Residents are supervised in all professional settings. Assignment of responsibility is largely dictated by the resident's level of training. The rate of advancement is individualized based on the resident's success in achieving certain benchmarks in clinical care and operative experience as determined on a service-to-service basis and well as through demonstrated mastery of the six general competencies. Learners who progress more rapidly are provided an accelerated assumption of responsibility.

In the outpatient clinics, residents perform histories and physical examinations, evaluate diagnostic tests and radiographs and formulate diagnoses and treatment plans. After presenting cases to the full-time faculty, residents are probed on various aspects of the assessment. Faculty members evaluate all patients in the presence of residents, emphasizing aspects of history-taking and performance of the physical examination. When patients are counseled regarding surgical procedures, basic concepts regarding the ethics of obtaining informed consent are reviewed on a case-by-case and rotation-by-rotation basis. When operative treatment is recommended, emphasis is placed on the presentation of options (both operative and non-operative), the listing of risks and potential complications, as well as the potential benefits of the proposed procedure.

The thrust of the program is to stress continuity-of-care in all resident educational settings. Residents are responsible for inpatient care on each rotation. They round on their surgical and non-surgical patients throughout hospitalization and continue directing care into the post-operative interval. Most rotations feature twice daily rounds and include at least weekly patient care meetings with nursing and physical therapy staff to discuss patient disposition.

Conduct of surgery by residents on each rotation is based on attendance at the Indications Conference. Because many of the operative procedures performed are done on a same-day surgery or outpatient basis, the goal of the Indications Conference is to review the history and physical examination, diagnostic tests and radiographs, and the indications for surgery on a pre-surgical day. The patient's assessment, management plan, and justification for surgery are discussed. The successful justification of the rationale behind the treatment plan during these conferences is a prerequisite for active resident participation in surgery on most private and ward patients. Selected original articles are recommended and a review of the anatomical approaches is emphasized.

Emergency room care of orthopaedic patients occurs initially at a junior resident level (PGY-2 or PGY-3) at most hospitals. This involves taking a history and performing a physical exam commensurate with the type of injury seen, as well as searching for other less obvious injuries. Radiographs are reviewed as appropriate, then a treatment plan is formulated. At every step in the process, the junior resident has a senior or chief resident available, as well as an attending when needed, to help with decision-making. All patients admitted to the hospital, and those requiring emergent surgery, are discussed with the Chief Resident, as well as with the attending surgeon. The Chief Resident on call is available at all times for assistance in the emergency room for multiple trauma patients, difficult joint and fracture reductions, as well as advice regarding other less serious problems.

Care of the multiply-injured trauma patient presenting to the emergency room is coordinated through the General Surgery Trauma Team with orthopaedic consultation as required. If the orthopaedic injuries are paramount, the patient's principle care is transferred to the Orthopaedic Trauma Service once the patient is deemed stable from the General Surgery Trauma Service perspective.