Program Requirements & Policies

Pre-Requisite Course Work: 

The OSPAF only requires that you have successfully completed and graduated from an accredited Physician Assistant program. Completion of an orthopaedic clinical rotation is desirable.


Policies and Practices that favor specific groups of applicants:

The Orthopaedic Surgery PA Fellowship program recognizes the value and importance of recruiting qualified men, women and minority candidates. There are no gender specific requirements and discrimination on the basis of gender will not be practiced. Nor will discrimination on the basis of race, national origin, ethnicity, or disability be practiced.


All candidates have an equal opportunity and no favors or preferences are made to any specific group of applicants.


Advanced Placement Policy:

The OSPAF does not offer advanced placement.



Moonlighting is not tolerated during the PA Fellowship.




Attendance Policy:

Regular attendance for didactic and clinic rotations is expected of all Fellows. If the Fellow fails to comply with the attendance of required courses, then disciplinary action will be taken in accordance with such policy.


Graduation Requirements:

Successful completion of the fellowship program requires the Fellow to obtain a cumulative score of 80% in both the didactic examinations/assignments and clinical performance evaluations.


The following criteria shall serve as guidelines:

  • Pass every clinical rotation with satisfactory marks in all competencies

  • Complete all curriculum assignments/examinations

  • Fulfill research requirements

  • Maintain professional behavior

  • Demonstrate sufficient professional ability to practice competently as a Physician Assistant in Orthopaedic Surgery


Duty Hours:

The regulations on Fellow duty hours set-forth by the ACGME are adhered to at all times.  


Duty hours are limited to 80 hours per week, averaged over a four-week period, inclusive of all in-house call activities.  The Fellow’s schedule rotates on a four to five week basis and is related to specific duties.  One week is designated to ER Day-call and clinical duties.  Two weeks are designated to ER-Night call and clinic.  One week is designated to Floor and OR duties. One week is designated as a Float week with multiple responsibilities. During the week of ER Day-call the PA works Monday thru Wednesday from 7:00 am to 6:00 pm, Thursday and Fridays off-call.  The weekend following ER Day-call consists of a 24 hour in-house call on Saturday.  The PA is post-call on Sunday and returns for a ER night-call on Sunday from 8:00 p.m. to 7:00 am.  The Monday following the weekend call the PA is post-call.  The Fellow returns on Tuesday to begin a week of Float duties from 7:00 am to 6:00 p.m.  The weekend following Float duties the Fellow is off-call.  Then the PA returns for a two weeks of Night-call and clinic Monday thru Friday from 6:00 p.m. to 7:00 a.m.  The weekends following Night-call the Fellow is off-call. The PA then has a week of Floor and OR duties Monday thru Friday from 7:00 am to 6:00 pm. The average of these hours for a four-week period is less than 80 hours per week.


PA Fellows are provided with 1 day in 7 free from all educational and clinical responsibilities, averaged over a four-week period, inclusive of all call.  During the ER-day call schedule the PA has off on Thursday & Friday.  During the Night-call and clinic schedule the PA is post-call and off for the remaining Saturday and has off on Sunday.  During the Float week the PA is post-call and off for the remaining Monday and has off the following Saturday and Sunday. During the OR and Floor weeks the PA is off the following Saturday and Sunday.


Adequate time off for rest and personal activities shall consist of a ten hour time period provided between all daily duty periods and after in-house call.  Based on the aforementioned schedule the Fellow is provided the appropriate amount of time off before having to return to regular duty hours.


In-house call only occurs every fourth / fifth (four vs. five week schedule) Saturday and therefore adheres to the standard that in-house call must occur no more frequently than every third night, averaged over a four-week period.


Three to four months of the twelve month Fellowship are designated to Outside OR / Clinic duties.  This rotation is strictly 7:00 am to 6:00 p.m. with all weekends off and no call responsibilities.

Leave Procedures:

The Fellow must request for leave/PTO to the program director two weeks in advance of the initial date of leave for approval.


If the Fellow requires more days of leave than allotted within their PTO, then the circumstances regarding the time off request will be considered and if granted an equal number of days/shifts must be remediated and arranged by the program director.


Details regarding leave and PTO are made available to the PA Fellow at the time of orientation.


Disciplinary Action and Dismissal Policy:

Types of disciplinary action:

  • Letter of Warning

  • Probation

  • Termination


Criteria for Termination: 

Failure of the Fellow to fulfill the obligations of the Fellowship training.


Any action, conduct, or health status of the Fellow that is adverse to the best interests of patient care or the institutions to which the Fellow is assigned.


Breach of professional ethics, as defined by the American Academy of Physician Assistants, in the Guidelines for Ethical Conduct.


Violation of the rules of the Fellowship program, the institution to which the Fellow is assigned, or the law.


Inadequate medical knowledge, deficient application of medical knowledge to either patient care or research, deficient technical skills, or any other deficiency that adversely affects the Fellow's performance.


Withdrawal Policy: 

A Fellow who fails to report to clinical/ER/OR responsibilities for three consecutive scheduled workdays without notice to, or approval by the program director, will be deemed voluntarily terminated.


When a Fellow decides to resign, he/she should prepare and submit a written resignation to the program director at least thirty (30) days in advance.


Technical Standards & Physical/Mental Requirements: 

Appointments will be based on the ability of the individual to perform the tasks required for that position. All potential Fellows must possess the minimal physical and cognitive requirements (with reasonable accommodations if needed) for this Fellowship program. These include but are not limited to:


  1. Mental, emotional and social attributes to be a successful orthopaedic PA. Communication skills to elicit all components of the medical history in a timely manner and then transmit these findings in a quick and effective manner as necessary. Effective communication with patients to provide and clarify information, reduce apprehension, and provide counseling.

  2. Vision & Hearing - ability to see out of both eyes with adequate acuity for the fine techniques involved in surgery. Must be able to observe a patient accurately at a distance or close at hand. Sufficient visual and auditory perception and the mental capacity to assimilate large volumes of detailed and complex information presented during formal lectures and individual procedural demonstrations. Ability to interpret all imaging modalities.

  3. Team effort - must possess ability to work well with colleagues, medical personnel and auxiliary personnel as well as have a good rapport with the patients and families.

  4. Dexterity - must be adept in fine movements of both hands with the ability to perform microsurgical techniques. Must have sufficient posture control, neuromuscular control, and eye-hand coordination to use effectively any tools for completion of a physical examination or surgical procedure.

  5. Stamina - must possess the ability to sit or stand for long periods of time with maximum concentration on the procedure at hand. Must be able to learn to respond with precise, efficient, and appropriate action in emergency situations.

  6. Behavioral attributes - candidates must possess the emotional health necessary for full utilization of their intellectual abilities, the exercise of sound judgment, and the prompt completion of responsibilities. Candidates must be able to learn and demonstrate the ability to recognize limitations in their knowledge and skills and to seek appropriate assistance with their limitations.


Supervision Policy: 

While on inpatient duty the Fellow is supervised by members of the medical staff of ARMC with appropriate privileges. This supervision shall be exercised by daily rounds, telephone consultations, and any other means necessary.


The Fellows are not expected nor should they perform any procedure that they have not been supervised on, nor feel competent in completing the procedure on their own. The PA Fellow will be able to observe a procedure, perform a procedure under supervision, and then when deemed competent by the program director or an attending surgeon perform the procedure without supervision.


The Fellow may order consultations and testing on behalf of the attending physician following discussion with the MD Resident and/or attending physician. This must be documented by the Fellow in the encounter notes.


The attending physician will be present and supervise all evaluations and management services in the clinic, including key components of the history, physical examination, and medical decision making. Exceptions to attending physician presence and supervision include: pre-operative evaluations, and post-operative care within the 90-day global period for surgery. All clinical encounters, except situations warranted above, are chiefed with an attending surgeon, program director, or medical director.


Details regarding the supervision policy are made available to the PA Fellow at the time of orientation.


Grievance Policy:

Arrowhead Orthopaedics is rooted in our desire to maintain a collegial work environment that promotes respect to all team members and one that encourages personal and professional growth. A formal protest by a Fellow regarding application of a policy that directly affects them will be considered a grievance and may be reviewed by the Fellowship Director, Fellowship Coordinator and other management as deemed necessary.


Details regarding the grievance policy are made available to the PA Fellow at the time of orientation.

Reduction in Class or Closure of Program Policy: 

If a need for reduction in the number of Fellows or closure of the program occurs, then the AO Board of Directors, Medical Director and Fellowship Director are to follow the responsibilities as noted in this policy.



AO Board of Directors

  • Determines that a reduction in the number of Fellows or closure of program is needed.

  • “Teach Out” remaining Fellows of each class until their training is complete and then proceeds with class size reduction or closure of program.


  • Once affected Fellow(s) is (are) notified they are to complete their 12 months of training and complete a program evaluation with the Fellowship Director.    


AO Board of Directors

  • Will determine that a reduction in the number of Fellows is required and produce a business rationale letter to be sent to the Fellowship Director at least six weeks before the proposed effective date. The effective date(s) must coincide with the completion date for each class.


Medical Director & Fellowship Director    

  • If the closure of the program is secondary to loss of contract with Arrowhead Regional Medical Center, then accommodations will be arranged for “Teach Out” through Arrowhead Orthopaedic clinics and letter affiliation with Redlands Community Hospital and St. Bernardine Medical Center.

  • Will provide written notification to current Fellows regarding the actions to be taken and publish the changes on the program website.