Being part of a trauma team many of the cases that I encountered were road traffic accident victims that I saw in ER first before they were operated on soon after. This was in addition to cases of elective orthopaedic surgery such as total hip replacements.

Whilst in ER there were several incidences of minor fractures that did not require surgery. For example in my second week there was a case of a visiting federal judge that had fractured his patella by tripping up on the sidewalk, the reason for mentioning this was that he was closely followed into the hospital by intense security including a US marshall who enquired about his state whilst he was in ER. 

The trauma team were also called to join other teams in more major cases. For example I was first on the scene to a girl who had attempted suicide by slitting her wrists and there were also cases of major burns that were transported to the hospital’s specialist burns unit containing specially constructed beds enclosed in plastic bubbles to prevent infection.

The prestigious Harvard orthopaedic programme is one of the most sought after in the US. This was reflected in the attitude of those who taught me, they were very keen to devote time to me and the other medical students for teaching despite their heavy workloads.

As part of orhto team A I was primarily under Dr. Smith who was the attending surgeon on the team. He was a professor of orthopaedics in Leeds and moved to the US in 2001. Being British he was well aware of our system and what I was wanting to get out of my elective which was very helpful. He was also very knowledgeable of the difference between our systems however was keen that I found out these differences myself during my time there. Interestingly Dr. Smith took his USMLE (United States Medical Licensing Exam) whilst he was a medical student. The USMLE is a national examination that all US medical students take. It costs about $700 to take however but is an absolute requirement to practice in the US from overseas. I did consider this before I set out, my experiences on elective certainly have not discouraged me to want to gain further experiences in the US during the course of my career.

In addition to an attending on each team, orthopaedics also has a chief and a director. The chief of orthopaedics Dr. Rubash has written several books on the acetabulum which is his field of interest. The director of orthopaedics Dr. Herndon is the President of the National Academy of Orthopaedics. Despite their very prestigious positions they were both very welcoming to me as a student for example Dr. Rubash invited me to a welcoming party that he held at his house for orthopaedic residents. This provided me with one of many opportunities to meet the junior members of the team at an informal level.

Much of my day to day teaching was primarily done by the junior members of the team many of whom worked over 80 hours a week. For example by shadowing the intern Greg whist on the ward, by second year resident Alex in ER, by final year resident Renn in theatre and not forgetting Erich the orthopaedic nurse who taught me how to do plastering and with whom I used to play chess with during night time on call sessions. Despite their busy schedules of work and impressive academic records I found it very impressive that they also had many outstanding achievements for example Renn competed in three Olympics at kayaking and Erich was North American kickboxing champion three times.

I also asked during my elective to be part of some of the research work that the department undertakes, as a result of this I wrote a case report on a patient seen by my team that has been submitted for publication, this can be seen in Appendix 1.