dislocation
  • Correction of complex mix deformities
  • Femoral Head Grafting Techniques such as mosaicplasty and allograft
  • Single stage femoral lengthening with step cup osteotomy.
• Femoral Osteotomy
  • De-rotational osteotomies dealing with excessive ante or retro torsion abnormalities
  • Varus/Valgus osteotomies for coxa valga and osteonecrotic lesions.

Research and Academic Career Training:

Involvement in research and academic-related activities during the fellowship are mandatory. In addition to clinical duties, dedicated time will be allotted for research endeavours related to pre-arthritic hip disease i.e. diagnosis, clinical outcome and quality of care. Dedicated research support is available including research coordinators and a dedicated statistician. The fellow will also have the opportunity to collaborate with other trainees, surgeons, and centers in pursuit of their research endeavours. A minimum of two projects that will be presented, and published in a peer-reviewed journal will be required.

Fellowship Duties:

• Clinical:
  • Participation in orthopedic consult clinics
  • Participation in Fracture clinics
  • Involvement in clinical teaching to residents and medical students
  • Participation in adult reconstruction rounds
  • Operative coverage during specified general trauma on-call as need.
  • Completion of one or two research projects.
• Surgical:
  • Participation in all hip preservation surgeries at various sites. This will require some coordination by the fellow with the five staff involved in hip preservation.
  • Participate in other aspect of hip reconstruction such as arthroplasty and revision hip arthroplasty.
  • Preoperative planning of surgical cases as well as entering surgical data in our ConEHR web-based platform
  • Participation in orthopaedic trauma cases (trauma room, and on call)

Under the direction of Dr. Geoffrey Dervin and Dr. Michael Pickell

Fellow will treat the gamut of knee pathology with meniscal and articular cartilage repair and allograft along with single and multiple ligament reconstruction, and progressive arthritis with osteotomy, unicompartment replacement and total knee replacement and some revision total knee.

Length: 1 year
Number of positions: 2
Type of Fellowship: Clinical
Fellowship Supervisor: Dr. Brad Meulenkamp
Fellowship Attending/Affiliated Surgeons: Dr. Karl-Andre Lalonde, Dr. Mark Steeves
Hospital Affiliation: The Ottawa Hospital, L’Hôpital Montfort

Under the direction of Dr. Karl-Andre Lalonde and Dr. Bradley Meulenkamp

The University of Ottawa offers a combined fellowship in comprehensive Foot and Ankle Reconstruction and Lower Extremity Trauma Surgery. This is a comprehensive, preceptor-based fellowship under the supervision of Dr. Karl-Andre Lalonde, Dr. Brad Meulenkamp and Dr. Mark Steeves, all dual subspecialty-trained in foot and ankle surgery and orthopedic trauma. Located at two sites – The Ottawa Civic Hospital and The Montfort Hospital, this is an enriching fellowship experience that covers all aspects of forefoot, midfoot, hindfoot and ankle reconstruction, as well as complex lower extremity fracture care.

• Duration: The University of Ottawa offers a 1-year comprehensive fellowship in Hand and Wrist Surgery through the Divisions of Orthopaedic and Plastic Surgery.

• Supervisor(s): Drs. Sarah Shiga, Brent Trull, Braden Gammon and Manisha Mistry. There is a preceptor-based format and fellows will spend 3 months with each supervisor. The fellow will participate in Hand Call with 2 supervisors on a rotating schedule (approximately 6 call per month).

• Fellows: 1-2 positions are offered annually. Canadian trainees or self-funded fellows from both Orthopaedic and Plastic Surgery programs are welcome to apply.

• Clinical Exposure: Between the clinical practices of the supervisors, fellows are exposed to all facets of hand, wrist and upper extremity non-operative care and surgery. Commonly encountered pathologies include those with congenital, degenerative, neurologic and/or traumatic origins. Fellows learn how to interact with a hand therapist and apply rehabilitative protocols and splints where appropriate. Fellows should arrive with an intimate knowledge of the Hand/Wrist physical exam and comfort performing some procedures independently under local anaesthetic (trigger finger/carpal tunnel release, extensor tendon repair).

During the year, fellows will enhance their ability to complete more advanced procedures independently. Common procedures performed include but are not limited to: surgical management of Dupuytren’s disease/carpal tunnel syndrome/hand and wrist tendinopathies; wrist arthroscopy for TFCC debridement and repair; scaphoid fracture fixation; non-vascularized and vascularized bone grafting of scaphoid non-union; surgical management of Kienbock’s disease; correction of distal radius malunion and other congenital distal radius anomalies (Madelung’s Deformity); flexor tendon repair and reconstruction; LRTI for CMC OA; hemi-resection interposition arthroplasty/semi-constrained DRUJ arthroplasty for DRUJ OA; partial/total wrist fusion/total wrist arthroplasty for radiocarpal OA; PIP/MP arthroplasty and rheumatoid hand reconstruction. Fellows will also be involved other complex reconstructive cases including congenital hand surgery, rotational and free flap coverage of upper extremity soft tissue loss, tendon transfers and peripheral nerve repair/reconstruction/transfer. The fellowship is based out of a Level 1 trauma center and there is ample exposure to hand and wrist trauma.

• Research: Protected time will be allocated for research and fellows are expected to generate a publishable manuscript over this period. There are a multitude of opportunities for involvement in novel projects or ongoing research programs. A database of PROM’s for hand and wrist surgical outcomes may be accessed. Fellows may also choose to participate in a project within the Orthopaedic Biomechanics Lab.

• Education: There is a weekly conjoint seminar series presented by Plastic and Orthopedic surgery staff, which covers a broad curriculum of hand and wrist topics on a 2-year rotating schedule. Other educational opportunities include: Biannual Hand/Wrist Journal Club, microvascular lab training and motor skills labs in the University of Ottawa Skills and Simulation center. Fellows are also encouraged to participate in various industry sessions throughout the year. There will be funding to subsidize attendance at a hand/wrist conference (generally either the AAHS or the ASSH). Fellows are expected to take a graduated role in resident education and develop the capacity to independently supervise residents and students for some procedures.

• Evaluation: Case-based feedback, mid-rotation feedback, end-of-rotation evaluation, end-of-year evaluation.

• Salary: $70 000/year

Fellowship Specific Objectives:

To assess and develop treatment plans for patients with disorders of the hand and wrist seen by referral in the outpatient clinic. These conditions may be congenital, degenerative, post-traumatic or neurologic in etiology.

To understand hand therapy management principles for routine and complex surgical disorders (eg. Reverse Kleinert Splint for extensor tendon reconstruction)

To assist and perform with indirect supervision, simple hand and wrist surgical procedures (eg. trigger finger and carpal tunnel release) and to understand the relevant surgical anatomy

To assist and perform under direct supervision, complex hand and wrist surgical procedures (eg. distal radius malunion correction) and to understand the relevant surgical anatomy

To partake in hand call with the attending staff on a rotating basis

To develop strategies for managing complex hand trauma, including acute damage control techniques and late reconstructive options

To become further educated in the theory and technical aspects of managing post-traumatic complications (eg. infection, CRPS, compromised soft tissue envelope)

To perform basic clinical and biomechanical research related to hand and wrist conditions. This would be presented and submitted for publication where appropriate

To participate in and conduct Hand and Wrist rounds for the residents and attending staff

• Reading List: Available upon request

Under the direction of Dr. Joel Werier

Length: 1 year (Aug 1 to July 31)
Type of Fellowship: Clinical Fellowship
Fellowship Director: Dr. James Jarvis
Fellowship Attending/Affiliated Surgeons: Drs Carsen, Jarvis, Kerrigan, Seth, Smit, Tice, Willis
Hospital Affiliation: The Children’s Hospital of Eastern Ontario (CHEO)

GOALS AND OBJECTIVES:

The overall educational goal of the program is for the Fellow to achieve competency and mastery of clinical and surgical skills for the management of children’s orthopaedic, trauma, and spine deformity problems by exposing the Fellow to all aspects of pediatric orthopaedics and spinal deformity. The Fellow will be expected to function effectively in the three major areas of: patient assessment and diagnosis, management, and surgical skill and will also be required to maintain a level of knowledge necessary to enable the Fellow to contribute to the clinical teaching and research activities of pediatric orthopaedics. They must acquire in-depth surgical skill in all aspects of reconstructive pediatric orthopaedics, trauma and infections.

PATIENT CARE:

The Fellow will develop the ability to accurately assess, diagnose and manage the broad spectrum of pediatric orthopaedic conditions and develop surgical skills in all aspects of acute pediatric orthopaedics.

MEDICAL KNOWLEDGE:

The Fellow will demonstrate a comprehensive knowledge of pediatric orthopaedic conditions and the most recent treatment modalities for these conditions in order to effectively treat patients, teach others, and conduct meaningful research.

PRACTICE-BASED LEARNING AND IMPROVEMENT:

Fellows must be able to investigate and evaluate patient care practices, appraise and assimilate scientific evidence, and improve patient care practices in pediatric orthopaedic care.

INTERPERSONAL AND COMMUNICATION SKILLS

Fellows must demonstrate the ability to effectively interact and communicate with patients and their families, professional associates, and health care support staff resulting in effective and accurate information exchange with patients, families, and professional associates.

PROFESSIONALISM

Fellows must demonstrate a commitment to carrying out professional responsibilities, adherence to ethical principles, and sensitivity to a diverse patient population.

SYSTEMS-BASED PRACTICE

Fellows must demonstrate an awareness of, and responsiveness to, the larger context and system of health care as well as the ability to effectively call on appropriate system resources to provide care that is of optimal value.

Curriculum to Achieve these Goals and Objectives:

The program includes a comprehensive set of resources which include the following:

• Weekly Pre-Operative Indications Conference
• Weekly Post-Operative Follow-up Conference
• Weekly Academic Didactic Teaching Schedule
• Division of Orthopaedic Surgery Academic Schedule
• Practice Oral Exam Schedule
• Division of Orthopaedic Surgery Grand Rounds Schedule
• Pediatric Surgery Grand Rounds Schedule

Length: 1 or 2 years
Number of positions: 4
Type of Fellowship: Combined Orthopedic and Neurosurgical Spine Fellowship
Fellowship Supervisor: Dr. Stephen Kingwell
Fellowship Attending/Affiliated Surgeons: Orthopedic Surgery- Drs. Stephen Kingwell, Eugene Wai, Philippe Phan, Alexandra Stratton; Neurosurgery- Drs. Eve Tsai, Adam Sachs, Safraz Mohammed
Hospital Affiliation: The Ottawa Hospital

Overview:

The combined Orthopedic and Neurosurgical adult spine fellowship is a 1 or 2 year fellowship in complex spinal surgery. Fellows will split their clinical time with both divisions however teaching rounds, spine call and research meetings are fully integrated. The fellowship is a comprehensive spine fellowship offering exposure to degenerative, traumatic, neoplastic and infectious conditions affecting the spine and neural axis from occiput to sacrum. The primary goal of the fellowship is to offer fellows clinical and research exposure that will allow them to transition to any independent spine practice.

Objectives:

• To develop an approach to degenerative, traumatic, neoplastic and infectious conditions affecting the spine from occiput to sacrum emphasizing decision-making skills in diagnosis and management
• To attain surgical skills in the management of these conditions, including open, MIS and navigated techniques, that can be used as foundational skills in independent practice and allow for future growth
• To obtain experience in scientific data collection, analysis and interpretation and publication

Surgical Exposure:

• Cervical Spine
  • Anterior including ACDF, disc arthroplasty, corpectomy, odontoid fixation
  • Posterior including laminectomy and instrumented fusion, laminoplasty, laminectomy and foraminotomy, C1-2 and occipital fixation/fusion
• Thoracolumbar Spine
  • Anterior including ALIF and OLIF
  • Posterior including laminectomy and instrumented fusion, micro and MIS discectomy and decompressions, TLIF
  • Posterolateral including vertebrectomy, thoracic discectomy
• Deformity
  • Scoliosis (adult AIS and degenerative)
  • Osteotomies including PSO, Smith-Peterson, VCR
  • Open and MIS (OLIF and percutaneous posterior fixation)
  • Pelvic fixation
• Oncology
  • Primary and metastatic tumours
  • Combined approaches with orthopedic oncology, thoracic and general surgery
• Trauma
  • Level 1 trauma and tertiary referral center
  • Percutaneous and open approaches

Research and Academic Career Training:

Involvement in research and academic-related activities during the fellowship are mandatory. In addition to clinical duties, dedicated time will be allotted for research endeavors related to spine. Dedicated research support is available including research coordinators and statisticians. The fellow will also have the opportunity to collaborate with other trainees, surgeons, and centers in pursuit of their research endeavors. A minimum of one project that will be presented and published in a peer-reviewed journal will be required.

Length: 1 year
Number of Positions: 2
Type of Fellowship: Clinical Fellowship
Fellowship Supervisors: Drs Allan Liew (Director), Steven Papp and Geoffrey Wilkin.
Hospital Affiliation: The Ottawa Hospital (TOH), Hawkesbury District and General Hospital (HGH). Kemptville District Hospital (KDH)

Overview:

The orthopaedic trauma fellowship is a one year program in the comprehensive management of musculoskeletal and soft tissue trauma covering both acute and delayed conditions. The fellowship will see significant involvement of the fellow in both clinical and surgical work to prepare them for independent orthopaedic practice with a subspecialty in orthopaedic trauma. Responsibilities will be delegated based on demonstration of the individual’s ability.

The program will emphasize the evaluation and treatment of long bone, pelvic ring, acetabular, and complex peri-articular injuries as well as the multiply injured trauma patient. As part of this team, the fellow will also participate in weekly trauma clinical case reviews, monthly journal review and research projects in optimizing the care for these patients.

Duration of Fellowship:

This is a one year fellowship, during which the fellow will be immersed in all aspects of the program and have the opportunity to work with multiple providers in the clinical practice unit of orthopaedic trauma.

Objectives:

• To assist and perform under supervision, simple and complex long bone fixation, pelvic ring, acetabular, and periarticular fracture reconstruction.
• To assess and develop treatment plans for patients seen by referral in the orthopaedic outpatient clinics with secondary deformities and complications.
• To become further educated in the theory and technical treatment aspects of post-traumatic complications including infected non-union and malunion of fractures.
• To perform basic clinical research related to adult trauma and gain experience in scientific data collection, analysis, and interpretation.
• To present and submit for publications clinical research as appropriate.

Clinical and Surgical Training:

The Ottawa Hospital is the primary level one trauma center providing coverage for eastern Ontario, western Quebec, and Nunavut. The Orthopaedic Trauma Service at The Ottawa Hospital provides comprehensive treatment for the total spectrum of acute musculoskeletal injuries and post-traumatic complications.

Care is provided using a comprehensive multidisciplinary approach to ensure each patient receives the treatment they need to optimize outcomes and avoid complications. Patients with multi-system injuries are admitted to the Intensive Care Unit or Trauma Unit at the Civic Campus with care supervised by General Surgery and orthopaedics directing the care of musculoskeletal injuries. Patients with isolated musculoskeletal injuries are triaged and either admitted for surgery or treated through our outpatient surgical system.

The fellow will be involved in a multidisciplinary orthopaedic trauma service based at the Civic Campus, with clinical exposure at both in patient campuses as well as 3 outpatient facilities.

At the end of the fellowship, the fellow is expected to demonstrate the cognitive and surgical skills required in the independent practice of orthopaedic trauma.

The fellow will work with three primary preceptors but may also be involved in cases and clinics with other orthopaedic trauma surgeons. A heavy emphasis will be placed on optimizing operative experience. The fellow can expect significant exposure to a wide range of procedures:

Research and Academic Career Training:

Involvement in research and academic-related activities during the fellowship are mandatory. In addition to clinical duties, dedicated time will be allotted for research endeavours related to orthopaedic trauma conditions, i.e., diagnosis, clinical outcomes, and quality of care. Dedicated research support is available including research coordinators and a dedicated statistician. The fellow will also have the opportunity to collaborate with other trainees, surgeons, and centers in pursuit of their research endeavours. A minimum of one project that will be presented and published in a peer-reviewed journal will be required.

Fellowship Duties:

• Clinical:
  • Participation in orthopaedic consult and fracture clinics
  • Involvement in clinical teaching to residents and medical students
  • Participation in orthopaedic trauma rounds
  • Responsibility for trauma call with the attendings on a rotating basis
• Surgical:
  • Participation in orthopaedic trauma surgeries at various sites.
  • Preoperative planning of surgical cases as well as entering surgical data in our ConEHR web-based platform

Length: 1 year
Number of Positions: 2
Type of Fellowship: Clinical Fellowship
Fellowship Supervisors: Drs Peter Lapner (Director), J Pollock

Hospital Affiliation: The Ottawa Hospital (TOH) and Hawkesbury District and General Hospital (HGH) and Kemptville District Hospital (KDH).

Overview

The University of Ottawa’s Shoulder and Elbow Surgery Fellowship is a comprehensive program that provides sub-specialty training in various areas of shoulder and elbow surgery. Fellows will receive training in shoulder and elbow arthroplasty and arthroscopic surgery. Additionally, fellows will receive training in complex shoulder and elbow trauma. The fellowship also includes a research component, where fellows will have the opportunity to conduct and participate in research projects. The fellowship places an emphasis on continuous quality improvement, with the goal of ensuring that fellows are able to provide the highest quality of care to their patients.

Duration of Fellowship:

August 1^st to July 30^th. Consideration for 6 month fellowships may be given to fellows interested in pursuing a concomitant hand and wrist fellowship.

Objectives:

• To develop an approach to soft tissue conditions of the shoulder and elbow with emphasis on both open and arthroscopic approaches to surgical care.
• To attain surgical skills required in shoulder and elbow arthroscopy for management of labral tears, rotator cuff pathology, and acromio-clavicular joint pathology.
• To obtain experience in scientific data collection, analysis and interpretation, and publication.

Clinical and Surgical Training:

The fellow will be involved in a highly specialized tertiary care referral center with care being provided at TOH, HGH, and KDH managing both pathology of the shoulder and elbow. In addition, the fellow will be engaged in providing level 2 orthopedic trauma care. The fellow will have additional surgical experience via dedicated operative time for the primary and revision shoulder arthroplasty and post-traumatic reconstruction. At the end of the fellowship, the fellow is expected to demonstrate the skills required in the independent treatment of both arthroscopic and open surgical techniques.

The fellow will work be based with two primary preceptors. A heavy emphasis will be placed on optimizing operative experience. The fellow can expect significant exposure to a wide range of procedures:

• Shoulder Arthroscopy
• Elbow Arthroscopy
• Primary and Revision Shoulder and Elbow Arthroplasty
• Mangement of complex Shoulder and Elbow Trauma (ORIF, arthroplasty).

Research and Academic Career Training:

Involvement in research and academic-related activities during the fellowship are mandatory. In addition to clinical duties, dedicated time will be allotted for research endeavours related to pre-arthritic shoulder disease i.e. diagnosis, clinical outcome and quality of care. Dedicated research support is available including research coordinators and a dedicated statistician. The fellow will also have the opportunity to collaborate with other trainees, surgeons, and centers in pursuit of their research endeavours. A minimum requirement is for two projects that will be presented and published in a peer-reviewed journal.

Fellowship Duties:

• Clinical:
  • Participation in orthopedic consult clinics
  • Participation in Fracture clinics
  • Involvement in clinical teaching to residents and medical students
  • Participation in upper extremity rounds
  • Operative coverage during specified general trauma on-call as needed.
  • Completion of one or two research projects.
• Surgical:
  • Participation in all shoulder and elbow surgeries at various sites.
  • Preoperative planning of surgical cases
  • Participation in orthopaedic trauma cases (trauma room, and on call)