Fessh deformity correction upper limb vr
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Deformity correction upper limb, Training local surgeons. curriculum development,
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Fessh deformity correction upper limb vr
- 1. Managing severe hand deformities in Cambodia V Rajaratnam, Senior Consultant Hand Surgeon Khoo Teck Puat Hospital, Singapore W Lam, J K Yong, Keo V, J Gollogly This work is licensed under a Creative Commons Attribution 4.0 International License.
- 2. Aim: Developing a targeted surgical training programme for the sustainable ,management of severe hand Deformities in CSC
- 3. Methodology Severe trauma Severe burn contractures Severe venomous injuries • Community-oriented curriculum • Needs analysis of surgeons • Personalised programme • Targeted training • Feedback and Practice • Assessment • Evaluation of the programme
- 4. Methods – Community-oriented Curriculum DELIVER Curriculum (Pedagogy Specific to Cambodia) Assessments INDEPENDENT PRACTICE & TEACH OTHERS DESIGN Curriculum (around Training Needs) Targeted Competency Based DISCERN Community Needs Visiting Centre Plan Training Needs based on Community Needs
- 5. Discerning the Community Needs: A Compilation of 600 Cases (before visit) Cases Percentage Burns and trauma deformity 453 76% Congenital 142 23.2% Nerve (not brachial plexus) 5 0.80% Total 600 100%
- 6. Designing the Curriculum TOPICS LEARNING PROCESS TIME Basic Science Hand Assessment Workshop 6 mths Deformity 1: Burn contractures Flap design workshop 1-2 yrs Deformity 2: Tendons Tendon workshop 6 mths Deformity 3 Fracture and dislocations Osteomyelitis Fracture fixation workshop 1 yr Nerve 1: Paralysis, cerebral palsy and spasticity Micronueral workshop 1-2 yrs Nerve 2: Brachial plexus Micronueral workshop 1-2 yrs Congenital Hand Deformities Lectures, tutorials, supervised operating 2-3 yrs ✔ ✔ ✔ ✔
- 7. Learning needs analysis of surgeons 1. Identify surgeon 2. Assess skill level 3. Develop personalized training program 4. Show and Supervise 5. Assess independent practice
- 8. Selected Workshops Microneural Workshop Nov 2013
- 9. Tendon Workshop May 2014
- 10. Fracture Fixation Workshop May 2015
- 11. English slides, but local language (Khmer) Live and Online Information Technology Workshop Nov 2014 GoPro Camera https://www.youtube.com/channel/UCbjUKspmSoIuOq2FUi PGt_g
- 12. Personalised program • Deformity assessment - CBD • Decision making and planning - CBD • Surgical option generation – Lectures, CBD • Selection/execution under supervision - DOP • Deliberate practice - DOPS • Independent performance/assessment - DOP
- 13. Results: Management of Deformities Cases Percentage Burn and trauma deformity 36 40% Congenital 18 18% Nerve Injuries 23 24% Tumour 3 3% Brachial Plexus 16 16% Total: 96 100% 66%
- 14. Results: Management of Deformities (59) 0 5 10 15 20 25
- 15. Targeted Training principles: flaps and skin grafts
- 16. The pedicled groin flap
- 17. The reversed radial forearm flap
- 18. Evaluation of the programme BEFORE AFTER THE FUTURE 1.375 4.46 4.875 DEFORMITY BEFORE AFTER THE FUTURE 1.625 4.41 4.5 CONGENITAL HANDS BEFORE AFTER THE FUTURE 1.25 4.375 4.28 BRACHIAL PLEXUS INJURIES Not confident Very confident 1 2 3 4 5
- 19. Thank you
Editor's Notes
- Good morning Mr Chairman, ladies and gentleman. My name is Ratha Soum and I am a surgeon at the CSC in Cambodia. It is my honour to present my experience of how I received hand surgery training from visiting surgeons to CSC.
- So how do we teach them how to fish? Well, by developing a curriculum, and making sure we are intentional about it. So that we do not just go there to do the work and neglect the training. We develop a three part process of discerning, designing and delivering the curriculum, so that the curriculum we developed is relevant to the needs of the community, and not just what we want to teach, with the eventual aim to facilitate independent practice.
- Back to Barbara’s analogy of fishing…if we can teach them how to fish, its great but if we can teach them how to fish so well they can teach others…then we are on to a winner. And in developing a sustainable service, we began to think about how to develop a faculty of trainers. And so on this most recent trip, we conducted an IT workshop, where we taught them learning through mobile devices, and also taught them how to record lectures into a video format, in their own language using English slides, so they can store it on their own URL, and so they can share it with the rest of their own people in Cambodia. Just imagine the impact this will have. Again, thanks to Bfirst for sponsoring some of the editing software.
- Snake bites are very common in Cambodia. And these injuries often require flap reconstruction. And this defect has been adequately treated, again with a reversed radial forearm flap which can be taught, and passed on. As Barbara said, I believe reconstructive surgery can be taught, and it has enormous implications in a country like Cambodia, where just learning two flaps can often make all the difference in restoring function to a hand.