Orthopaedic training in India & western world Roads to walk and bridges to be crossed

Orthopaedic training in India & western world Roads to walk and bridges to be crossedDr Farokh Wadia MS Orth, DNB Orth, MRCSEd, FRCS Tr & OrthConsultant Paediatric Orthopaedic SurgeonSir HN Reliance Foundation HospitalMumbai, India

Training???

Orthopaedic TrainingHigh degree of surgical skill

Apprentice based model

Acquiring skill sets that are unique to trauma and orthopaedics

Decision making

Orthopaedic Training ProgramA surgeon trained in the generality of Orthopaedics and trauma Able to manage trauma of moderate complexity from Day 1 as a ConsultantDevelop a specialty interest towards the end of the trainingSeamless development of this subspecialty interest by means of a fellowshipAcquire the skills and knowledge in the shortest amount of time, yet be safe and surgically ready

Structure of Orthopaedic trainingIn MumbaiThen

Structure of Orthopaedic training3 yearsFirst year as a junior ResidentAllied post (General / Neuro / Plastic Surgery) +/-Next two years as a Registrar or Senior Resident. One Institution with Allied HospitalsRotation every 6 monthsExit Exam at the end.No Fellowship opportunities

Structure of Orthopaedic trainingNow

Structure of Orthopaedic trainingStill 3 yearsFirst year as a junior ResidentAllied post - NONext two years as a Registrar or Senior Resident.One Institution with Allied HospitalsRotation every 6 monthsExit Exam at the end.? Fellowship opportunities

How is Knowledge Acquired?

Read or Perish!

How is Knowledge Acquired?

How are skills Acquired?See one

Do one

Keep Doing

How is knowledge assessed? Exit ExamTheory

Clinical cases

Viva Voce

How are skills assessed?

What about Research?Thesis

How was it different in UK?6 yearsAll years as a Registrar (Specialist Trainee Year 3-8)Multiple Institutions / Hospitals in the same regionRotation every 6 months to a different subspecialtyEmphasis on trauma in each post. Especially first two yearsExit Exam at the end of 4 years.Ample Fellowship opportunities.Automatically becomes a Consultant at the end.

How was it different in UK?Are 6 years enough for a surgical craft specialtyEmphasis on work life balance!EWTD- Restricts working beyond 48 hours a week (on Average)

Re-thinking of training delivery

How was it different in UK?Orthopaedic Competancy Assessment Project (OCAP)

Intercollegiate surgical curriculum project (ISCP)www.iscp.ac.uk

Learning Agreements

ST3 ST8 Fellow

How is knowledge assessed?Annual In training exam UKITE (Nationwide)

Annual practical exam- clinical cases and Viva voce

Exit Exam FRCS Trauma and Orthopaedics (National level standardisied exam)TheoryClinical casesViva Voce

How are skills assessed?PBAs

WBAs

Multi-source feedback

Simulation training

What else?Emphasis on research

Mandatory to publish, present and Audit

Teaching

Leadership and management

Courses

Annual AssessmentARCP

Annual Review of Competance Progression33

DrawbacksAssessments can become a form filling exerciseFocus may shift towards paper work rather than skills acquisition?Too long a training time

Training can still vary!

Standardisation Averaging and LeverageIdentification of Motivated trainersEvolution of assessment tools

Do we need a change?Uniform structureIncrease the number of years for trainingDefined subspecialty exposureRegionalisation of training programsIn-training assessmentSkills assessmentSimulation labs (Role of Industry partners to fund these programs)Fellowships

Thank you