Post on 02-Jan-2016
Rural SurgeryInnovation in
trainingKM Shyamprasad, Vice-President
National Board of Examinations(Postgraduate Medical Education)
Ministry of Health, Government of India
NATIONAL BOARD OF EXAMINATIONS
Apex post graduate medical education body
Under the Ministry of Health, Government of India
Accredits institutions for training and conducts post graduate examinations in 42 disciples of medicine both in broad and sub/superspecialities
Need for Rural Surgical Training Surgical training focused on surgical burden of
disease in India The current Euro-western models of medical
education- depriving health care providers for rural India ( 70% of population)
25% of all deaths in India are due to two surgical causes: Maternal Mortality Injuries
INJURIES
11% of all deaths and 170,00,000 hospitalizations. A further 5,00, 00 000 seek hospital care for injuries according to the estimation of the NCMH.
INJURIES Blunt and penetrating injuries- 3rd leading
cause of death and disability Decreasing in developed countries Increasing in developing countries
What is Rural Surgery Surgical emergencies and problems
causing rural morbidity and mortality Training on a different model- new
paradigm Training should be in rural settings Cost containment Less reliance on sophisticated
investigations and equipment
Syllabus Syllabus ensures knowledge, competencies
and skills to function as an independent surgeon in resource limited settings of a rural surgical centre
Syllabus Management of a Rural Surgical Centre Management of Urological, Pediatric, Thoracic,
Plastic, and Neurosurgical emergencies, Management of Abdominal emergencies,
Essential elective general surgery, Essential Orthopedics and Trauma, Obstetrics and Gynecology Emphasis on prevention and management of
obstetrical emergencies
Essential Orthopedics and Trauma
Acute trauma Injuries of upper limb Injuries of lower limb Injuries of the spine Amputations
SKILLS TO BE LEARNT IV access, Intubations CPR Splintage, Skin and Skeletal traction CTEV cast correction Close Reduction of fractures and
dislocations Debridement and management of open
fractures -external fixators
SKILLS TO BE LEARNT Hand injury Amputation Sequestrectomy Arthrotomy Use of tongs and calipers Bone Biopsy
INNOVATIVE MODEL A model of training is on trial in 6 centers across
India Each centre has been chosen for its commitment
to provide surgical care for the rural population. A peripheral rural and a nodal center have been
connected for training The nodal center provides the variety of surgical
training opportunities needed
Peripheral Center Prepares the candidate for the living
conditions Economics of rural health care Infrastructural constrains Helps develop the right attitude
ROTATIONS
General Surgery- 1 year Obstetrics and Gynecology -6 months Orthopedics and Trauma - 5 months Anesthesia – 1 month Peripheral Centre- 1 year
Learning Resources Emergency and Essential Surgical Care E-
learning Tool Kit developed by the Emergency and Essential Surgical Care project of the World Health Organisation, which includes and the Text Book on Surgery at the District Hospital.
A detailed modular Syllabus and Curriculum for Rural Surgical training developed by the Indira Gandhi National Open University.
Audio Visual learning material developed by NBE in various disciples of medicine and surgery.
Review of the Program 10 candidates have been registered Nodal and peripheral centers have to define
their roles more clearly Faculty training required Emphasis on life saving skills/hands on
training Log Book Thesis
FUTURE NEEDS Text Book of Rural Surgery Faculty Development Programs Standardized courses in Basic Surgical
Skills and Trauma Identifying experts for evaluation, TOT,
examiners Methodology for final summative
examination
“STEPS”Sequential Trauma Education ProgramS
Global Injury Solutions
Future perspectives Teams for Rural Surgery Anesthetists Surgical Care providers-Pre- Hosp care Family Physicians- +PAs’ Force Multipliers Alternative Health Care Delivery Systems-
Suitable for regional needs Appropriate Technology
Thank you for the Attention