International Orthopaedic EducationInternational Orthopaedic Education 

Global Orthopaedic Residency Training ProgramsGlobal Orthopaedic Residency Training Programs

Prof. Syed Muhammad Awais (S.I.)y ( )

Dean and Chairman Orthopaedic Surgery. King Edward Medical University , Lahore, Pakistan

Member, Pakistan Medical and Dental Council (PMDC).

National Delegate, Editorial Secretary, Member Board of Directors  ofInternational Society of Orthopaedics and Traumatology. (SICOT).

Asstt Editor, International Orthopedics,Editor, Annals of King Edward Medical UniversityChairman, Medical and Dental Journals Committee of PMDC 

Former Pro Vice Chancellor, King Edward Medical University, LahorePast President: Pakistan Orthopaedic Association. (POA)Past Editor: Journal of Pakistan Orthopaedic Association. (JPOA) 

8/31/2011 1

LAHORE

International Orthopaedic Education p

Global Orthopaedic Residency Training Programs

VisionVision

“Improve Quality of Orthopaedic Health Care byImprove Quality of Orthopaedic Health Care by Improving Education of Orthopaedic Surgery”

andand

• Improve Quality of Life of Orthopaedic Care P id d P ti t d th f th i tProviders and Patients and thus of the society

8/31/2011 3

GoalsGoals

1 To Develop Global Orthopaedic Education lay down uniform:1. To Develop Global Orthopaedic Education, lay down uniform:1.1 Rules & Regulations (Framework) of Programs,1.2. Curriculum/Training Manual (Learning Objectives)1.3. Requirements for Teaching Hospitals.1.3. Requirements for Teaching Hospitals.1.4. Processes for Quality Assurance.1.5. Policy to encourage ethical practices

2. Prepare all possible hospitals to meet standards.

3 Enroll maximum number “Residents” no slot vacant3. Enroll maximum number  Residents  no slot vacant.

4. Thus provide high quality Orthopaedic Care.

5. Encourage Research and Development and discover new knowledge, techniques and technology.

8/31/2011 4

IntroductionIntroduction

1 H lth i i t ti l1. Health is international. 2. The patients have right to access to a high quality of Health Care 

all over the world. 3. The number and competencies of orthopaedic surgeons and 

orthopaedic  hospitals in various countries (especially Asia and Africa)  are not uniformly satisfactory.

4. The developed ‐industrialized countries are raising standards of ortrhopaedic health care very rapid. Whereas, the standards in developing countries  are not improving. 

5. All stake holders must pay immediate attention to develop Uniform International Standards and make them available to the developing countries of the world  to narrow the gap in quality.

6. This can be achieved by training required number of competent orthopaedic surgeons  of Global Quality.

8/31/2011 5

Orthopaedic Surgery in PakistanOrthopaedic Surgery in Pakistan• Population 160 millions• Population; 160 millions• Universities & DAI

Medical (9),  General (15),  DIA “CPSP” (1), PGMI (8)• Medical Colleges: 78• Medical Colleges: 78• Hospitals:

Teaching (82) Non Teaching District (80), Tehsil Hospitals (128)• Hospital Beds 78/ 100 000 people• Hospital Beds 78/ 100,000 people• MGraduate Drs. 120,000. (against 300,000)• Postgraduate Resident Capacity NOT CALCULATED.

d i li ( i )• Postgraduate Specialists: 20,000 (against 200,000)• Medical Teachers ; 4500 (against 30,000)• Orthopaedic Surgeons;   450 (against 6,000)• edical Students intake 5000 per year• Quality Assurance; Individual Teacher/Student based (against Systems)•

8/31/2011 6

Orthopaedic Education in PakistanOrthopaedic Education in Pakistan

1 Nurses : Orthopaedic Surgery in Curriculum1. Nurses  : Orthopaedic Surgery in CurriculumOn Job Training

2. MBBS : Orthopaedic Surgery in Curriculum2. MBBS : Orthopaedic Surgery in Curriculum3. Postgraduate Diploma (2 years)4. Postgraduate Terminal Qualifications; M.S. / FCPS (Orth) 5‐yrsg ( ) y5. PhD (Orth)6. CME (For Family Physicians, Orthopaedic Surgeons)7. Public Seminars

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Global/National/Individual Capital (W l h)(Wealth)

Moral Capital•Behaviors•Attitudes

Knowledge

Attitudes

•KnowledgeOrder

Knowledge Capital

g• Skills

ame O

Economic Capital

• Kind•CashTh

e S

Capital  •CashIn 

8/31/2011 8Social Capital‐ “Quality of Life” of the society.

Social/Economic Growth of SocietySocial/Economic Growth of Society

.Natural Resources1 Time

National Resources

1. Human Resource1. Time

2. Life 2. Physical StructuresMENPOWER

3. Soil

4. Air

3. Products & Services1. Morals

2. Knowledge

5. Water3. Funds

6. Light

7. Energy & MineralsHealth Care ServicesIn the Field of Orthopaedic Surgery

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Transformation of Knowledge into Economy & Well Being of Society

given 

s”. 

Money Improves dge is g

al Skills

Quality of Life 

Know

led

Practica

Skills/Services bring Money 

etical K

n the “P

Knowledge is converted into Skills/ Servicese 

Theo

rto learn

into Skills/ Services

The

Only t

8/31/2011 10

WHAT IS EDUCATION?

Education is not I f ti B tInformation But Formation

i i i i i iEducation is Teaching + Training of Mind & Character8/31/2011 11

“Properly planned and carefully conductedProperly planned and carefully conducted medical education is the foundation of a 

comprehensive health care”comprehensive health care . 

Report of the Inter‐Departmental p pCommittee on Medical Schools (The 

Goodenough Report) London, HMSO; 1944g p ) , ;

8/31/2011 12

N i l H l h C SNational Health Care Systems

Health Care Delivery Organizations

Health Care ProvidersOrganizations Providers

Curative How Trained

g, Allied

 Med

ical 

ary, 

rimary 

H

Nursing

nd Para M

ed, Terti

ry and

 P

Preventive How Regulated

Med

ical, 

Health an

HCP

s.

Specializ

Second

arHCD

Os

8/31/2011 13

M H HS S H

The size of the “National Health Care Systems is determined by the size of the population” and the level of technical standards is based on the available funds.

Knowledge Capital of the SocietyKnowledge Capital of the Society

X‐Axis: No. of Subjects in all Disciplines

Axis• ..

n :Y‐A

1. X multiply  Y  =2 Edu Delivery Org to Population Ratio =

cialties in 2. Edu. Delivery Org to Population Ratio =

3. Education Providers to Population Ratio =4. Students to Population Ratio =

per Spec

ect

p5. Publications/yr to Population Ratio6. Innovations & Patents to Population Ratio 

No. of S

upach subj

1. No. of Orthopaedic Surgeons and Super‐Specialista determine the knowledge

8/31/2011 14

N e Specialista determine  the knowledge Capital of Orthopaedic Surgery in World 

Framework of Education

• The  “framework” means legal boundaries ( l d l i ) i hi hi h h(rules and regulations) within which the higher education systems, particularly the institutions, faculty may freely operate.

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Academic StandardsAcademic Standards

• The statements of learning objectives to beThe statements of learning objectives to be attained by the learners during a program are known as “Academic Standards”known as  Academic Standards . 

To improve the standards improve the statement.

8/31/2011 16

Academic QualityAcademic Quality

• The measurement of the effectiveness ofThe measurement of the effectiveness of the academic standards in a program is known as “Academic Quality”as  Academic Quality .

8/31/2011 17

Framework of Uniform Standards of Orth Education

All selected universities, institutions, hospitals will run uniform;1. Framework of Learning Levels with duration and their corresponding g p g

qualifications2. Uniform Learning Objectives of Programs of same level (Curriculum/Training 

manual)3 E t R i t3. Entry Requirements.4. Criteria of No of Seats in a Program. (Bed and Student Teacher Ratio)5. Criteria to Become Supervisors/Trainers.6 Evaluations/Progression/Examination6. Evaluations/Progression/Examination7. Log Book/Portfolio to record day to day learning.8. Compulsory Research in Program 9 Quality Assurance9. Quality Assurance10. Student Exchange11. Program Administration 12. Credit Accumulation and Transfer System (EU Based) and Blooms Taxonomy of12. Credit Accumulation and Transfer System (EU Based) and Blooms Taxonomy of 

Learning Levels (USA Based)13. Criteria to accept past training experience.14. Policy for Faculty development and Faculty Exchange.15. Minimum Standards of Teaching Hospitals

Framework of Learning Levels with Duration and their Corresponding Qualifications

l l d l fLevel No Level description Duration Qualification

1 Undergraduate Certificate  Months to Years Certificate

2 Graduate 6 7years MBBS/MD2 Graduate  6 ‐7years MBBS/MD

3 PostgraduateIntermediate Qualification

2‐Years Diploma (Orth)

4 PostgraduateTerminal Qualification

5‐Years MS/MD/FCPS

5 Super SpecializationFellowships

2‐years Fellowships

6 Research Doctorate 4‐5 Years after PhD6 Research Doctorate  4 5 Years after  Level 2 Qualification

PhD

8/31/2011 19

Common List of Sub SpecialtiesCommon List of Sub Specialties

1. Arthroscopy and Sports Medicine

6. Spine

7. Traumatology2. Arthroplasty

3. Hand Surgery8.

93. Hand Surgery

4. Musculoskeletal Oncology

9.

10.Oncology

5. Pediatric Orthopaedics11.

12.

Entry/Admission RequirementsEntry/Admission Requirements.

.1. Graduate Degree (MBBS/MD)1. Graduate Degree (MBBS/MD)

2. License to Practice Medicine in the country

3. Pass Entry Test

4 Accepted By Program Director4. Accepted By Program Director

8/31/2011 21

Criteria of No of Seats in a Program. (Bed and Student Teacher Ratio)

• One Resident each year against 10 beds

• One Resident each year against each trainer/supervisor/ p

8/31/2011 22

Criteria to Become Supervisors/TrainersCriteria to Become Supervisors/Trainers.

Consultant holding;1 T i l Q lifi i & PhD1. Terminal Qualification & PhD2. Terminal Qualification and Fellowship3. Terminal Qualification

In same order of PreferenceIn same order of Preference.

8/31/2011 23

Curriculum /training manual

• Learning Objectives of;1. Certificate Programs.2 G d t P (MBBS/MD)2. Graduate Program (MBBS/MD) 3. Intermediate Program. (Diploma)4. Terminal Qualification. (MS/MD/Boards/FCPS)5. Super Specialization Fellowships 6. PhD

• In which followings are closely Integrated1.  Theoretical Learning and Technical Skills2 Preventive Health and Curative Health2. Preventive Health  and Curative Health3. Clinical Medical Sciences and Basic Medical Sciences

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Log Book/Portfolio to record day to day learning.

• Record of the Learning Experiences;1 In Patients1. In Patients.2. Out Patients.3 Accident & Emergency3. Accident & Emergency4. Operation Theaters5 Laboratories5. Laboratories6.  Conference Seminars7 Others7. Others

• Recommendation: Adopt The US Portfolio System

8/31/2011 25

Learning StrategiesLearning Strategies

1. 1960s. Student‐Centered‐Learning (SCL), 

2. 1970s. Problem –Based‐Learning (PBL), 

3. 1980s. Integrated Teaching (IT), 

4 1985 Community‐based‐education (CBE)4. 1985. Community‐based‐education (CBE),

5. 1990s. Task‐based‐learning (TBL), 

6. 1995. Team Based Learning (TBL), and 

7. 2000s. Evidence‐Based‐Learning (EBL).

8. 2002. Best Evidence Medical Education (BEME)

8/31/2011 26

Taxonomy of Levels of Learningy g(Bloom’s Taxonomy)

1. Cognitive.  Mental Skills (Theory)

2. Psychomotor.  Manual or Physical Skills 

3. Affective.   Feelings / Emotional (Attitudes)

8/31/2011 27

Credit Accumulation & Transfer SystemCredit Accumulation & Transfer System 

A credit accumulation and transfer system is a systematic way of describing an educational program by attacking y g p g y gcredits to its components. Credit Hour is basically the academic currency of the academic activities i.e. units, modules, semesters or programs.modules, semesters or programs.

1. In Europe d kl d i h2. One year Study workload is 1500‐1800 hrs.

3. Credit Hours in one year are 604 One credit stands for around 25 to 30 working hours4. One credit stands for around 25 to 30 working hours

This is the most convenient system of recording credit ofThis is the most convenient system of recording credit of learning in Transcript. 8/31/2011 28

Uniform ResearchUniform Research

• Rules and regulations for writing g gproposal/synopsis, collecting data and writing final;final;

1. Case Reports 

2. Dissertations

3. Thesis

• Guide Lines/Training Material for Supervisors.

8/31/2011 29

Uniform ExaminationsUniform Examinations

• Global Entry/Admission Examination

• Global in‐training Annual ExaminationGlobal in training Annual Examination

• Global End of Program Examination

• Written PapersWritten Papers Clinical and oral Examinations

8/31/2011 30

Program(s) AdministrationProgram(s) Administration

1. At each Institution/Teaching Hospital;Program Faculty Committee for each Program headed by the Program Director .

2 In each Country:2. In each Country:Program Coordination Committee of each program with all Program Directors as members having elected Chairman.

3. At  Global Level;“I i l B d f O h di Ed i ” i h i“International Board of Orthopaedic Education” with its Organs.

8/31/2011 31

Quality AssuranceQuality Assurance 

f i i• 1. Of Institution.• 2. Of Programg

• Levels / Cycles of Quality Assurance• Levels / Cycles of Quality Assurance.1.  Monitoring.2 Peer Review / Internal Review2. Peer Review / Internal Review.3. Accreditation / External Review.

PIF (US Program Information File) can be most useful

8/31/2011 32

Scheme of Diploma  (Orth) –Intermediate Qualification

Exit‐ Examination‐Written (Global) and Oral (Local)Exit Examination Written (Global) and Oral  (Local)

Years Curriculum Content TrainingPortfolio

Research AssessmentsProgression

2 YEAR-1,21. Adult Trauma2. Hand and Neuromuscular Disorders 3. Joints affections and Infections

Learning Record;

Education inResearchBiostats.

End of year 1(Global)Written MCQ1 4. Spine, Foot and Ankle, Sports Medicine

5. Amputations, Prosthetics and Orthotics and Rehabilitation6. Tumors (Paediatric and adult)7. Metabolic Disorders and Pain

Record;

1. In Pts.2. Out Pts.

Biostats. 

WritingReport of 25 

Written MCQAssessments andProgression

1

8. Congenital Disorders9. Paediatric Traum

3. A & E4. O.T.5. Labs

pCases

6. Others

Entry – Examination ‐ Written (Global) and Interview (Local)

8/31/2011 33

Scheme of Residency Program‐ Terminal Qualification

Exit‐ Examination‐Written (Global) and Oral (Local)Exit Examination Written (Global) and Oral  (Local)

Years Curriculum Content TrainingPortfolio

Research Others AssessmentsProgression

5 YEAR-1Introduction to Orth. Principals of Surgery Learning 

Record;

Education inResearch

Rotation In Other Related

End of year1,2,3,4(Global)4 YEAR-2,3,4,5

1. Adult Trauma2. Hand and Neuromuscular Disorders 3. Joints affections and Infections

Record;

1. In Pts.2. Out Pts.

ResearchBiostats. 

Proposal 

RelatedSpecialties

Conferences

(Global)Written MCQAssessments and

4

3

4. Spine, Foot and Ankle, Sports Medicine5. Amputations, Prosthetics and Orthotics and Rehabilitation6 Tumors (Paediatric and adult)

3. A & E4. O.T.5. Labs

pwriting

DataOtherInstitutions

Progression2

1 6. Tumors (Paediatric and adult)7. Metabolic Disorders and Pain8. Congenital Disorders9. Paediatric Traum

6. OthersWriting

1

E t E i ti W itt (Gl b l) d I t i (L l)Entry – Examination ‐ Written (Global) and Interview (Local)8/31/2011 34

PhD OrthopaedicsPhD Orthopaedics

• In Pakistan• Enrolment after Residency (terminal qualifications)

• In USA/EU/China/Japan/India• Enrolment During ResidencyEnrolment During Residency 

8/31/2011 35

Final RecommendationsFinal Recommendations

Establish “International Board of Orthopaedic p

Education” (IBOE) with following organs.

1 Ad i i B d1. Admission Board

2. Curriculum Board

3. Examination Board

4 Research dissertation/Thesis Evaluation Board4. Research dissertation/Thesis Evaluation Board

5. Quality assurance Board

8/31/2011 36

SICOT‐WOC  Seminar on Postgraduate Training in O th di S d T t lOrthopaedic Surgery and Traumatology

19th February 2010, Pokhra, NepalJ i l S d b i i i C i• Jointly Supported by

1. Nepal Orthopaedic Association (NOA)

• Participating Countries

1 ThailandAssociation. (NOA)2. Japan Orthopaedic 

Association (JOA)

1. Thailand2. Nepal3 India

3. International Society of Orthopaedics and Traumatology (SICOT)

3. India4. Japan5. BangladeshTraumatology (SICOT)

4. World Orthopaedic Concern (WOC)

5. Bangladesh6. Pakistan

Concern (WOC)5. Orthopaedic Societies of 

SAARC  Countries (OASAC)

8/31/2011 37

Framework: 1‐ Entry Requirements.

S C i i i ddi i l iSr. No.

Country Existing Practices Additional Requirements

1 Thailand 12 years of School Education  Govt Service for 3 yearswith Biology and Science6 years of Medical Graduation 

2 Nepal Same Experience of 2 yearsp p y

3 India Same Entry Test

4. Japan Same Small Hospital Service for 2 yrs.

5 Bangladesh Same

6 Pakistan same Entry Test

Recommendations:1. Higher School for 12 years with Biology and Science Subjects.2. Entry Test . (where licensing examination practiced, it can act as entry test.3. Additional requirements of service may remain optional with the countries.

Framework: 2‐Duration of Levels of Education

Recommendation.

All Degree Awarding Institutions may arrangeAll Degree Awarding Institutions may arrange education in the field of Orthopaedic Surgery as underas under.Education Level Minimum

D iNomenclature Additional 

O i iDuration Opportunities

1 6 MBBS/MD

2 2 Diploma2 2 Diploma

3 4 MS/Fellowship/National Board

PhD

4 2 Sub specialty Fellowship

PhD

Framework: 3‐Learning Objectives.

i G id i k h dLearning Guide Line Log Book Research Mandatory Workshops

(a) Cases Load for each of  A Uniform  (a) Thesis or  Common List the subspecialties may be made for practical training.

Logbook may be developed so that residents may find 

Dissertationof Level of M.Phil.

and Curriculum must be developed so 

(b) SICOT Training Manual may be adapted for Cognitive Learning and 

b i di i d

convenient to fill even when working abroad.

OR(a) Minimum 

one research P

that residents may attend in other i i imay be indigenized. Paper institutions.

The Learning Objectives, Training Manual, Log Book, Guide Lines for Research and List of Mandatory Workshops along with their Learning Objectives may be laid down at Asian LevelObjectives may be laid down at Asian Level

Framework: 4‐ExaminationsRecommendations

1. Regular Assessments, Assignments, Work Load Experience carried out and recorded in the Log Book.

2 Yearly Examination and Log Book Evaluation Ethical Practices General2. Yearly Examination  and Log Book Evaluation, Ethical Practices, General Relationship with others‐ Record constitute basis for promotion to next year.

3 Intermediate Examination if any may be passed any time before final3. Intermediate Examination, if any may be passed any time before final examination.

4. Research Dissertation, Thesis , or publication of Research Paper must be li h d b f th Fi l E i tiaccomplished before the Final Examination.

5. Final Exit examination subjected three certificates.A‐ Completion of Residency Training.B‐ Approval of the Log Book C‐ Approval of the Research Work.

6. Exit Examination will be written and Oral

Framework: 5 Certification of Training HospitalsFramework: 5‐ Certification of Training Hospitals

• Recommendations

• There maybe  an Global Minimum i f i i f hiRequirements for Recognition of a Teaching 

Hospital and a Teaching Department for “Recognition” of Training Hospitals and Departments to run Diploma/ Residency /Departments  to run Diploma/ Residency / PhD/ Fellowship  (one or all) Program.

EndThank you

07‐09‐09 Ziauddine University, Karachi 45