DEPARTMENT OF MEDICAL EDUCATION ACADEMIC AFFAIRS … Manuals/Ortho-Trauma Program... ·...

ORTHOPEDIC & TRAUMA SURGERY A Guide to the Six Year Specialty Training Program

DUBAI RESIDENCY TRAINING PROGRAM

Last Updated :: November 2016

DEPARTMENT OF MEDICAL EDUCATION

ACADEMIC AFFAIRS CENTRE

Contents

Introduction .......................................................................................................................................... 1

Program Administrators ......................................................................................................................... 2

Competencies ....................................................................................................................................... 3

Program Structure & Rotations ............................................................................................................... 6

Education Modules ................................................................................................................................ 6

Clinical Research .................................................................................................................................. 7

Resident Job Descriptions ...................................................................................................................... 9

Assessments & Supervision .................................................................................................................. 10

Syllabus .............................................................................................................................................. 11

Operative Procedures .......................................................................................................................... 16

Recommended Readings & References ................................................................................................ 20

DRTP :: Orthopedic & Trauma Surgery Program Manual 2016 Page 1 | 20

Introduction

This document outlines the Orthopedic & Trauma Training Program under the Dubai Residency Training Program at Dubai Health Authority (DHA), Dubai - UAE Details included descriptions of Residents’ Entry requirements, knowledge & skills content, rotations, assessment methods, accreditation and certification for training in Orthopedic & Trauma and elaborated appendices. It is expected that trainees will acquire the training and experience essential for independent practice in Orthopedic & Trauma. The Program The Program is in accordance with the German regulations for Specialist Training of the Berlin Chamber of Physicians (Weiterbildungsordnung Orthopädie und Unfallchirurgie der Ärztekammer Berlin). After satisfactory completion of the six year program, graduates will be German Board certified in the specialty of Orthopedic & Trauma Surgery. Residents, by way of enrolling and training under the program, attain membership to the Berlin Chamber of Physicians. The Medical Association of Berlin (ÄKB) authorizes them to take the Board Examination (Facharzt), subject to observance of program regulations and specific training criteria being met during the Residents’ training in Dubai. The Berlin Chamber of Physicians however will not guarantee the Residents’ success in the Examination, which is deemed a personal obligation of the candidate. After having successfully achieved the Facharzt Certification, trainees are required to resume work at DHA in the capacity of Specialist (SSR) in Orthopedics and Trauma Surgery. The mission of the program is to develop and train Orthopedic & Trauma Surgeons who are competent to practice in the field of Orthopedic & Trauma independently. The main goal is to prepare the Residents for a career in Orthopedic & Trauma and post Residency Fellowship Training. General Objectives The training program (Facharzt) will provide a broad educational experience in recognition and treatment of surgical musculoskeletal disorders including trauma. Upon completion of training, the graduate is expected to be a competent Specialist in Orthopedic & Trauma, capable of independent practice. During training, the resident will acquire thorough knowledge of the theoretical basis of Orthopedic & Trauma, including its foundations in the basic medical sciences and exposure to research activities. The graduate will be able to access and apply relevant knowledge and skills to clinical practice and provide effective consultation services with respect to patient care, education and medico-legal issues. The resident in Orthopedic & Trauma must acquire:

- Knowledge and expertise in clinical and operative management of diseases of the musculoskeletal system, trauma, emergency & critical care and ambulatory patient care.

- Mastery of surgical skills of Orthopedic & Trauma, soft tissue surgery and a basic training in general surgery

- Effective clinical judgment & decision making in dealing with Orthopedic & Trauma surgical problems based on sound surgical principles.

- The knowledge, skills and attitudes relating to gender, culture and ethnicity pertinent to Orthopedic and Trauma Surgery and incorporate these in research activities.

Specific Objectives The resident in Orthopedic & Trauma is required to attain sufficient training and knowledge of:

- Basic science related to Orthopedic & Trauma including relevant clinical applied anatomy.

- The pathophysiology, differential diagnosis and management of orthopedic diseases, including trauma.

- Appropriate skills in diagnostic procedures

- Clinical examinations, laboratory investigation, performance of ultrasound, Focused Assessment with Sonography for Trauma (FAST), musculoskeletal Ultrasound, Understanding of X-ray, CT and MRI

- Indications for appropriate operative and conservative treatment as well as the use of pharmacological agents and contrast media in surgical practice

- Clinical and operative competence in both emergency and elective settings

- Intensive care, management of shock and resuscitation

- Local and regional anesthesia.

- Enteral and Parenteral nutrition

- Specific Requirements for Day Case Surgery.

- Quality control measures for surgical procedures.

- Palliative care and quality of life issues.

- Medical ethics, health economics, medico-legal matters, risk management, medical statistics, information technology and health service management

- Clinical audits & Research methods.

- Teaching and training others in Trauma and Orthopedic Surgery

- Making oral presentations at professional meetings effectively


Program Administrators

Our Program Administrators in partnership with an expert team of supervisors & faculty steer the Orthopedic & Trauma Surgery

Program towards the zenith of quality Residency training education offered in Dubai.

Under their expert care, your training journey is guaranteed to be an enlightening experience.

Dr. Bilal El Yafawi

PROGRAM DIRECTOR

Consultant - Rashid Hospital

Dr. Khalid Abdulla Mohammed Alawadi

PROGRAM CO-DIRECTOR

Consultant - Rashid Hospital

Dr. Malallah Hassan Ali

PROGRAM CO-DIRECTOR

Consultant - RH


Competencies MEDICAL EXPERT / CLINICAL DECISION-MAKER Ortho Trauma Specialists will possess a defined body of knowledge and procedural skills, which are used to collect and interpret data, including X-ray images, CT, MRI & ultrasound, make appropriate clinical decisions and carry out diagnostic and therapeutic procedures within the boundaries of their discipline and expertise. Their care is characterized by up-to-date (and whenever possible evidence-based), ethical, cost-effective clinical practice, effectively communicating with patients, other health care providers & the community. The role of medical expert/clinical decision maker is central to the function of the specialist clinician. The Resident is required to attain sufficient knowledge, diagnostic expertise, judgment and skills in Orthopedic & Trauma surgical techniques including polytrauma management and minimal access surgery to manage patients with regard to:

- Degenerative disease

- Trauma/Critical illness including Emergency/ Intensive care

- Surgical infections and inflammatory diseases

- Skin and soft tissue injuries

- Principles of thoracic surgery

- Orthopedic trauma with neurovascular compromise - Interventional imaging technologies - Diagnostic laboratory procedures & their interpretation - Multidisciplinary care - Pathology of injuries - Biomechanics

General Requirements

- Demonstrate diagnostic and therapeutic skills for ethical and effective patient care

- Access and apply relevant information and therapeutic options to clinical practice

- Demonstrate effective consultation services with respect to patient care, education and legal options.

- Recognize personal limits of expertise Specific Requirements

Knowledge - Basic Science and Anatomy Demonstrate knowledge of the following:

- The anatomy growth and development of the axial and appendicular skeleton, embryology, histology, physiology and biochemistry of bone, cartilage, tendon, ligament, muscle, nerve and skin

- Fracture / Wound healing, thermal and chemical injuries

- Metabolic bone disease, congenital abnormalities, inflammatory conditions and arthritis, infections related to the musculoskeletal system

- Pertinent biomechanical principles of the musculoskeletal system, including joint reconstruction

- Pathology and treatment of soft tissue and bone neoplasia related to the musculoskeletal system, Pharmacology including principles of metabolism, action and toxicity of drugs commonly used in orthopedics, as well as variations associated with age, gender and ethnicity; be familiar with drug interactions and recognize and manage adverse drug reactions.

Knowledge - Technical Demonstrate knowledge of surgical options that allow appropriate operative selection, including:

- Trauma: care of fractures, joint and soft tissue injuries as well as polytrauma management and care

- Competence in all surgical & technical procedures commonly performed in orthopedics

- Use of surgical equipment: understand its use, recognize its limits and apply to tissues safely, taking measures to protect both self & other associates from blood and airborne debris

- Use of imaging equipment: understand usage, recognize risks of and appreciate safety measures require to protect patients, self and other personnel from ionizing radiation

Knowledge - Clinical Recommend appropriate method in performing:

- Medical history: relevant, concise, accurate and appropriate to patient’s problem(s)

- Physical Exam: relevant, sufficiently elaborate & appropriate

- Diagnostic tests: medically appropriate investigative tools in a cost-effective, ethical and useful manner

- Medical imaging tests: appropriate imaging investigations; interpretation of basic X-ray, ultrasound, computer-assisted tomography (CT), MRI and radionuclide studies

- Clinical diagnosis and decision-making: analysis, synthesis and integration of all relevant data to formulate a rational and effective diagnostic and therapeutic strategy for problems encountered in patients of all ages

- Documentation/presentation: well-documented and organized assessments and recommendations in written and/or coherent and concise verbal form in response to a request from another health provider

- Intra-operative decision making: arrive at correct, timely operative decisions for routine and complex procedures

- Preoperative planning: understand the concept order of appropriate preoperative investigations to assist in planning; execution of preoperative plan during surgery

- Post-operative care: provide appropriate care to include effective pain management (with multidisciplinary assistance, if necessary), both in the hospital and office environment; recognize & manage postoperative complications effectively

- Emergency management - recognition and first therapeutic response: Able to identify and respond appropriately to urgent medical and surgical problems. Efficiently provide appropriate primary emergency therapy

- Emergency management - decision to operate: Intervene based on rational interpretation of clinical and ancillary investigation. Intervention is timely, with appropriate pre-operative assessment

- Evidence-based practice: aware of the role of evidence in clinical decision making. Able to access, retrieve and apply relevant information. Makes clinical judgments based on sound evidence.

COMMUNICATOR In order to provide humane, high-quality care, Orthopedic & Trauma Residents establish effective relationships with patients, other physicians and health professionals. Communication skills are essential for the functioning of a specialist, and are necessary for obtaining and revealing information to patients and their families. Furthermore, these abilities are critical in eliciting patients' beliefs, concerns, and expectations about their injury or disease and for assessing key factors impacting on patients' health. Copyright © 2009 The Royal College of Physicians and Surgeons of Canada. http://rcpsc.medical.org/canmeds. Reproduced with permission


General requirements include the ability to:

- Establish therapeutic relationships with patients/families

- Obtain relevant history from patients/families/communities, listen effectively

- Discuss appropriate information with patients/families and the health care team

- Know how to react to situations of adverse effects, critical situations & errors e.g. basics of risk management & patient safety malpractice Specific Requirements

- Recognize that being a good communicator is an essential function of a surgeon & understand that effective communication can foster patient satisfaction and compliance as well as influence the manifestations and outcome of patients’ illness, trauma & surgical intervention.

- Establish relationship with the patient that is characterized by understanding, trust, respect, empathy & confidentiality

- Recognize the emotional stress for patients & families faced with orthopedic conditions and their associated surgical management, a stress especially accentuated in the treatment of children

- Gather information not only about the injury but also about the patient's beliefs, concerns and expectations about the injury / trauma, while considering the influence of factors such as the patient's age, gender, ethnic, cultural and socioeconomic background, and spiritual values on that injury / trauma and any proposed surgical intervention.

- Write well-organized letters, providing clear directions to the referring physician and other physician and allied personnel, where indicated.

- Deliver information to patient & family in a humane manner and in such a way that it is understandable, encourages discussion and promotes the patient's participation in decision-making to a degree that is compatible with current surgical practice

- As a prelude to surgical intervention use above skills to obtain informed consent; consider alternative means of acquiring consent if the patient is incompetent to provide consent on the grounds of age or mental status or other disqualifying factors

- Understand & demonstrate the importance of cooperation and communication among healthcare professionals involved in the care of individual patients such that their roles are defined and consistent message is delivered to patients & their families

- Demonstrate skills in working with others who present significant communication challenges as a result of an ethno-cultural background which is different from the clinician’s own or those who exhibit anger or confusion

- Maintain clear, accurate and appropriate written records

- Write well organized, legible orders & progress notes

- Complete concise hospital discharge summaries promptly

COLLABORATOR Orthopedic & Trauma Residents work in partnership with others who are appropriately involved in the care of individuals or specific groups of patients. It is therefore essential for Orthopedic & Trauma Residents to be able to collaborate effectively with patients and a multidisciplinary team of expert healthcare professionals for provision of optimal patient care, education, and research. General Requirements

- Consult effectively with other physicians and health care professionals.

- Contribute effectively to other interdisciplinary team activities. Specific Requirements

- Develop an ability to work effectively and harmoniously with other health care workers.

- Function competently in initial management of conditions that in major centers fall within the realm of other surgical specialties

- Develop a care plan for a patient, who has been assessed, including investigation, treatment and continuing care, in collaboration with interdisciplinary teams.

- Identify and describe the role, expertise and limitations of all members of an interdisciplinary team required to optimally achieve a goal related to patient care, a research problem, an educational task, or an administrative responsibility.

- Participate in an interdisciplinary team meeting, demonstrating the ability to accept, consider and respect the opinions of other team members, while contributing personal specialty-specific expertise.

- Understand how health care governance influences patient care, research and educational activities at a local, provincial, regional, and national level.

- Effectively communicate with the members of an interdisciplinary team in the resolution of conflict, provision of feedback, and where appropriate, be able to assume a leadership role.

MANAGER Orthopedic & Trauma Residents function as managers when they make everyday practice decisions involving resources, co-workers, tasks, policies and their personal lives. They do this in the settings of individual patient care, practice organizations and in the broader context of the health care system. Thus, Orthopedic & Trauma Residents require abilities to prioritize and effectively execute tasks through teamwork with colleagues and make systematic and rational decisions when allocating finite health care resources. As managers, they take on positions of leadership within the context of professional organizations and the health care system. General Requirements

- Utilize resources effectively to balance patient care, learning needs, and outside activities.

- Allocate finite health care resources well.

- Work effectively and efficiently in health care organizations.

- Utilize information technology to optimize patient care, life-long learning and other activities. Specific Requirements

- Understand how to function effectively in health care organizations, ranging from individual clinical practice to local, regional and national surgical associations.

- Understand the structure, resourcing, and operation of the Emirates healthcare system and function effectively within it, as well as being capable of playing an active role in its evolution.

- Acquire the ability to access and apply a broad base of information to the care of ambulatory patients, and those in hospitals and other health care settings.

- Make clinical decisions and judgments based on sound evidence for the benefit of individual patients & the population served.

- Understand population-based approaches to health care & its implication on medical practice & prioritization to access for services. Copyright © 2009 The Royal College of Physicians and Surgeons of Canada. http://rcpsc.medical.org/canmeds. Reproduced with permission


HEALTH ADVOCATE Orthopedic & Trauma Residents recognize the importance of advocacy activities in responding to the challenges represented by the social, environmental, and biological factors that determine the health of patients. They recognize advocacy as an essential and fundamental component of health promotion that occurs at the level of the individual patient, the practice population, and the broader community. Health advocacy is appropriately expressed both by the individual and collective responses of specialist physicians in influencing public health and policy. General Requirements

- Identify the important determinants of health, affecting patients.

- Contribute effectively to improved health of patients and community.

- Recognize and respond to issues where advocacy is appropriate. Specific Requirements

- Demonstrate an understanding of determinants of health by identifying those that are the most important (i.e., poverty, unemployment, early childhood education, social support systems), being familiar with the underlying research evidence, and applying this understanding to common problems and conditions in general surgery

- Demonstrate an understanding of determination of the patient's status with respect to one or more of the determinants of health and adapting management accordingly; and assessing the patient's ability to access various services in the health and social system;

- Demonstrate an understanding of the need to work collaboratively with specialty societies and other associations in identifying current ‘at risk’ groups and application of available knowledge regarding prevention to ‘at risk’ groups.

SCHOLAR Orthopedic & Trauma Specialists engage in a life-long pursuit of mastery of their professional expertise. They recognize the need to be continually learning and model this for others. Through their scholarly activities, they contribute to the appraisal, collection, understanding of health care knowledge, and facilitate the education of their students, patients & others. General Requirements

- Develop, implement and monitor a personal continuing education strategy.

- Critically appraise sources of medical information.

- Facilitate learning of patients, interns, students and other healthcare professionals.

- Contribute to development of new knowledge. Specific Requirements

The Resident in Orthopedic & Trauma will develop an analytical mind and a critical attitude to scientific literature, as well as an ability to adapt to innovations and development which will occur during a career in Orthopedic & Trauma. Clinical:

- Identify clinical problems in Orthopedic & Trauma

- Recognize & identify gaps in knowledge and expertise

- Formulate a management plan

- Conduct appropriate literature search based on clinical question

- Assimilate and appraise the literature

- Develop a system to store & retrieve relevant literature

- Consult health professionals in a collegial manner

- Propose treatment for the clinical problem

- Evaluate the outcome

- Identify practice areas for research Research:

- Pose a research question (clinical, basic or population health)

- Develop a proposal to solve the research question

- Conduct appropriate literature search based on research question

- Identify, consult and collaborate with appropriate content experts to conduct the research

- Propose a methodological approach to solve the question

- Carry out the research outlined in the proposal

- Defend and disseminate the results of the research

- Identify areas for further research that flow from the results. Be familiar with the principles of evidence based medicine and prove this by analyzing four different recent publications in trauma and orthopedics (clinical intervention studies) in a short written appraisal

Education: Demonstrate an understanding and the ability to apply the principles of adult learning, with respect to others & self with an understanding of preferred learning methods in dealing with students, residents, and colleagues. PROFESSIONAL Orthopedic & Trauma Residents have a unique societal role as professionals with a distinct body of knowledge, skills, and attitudes dedicated to improving the health and wellbeing of others. Orthopedic & Trauma Surgeons are committed to the highest standards of excellence in clinical care and ethical conduct and continually aspire to master their discipline. General Requirements

- Deliver the highest quality care with integrity, honesty and compassion. - Exhibit appropriate personal and interpersonal professional behavior. - Practice medicine ethically, consistent with the obligations of a clinician. Specific Requirements

- Acquire the training and experience to maintain competence as a specialist or sub specialist

- Assume responsibility for the overall care of the surgical patient

- Have comprehensive knowledge of the principles of biomedical ethics and medical jurisprudence

- Maintain ethical relationship with colleagues, patients & families

- Recognize one's own limitations of professional competence

- Demonstrate ways of attempting to resolve conflicts & role strain

- Have the ability to explore and resolve interpersonal difficulties in professional relationships

- Have a knowledge and understanding of the professional, legal and ethical codes to which clinicians are bound

- Have the ability to recognize, analyze and know how to deal with unprofessional behavior in clinical practice, taking into account local and national regulations


Program Structure & Rotations The total duration of training will be 6 years. The resident will start with 3 months in the Orthopedic & Trauma Department, intended to serve as a means of Orientation to the Department and Program as such. 2 years in the Common Trunk shall involve: General Surgery 6 months Neurosurgery 6 months Emergency 6 months Intensive Care & Anesthesia 6 months 4 years in Trauma & Orthopedics, this includes: - Initial 3 months Orientation - One Year in Berlin - Germany Contents of the curriculum that is not available Dubai shall be covered in Germany, during the mandatory professional activity at the end of the Residency Program. Residents are required to travel to Berlin for a minimum of 6 months at the end of their specialist training and become registered members of the Berlin Chamber of Physicians during this time. This is however subject to: - Obtaining an official working permit from the German authorities - Acquiring sufficient knowledge of the German language ‘Level C’ - Goethe-Institut A Typical Weekly Schedule in the Orthopedic & Trauma Department: Sunday Ward Round/ Outpatient Clinic Monday Operating Theatre Tuesday Academic Day Wednesday Operating Theatre Thursday Ward Round/ Outpatient Clinic

Education Modules

Module 1 :: Core Lecture Series Weekly lectures, lasting 1hour: formal lectures, case discussions. There will be a consultant in attendance to moderate the session and lead the discussion. Attendance of the daily meetings to discuss all the admitted cases Schedule for the Academic Day (Tuesday of Every Week)

Time* Activity* Time* Activity* 07.30 Morning meeting 11.30 Case discussion 08.00 Department CME program 12.30 Clinical examination on patients (bedside)09.00 1st presentation about main subject 13.30 Questions and discussion 10.00 Coffee break 14.00 Afternoon meeting 10.30 2nd presentation about main subject *Schedule subject to annual review & revision

- Main subject 1st presentation prepared and presented by one of the Education Committees.

- Main subject 2nd presentation prepared and presented by one of the education comity.

- Case discussion to be prepared by one of the candidates under supervision of one of the education committee.

- Clinical examination session can be replaced by X-ray meeting (pre-op and post-op X-ray diagnosis and discussion) done by one of the Education Committee members.

Module 2 :: Operation Log Book and Surgical Skills A log Book must be maintained. At the end of each year, it will be the responsibility of the Program Director or the Department Head to ensure that the trainee in his department completes his respective list Module 3 :: Research and Publications In each year of training, at least one case report should be completed and presented at a scientific meeting which may be subsequently published. In addition, one basic science research project can be undertaken. Also the Resident should collect 20 major cases in which he was in direct contact during management Module 4 :: Training Courses and Conferences These are courses that are essential for training. Some courses must be funded in part or whole by the trainee’s employing institution, also attending scientific conferences and CME activities in the hospital

Course Year 1 Year 2 Year 3 Year 4 Year 5 Year 6 Basic Life Support / BLS Advanced Trauma life Support / ATLS AO Basic Course Ultrasound Course AO Advanced Course AO Spine Principle Knee-Shoulder Arthroscopy — Basic Endo-prosthetic Principle Course AO Master Course


Clinical Research

Residents are required to present a research through final year thesis and for this purpose, workshops are held as follows:

- Research methodology (3 days)

- Literature review & Refworks (1 day)

- SPSS (Basic Statistics) The goal of these workshops is to understand and able to apply the following:

- Using electronic databases such as Medline & Internet to conduct literature searches and to locate information

- Critically appraise/evaluate relevant literature, reviews and new techniques/technologies

- Use word processors, databases, spreadsheets and statistical packages to produce statistical analysis & research papers

- Conduct a literature review

- Develop an hypothesis to be tested

- Choose an appropriate research methodology and design a research study

- Write a grant application to fund a research project.

- Apply for ethics committee approval for a clinical or laboratory based study

- Collect, collate and interpret data

- Apply basic statistical analysis to clinical data

- Develop an outline structure for a research paper

- Write a literature review for a research paper

- Apply the developed outline to write a research paper

- Searching the literature and data-bases purposefully

- Appraising critically relevant articles and reports

- Interpreting findings and consider their applications to other contexts

- Know how to select and draw on clinical evidence to inform practice

- Be able to define the following terms

Clinical significance

Statistically significant / insignificant

Variability

Biological variability

Laboratory variability

Observer variability

Data types: categorical, continuous, qualitative, quantitative, discrete

- Understand the following methods of and terms associated with data collection:

Epidemiological studies

Randomized controlled & crossover clinical trials

Randomized controlled laboratory study

Observational studies

Discrete and continuous variables

Sample size determination

- Recognize and understand the following concepts of problems associated with data:

Bias: confounding - measurement - sampling

Randomization

Stratification

Blindness (masking)

Relevance of sample size to the ultimate

Outcome of the statistical analysis

Understand the significance & limitations of measures of central tendency: o Mean, median, mode o Variance o Co-variance o Standard deviation o Confidence interval

- Understand and apply the following statistical terms:

Probability & probability distribution models

Regression and correlation analysis

Risk — sensitivity analysis, particularly:

Exposure odds ratio

Number needed to treat

Significance testing

Meta-analysis

Absolute risk o Absolute risk difference o Absolute risk reduction o Attributable risk o Etiologic fraction o Relative Risk

- Getting Research skills: Choosing a topic for research

Having a detailed literature review for this purpose

Designing a research as per standard methodology

Choosing a mentor on the related field

Finalize the research proposal and get both scientific and ethical approval

The research proposal will consist of at least of Title page, Specific Aims

Introduction/Background and Significance

Objectives and Hypothesis

Research Design and Methodology

References / Bibliography

Conduct the research through data gathering, survey, or any standard tool

Analyze the data

Present the data on a thesis as per DRTP thesis guidelines.


Each thesis must be arranged in the following order:

- Title Page (Sample A). Do not place a page number on this page.

- Dedication. Do not place a page number on this page.

- Acknowledgements and/or Preface. Do not place a page number on this page.

- Abstract (Sample B). Do not place a page number on this page.

- Table of Contents. Do not place a page number on this page.

- List of Tables, Figures, Illustrations/Maps/Slides, List of Supplemental Files such as multimedia files.

- List of abbreviations

- Text of the Thesis. All pages from the first page of text through the bibliography or Vita, if included, are numbered consecutively

in Arabic numerals, beginning with Arabic numeral “1” on the first page of the thesis text.

- Introduction

- Material and Methods

- Results

- Discussion

- Limitations

- Conclusion

- Appendix or Appendices. Continue text numbering with Arabic numerals.

- References. Vancouver or Harvard standard style.

- Publications (please insert the full text of your published paper if you have any)

- Curriculum Vita. Continue text numbering with Arabic numerals.

Thesis Formatting and Layout Requirements: Page Size Page size should be standard A4 size (8.50 x 11.00).Margins 1 inch on all sides, including page numbers.Page Nos. Should be at least 1" from the below margins edges of the page, as appears in this document. Spacing Preliminary pages and text must be double-spaced or 1.5-spaced. Under certain conditions, quotations may be

single spaced. Table of Contents and lists with lengthy entries may be single spaced with a double space between entries. References may be single spaced, with a double space between entries.

Page Alignment Each new chapter/ major section (i.e. Chapter 1 - 2, Appendix, Bibliography, Vita) must begin on a new page.Pagination All text page in the thesis is numbered.

All text page numbers in the thesis must be centered under the text in the same location on each page and located at least one inch from the bottom of the page.

Word Processing

Your final thesis must be correct in spelling and punctuation and presented in a consistent, structured format. A single, legible font must be used throughout the thesis, the only exceptions being in tables, figures, graphs, appendices, foot notes, and supplemental files. The font size should be 12-pt. Accuracy and consistency is required in format of the thesis.

Tables & Illustrations

Pages carrying illustrative material must be given page numbers appropriate to their place in the document. Illustrative material may not be inserted after the document has been numbered and given numbers such as “10a.” All tables, figures, illustrations, and other types of examples included and referenced in the text of the thesis should be numbered for identification. There should be no duplication of these numbers; i.e., no two tables should be assigned the same number. Figures may be numbered in one of two ways: consecutively throughout the document (Table 1, Table 2, Table 3, etc.), or double-numbered so that illustrations’ numbers reflect their locations in the document (Fig. 9.3 is the third figure in Chapter 9, or Fig. A2 is the second figure in Appendix A.)

Captions & legends

To be placed on the same page with the figure, graph, table or illustration they describe. In order to fit both figure and caption on the same page, captions may be single-spaced, margins may be decreased to one inch, and figures may be reduced in size to fit. If the figures are reduced from their original size, then the page number must be added after the reduction so as not to alter its size. If there is no other way to manage the amount of material to be shown, the caption and figures should be side-by-side in continuous view. This method should only be used in the rare instance where all of the pertinent material will not fit on the same page. Figures, captions, and page numbers must be easily readable when the electronic document is viewed at 100 percent.

Copies Required

Residents upload a single pdf file of their thesis to Research website (e.g. thesis submission site). The electronic pdf file serves as the DHA archival copy of the thesis. As an extra measure of security, students are strongly encouraged to keep a copy of their approved thesis and to provide an additional copy to their thesis supervisor or department/program library, if applicable. By keeping an electronic backup on hand, students can easily provide scholars with a copy of the thesis during the time between submission and publication, if necessary. A paper copy of the thesis is required by the AAC

Footnote Citations, References & Bibliography

Each thesis must include a reference, or bibliography section,. This section may be called “Bibliography” or “References”. The bibliography is the last required section of the thesis and the last section heading listed on the Table of Contents unless an optional Vita page is included. When a Vita page is included, the bibliography immediately precedes the Vita at the end of the thesis. The bibliography must indicate materials actually used, such as articles, chapters of books, websites, etc


Resident Job Descriptions In Emergency room In Wards In Out Patient Department In Operating Room Educational Activities

YEAR

3

- The first on call; conducts primary assessment and management of patients in ER

- Suggest admission of patients

- Perform closed reduction of fractures and cast application under supervision.

- Assist in various emergency procedures performed in ER.

- Clerk all admissions (history, general & orthopedic clinical examination); suggest basic investigations & plan of management.

- Perform daily rounds. Write detailed daily progress notes - Arrange discharge, home medication & follow up appointments of inpatients. - Assist and learn to perform various bedside procedures; including traction, cast

application, joint aspiration, etc - Follow and obtain various results of investigations and reports abnormal results

to seniors. - Follow up referral of patients to other specialties - Observe seniors explaining to patients, methods of management & their illness

and discusses this process with seniors. - Observe the approaches taken by the seniors when talking to patients about

prognosis of their illness - Check completeness of medical reports of patients - Participate in pre and post-operative assessment of the patient.

- Attend the general orthopedic and fracture clinic with other senior staff

- Complete various hospital forms.

- Assist and learns outpatient procedures in the clinic and plaster room.

- Participate in basic operative planning of fracture fixation

- Participate in minor surgical procedures and perform some under supervision

- Participate in moderate surgical procedures as an assistant.

- Attend major and subspecialty surgical procedure.

- Write operative notes and postoperative orders.

- Usage of various operative instruments and implants

- Presentation of cases in rounds. - Participation in grand rounds and journal

clubs - Attend all educational activities of the

residency program, local education courses and basic courses of internal fixation.

YEAR

4

- The first/ second on call; conducting primary assessment and management of patients in ER

- Decide on and admits patients with consultation of seniors

- Perform closed reduction of fractures and cast application

- Perform various emergency procedures performed in ER

- Perform or Supervising clerking of all admissions, requests basic and special investigations and draws plan of management

- Perform daily rounds - Comment on daily progress notes, write discharge notes with supervision and checks proper home medication and doses and proper follow up appointments of inpatients

- Perform various bedside procedures under supervision if necessary; including traction, cast application, joint aspiration etc.

- Check results of various investigations. - Suggest referral of patients to other specialties - Assist in explaining to patients the methods of management and their illness

and discusses this process with senior staff - Observe the approaches taken by the seniors when talking to patients about

prognosis of their illness - Write preliminary medical reports of patients - Ensure full preoperative assessment and preparation under supervision of

seniors, Perform post-operative follow up of patients

- Assess patients in the generalorthopedics & fracture clinic with supervision

- Attend sub-specialized ortho clinics with consultants

- Request investigations - Perform basis outpatient

procedures in the clinic and plaster room (removal of the cast, change of cast, joint aspiration)

- Suggest booking patients for elective admission under supervision & Completing admission forms

- Prepare operation lists & active engagement in operative planning of various fractures and reconstructive operations

- Perform minor surgical procedures- Perform moderate surgical

procedures as first assistant - Assist consultants/senior

performing major & sub-specialty surgical procedure (2nd Assistant)

- Write operative notes and post-operative orders under supervision

- Master the usage of various operative instruments & implants; their advantages & disadvantages

- Supervise junior in daily case presentation in the rounds

- Present cases in grand rounds and prepares topics for journal clubs

- Participate and presents cases in pathology/radiology meetings

- Participate in morbidity & mortality mtngs - Presents topics in the orthopedic club - Attend all educational activities and

lectures of continuous education. - Attend local education courses & basic &

advanced courses of internal fixation - Plan clinical research projects; Helping

in data collection and data search of ongoing research

- Prepare A/V materials for presentations

YEAR

5

- The second on call; Supervising junior trainee on primary management of patients in ER

- Check and approve decision of admission and management of patients

- Supervise and perform closed reduction of fractures

- Supervise & perform various procedures performed in ER

- Comprehensive clinical assessments of all admissions, supervising junior traineesapproving basic investigations & requesting advanced investigations

- Execution & modification management plan after consulting with senior staff - Daily rounds on all patients - Supervise & ensure complete & up-to-date clinical progress notes are written - Resolve problems related to discharge of patients, their home medications &

follow up appointments - Supervise various bedside procedures; and Ensuring the quality of execution

and follow up of such procedures - Take actions based on results of investigations after consulting with seniors

when required - Suggest and execute referral of patients to other specialties - Ensure understanding of patients, their management plan, Surgeries,

medications & various procedures - Answer patients with regards to prognosis under the supervision of or after

discussion with consultants - Approve preliminary & write detailed medical reports - Perform preoperative assessment of inpatients & discusses assessment with

seniors. Ensure proper post-operative follow up of patients

- Run a general orthopedic and fracture clinic alone with supervision of seniors

- Attend sub-specialized orthopedic clinics with consultants

- Interpret results of various investigations and takes decisions related to patient management

- Supervise performance of basic outpatient procedures in the clinic and plaster room, ensuring quality control

- Arrange booking patients for elective admission after consulting with the seniors

- Ensure completion of operation lists, operative planning of various fractures and reconstructive operations

- Assist junior trainee performing minor surgical procedures

- Perform moderate surgical procedures as independently

- Perform major and sub-specialty surgical procedure (1st/ 2nd Assst)

- Write operative notes and postoperative orders independently and Supervising juniors doing so

- Learn special techniques and usage of special implants for complicated cases.

- Head daily rounds - Supervise case presentation in grand

rounds and topics for journal clubs - Prepare and present cases in

pathology/radiology meetings - Help in preparation of morbidity and

mortality meetings - Present cases in the orthopedic club - Attend educational activities & prepares

the schedule for lectures of continuous education & teaching of the residency program & Supervising juniors

- Attend education courses - Organize the on call Rota - Allocate duties and tasks to juniors and

Supervising their execution - Prepare various A/V presentations - Participate in ongoing research and

preparation of papers and data collection Copyright © 2008 Jordanian Royal Medical Services - http://www.jrms.gov.jo/Portals/1/logbook/Logbook%20Orthopedics.pdf


Assessments & Supervision

Examinations

With an aim to streamline the Annual Promotion of Residents, a yearly internal assessment examination to evaluate his/her eligibility for progress will be held. There will be Formal assessments in Written and/or Oral form at the end of the common trunk to decide the Resident’s promotion from Phase 1 (Year 1-2) to Phase 2 (Year 3-4-5-6). Log Books

Resident in Phase 2 shall be assessed on the logbook as well. It is mandatory that all activities that the Resident undertakes during the Program are recorded in a logbook of procedures and interventions (operative and conservative treatment). Each entry is to be signed by the Resident as well as by the responsible Supervisor. At the completion of the rotation all documents, the logbook and assessment records will be forwarded to the Program Director.

The trainee’s log book, and copies of reports which record the Resident’s operative and diagnostic experience (Refer Annexure), shall indicate the degree of supervision (A) Assisting senior surgeon

(S1) Performing a procedure under direct supervision - Consultant” scrubbed” for the major part of the operation (includes performing a significant part of the operation under supervision)

(S2) Performing a procedure under supervision - Consultant present in the theatre but not “scrubbed” (P) Performing a procedure without direct supervision (T) Supervising a more junior trainee. The log book is a means of analysis to assess both the experience & training level/position of the Resident. Minimum requirements for numbers of procedures: A minimum number of cases to be operated upon or examined by the Resident, in addition methods of assessment of competencies, both clinical and operative, should be developed. Specialty Examination In Orthopedic & Trauma Participants of the program will be trained according to the curriculum of the German Society of Orthopedics and Trauma (DGOU) in Dubai thus reaching the level of skills necessary for a specialist in Orthopedics and Trauma. Contents of the curriculum that participants cannot obtain in Dubai will be acquired in a hospital during the mandatory professional activity at the end of the program in Germany. Subject to following conditions, Residents may be admitted to the Facharztprüfung Exam at the Berlin Chamber of Physicians. - Necessary legal requirements being met - Residents’ Registration to the Berlin Chamber of Physicians DGOU is responsible for the placement of the participants of the Dubai Residency Training Program in suitable hospitals and will ensure the professional mentoring of the trainees during their stay in Germany. Thus the requirements are met to apply for presenting themselves for the board exam at Berlin Chamber of Physicians. ÄKB allows registered members of the Berlin Chamber of Physicians that also were participants of the Dubai Residency Training Program to take the board exam (Facharztprüfung), if the requirements with regard to requested contents and times of the regulations on specialized training are met. Passing of the exam lies within the personal responsibilities of the candidate and cannot be guaranteed by the Berlin Chamber of Physicians. After having successfully taken the exam at Berlin Chamber of Physicians, the specialists will return to Dubai and work for DHA as Specialists (SSR) in the Orthopedics and Trauma Department. Supervision - Clinical responsibilities must be assigned to the residents in a carefully supervised and progressive manner, so that the resident

assumes increasing responsibility in accordance with their level of education, ability and experience - Teaching staff supervision must include timely and appropriate feedback to the residents - The Resident’s clinical involvement must be in fulfillment of the program’s written educational curriculum - Teaching staff must demonstrate concern for each Resident’s well-being and professional development. - Teaching staff who supervise the residents have overall responsibility for patient care and are the authority for final decision - Teaching staff schedules must be structured to ensure continuous supervision of residents and availability of consultation - All decisions regarding diagnostic tests and therapeutics, initiated by the residents will be reviewed with the responsible Consultants

during patient care rounds - Patients will be seen by the team of residents, interns and medical student and their care will be reviewed with the Consultant at

appropriate intervals - The residents are required to promptly notify the patient’s Consultant physician in the event of any controversy regarding patient

care or any serious change in the patient’s condition - In clinics and consultation services, the Consultant or supervising physician must review overall patient care rendered by residents - In the operating theatres, the Consultant or supervising physicians are responsible for the supervision of all operative cases.

Consultants or supervising physicians must be present in the operating room with residents during critical parts of the procedure. For less critical parts of the procedure, the Consultant or supervising physician must be immediately available for direct consultation.


Syllabus

General Orthopedic Trainees are expected to possess in depth knowledge and exposure to following areas and key aspects of Orthopedic & Trauma, eventually, applying this knowledge when interpreting clinical symptoms, signs and investigations in the practice of orthopedics and identifying available therapeutic options and preventative measures

Basic Science Knowledge of basic science, when interpreting clinical investigations & the practice of orthopedic surgery. Anatomy: Anatomy of the musculoskeletal system and neuro-anatomy with special emphasis on applied anatomy relevant to clinical methods of assessment and management in orthopedic practice, particularly: - Anatomy & embryology of musculoskeletal system - Anatomy of nervous and vascular systems - Clinical & functional anatomy with pathological and

operative relevance - Surgical approaches to the limbs & axial skeleton

Tissues: Normal histological structure & function of musculoskeletal tissue: - Cellular & molecular biology - Bone - Cartilage - articular, & meniscal - Muscle and tendon - Synovium - Ligament - Nerve - Intervertebral Disc

Operative Topics: Different aspects of design of operating theatre & their application, determining the possible discomfort, distress and risks to which the patient may be exposed pre/intra/post operatively, particularly: - Pre- Operative assessment - Tourniquets - Operative theatres (Design, Circulation &

Ventilation) - Anesthesia - principles and practice of local and

regional anesthesia and principles of general anesthesia

- Postoperative assessment and care

Thromboembolism & Pain: Different aspects & principles of: - Thromboembolism & prophylaxis - Pain and pain relief - Complex regional pain syndromes e.g.

Reflex Sympathetic Dystrophy and Causalgia

Infections Classification of different infectious diseases of bone and joints, soft tissue and their pathogenesis and identifying common causative organisms

Physiology, Biochemistry & Genetics: - Bone homeostasis, metabolism & hormonal regulation - Physiology of cartilage - Bone grafts, bone banking & tissue transplantation - Shock- types, physiology, recognition & treatment - Metabolic & immunological response to trauma - Blood loss in trauma/surgery, fluid balance & blood

transfusion - Application/ relevance of modern genetics to

orthopedic disease and treatment

Biomechanics & Bioengineering: - Biomechanics of musculoskeletal

tissues - Biomechanics of fracture fixation - Tribology of natural and artificial

joints - Design of implants and factors

associated with implant failure (wear, loosening)

- Kinematics and gait analysis - Biomaterials

General Diseases Describing and Categorizing the pathology of bone & joints, incl. Metabolic bone diseases, osteoarthritis, osteoporosis, rheumatoid arthritis & other arthropathies (inflammatory, crystal, etc), haemophilia, inherited musculoskeletal disorders, neuromuscular disorders (inherited and acquired), osteonecrosis, osteochond-ritides & heterotopic ossification.

Research & Audit in Orthopedic practice: - Design & conduction of clinical trials - Data analysis and statistics - Epidemiology - Evidence based medicine - Audit

Investigations: - The range of investigations available and the

circumstances in which they are used. - Selection appropriate investigations and recognize

when further action is required. - Limitations of the investigation and the implications of

a positive or negative test result. - The possible discomfort and distress and risks to which

the patient may be exposed during the test - The cost & localize the resources involved, particularly

blood tests. - Musculoskeletal imaging: x-ray, contrast studies

(myelography, arthrography), CT, MRI, ultrasound, radioisotope studies & the effects of radiation, bone densitometry & electrophysiological investigations

Prosthetics & Orthotics: - Design of standard prostheses - Prescription and fitting standard

prostheses - Orthotic bracing for control of

disease, deformity and instability

Infection - Prevention & Control The standard guidelines and protocols for infection control and prevention in the orthopedic setting, including: - Standard precautions - Aseptic techniques - Antiseptics and disinfectants - Sterilization - Antimicrobial policy - Surgery in high risk patients with blood-borne

viruses (HBV-HCV-HIV) & its ethical implications on healthcare providers.

Orthopedic Oncology Identify & describe the presentation, radiological features, pathological features, treatment and outcome of orthopedic benign and malignant bone and soft tissue tumors. Principles of management of patients with metastatic bone disease in terms of investigation, prophylactic and definitive fixation of pathological fractures and oncological management


TRAU

MA

GEN

ERAL

Basic Science The basic science (anatomy, biomechanics & pathology) applied to diagnosis and surgical treatment of common bone, joint and soft tissue injuries. Anotomy: - Anatomical structures particularly at risk

from common injuries/ surgical approaches - Physical anatomy & its application to

injury. Biomechanics: - Fracture pattern and fracture treatment

both operative and non-operative. - Open reduction and internal fixation of

fractures and external skeletal fixation. - Biomechanics of implants &fracture

fixation systems, incl. their material properties.

Pathology: - Systemic response of body to major injury. - Response of infants, children & elderly to

injury. - Science of fluid replacement therapy in the

acutely injured. - Classification systems for fractures &

dislocations. - Bone & soft tissue healing, including skin,

muscle, tendon & neurological structures. - Pathogenesis of compartment syndrome. - Mechanisms underlying Acute Respiratory

Distress Syndrome and similar life threatening conditions.

- Response of the body & local musculo-skeletal tissues to infection.

- Pathology of non-union of fractures.

Clinical Assessment: - Clinical assessment of patients with severe injury,

including spinal cord injury, soft tissue injury, burns & head injury.

- Assessment of all types of fractures and dislocations, their complications, early and late.

- Life & limb threatening injuries and priorities of treatment.

- Investigations: Principles, application and side effects of commonly used investigations, including radiographs, CT and MRI scans, radio-isotope imaging, ultrasound scans and electrophysiological investigations.

Treatment: - Categorizing different treatment options for musculoskeletal injury, both

non-operative and operative. - Explaining the principles necessary to plan the overall care of severely

injured - Outlining & justifying the treatment of all types of common fracture &

dislocation incl. the bone and soft tissue treatment of open fractures & treatment of pathological fractures

- Management and treatment of patients with common injuries that are normally treated by a subspecialist (e.g. spinal injury, arterial injury or intra cranial hemorrhage) and outline the principles of the specialist treatment.

- Principles of reconstructive surgery for the injured, treatment of non-union & mal-union of fractures, bone defects, chronic post-traumatic osteomyelitis, principles of soft tissue reconstruction & delayed treatment of nerve injury

- Principles of amputation in the injured & rehabilitation of such patients.

PED

IATR

IC O

RTH

O S

UR

GER

Y

Basic Science - Growth of bones, physeal anatomy & its

application to fracture types & pathological processes & infection in particular.

- Anatomy of bones and joints in the growing child and its application to growth and deformity.

- Neurological processes involved in the deformity e.g. spina bifida, cerebral palsy, muscular dystrophy and poliomyelitis.

Clinical Assessment: - Competently interpret orthopedic clinical

examination of a child & to relate effectively with the family.

- Normal variants that would be considered deformities by family and pediatricians

- Identification of proper management in pediatric orthopedic practice & when to refer suitably for specialists’ treatment.

Investigations: - Indications for plain x-ray, CT, MRI & interpret images. - Indications for the use of ultrasound, arthrogram and

nuclear imaging. - Limitations of certain investigations in Pediatric practice - Screening methods for congenital abnormalities &

methods for assessment of physical disability.

Treatment: - Fractures (including non-accidental injury) and growth plate injuries and

recognize the sequelae. - Bone and joint infection - Common Pediatric Orthopedic conditions; irritable hip, anterior knee pain,

Talipes, slipped epiphysis & Perthes' disease. - All trainees should be able to list the treatment options for birth injuries,

Developmental dysplasia of the hip, Scoliosis, Simple foot deformities (e.g. hallux valgus, metatarsus varus), Simple congenital hand abnormalities (e.g. trigger thumb), Osteogenesis imperfect, Skeletal dysplasias, Tarsal coalitions, Torticollis, and leg length discrepancy.

Copyright © 2008 Jordanian Royal Medical Services - http://www.jrms.gov.jo/Portals/1/logbook/Logbook%20Orthopedics.pdf


HIP

Anatomy - The regional anatomy of the hip

including: Development of the hip joint, relationship of bony elements, blood supply of the femoral head, anatomical course of all major regional vessels, nerves and the capsule, labrum and related ligaments.

- The action, anatomy and innervations of the regional musculature

- The applied anatomy of common surgical approaches to the hip (medial, anterior, lateral and posterior).

- Biomechanics - Lever arms, muscles & body weight forces that produce the joint reaction force in both normal & abnormal hips & their application to the rationale of pelvic and femoral osteotomies, and replacement arthroplasty.

- Tribological properties of materials used for articulating surfaces.

- Recognize the biocompatibility and mechanical properties of materials in common use in total hip arthroplasty.

Pathology - Pathology of pyogenic/non-

pyogenic arthritis, slipped capital femoral epiphysis (SCFE), Perthes' disease & hip dysplasia

- Explain the mechanism and pattern of common fractures & fracture dislocations around the hip (intracapsular, extra-capsular, acetabular & peri-acetabular, femoral head, etc).

- Describe the pathology of osteoarthritis, rheumatoid arthritis and the seronegative-arthritides at the hip and of osteonecrosis of the femoral head.

- Explain current theories of the aetiopathogenesis of osteo-arthritis

- Explain the microbiological rationale for the prevention of sepsis in total hip arthroplasty.

Clinical Assessment: All trainees must be able to discuss the clinical assessment of the hip, lumbosacral spine and knee. Particular reference should be paid to the gait, the Trendelenberg sign, limb length, loss of movement and deformity at the joint. Interpreting aetiopathogenesis, clinical presentation and appropriate investigation of: - Proximal femoral fractures (intracapsular, extra-

capsular) & simple fracture dislocations of the hip - Osteoarthritis and the inflammatory arthropathies - Perthes' disease - Slipped capital femoral epiphysis - Infective arthritis - Osteonecrosis - Soft tissue conditions around the hip (snapping

hip, gluteus medius tendonitis, etc) Identify the clinical presentations of and investigations required for: - Thesequelae of DDH and hip dysplasia - Thesequelae of SCFE - Juvenile chronic arthritis - Non pyogenic arthritis - The painful total hip replacement

Investigation: - Interpretation of plain radio-

graphs, CT & MRI of the hip region

- Recognizing the value of dynamic arthrography, bone scintigraphy

- Interpretation of proximal femoral and peri-acetabular fractures.

Mechanisms of failure of joint replacement and of peri-prosthetic fractures

Treatment (Non-operative and Operative): - Principles of traction, bracing and Spica immobilization. - Non operative aspects of the management of hip pathology - Soft tissue surgery, osteotomy, arthrodesis and arthroplasty

(excision and replacement). - Anterior, anterolateral, lateral & posterior approaches to the

hip and of the complications associated with each - Internal fixation of proximal femoral fractures, hemi-

arthroplasty for intra-capsular fractures, primary total hip replacement for OA and inflammatory arthropathies in the elderly, simple proximal femoral osteotomies.

- Potential complications (i.e. thromboembolism, sepsis, dislocation, etc) and explain the prevention and management of these complications.

- Indications for, and principles of, complex proximal femoral osteotomies, hip arthroscopy, reconstruction of the hip in young adults (Juvenile chronic arthritis & hip dysplasia, etc.) & complex hip revision surgery.

- Management of complex Acetabular and pelvic fractures, complex peri-acetabular osteotomies

- Modern technologies such as, joint resurfacing procedures minimally invasive hip replacements and computer assisted implantation in the management of hip pathology and the attendant risks and complications.

HAN

D S

UR

GER

Y

Anatomy - Regional anatomy of the hand including

wrist/MCP/PIP/DIP joints and CMC joint of the thumb

- Flexor and extensor mechanism of the fingers including interaction between extrinsic and intrinsic mechanism

- Posture of the thumb in pinch, power and key grip

- Nerve supply to the hand - Closed compartments of forearm and

hand

Pathology: - Circumstances associated with

swelling & the effects of rising pressure in a closed compartment secondary to infection & injury

- Circumstances in which edema causes fibrosis and permanent stiffness

- Tendon injury and healing - Nerve injury and healing - Imbalances and deformities

associated with inflammatory arthritis

- The classification system for congenital hand disorders

- Langers lines - Hand tumors (e.g. ganglion/

enchondroma) - Dupuytren's disease

Clinical Assessment: - Compilation of data for clinical history taking and

examination of hand and wrist in the assessment of tendons, distal radioulnar and radiocarpal joints

- Methods for eliciting median, ulnar and radial nerve function and disorders

- Patterns of presentation of common compressive neuropathies and brachial neuralgia

- Assessing intrinsic and extrinsic motors in digits & recognize common deformities and deficiencies

- Presentation of work-related hand disorders - Examination & assessment of common

rheumatoid hand deformities e.g. inferior radio-ulnar subluxation and carpal trans-location; MCP subluxation and ulnar drift; digital Boutonniere and swan neck; thumb Boutonniere deformity and CMC disease

- Assessment of focal hand swellings

Investigations: - Interpretation of Plain and

stress x-rays of wrist and describe other views.

- The role of MRI/ bone scan/ arthrography/ arthroscopy

Electrophysiological studies and correlate them with clinical situation

Treatment: - Strategy of management for the osteoarthritic and

rheumatoid hand. - Recognize the place of soft tissue reconstruction, joint fusion,

interposition and excision arthroplasty in the treatment of the arthritic hand and wrist.

- Outline the management of stenosingtenovaginitis - Principles of treatment for common flexor & extensor tendon

injuries and common surgical approaches to the digital flexor & extensor compartments

- Principles of treatment for fractures of metacarpals and phalanges

- Surgical treatment of Dupuytren’s disease - Treatment of common compressive neuropathy - Principles of tendon transfer for reconstruction of median,

ulnar/radial nerve palsy & describe simple transfers - Splinting techniques and rehabilitation principles - Management of fingertip injuries - Surgical approach to digits with particular regard to the

restoration of function & prevention of stiffness - Levels for digital amputation - Treatment options for injuries of ulnar collateral ligament of

thumb and dislocations of carpus and carpal instability - Closed & operative options of treatment for fractures of distal

radius & common carpal injuries incl. scaphoid nonunion. - Surgical techniques for treating hand infections


KN

EE

Anatomy - Regional anatomy of the

knee, incl. surface anatomy - Neural/Vascular structures,

their relations with particular reference to standard anterior/ posterior surgical approach

- Bones and articulations of the knee region

- Functional anatomy of ligaments & supporting muscles

- Innervation of knee incl. controlling musculature

- The extent & function of the synovium & bursae of knee

- The structure of the menisci, and articular cartilage.

Biomechanics: - Mechanics of Patello-femoral

mechanism - Medial & lateral compartments and

their inter-relationship - Cruciate & collateral ligaments and

other ligamentous and muscular supports

- Function of the menisci and articular cartilage.

Pathology: - Mechanism of ligamentous, bony and

combined trauma to the knee and healing potential

- Arthritides, incl. degenerate wear, ageing changes and traumatic damage

- Pathology of inflammatory disease & infection affecting the knee

- Response of synovium to debris - Benign & malignant conditions in the

knee and surrounding structures

Clinical Assessment: - Compilation of data, by way of clinical history taking, examination of

the knee and relevant surrounding structures - Standard clinical signs and symptomatology of the knee and relevant

adjacent structures - The rating and outcome measures in common use for knee diseases. Investigations: - Radiographs (Standard & specialized - Blood investigations and Aspiration - Special investigations incl. CT, MRI and radioisotope scanning, - Arthroscopy -

Treatment: Selection of conservative and surgical management, (including the indications for referral to a specialist) of: - Pediatric disorders, including deformity, dislocations, epiphyseal disorders,

osteochondritis and discoid meniscus - Adolescent disorders including patello femoral and meniscal dysfunction,

osteochondritis dissecans - Young adult disorders including patello femoral & meniscal injuries, instability &

ligament deficiency, synovial disorders, benign and malignant tumors - Degenerative/ inflammatory arthritis, incl. balance between conservative &

surgical options, incl. osteotomy, arthrodesis & arthroplasty - Traumatic disorders including skin and soft tissue injuries, fractures and

dislocations of patella, tibia and femoral components, ligament ruptures, internal derangement of the knee, the conservative and surgical indications and detailed methods of treatment and the outcomes of conservative and operative management

- Infections & inflammations of bursae, intra-articular sepsis, prevention & management of sepsis in implant surgery.

- Range of primary arthroplasties for patellafemoral, unicompartmental and total replacement of the knee with particular reference to secure bone anchorage, alignment, ligament stability and optimizing range of movement; in addition, they must be able to discuss post-operative complications, their prophylaxis and management

- Indications and techniques for revision arthroplasty particularly for aseptic and septic loosening

- Simple arthroscopic surgery including meniscectomy, trimming &shaving - Recognize the complexity of arthroscopic procedures. - Medical/surgical techniques available to repair & replace articular cartilage

ANK

LE &

FO

OT

SU

RG

ERY

Anatomy: - Regional anatomy of the

ankle and foot including Bones and articulations

- Ligamentous structures - ankle/ hind foot/ mid foot

- Plantar fascia & MTP anatomy

- Surface markings of neural and vascular structures

- Tendon anatomy - Muscle compartments of

the foot

Biomechanics: - Function of the lower limb and foot in

gait - Ankle and Subtalar joint - Plantar fascia mechanisms - Tendon function - Orthoses and footwear Pathology: - Arthritides: Degenerative joint disease

and Rheumatoid foot disease - Neuropathy: Neuropathic joint and skin

changes - Tumors: Bony and soft tissues.

Clinical Assessment: - Compilation of data from direct history taking and clinical examination

of the foot and ankle in order to assess pain, joint function, deformity, nerve, muscle and tendon function

- Clinical presentation of the following diseases of the ankle and foot: - Neurological disorders: Charcot joint, Morton's neuroma, Nerve

entrapment, Neurological foot deformity - Trauma: Evaluation of skin and soft tissue injury, Compartment

syndrome, recognition of fractures & dislocations - Ankle & hindfoot disorder: Hindfoot pain, Ankle instability, Heel pain,

Degenerative disease of the ankle, Rheumatoid arthritis & Osteochondritis-dissecans of talus

- Forefoot disorders: Hallux valgus, Hallux rigidus, Lesser toe deformities, Metatarsalgia, Inflammatory arthritis,

- Tumors and local foot swellings - Diabetic foot - Complex foot deformity: Flatfoot deformity, mobile & rigid, Cavus

deformity, Residual congenital foot deformity Investigations: - Radiographs - Standard foot & ankle views, CT, MRI and Scintigraphy

in certain conditions e.g. infection, tumor, tibialis posterior rupture, osteonecrosis Electrophysiological studies in certain foot & ankle disorders e.g. tarsal tunnel syndrome.

Treatment: Non-operative and Operative - Rational for the use of footwear modifications, orthoses and total contact

casting. - Selection of suitable closed/ operative methods for management of fractures/

dislocations of ankle, hind & fore foot. - Common reconstructive surgical procedures for degenerative and inflammatory

disorders of ankle and foot - Common amputations through foot and ankle.



SH

OU

LDER

& E

LBO

W

Anatomy: Regional anatomy of the shoulder including: - Anatomy of Sternoclavicular,

Acromioclavicular, Glenohu-meral & elbow joints to include the connecting bones, muscles & tendons acting across them, neurovascular supply, bursae & relationships to local structures

- Surgical approaches: deltopectoral and posterior approaches to Glenohumeral joint; superior (McKenzie) approach to rotator cuff; and surgical approaches to the Acromioclavicular and Sternoclavicular joints

- Structure and function of the above joints; and the static and dynamic stabilisers of the Glenohumeral & elbow joints

Biomechanics: - Biomechanics of the shoulder and

elbow - Various types of shoulder & elbow

prostheses including factors influencing design, wear & loosening

Pathology: - Benign and malignant conditions

affecting the shoulder girdle, elbow and surrounding soft tissues

- Interpretation of the pathology of: Impingement and rotator cuff disorders, Instability of the shoulder and the elbow, Inflammatory and degenerative conditions affecting the articular cartilage and synovium, Infection, Adhesive capsulitis of the shoulder. The pathology of the stiff elbow, Disorders such as ulnar neuritis and tennis or golfer’s elbow.

Clinical Assessment: - Compilation of data from history taking and examination of the

painful, stiff or unstable shoulder or elbow - Categorize clinical tests used specifically to assess instability of

the shoulder and elbow, rotator cuff disorders, the stiff shoulder or elbow and the use of local anesthetic in assessment. Examples are the apprehension tests for shoulder instability, impingement signs and tests, Gerber’s lift off test, Napoleon's sign, elbow instability tests, ulnar nerve assessment.

- Conditions causing referred symptoms to shoulder & elbow (cervical spine diseases, entrapment neuropathies and thoracic outlet disorders etc)

- Common conditions affecting the shoulder including: instability, impingement, rotator cuff tears, adhesive capsulitis, osteoarthritis, rheumatoid disease, avascular necrosis, biceps tendon disorders, fractures of the proximal humerus and clavicle, and disorders of the Acromioclavicular and Sternoclavicular joints and scapula.

- Common conditions affecting the elbow including instability, osteoarthritis, rheumatoid arthritis, causes of stiffness, soft tissue problems such as medial and lateral epicondylitis, neuropathies and fractures around the elbow.

Investigation: - Role of plain radiographs as used to

assess shoulder and elbow disorders; including special views (e.g. Modified axial, Stryker notch, Supraspinatus Neer outlet & cubital tunnel views) required to assess adequately the conditions which commonly affect the shoulder & elbow and interpret correctly normal and abnormal abnormalities on plain radiographs.

- Value of ultrasound, arthrography, CT and MRI as used to assess the shoulder and elbow and describe straightforward abnormalities on CT and MRI (e.g. full thickness & partial thickness rotator cuff tears on MRI and the pathological anatomy of fractures around the shoulder and elbow using CT).

- Use & abuse of arthroscopy of the shoulder & elbow including description of normal & abnormal arthroscopic findings

Treatment: Non-operative and operative treatment of: - Straightforward fractures and dislocations of

the shoulder girdle and elbow. - Complex fractures including referral to

specialist; examples of these include four part fractures of the proximal humerus and complex intra-articular fractures of the distal humerus, upper limb injuries involving injuries to the brachial plexus.

- Disorders such as recurrent anterior traumatic instability of shoulder, rotator cuff impingement & small rotator cuff tears, adhesive capsulitis & Acromioclavicular joint pain.

- Soft tissue elbow disorders such as lateral & medial epicondylitis and ulnar neuropathy.

- The principles of management of tumors around the shoulder and elbow.

- Injection techniques for both the shoulder and the elbow.

- Arthroscopy of the shoulder and elbow. - Prosthetic replacement of shoulder & elbow

(without details of surgical techniques).

THE

SPIN

E

Anatomy: - Recall the development of the

spine - Surgical anatomy of the

cervical, dorsal, lumbosacral spine, spinal cord and nerve roots

- Anterior and posterior surgical approaches to the spine at each level

Biomechanics: - Cervical and lumbosacral spines - Spinal instability as applied to

trauma, tumour, infection and spondylolysis/ listhesis

- Spinal deformity - Basic mechanics of spinal

instrumentation Pathology: - Pathophysiology of the ageing

spine & degenerative disc disease - Acute and chronic infections of the

spine - Pathology of spinal deformity &

acutely prolapsed cervical and lumbar disc

- Patterns of spinal injury and associated cord and nerve root damage

- Tumors of the spine

Clinical Assessment: - Compilation of data necessary for general and Orthopedic

history-taking and examination - Methods of assessment of spinal deformity & Thoracic pain - Clinical assessment of the spine for low back pain, sciatica,

spinal claudication, neck pain, radiating arm pain, spinal injury & incipient myelopathy

- Describe the clinical assessment of spinal tumor - Outline the assessment of a patient after failed spinal surgery.

Investigation: - Selection of basic investigations

required in spinal surgery, specifically, blood tests, plain radiographs, bone scintigraphy, discography, electrophysiological studies [including cord monitoring], CT scanning, MRI scanning

- Use of investigations for the diagnosis and management of each of the major areas of spinal disease

Treatment: Non-operative - Non-surgical methods for the treatment of

low back pain, sciatica, claudication, neck pain, spinal deformity, instability, tumor, infection & fracture

- Indications for use of analgesics and NSAIDs, physiotherapeutic regimes, pain clinic techniques, bracing, use of radiotherapy and chemotherapy and other non-operative management approaches of spinal injuries.

Operative - Indications for and technique of operative

surgical management of the acute prolapsed lumbar intervertebral disc, spinal stenosis, lumbar spinal instability due to spondylolysis/ listheses.

- Indications and operative surgical management for the acutely prolapsed cervical disc, cervical stenosis, spinal injury and the surgery of spinal infection.

- Surgical treatment options for spinal deformity and tumors of the spine.



APPLIED INTELLECTUAL AND OPERATIVE SKILLS Clinical Assessment and Management Applies to Trauma (General, spine, pelvis, UL&LL) Orthopedics (site nonspecific, spine, UL &LL) - Take a directed clinical history from a patient, which is appropriate for the clinical problem and the individual

patient's needs. - Examine the patient both general & musculoskeletal examinations. - Formulate an evaluation plan for appropriate medical, laboratory, and radiological examinations. - Construct a diagnosis and differential diagnosis. - Identify when a situation is sufficiently complex or multifaceted to require a further opinion and investigations. - Plan for treatment (surgical or non-surgical). - Explain the perioperative process and likely outcome to the patient and/or relatives or caregivers and check

understanding. - Take informed consent. Preoperative planning - Recognize anatomical and pathological abnormalities (and relevant comorbidities) and select appropriate

operative strategies/techniques to deal with these. - Choose with reasoning appropriate equipment, materials or devices (if any) taking into account appropriate

investigations e.g. x-rays, ECG. - Check materials, equipment and device requirements with operating room staff. - Ensure the operation site is marked where applicable. - Check patient records, personally review investigations. Preoperative preparation - Check in theatre that consent has been obtained - Give effective briefing to theatre team - Ensure proper and safe positioning of the patient on the operating table - Demonstrate careful skin preparation - Demonstrate careful draping of the patient’s operative field - Ensure general equipment and materials are deployed safely (e.g. catheter, diathermy) - Ensure appropriate drugs administered - Arrange for and deploy specialist supporting equipment (e.g. image intensifiers) effectively Exposure and closure - Selection of the proper skin incision / portal / access - Adequate exposure through purposeful dissection in correct tissue planes & identifies all structures correctly - Completion of a sound wound repair where appropriate - Protection of wound with dressings, splints and drains where appropriate Intra operative Technique - Follow an agreed, logical sequence or protocol for the procedure - Consistently handle tissue well with minimal damage - Control bleeding promptly by an appropriate method - Demonstrate a sound technique of knots and sutures/staples - Use instruments appropriately and safely - Proceed at appropriate pace - Anticipate and respond appropriately to variation e.g. anatomy - Deal calmly and effectively with unexpected events/complications - Use assistant(s) to the best advantage at all times - Communicate clearly and consistently with the scrub team anesthetist Post-operative Management - Ensure the patient is transferred safely from the operating table to bed - Construct a clear operation note - Record clear and appropriate post-operative instructions - Deal with specimens. Label and orientate specimens appropriately

Operative Procedures

All trainees have to demonstrate competence in the procedures in relevance to the defined levels Defined Levels of Competence

1 Has observed (Real/Video) 2 Can assist 3 Can do under supervision 4 Competent to do whole without assistance, including managing complications SL Competent to perform in skill lab

Procedures to be performed according to the level of competence by the end of the 3rd Year

Category Procedure description Competence level Trauma General Free flap 1 Full thickness skin graft 2 Muscle flap 1 Nerve repair 2 Removal external fixator or frame 4 Removal foreign body from skin / subcutaneous tissue 4 Removal K wires or skeletal traction 4 Split skin graft 2 Trans positional flap 1 Wound closure, delayed primary or secondary 4 Wound Debridement 3/4 Closed management of fractures and plaster application 4 Spine Cervical Spine Anterior fixation fracture / dislocation cervical spine 2 Cervical spine traction / tong traction cervical spine SL MUA fracture / dislocation cervical spine 2 Posterior fixation fracture / dislocation cervical spine 2/3 Thoracic Spine Anterior decompression / fixation thoracic spine 1 Posterior decompression / fixation thoracic spine 2/3 Lumbar Spine Anterior decompression / fixation lumbar spine 2 Posterior decompression / fixation lumbar spine 2/3 Pelvis Acetabular fracture ORIF 2 Pelvic fracture external fixator application 2/3 Pelvic fracture ORIF 2 Upper Limb Clavicle ORIF clavicle fracture 2 ORIF non-union clavicle fracture 1 Shoulder Anterior dislocation shoulder closed reduction 4 Anterior dislocation shoulder open reduction +/- fixation 2 Acromioclavicular joint dislocation acute ORIF 2 Fracture proximal humerus ORIF 2 Glenoid fracture ORIF 1 Humeral Shaft Fracture diaphysis humerus POP +/- MUA 2 Fracture diaphysis humerus ORIF plating 2 Fracture diaphysis humerus IM nailing 3 Non-union ORIF +/- bone grafting 3



Category Procedure description Competence level Category Procedure description Competence level Elbow Dislocated elbow +/- fracture closed reduction 3/4 Lower Limb Dislocated elbow +/- fracture open reduction +/- fixation 3 Hip Dislocated hip closed reduction 4 Intra-articular distal humerus fracture ORIF 2 Dislocated hip open reduction +/- fixation 2 Lateral condyle fracture ORIF 3 Intracapsular fracture internal fixation 2 Medial condyle / epicondyle fracture MUA / K wire / ORIF 3 Intracapsular fracture hemiarthroplasty -Bipolar(excluding bipolar) 1/2 Olecranon fracture ORIF 3 Intracapsular fracture THR 1 Radial head / neck fracture MUA +/- K wire/ excision 3 Extracapsular fracture DHS 2/3 Radial head / neck fracture ORIF 1 Extracapsular fracture intramedullary fixation 1 Supracondylar fracture MUA +/- K wires 3 Extracapsular fracture other fixation 1 Supracondylar fracture ORIF 3 Femur Sub trochanteric fracture plate/screw fixation 2 Forearm Fasciotomy for compartment syndrome 2 Subtrochanteric fracture intramedullary fixation 2 Fracture shaft radius / ulna MUA & POP 3 Diaphyseal fracture in children traction or spica 3 Fracture shaft radius / ulna MUA & percutaneous wires 3 Diaphyseal fracture intramedullary nailing 2/3 Fracture shaft radius / ulna ORIF 3 Diaphyseal fracture plate/screw fixation 2/3 Fracture distal radius MUA & POP 3 Diaphyseal fracture external fixator 3 Fracture distal radius MUA & percutaneous wires 3 Supracondylar fracture (not intraarticular) LISS plate 1/2 Fracture distal radius external fixation 3 Intraarticular fracture distal femur ORIF 2 Fracture distal radius ORIF 2 Knee Acute haemarthrosis aspiration/ arthroscopy 2/3 Wrist Carpal fracture / dislocation MUA & percutaneous wires/ MUA & POP/ ORIF 1 Quadriceps tendon repair 3 Scaphoid fracture non-op 4 Patella tendon repair 3 Scaphoid fracture MUA & percutaneous wires 1 Acute ligament repair 2 Scaphoid fracture ORIF 2 Patella dislocation closed reduction +/- open repair 3 Scaphoid fracture non-union ORIF +/- graft 2 Patella fracture ORIF 2/3 Hand Metacarpal fracture / dislocation POP & MUA 4 Tibial plateau fracture ORIF with plates & screws 3 Metacarpal fracture / dislocation MUA & percutaneous wires 3 Tibial plateau fracture treatment with circular frame 2 Metacarpal fracture / dislocation ORIF 2 Tibia & Fibula Diaphysealtibial fracture MUA & POP 4 Base of 1st metacarpal fracture/dislocation POP/Percutaneous wire/ORIF 4 Diaphysealtibial fracture intramedullary nailing 2/3 Phalangeal fracture MUA +/- POP 4 Tibial shaft plating 2/3 Phalangeal fracture MUA & percutaneous wires 3 Diaphysealtibial fracture external fixation (including frame) 2/3 Phalangeal fracture ORIF 2 Fasciotomy for compartment syndrome 2/3 MCPJ fracture / dislocation MUA +/- POP 4 Tibial non-union management 2 MCPJ fracture / dislocation MUA & Percutaneous wires 3 Ankle Ankle fracture / dislocation MUA & POP 4 MCPJ fracture / dislocation ORIF 2 Ankle fracture / dislocation ORIF 2/3 Extensor Tendon repair 3 Pilon fracture with external fixator 2 Flexor Tendon repair 2 Pilon fracture ORIF 1 Ligament repair hand 1 Tendoachilles repair 1 Fingertip reconstruction 2 Foot Calcaneal fracture ORIF 1 Nail bed repair 4 Talar, subtalar or midtarsal fracture/ dislocation MUA +/-POP +/-K wires 1 Infected hand drainage (not tendon sheath) 4 Talar, Subtalar or midtarsal fracture/ dislocation ORIF 1 Infection tendon sheath drainage 2 Lisfranc fracture ORIF 2 Hand compartment syndrome decompression 2 Metatarsal fracture ORIF 3 Phalangeal fracture MUA +/-K wire +/- ORIF 3


By the end of Year 4 & 5 all trainees have to demonstrate competence in the below procedures

Category Procedure description Competence levelSite Non-specific Aspiration / injection joint 4 Benign tumor excision (not Exostoses) 3 Biopsy bone – needle Biopsy bone - open 2 Bursa excision 4 Cyst bone curettage +/- bone graft 3 Epiphysiodesis 2 Malignant tumor excision 2 Drainage of acute infection of bone and joints 4 Spine Spine Cervical Spine Anterior decompression +/- fixation/ fusion (C2-C7) 2 Atlantoaxial fixation +/- fusion 2 Biopsy cervical spine 2 Excision cervical / 1st rib 2 Nerve root / facet joint injection cervical spine 2 Occipito-cervical fusion +/- fixation 2 Posterior decompression +/- fixation/ fusion (C2-C7) 2/3 Thoracic Spine Anterior decompression +/- fixation/ fusion 2 Biopsy thoracic spine 2 Posterior decompression +/- fixation/ fusion 2/3 Scoliosis correction – anterior release +/- instrumentation 2 Scoliosis correction – posterior fusion +/- instrumentation 2 Lumbar Spine Caudal epidural injection 3 Decompression lumbar spine with fusion +/- fixation 2/3 Decompression lumbar spine without fusion (not discectomy alone) 2/3 Discectomy open / micro 2 Nerve root / facet joint injection lumbar spine 2 Upper Limb Shoulder Acromio-clavicular joint excision- arthroscopic / open / lateral clavicle 2 Acromio-clavicular joint reconstruction (e.g. Weaver Dunn) 2 Acromioplasty open 2 Anterior repair for instability arthroscopic/open 2 Arthroscopic subacromial decompression 2 Arthroscopy diagnostic 2 Rotator cuff repair (open or arthroscopic) +/- acromioplasty 2 Total shoulder replacement 2 Elbow Elbow arthroscopy SL Arthrotomy elbow 4 Excision radial head +/- synovectomy 4 Radial head replacement 2 Tennis / golfer elbow release 3 Ulnar nerve decompression /transposition 3/4 Wrist Arthrodesis wrist (includes partial arthrodesis) 1 Carpal tunnel decompression 4 De Quervain's decompression 4 Excision distal ulna 4 Ganglion excision at wrist 4 Ulna shortening 4 Ulnar nerve decompression at wrist 3

Category Procedure description Competence level Hand Fusion of MCPJ or IPJ 2 Soft tissue reconstruction hand 2 Tendon transfer hand 2 Trapezium excision or replacement 2 Trigger finger release 4 Trigger thumb release 4 Lower Limb Hip Arthrotomy hip (drainage) 4 Excision arthroplasty hip (e.g. Girdlestone) 3 Open reduction for DDH 3 Revision of Hip Replacement 2 Slipped upper femoral epiphysis pinning 4 THR cemented/ hybrid/ surface replacement/ uncemented 3 Femur Amputation above knee 4 Femoral lengthening 2 Proximal femoral osteotomy (not for DDH) 3 Knee ACL reconstruction 3 Arthroscopic lateral release 3 Arthroscopic partial meniscectomy 3 Arthroscopic removal loose bodies knee 3 Arthroscopic synovectomy 3 Arthroscopic knee diagnostic 3 Osteotomy distal femoral 3 Osteotomy proximal tibial 3 Patella realignment 2 Unicompartmental knee replacement 2 TKR 3 Revision TKR 2/3 Tibia & Fibula Amputation below knee 4 Tibial lengthening 2 Ankle Arthrodesis ankle 3 Arthroscopy ankle SL Arthrotomy ankle 4 Decompression tendons at ankle 4 Tendoachilles lengthening 4 Foot Amputation toe / ray 4 Calcaneal osteotomy 3 CTEV correction non-operative 4 CTEV correction operative 3 Fifth toe soft tissue correction 1 First metatarsal osteotomy 3 First MTPJ arthrodesis 4 First MTPJ soft tissue correction 3 Hind-foot arthrodesis 4 In growing toenail operation 4 Tendon decompression or repair 2 Tendon transfer foot 2 Wedge tarsectomy 3


MUST DO LIST :: For all Residents to master in these procedures by the end of the training


Operative Skill Competence Level

Removal external fixator or frame 4

Removal foreign body from skin / subcutaneous tissue 4

Removal K wires or skeletal traction 4

Wound closure, delayed primary or secondary 4

Wound Debridement 4

Closed management of fractures and plaster application 4

Anterior dislocation shoulder closed reduction 4

Fracture diaphysis humerus IM nailing 4

Non-union ORIF +/- bone grafting 4

Dislocated elbow +/- fracture closed reduction 4

Lateral condyle fracture ORIF 4

Medial condyle / epicondyle fracture MUA / K wire / ORIF 4

Olecranon fracture ORIF 4

Radial head / neck fracture MUA +/- K wire/ excision 4

Supracondylar fracture MUA +/- K wires 4

Fracture shaft radius / ulna MUA & POP 4

Fracture shaft radius / ulna MUA & percutaneous wires 4

Fracture shaft radius / ulna ORIF 4

Fracture distal radius MUA & POP 4

Fracture distal radius MUA & percutaneous wires 4

Scaphoid fracture non-op 4

Metacarpal fracture / dislocation POP & MUA 4

Base of 1st metacarpal fracture/dislocation POP/Percutaneous wire/ORIF 4

Phalangeal fracture MUA +/- POP 4

MCPJ fracture / dislocation MUA +/- POP 4

Nail bed repair 4

Infected hand drainage (not tendon sheath) 4

Dislocated hip closed reduction 4

Intracapsular fracture internal fixation 4

Intracapsular fracture hemiarthroplasty 4

Extracapsular fracture DHS 4

Diaphyseal fracture in children traction or spica 4

Diaphyseal fracture intramedullary nailing 4

Diaphyseal fracture plate/screw fixation 4

Acute haemarthrosis aspiration/ arthroscopy 4

Patella fracture ORIF 4

Diaphysealtibial fracture MUA & POP 4

Diaphysealtibial fracture intramedullary nailing 4

Operative Skill Competence Level

Tibial shaft plating 4

Diaphysealtibial fracture external fixation (including frame) 4

Fasciotomy for compartment syndrome 4

Ankle fracture / dislocation MUA & POP 4

Ankle fracture / dislocation ORIF 4

Amputation toe / ray for trauma 4

Aspiration / injection joint 4

Bursa excision 4

Drainage of acute infection of bone and joints 4

Arthrotomy elbow 4

Excision radial head +/- synovectomy 4

Carpal tunnel decompression 4

De Quervain's decompression 4

Excision distal ulna 4

Ganglion excision at wrist 4

Ulna shortening 4

Trigger finger release 4

Trigger thumb release 4

Arthrotomy hip (drainage) 4

Slipped upper femoral epiphysis pinning 4

Amputation above knee 4

Osteotomy distal femoral 3/4

Amputation below knee 4

Arthrotomy ankle 4

Decompression tendons at ankle 4

Tendoachilles lengthening 4

Amputation toe / ray 4

CTEV correction non-operative 4

First MTPJ arthrodesis 4

Hind-foot arthrodesis 4

In growing toenail operation 4

Total Knee Replacement (TKR) 3

SPINE posterior fusion/disc, decompression 3

Biopsy 4

Oncology surgery 2/3

Revision TKR 2/3

Arthroscopy knee 3


Recommended Readings & References

Anatomy

ANATOMY, Regional and Applied RJ Last, Churchill Livingstome GRAY’S ANATOMY, Descriptive and surgical Henry Gray GRANT’S Atlas of Anatomy James E. Anderson MD, Williams and Wilkins Physiology

Review of Medical Physiology W. Ganong, Lange Medical Physiology A Guyton, W.B. Saunders Surgical Physiology Lendingham and McKay, Churchill Livingstome Pathology

General Pathology Walter and Israel, Churchill Livingstone Boyd’s Pathology for the Surgeon Anderson, Saunders Surgery

Principles of Surgery Schwarts, McGrawhill Book Co Orthopedic Surgery

Orthopedic Basic Sciences Edited by: Sheldon R Simon M.D., AAOS Orthopedic Knowledge Update (5) Home study syllabus Edited by: James R. Kasser, M.D., AAOS American Academy of Orthopedic Surgeons Orthopedic Knowledge Update Trauma Alan M. Levine, M.D Orthopedic Trauma Association American Academy of Orthopedic Surgeons (AAOS) Orthopedic Knowledge Update Hip and Knee Reconstruction Hip Society, Knee Society American Academy of Orthopedic Surgeons Standard Orthopedic Operations J. Crawford Adams, Churchill Livingstone Fracture Rockwood and Green, 2002, Lippincott Clinical Orthopedic Examination Ronald McRae, Churchill Livingstone AO Principles of Fracture Management, Vol 1 and 2 Ed: Ruedi, Buckley , Moran, Thieme 2007 The Practice of Hand Surgery D.W. Lamb and K. Juczynski Blackwell Scientific Publications Pediatric Orthopedics Mihran O.Tachdjian, W.B. Saunders Company The Closed Treatment of Common Fractures John Charnley, Churchill Livingstone Review of Orthopedics Mark D. Miller, Saunders Orthopedic Secrets Hanley & Belfus, Mosby Biomechanics

Basic Biomechanics of the Musculoskeletal System Margareta Nordin, Victor h. Frankel, Leo & Febinger Introduction to the Biomechanics of Joint and Joint Replacement D. Dowson and V. Wright Mechanical Engineering Publication Ltd. London

General Surgery Journals:

British Medical Journal BMJ Lancet British Journal of Surgery BJS Annals of Surgery Achieves of Surgery Surgery Clinics of North America Current Problems in Surgery Journal of Trauma World Journal of Surgery New England Journal of Medicine British journal of Hospital Medicine

Orthopedics Journals:

Journal of Bone and Joint Surgery JBJS The Hand Injury Trauma Orthopedic Clinics of N. America Clinical Orthopedics and Related Research (CORR)

Logbuch (Prescribed by German Board - Required Operative Procedures during the Training)

zum Zweck der Dokumentation der Weiterbildung gemäß der Weiterbildungsordnung der Ärztekammer Berlin (WbO) von 2004 Facharztweiterbildung Orthopädie und Unfallchirurgie (WbO 2004 — 9. Nachtrag) REFERENCES

Copyright © 2009 The Royal College of Physicians and Surgeons of Canada. http://rcpsc.medical.org/canmeds. Reproduced with permission Copyright © 2008 Jordanian Royal Medical Services - http://www.jrms.gov.jo/Portals/1/logbook/Logbook%20Orthopedics.pdf Training Program — German Board (Facharzt) - Musterweiterbildungsordnung 2003 der BundesärzteKammer und WeiterBildungsordnung der Berliner Landes Ärztekammer 2005

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