orthopaedic training in india
TRANSCRIPT
Orthopaedic training in India & western world Roads to walk and bridges to be crossed
Orthopaedic training in India & western world Roads to walk and bridges to be crossedDr Farokh Wadia MS Orth, DNB Orth, MRCSEd, FRCS Tr & OrthConsultant Paediatric Orthopaedic SurgeonSir HN Reliance Foundation HospitalMumbai, India
Training???
Orthopaedic TrainingHigh degree of surgical skill
Apprentice based model
Acquiring skill sets that are unique to trauma and orthopaedics
Decision making
Orthopaedic Training ProgramA surgeon trained in the generality of Orthopaedics and trauma Able to manage trauma of moderate complexity from Day 1 as a ConsultantDevelop a specialty interest towards the end of the trainingSeamless development of this subspecialty interest by means of a fellowshipAcquire the skills and knowledge in the shortest amount of time, yet be safe and surgically ready
Structure of Orthopaedic trainingIn MumbaiThen
Structure of Orthopaedic training3 yearsFirst year as a junior ResidentAllied post (General / Neuro / Plastic Surgery) +/-Next two years as a Registrar or Senior Resident. One Institution with Allied HospitalsRotation every 6 monthsExit Exam at the end.No Fellowship opportunities
Structure of Orthopaedic trainingNow
Structure of Orthopaedic trainingStill 3 yearsFirst year as a junior ResidentAllied post - NONext two years as a Registrar or Senior Resident.One Institution with Allied HospitalsRotation every 6 monthsExit Exam at the end.? Fellowship opportunities
How is Knowledge Acquired?
Read or Perish!
How is Knowledge Acquired?
How are skills Acquired?See one
Do one
Keep Doing
How is knowledge assessed? Exit ExamTheory
Clinical cases
Viva Voce
How are skills assessed?
What about Research?Thesis
How was it different in UK?6 yearsAll years as a Registrar (Specialist Trainee Year 3-8)Multiple Institutions / Hospitals in the same regionRotation every 6 months to a different subspecialtyEmphasis on trauma in each post. Especially first two yearsExit Exam at the end of 4 years.Ample Fellowship opportunities.Automatically becomes a Consultant at the end.
How was it different in UK?Are 6 years enough for a surgical craft specialtyEmphasis on work life balance!EWTD- Restricts working beyond 48 hours a week (on Average)
Re-thinking of training delivery
How was it different in UK?Orthopaedic Competancy Assessment Project (OCAP)
Intercollegiate surgical curriculum project (ISCP)www.iscp.ac.uk
Learning Agreements
ST3 ST8 Fellow
How is knowledge assessed?Annual In training exam UKITE (Nationwide)
Annual practical exam- clinical cases and Viva voce
Exit Exam FRCS Trauma and Orthopaedics (National level standardisied exam)TheoryClinical casesViva Voce
How are skills assessed?PBAs
WBAs
Multi-source feedback
Simulation training
What else?Emphasis on research
Mandatory to publish, present and Audit
Teaching
Leadership and management
Courses
Annual AssessmentARCP
Annual Review of Competance Progression33
DrawbacksAssessments can become a form filling exerciseFocus may shift towards paper work rather than skills acquisition?Too long a training time
Training can still vary!
Standardisation Averaging and LeverageIdentification of Motivated trainersEvolution of assessment tools
Do we need a change?Uniform structureIncrease the number of years for trainingDefined subspecialty exposureRegionalisation of training programsIn-training assessmentSkills assessmentSimulation labs (Role of Industry partners to fund these programs)Fellowships
Thank you