Orthopaedic training in India compared to the western world. Do we need to improve? What changes are needed?

1. Orthopaedic training in India
& western world
Roads to walk and bridges to
be crossed
Dr Farokh Wadia MS Orth, DNB Orth, MRCSEd, FRCS Tr & Orth
Consultant Paediatric Orthopaedic Surgeon
Sir HN Reliance Foundation Hospital
Mumbai, India

2. Training???

5. Orthopaedic Training
• High degree of surgical skill
• Apprentice based model
• Acquiring skill sets that are unique to trauma and orthopaedics
• Decision making

6. Orthopaedic Training Program
• A surgeon trained in the “generality” of Orthopaedics and trauma
• Able to manage trauma of moderate complexity from Day 1 as a
Consultant
• Develop a specialty interest towards the end of the training
• Seamless development of this subspecialty interest by means of a
fellowship
• Acquire the skills and knowledge in the shortest amount of “time”,
yet be safe and surgically ready

7. Structure of Orthopaedic training
In Mumbai
Then

8. Structure of Orthopaedic training
• 3 years
• First year as a junior Resident
• Allied post (General / Neuro / Plastic Surgery) +/-
• Next two years as a Registrar or Senior Resident.
• One Institution…… with Allied Hospitals
• Rotation every 6 months
• Exit Exam at the end.
• No Fellowship opportunities

9. Structure of Orthopaedic training
Now

10. Structure of Orthopaedic training
• Still 3 years
• First year as a junior Resident
• Allied post - NO
• Next two years as a Registrar or Senior Resident.
• One Institution…… with Allied Hospitals
• Rotation every 6 months
• Exit Exam at the end.
• ? Fellowship opportunities

11. How is Knowledge Acquired?

12. Read or Perish!
How is Knowledge Acquired?

13. How are skills Acquired?
See one
Do one
Keep Doing

15. How is knowledge assessed?
Exit Exam
• Theory
• Clinical cases
• Viva Voce

16. How are skills assessed?

17. What about Research?
• Thesis

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

20. How was it different in UK?
• Are 6 years enough for a surgical craft specialty
• Emphasis on work – life balance!
• EWTD- Restricts working beyond 48 hours a week (on Average)
• Re-thinking of training delivery

21. How was it different in UK?
Orthopaedic Competancy Assessment Project (OCAP)
Intercollegiate surgical curriculum project (ISCP)
www.iscp.ac.uk

22. Learning Agreements

28. ST3 ST8 Fellow

30. 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)
Theory
Clinical cases
Viva Voce

31. How are skills assessed?
PBAs
WBAs
Multi-source feedback
Simulation training

32. What else?
Emphasis on research
Mandatory to publish, present and Audit
Teaching
Leadership and management
Courses

33. Annual Assessment

34. Drawbacks
Assessments can become a form filling exercise
Focus may shift towards paper work rather than skills acquisition
?Too long a training time
Training can still vary!

37. Standardisation
Averaging and Leverage
Identification of Motivated trainers
Evolution of assessment tools

38. Do we need a change?
• Uniform structure
• Increase the number of years for training
• Defined subspecialty exposure
• “Regionalisation” of training programs
• In-training assessment
• Skills assessment
• Simulation labs (Role of Industry partners to fund these programs)
• Fellowships

39. Thank you