Potential for conflict will certainly exist between orthopaedic residents and fellows. Although the potential for conflict is present, we believe that the conflict should be only potential and never actual.
The fellow must recognize the sensitive nature of a fellowship position based within a residency training program. Residents must continue to feel part of the team when providing care to orthopaedic patients. Orchestrating the residents within the outpatient arena and in the operating room is the direct responsibility of the fellow. Residents should be permitted to progress in surgical procedures according to their experience and their individual abilities. On the other hand, residents should not be involved as primary surgeons when dealing with difficult procedures. Less experienced surgeons may, however, participate in less technically demanding surgeries. The key responsibility of the fellow is to evaluate each patient situation and to direct the team appropriately.
We believe the presence of a fellow augments the educational mission for residents. The fellow must constantly provide information to residents. In addition, the fellow is responsible to head conferences and to present cases to optimize learning for all. The fellow is stimulated by the attending physicians who dedicate themselves to additional investigation and research of clinical outcomes and critical evaluation procedures. Only by a thorough understanding of the pathophysiology of various disorders is the fellow able to develop a matrix upon which to grow. Developing a sound matrix for further scholarship and learning is a fundamental objective of this fellowship experience.
If problems develop during the fellowship year with respect to logistics or resident involvement, the situation should be promptly discussed with the director of the fellowship program. The overall objective of the fellowship program is to facilitate the learning experience for the resident while providing similar opportunities for the fellow. When properly implemented, conflict between these two educational missions should be rare.