The Royal Children s Hospital. Registrar Orthopaedic Training Program. Curriculum

Transcription

1 The Royal Children s Hospital Registrar Orthopaedic Training Program Curriculum 8 August February 2012

2 Document history Version Date Prepared by Comments Draft 1 25 May 2011 Jit Balakumar, Leo Donnan & Michelle Vu Draft 2 29 June 2011 Jit Balakumar & Michelle Vu Circulated for orthopaedic consultant review Circulated for orthopaedic consultant review Final 4 July 2011 Michelle Vu Circulated for orthopaedic consultant review

3 Orthopaedic Registrar Training Curriculum Contents Rotation overview... 2 Important dates... 3 Core curriculum textbooks/reading... 4 Prior to rotation... 4 During rotation... 4 Competencies... 5 Mandatory training... 8 Emergency procedures training... 8 Structured teaching program... 9 Core curriculum tutorials... 9 Clinical Presentations Mortality & Morbidity Conferences Surgical Skills Labs Journal Club: Evaluation of competencies Operative oral viva Oral viva 1 (Week beginning 8 August 2011) Oral viva 2 (Week beginning 24 October 2011) Oral viva 3 (Week beginning 30 January 2012) Procedure based assessment Competencies to be achieved at end of rotation Paediatric MCQs Short answer essay questions Department projects Orthopaedic registrar curriculum RCH DRAFTvFINAL Last updated: 11 July 2011 Page 1 of 13

4 Rotation overview Welcome to the six month orthopaedic rotation at The Royal Children s Hospital. The purpose of this guide is to provide an overview of the training program, expectations and assessments. You will be part of an internationally acclaimed hospital. The paediatric orthopaedic department is also steeped in world orthopaedic history. This rotation is both exciting and extremely valuable and is a key cornerstone to orthopaedics. It is an integral part of all orthopaedics and up to 50% of the FRACS exam has some relevance to your rotation at the RCH. By using this rotation to its maximum potential, registrars can master and gain knowledge not just in paediatric orthopaedics. Adolescent conditions such as ACL deficiency, patella-femoral disorders, tumors, adolescent hip conditions are also treated and taught at The Royal Children s Hospital. Most trainees gain inspiration from operating and being taught technical surgical skills. In this rotation the hands on component will be exciting and new. You will see and perform operations that are only seen in a few tertiary referral institutions around the world. Your supervisors and consultants will aim to teach and have you perform basic paediatric orthopaedic operations. It will be an exciting six months, where you will gain knowledge rapidly and feel confident about sitting your FRACS exam. You will also gain inspiration from learning basic orthopaedic techniques, such as osteotomies, soft tissue surgery and deformity correction and be able to draw parallels to the adult world. By the end of the rotation, you will be expected to achieve competencies expected for a general orthopaedic surgeon in the area of paediatrics (see competencies). These are based on the AOA training syllabus. To achieve the competencies, the curriculum comprises of a structured program which includes: Tutorials Journal club Self directed learning Skills lab Projects; and Clinical based teaching (inpatients, outpatients and operating theatre). The following methods are used to assess registrar learning and performance skills expected of a SET4: 1. Oral vivas 2. Procedure based assessments 3. MCQs 4. Short essays Registrars will meet with their supervisor three (3) times during the rotation to formally review (and receive formative feedback) and plan their progress. Orthopaedic registrar curriculum RCH vfinal Last updated: 11 July 2011 Page 2 of 13

5 Important dates Week beginning Activity One month before rotation Project allocation Prior to rotation Read core textbooks 8 August 2011 Meeting with supervisor Oral viva 1 15 August 2011 Paediatric MCQs exam Short answer essay question 29 August 2011 Skills lab week 12 September 2011 Short answer essay question 26 September 2011 Short answer essay question 10 October 2011 Short answer essay question 24 October 2011 Short answer essay question Meeting with supervisor Oral viva 2 7 November 2011 Short answer essay question 21 November 2011 Short answer essay question 5 December 2011 Short answer essay question Present project to Ortho Dept (Wed 7 Dec 2011) 19 December 2011 Short answer essay question 2 January 2012 Short answer essay question 16 January 2012 Short answer essay question 30 January 2012 Short answer essay question Meeting with supervisor Oral viva 3 Skills Lab Date Activity Presenter Monday 8 August 2011 Varus proximal femoral Jit Balakumar osteotomy & safe insertion of pedicle screw Monday 29 August 2011 Ponseti casting Prue Weigall Tuesday 30 August 2011 Application of hip spica & Michael Johnson traction table Wednesday 31 August 2011 Supracondylar fracture pinning Mark O Sullivan Thursday 1 September 2011 Application of external fixator & elastic nailing of femur Chris Harris & Leo Donnan Orthopaedic registrar curriculum RCH vfinal Last updated: 11 July 2011 Page 3 of 13

6 Core curriculum textbooks/reading Prior to rotation Prior to commencing rotation, you will be expected to have read: 1. RCH rotation core competencies and AOA training syllabus 2. A textbook of paediatric orthopaedics (Broughton, Nigel) 3. Fundamentals of Pediatric Orthopedics (4 th Ed, Staheli, Lyn) - Available through Medline OVID (RCH Library intranet) 4. Rang s Children s Fractures (3rd Ed, Rang, Pring & Wenger) Available through Medline OVID (RCH Library intranet) During rotation During the rotation, the following reading is required: 1. Fundamentals of Pediatric Orthopedics (Staheli, Lyn) 2. Surgical Exposures in Orthopaedics: The Anatomic Approach ( Stanley Hoppenfeld) 3. JAAOS Review Articles in Paediatric Orthopaedics for the past 10 years Orthopaedic registrar curriculum RCH vfinal Last updated: 11 July 2011 Page 4 of 13

7 Competencies The following competencies are from the AOA training syllabus Module 3 (Paediatric Surgery). The competencies are in three domains: Knowledge Skills Attitudes and additional competencies For full description of the competencies, please refer to RCH Paeds Ortho Competencies Module 3 Paediatric Surgery Syllabus. The level of expertise in each competency to be achieved by the end of the rotation has been adapted according to the POSNA core curriculum. Level of expertise A B C Description The finished trainee is capable of assessing/managing the problem alone, without need for consultation or assistance. The finished trainee is capable of assessing/ managing well defined problems, but lacks expert capabilities; uses others for complex problems. The finished trainee triages, leaving complete patient assessment and/or management (as specified) to those with complete knowledge and expertise in this problem area. Orthopaedic registrar curriculum RCH vfinal Last updated: 11 July 2011 Page 5 of 13

8 Competencies Knowledge Topic Anatomy Pathology / Pathophysiology Biomechanics Clinical presentation Current controversies Cerebral Palsy A A B B C Perthes Disease A A A B DDH A A A A CTEV & other foot disorders A A A A Congenital limb deficiencies A A A B Spina Bifida/ Dysraphism A A A A Slipped capital femoral epiphysis A A Paediatric spinal deformity (scoliosis) B History - B Growth plate disorders A A A Leg length discrepancy A A A A Metabolic bone disorders B B B B Skills Topic Examination Investigation Treatment Cerebral Palsy B A B/C* Perthes Disease A A B DDH A A B CTEV & other foot disorders A A B Congenital limb deficiencies A A B Spina Bifida/Dysraphism A A C Slipped capital femoral epiphysis A A Paediatric spinal deformity (scoliosis) A A C Growth plate disorders A A C Leg length discrepancy A A C Metabolic bone disorders A A C * Please refer to syllabus for description of CP treatment options Orthopaedic registrar curriculum RCH vfinal Last updated: 11 July 2011 Page 6 of 13

9 Attitudes and additional competencies: A. Please refer to syllabus for full description of attitudes and additional competencies for each topic area. Orthopaedic registrar curriculum RCH vfinal Last updated: 11 July 2011 Page 7 of 13

10 Mandatory training Emergency procedures training All registrars must complete the mandatory RCH online emergency procedures training course within the first two weeks of their rotation. You can access the learning at When logging on to the system, you will be asked for your username and password. This will be provided to you, once you have obtained your RCH address. Orthopaedic registrar curriculum RCH vfinal Last updated: 11 July 2011 Page 8 of 13

11 Structured teaching program The following table shows the meetings that take place in the orthopaedic department: Day Time Activity Frequency Tues or Wed 6pm Mortality and Morbidity Monthly Tues or Wed 7pm Journal club Monthly Wed 10.30am Core tutorials Weekly Wed am Clinical presentation Weekly except for first and last Wed of each month Wed am Department presentation First week of every month Core curriculum tutorials Every Wednesday, 10.30am am These are structured tutorials presented by orthopaedic consultants. Attendance is mandatory. A day before each core tutorial, you will be given five MCQs which should be submitted to the teaching consultant at the start of the session. Please see below for topics: Date Tutorial Topic Presenter 10 Aug 2011 Normal variations Leo Donnan 17 Aug 2011 Growth plate biology Michael Johnson 24 Aug 2011 Infections Leo Donnan 31 Aug 2011 Upper extremity fractures & child abuse Abhay Khot 7 Sept 2011 Lower extremity fractures Chris Harris 14 Sept 2011 DDH Ian Torode 21 Sept 2011 Casting (plus practical session) Kerr Graham 28 Sept 2011 Gait Paulo Selber 5 Oct 2011 Osteochondropathies, SUFE/ Perthes Jit Balakumar 12 Oct 2011 Clubfoot, VT, Coalitions Paulo Selber 19 Oct 2011 Adolescent DDH/ Hip and Pelvic # Jit Balakumar 26 Oct 2011 Paediatric sports Jit Balakumar 2 Nov 2011 Scoliosis Michael Johnson 9 Nov 2011 Congenital upper extremity Ian Torode 16 Nov 2011 Congenital lower extremity Leo Donnan 23 Nov 2011 The multiply injured child Michael Johnson *Mon 28 Nov 2011 Spine fractures Gary Nattrass 7 Dec 2011 Kyphosis/Back Pain Ian Torode 14 Dec 2011 Bone & ECM Biology Chris Harris 21 Dec 2011 Congenital scoliosis Gary Nattrass 4 Jan 2012 OI/ Skeletal Dysplasia/NF Mark O Sullivan 11 Jan 2012 Tumors Mark O Sullivan 18 Jan 2012 Myelodysplasia Paulo Selber 25 Jan 2012 Deformity/Correction Chris Harris 1 Feb 2012 Cerebral Palsy Kerr Graham Orthopaedic registrar curriculum RCH vfinal Last updated: 11 July 2011 Page 9 of 13

12 Clinical Presentations Wednesday, am During this session, three patients will be presented by a registrar for discussion around investigation and management issues related to that patient Mortality & Morbidity Conferences Every month on Tuesday or Wed, 6pm The mortality and morbidity data is collected from MDAnalyze and a standardised template by which the cases are presented to the department exists and should be utilised. Surgical Skills Labs Surgical skills sessions will be held in the evening. Please refer to Important dates for schedule. A number of practical sessions will be available in your rotation and these include: Supracondylar fracture pinning Stable application of an external fixator Varus proximal femoral osteotomy Stable elastic nailing of femur Safe insertion of a pedical screw Tendon transfer suturing end to end, end to side Ponseti casting Percutaneous tendoachilles lengthening Hip spica Fitting a DB bar, pavlik harness Paediatric resuscitation ie PLS course Radiology safety course Mini II course Journal Club: Every month on Tuesday or Wed, 7pm Journal club is held monthly and is designed to improve the registrar s ability to determine the validity and significance of the literature. Each registrar will be given an article to present at the meeting. Most journal clubs will have a classic article, a review article, landmark and current articles. The topics are determined by Mr. Chris Harris. Orthopaedic registrar curriculum RCH vfinal Last updated: 11 July 2011 Page 10 of 13

13 Evaluation of competencies Evaluations of competency will be comprised of: 1. Operative oral viva 2. Procedure based assessment 3. Paediatric MCQs 4. Short answer essay questions 1. Operative oral viva The vivas are designed to test your knowledge of specific surgical procedures. They will be conducted at the bi-monthly meeting with the supervisor. The oral viva will be 15 mins in length Oral viva 1 (Week beginning 8 August 2011) At your initial meeting with your supervisor, you will be asked to verbally describe one of the following operations: 1. Pinning of a supracondylar fracture 2. Smith Peterson Approach for draining a septic hip 3. GAMP wrist fracture and forearm fracture 1.2. Oral viva 2 (Week beginning 24 October 2011) At your second meeting with your supervisor, you will be asked to verbally describe one of the following procedures: 1. Closed reduction of dislocated hip 2. Open reduction of a dislocated hip 3. Dega or Pemberton Pelvic Osteotomy 4. Salter Pelvic Osteotomy 5. Triple Pelvic Osteotomy 6. Ponseti casting technique for CTEV 7. Anterior approach to spine for spinal fusion 8. TENS nailing technique for Femur # 9. VDRO for CP or Perthes Disease 10. Posterior spinal fusion for scoliosis surgery Orthopaedic registrar curriculum RCH vfinal Last updated: 11 July 2011 Page 11 of 13

14 1.3. Oral viva 3 (Week beginning 30 January 2012) At your final meeting with your supervisor, you will be asked to verbally describe one of the following procedures: 1. Supracondylar osteotomy distal humerus for cubitus deformities 2. Application of Ex-Fix for paediatric tibial fractures 3. Open reduction and internal fixation of supracondylar fractures 4. Surgical hip dislocation approach for adolescent hip conditions 5. Femoral valgus osteotomy 6. Hip fusion surgery 7. ACL surgery in the Adolescent 8. Tibial tubercle transfer for P-F dislocater 9. MPFL reconstruction for P-F dislocater 10. Growth guidance surgery for genu valgus, genu varum 2. Procedure based assessment A procedure-based assessment is a method for assessing surgical skills in the operating theatre during more advanced interventional procedures. The PBA takes the form of you performing a specific surgical procedure that is directly observed and assessed by a consultant observer, using a standard form. The assessment tool uses two principal components: A series of competencies within six domains covering consent, preoperative planning, preoperative preparation, exposure and closure, intra-operative technique and post-operative management. Most of the competencies are common to all procedures, but a relatively small number of competencies within certain domains are specific to a particular procedure. A global assessment that is divided into four levels of overall global rating. Orthopaedic registrar curriculum RCH vfinal Last updated: 11 July 2011 Page 12 of 13

15 2.1 Competencies to be achieved at end of rotation Competence in six of the 11 listed procedures is required to be achieved by the end of the rotation: 1. Pinning of supracondylar fracture 2. Fasciotomies in the calf 3. Fasciotomies in the forearm 4. Compartment pressure measurement in the leg 5. GAMP of forearm fracture 6. GAMP of wrist fracture 7. GAMP of tibia fracture 8. GAMP of femur fracture and application of hip spica 9. Arthrogram of paediatric hip joint 10. Open athrotomy and washout of hip joint 11. Pinning of SUFE Where opportunities to perform a procedure are scarce or the registrar has missed out on the opportunity, they may have to return during an alternative time to complete this task. In exceptional circumstances the registrar may be allowed to give a verbal description of the operations. 3. Paediatric MCQs In Week 2 (week beginning 15 August 2011), you will be given a set of paediatric MCQs to complete under exam conditions. The exam will be two hours in duration (plus 10 minutes reading time) and will be completed online. A day before each core tutorial, you will be given 5 MCQs, which should be submitted to the teaching consultant at the start of the session. 4. Short answer essay questions Each fortnight, you will be given a short answer essay question to complete. As per FRACS exam requirements, please sit down for one hour and handwrite (not typed) about the topic without reviewing textbooks or other references. The essay should be 2-3 pages in length. The essay needs to be submitted to Cvetanka the following Monday for marking by the by the consultant who is on call. If you have not received your graded response please remind the consultant by Wednesday. Orthopaedic registrar curriculum RCH vfinal Last updated: 11 July 2011 Page 13 of 13

16 Department projects Participation in departmental projects is an integral component of the rotation. Each registrar is required to participate in at least one departmental project under the guidance and supervision of a nominated supervisor. Departmental projects can comprise of either: Audit Clinical research Development of educational materials One month prior to the commencement of the rotation, registrars will be allocated a project topic. In order to successfully complete the rotation, the registrar must have completed the project, such that it is deemed suitable for presentation at a conference or for publication. This experience should improve the registrar s ability to critically review scientific papers, as well as their ability to prepare and present at a local, and national level. It is expected that registrars present their research to the orthopaedic department one month prior to completion of the rotation. All projects need to be to be approved by the Head of Department. Orthopaedic registrar curriculum RCH vfinal Last updated: 11 July 2011 Page 14 of 13