MASTERS IN MEDICINE (ORTHOPEDICS AND

TRAUMATOLOGY)

Institute of Health Science Education

Georgetown Public Hospital
Corporation
&
University of Guyana
School of Medicine
Faculty Health Sciences
Introduction:
In 2009 the Georgetown Public Hospital Corporation, in collaboration with the University of
Guyana initiated a 2 ½ year postgraduate training program in surgery. This was the first
Orthopedics and Traumatology medical postgraduate training program in Guyana, and it has
been a resounding success, to date 8 doctors have been graduated with the Postgraduate
Diploma in Orthopedics and Trauma Surgery and all are still in country functioning in various
capacities.

Cameron BH, Rambaran M, Sharma DP, Taylor RH: The Development of Postgraduate Surgical
Training in Guyana. Can J Surg 2010; 53:11-16).
Cameron BH, Martin C, Rambaran M: Surgical Training in Guyana: the next generation. Can J
Surg 2015; 58: 7-9

From 2009 to present Postgraduate Diploma in Orthopedics & Traumatology and Masters
programs in Emergency Medicine, Pediatrics, Obstetrics & Gynecology, Anesthesia and Intensive
Care, Internal Medicine & Infectious Disease and Family Medicine were introduced.

The model for delivery of these programs has been through partnership with overseas expert
individuals to complement and supplement local faculty for delivery of the programs and quality
assurance.

Pursuant to review and consultation among local and overseas faculty partners and deliberation
by the postgraduate education committee, it is being proposed that the University of Guyana
upgrade the 2 ½ year Diploma in Orthopedic and Traumatology program to a 4-year Masters of
Orthopedics and Traumatology. This will conform to an emerging standard for the milestones in
medical education to be 4-5year MBBS, 3-4-year MMed and 2-3years DM qualifications.

It is therefore proposed that the Institute of Health Science Education at Georgetown Public
Hospital Corporation establish and execute a four-year post-graduate Orthopedics and
Traumatology training program that will lead to a Masters of Medicine (Orthopedics and
Traumatology) Degree from the University of Guyana.

2
Vision:

It is our vision that this program will serve to enhance the healthcare and well-being of the
people of Guyana and beyond through delivery of excellent, evidence based Orthopedics care to
those in need.

Mission Statement:

The Orthopedic and Traumatology Post-Graduate Degree Program will serve to produce
competent and compassionate physicians who have achieved excellence in clinical skills,
procedural capabilities, professionalism and service for all. The post-graduate residency training
program will serve to advance the specialty of Orthopedic surgery and its subspecialties both
locally and globally.

3
Goals
The goal of the program is to produce graduates who would have the core competencies in the
six areas below and be able to function at the level of an autonomous surgical practitioner.

1. Patient Care
Graduates will be able to provide patient care that is compassionate, appropriate, and effective
for the treatment of health problems and the promotion of health.
Orthopedic graduates must:

Demonstrate manual dexterity for the range of procedures included in the scope of this
program.
Be able to develop and execute patient care plans appropriate for the patient’s condition.

2. Medical Knowledge

Graduates must demonstrate knowledge of established and evolving biomedical, clinical, and
cognate (e.g. epidemiological and social behavioral) sciences and the application of this
knowledge to patient care. Orthopedic graduates are expected to critically evaluate and
demonstrate knowledge of pertinent scientific information.

3. Practice-Based Learning and Improvement

Graduates must demonstrate the ability to investigate and evaluate their care of patients, to
appraise and assimilate scientific evidence, and to continuously improve patient care based on
constant self-evaluation and life-long learning. Residents are expected to acquire skills and
habits to be able to meet the following goals:

Identify strengths, deficiencies and limits in one’s knowledge and expertise

Set learning and improvement goals
Identify and perform appropriate learning activities
Systematically analyze practice using quality improvement methods, and implement changes
with the goal of practice improvement
Incorporate formative evaluation feedback into daily practice
Locate, appraise, and assimilate evidence from scientific studies related to their patients’ health
problems
Use information technology to optimize learning, and
Participate in the education of patients, families, students, residents and other health
professionals.

4
4. Interpersonal and Communication Skills
Graduates must demonstrate interpersonal and communication skills that result in the effective
exchange of information and collaboration with patients, their families, and other health
professionals. Graduates are expected to:

Communicate effectively with patients, families, and the public, as appropriate, across a broad
range of socioeconomic and cultural backgrounds.
Communicate effectively with physicians, other health professionals, and health related
agencies.
Work effectively as a member or leader of a health care team or other professional group.
Act in a consultative role to other physicians and health professionals, and
Maintain comprehensive, timely, and legible medical records.

5. Professionalism
Graduates must demonstrate a commitment to carrying out professional responsibilities and an
adherence to ethical principles. Residents are expected to demonstrate:

Compassion, integrity, and respect for others.

Responsiveness to patient needs that supersedes self-interest.
Respect for patient privacy and autonomy.
Accountability to patients, society and the profession, and
Sensitivity and responsiveness to a diverse patient population, including but not limited to
diversity in gender, age, culture, race, religion, disabilities, and sexual orientation.

6. Systems-Based Practice
Graduates must demonstrate an awareness of and responsiveness to the larger context and
system of health care, as well as the ability to call effectively on other resources in the system to
provide optimal health care. Graduates are expected to:

Work effectively in various health care delivery settings and systems relevant to their clinical
specialty
Coordinate patient care within the health care system relevant to their clinical specialty
Incorporate considerations of cost awareness and risk-benefit analysis in patient and/or
population-based care as appropriate
Advocate for quality patient care and optimal patient care systems
Work in inter-professional teams to enhance patient safety and improve patient care quality,
and
Participate in identifying system errors and implementing potential systems solutions.

5
The core competencies of the Masters in Orthopedics and Traumatology conform to those
identified by the Accreditation Council for Medical Education (ACGME) to be used by Graduate
Medical programs to evaluate their residents in training. The Accreditation Council for Graduate
Medical Education (ACGME) is a private, non-profit council that evaluates and accredits more
than 9,000 residency programs across 135 specialties and subspecialties in the United States.
The ACGME establishes educational standards and common program requirements for all
training programs and is committed to maintaining quality education for residents and safe care
for patients.

The content and mechanism for achieving the competencies would be organized and articulated
in Appendix 1: Mazters in Orthopedics and Traumatology CORE COMPETENCIES.

Assessment of Core Competencies: The Resident will undergo a global evaluation of the
competencies above every three months based on the Orthopedics and Traumatology Resident
Global Rating Form. (Appendix 2: Global Rating Form). The resident will be evaluated by the
consultant in collaboration with his team that has worked directly with the resident. The resident
will also be evaluated at least twice during their subspecialty rotations, once at the beginning
and another towards the end of their rotation.

6
Delivery of the MMed Orthopedic and
Traumatology Program
The MMed in Orthopedic Program will be centered at the Institute of Health Science Education,
Georgetown Public Hospital Corporation and delivered by the staff of Georgetown Public
Hospital in association with overseas faculty partners in a variety of interactive clinical and non-
clinical environments:

Operating theatre
Outpatient clinic
Emergency on-call duties
Pre-and post-operative care of patients on the wards
Plaster room
Morning departmental meetings
Journal club
Clinical governance meetings (to include mortality and morbidity and clinical audits of current
practice)
Clinical and case conferences

The Resident will achieve the competencies through undertaking a program characterized by
clinical practice rotations – 8 weeks General Surgery, 8 weeks Plastic Surgery,4 weeks ICU,4
weeks Pediatric surgery,4 weeks Maxillofacial and Neurosurgery combined and 180 weeks
Orthopedics - and didactic learning. These aspects will be complemented by scholarly projects.
No resident should be expected to perform duties which are beyond his/her capabilities.
All clinical sessions will be supervised by a consultant or a senior member of the orthopaedic
staff.
The consultants in the department will undertake to:

Ensure safe and effective patient care through training

Establish and maintain an environment for learning
Teach and facilitate learning in the clinical environment
Participate in continuing formative and summative assessments
Support and monitor educational progress
Guide personal and professional development

Taught Component

The interactive program will be engaged through undertaking the identified 21 modules in
Applied Clinical Science as seen in Appendix 3 complimented by the recommended reading
resources
The consultants and senior staff members of the orthopaedic department will be responsible for
delivery of the curriculum and supervision of junior doctors.

7
Short courses on specific topics may be arranged with the help of World Orthopaedic Concern
UK.
World Orthopaedic Concern UK (represented by Deepa Bose) will provide regular input to
ensure the smooth delivery of the curriculum.
Visiting faculty will be 6 monthly bases lasting one week. There will also be Skype sessions with
overseas faculty. Tuesday afternoons from 1300 to 1600 hrs is designated residents teaching
sessions.

Operative (Practical) Component

The Resident of the MMed Orthopedic Program will gain exposure to the surgical procedures
detailed in appendix and become proficient in identified core procedures. Each resident would
have to complete at least 10 of each core procedure and attain level 4 PBAs in these core
procedures and at least one of the other identified procedures by the completion of their
program. The residents will have mentored and supervised exposure to appropriate surgical
procedures during their surgical rotations and have graduated levels of operative responsibilities

Applied Clinical Skills

Trauma & orthopedics is a surgical specialty covering a massive spectrum of treatment options.
No consultant orthopedic surgeon can be an expert in all areas of trauma & orthopedics.
Similarly, residents cannot be expected to attain the highest levels of competence for all the
procedures covered in the applied clinical skills syllabus. The skills syllabus is not simply a list of
procedures with their defined levels of competency, but considers each procedure as a whole
from the first encounter with the patient pre-operatively to their management afterwards, and
onwards to discharge. The aim is not simply to credential individuals to carry out a particular
hip replacement or fix a certain type of fracture. We want to train and assess the ability of the
resident in the context of the whole patient problem and extrapolate that to dealing with
problems in general.

I Consent

Demonstrates sound knowledge of indications and contraindications including alternatives to

surgery
Demonstrates awareness of sequelae of operative or non-operative management
Demonstrates sound knowledge of complications of surgery
Explains the perioperative process to the patient and/or relatives or careers and checks
understanding
Explains likely outcome and time to recovery and checks understanding

8
II Pre-operative planning

Demonstrates recognition of anatomical and pathological abnormalities (and relevant co-

morbidities) and selects appropriate operative strategies/techniques to deal with these e.g.
nutritional status
Demonstrates ability to make reasoned choice of appropriate equipment, materials or devices
(if any) taking into account appropriate investigations e.g. x-rays
Checks materials, equipment and device requirements with operating room staff
Ensures the operation site is marked where applicable
Checks patient records, personally reviews investigations.

III Pre-operative preparation

Checks in theatre that consent has been obtained

Gives effective briefing to theatre team
Ensures proper and safe positioning of the patient on the operating table Demonstrates careful
skin preparation
Demonstrates careful draping of the patient’s operative field
Ensures general equipment and materials are deployed safely (e.g. catheter, diathermy)
Ensures appropriate drugs administered
Arranges for and deploys specialist supporting equipment (e.g. image intensifiers) effectively

IV Exposure and closure

Demonstrates knowledge of optimum skin incision / portal / access
Achieves an adequate exposure through purposeful dissection in correct tissue planes and
identifies all structures correctly
Completes a sound wound repair where appropriate
Protects the wound with dressings, splints and drains where appropriate

V Intra-operative technique
Follows an agreed, logical sequence or protocol for the procedure
Consistently handles tissue well with minimal damage
Controls bleeding promptly by an appropriate method
Demonstrates a sound technique of knots and sutures/staples
Uses instruments appropriately and safely
Proceeds at appropriate pace with economy of movement
Anticipates and responds appropriately to variation e.g. anatomy
Deals calmly and effectively with unexpected events/complications
Uses assistant(s) to the best advantage at all times

9
Communicates clearly and consistently with the scrub team
Communicates clearly and consistently with the anesthetist

VI Post-operative management
Ensures the patient is transferred safely from the operating table to bed
Constructs a clear operation note
Records clear and appropriate post-operative instructions
Deals with specimens. Labels and orientates specimens appropriately

VII Feedback and reflection

The supervisor will provide constructive feedback.
The resident will record his or her reflections on the procedure.

Appendix 4: Please refer to appendix 4 for the list of surgical competencies to be achieved.

Assessment: This component of the curriculum will be assessed using the Resident Performance
Based Assessment (See Appendix 5] in conjunction with the Resident’s Surgical Case Logbook
(Logbook reviewed every quarter). Each Resident is encouraged to present for evaluation of the
core procedures after their 3rd, 8th and 12th time perform the procedure.

The core procedures include ankle fracture fixation, bone graft harvesting, foot and ankle tendon
repair, foot and ankle arthrodesis, ORIF clavicle, ORIF proximal humerus,AC joint stabilization,
ORIF humeral shaft,olecranon,distal humerus,Cannulated Screw insertion for SCFE,Proximal
femoral Osteotomy in children,MUA +Kwiring of paediatric supracondylar fracture,Ponsetti Cast
application,MUA and Kwiring for paediatric distal radius fractures,Arthrotomy for septic hip in
child,Carpal tunnel release,Knee arthroscopy,Tension band wiring of olecranon and
patella,Intramedullary nailing of femoral and tibial fractures,General tendon
repair,Hemiarthroplasty,DHS fixation,Application of external fixator,paediatric long bone
fixation,Paediatric epiphyseal injury surgery,Posterior spinal decompression and fixation,Lumbar
discectomy, Fasciotomy for compartment syndrome.Club foot correction,Radius and ulna
fracture fixation,Femur and tibia fracture fixation.

Postgraduate Year Milestones

Postgraduate Year (PGY) Milestones: Setting annual milestones provides a guide to residents
about their expected progression from novice to competent surgeon, through the program.
Milestones should lead to a better understanding of what is expected of the resident and guide
faculty mentoring and feedback. Appendix 6: Please see attached the MASTERS of ORTHOPEDICS
AND TRAUMATOLOGY Milestones.

10
Assessment: These milestones are not meant to be absolute benchmarks, but however, may
impact progression from one year to another. At the end of each academic year the resident will
be evaluated using the Annual Evaluation Resident Performance form (see attached Appendix 7)
with a final comment on whether the candidate should progress to their next year of training.

Scholarly Project (Research)

Each resident is required to complete at least ONE scholarly project each year for the
first two years of their program. This can either be an audit or a protocol.
Each resident will be required have a final research project, held to a standard
publishable by a peer-reviewed journal. Each Resident will have a research supervisor to
monitor their progress and assist where necessary. The project will be evaluated and
graded by the programme research panel. It is expected that this project would be
presented at an international conference.
The main goal of these projects are to “instruct residents in the process of scientific
inquiry”. Other goals include developing problem-solving abilities, learning the art of
medical writing, exposure to research, and focus on an area of expertise.

Please refer to Appendix 8 for full description of the Scholarly Project and its
assessment.

Conferences

The Resident activities below are aimed at developing competencies in: Medical Knowledge,
Interpersonal and Communication Skills, Practice-Based Learning
O Morbidity & Mortality Meeting:
This is a meeting occurring every last Thursday at 18 00
This conference is most often in an interactive format. Residents from each service present
mortality and significant morbidities from the preceding week.
Resident presentations may include: case presentations, topic presentations, research
presentations.
A Registrar or Consultant must supervise each presentation.
The residents will also take turns in moderating the Orthopedics Morbidity & Mortality Meeting
Please see Appendix 9 for further details on Orthopedics M&M Meeting
Journal Club:
There will be a monthly Journal Club where faculty will assign articles from established
Orthopedic Surgery journals. Residents will be assigned to summarize articles and/or will be
asked to categorize the methodology of the study (e.g., case series, controlled, blinded, etc.),
appropriateness of the statistical analysis, and alternative study designs that might better
answer the hypothesis presented by the authors.
Assessment: Documentation: Attendance Record, Faculty Evaluations

11
Subspecialty Rotations
In addition to a 180 weeks in-service Orthopedic Surgery rotation, each resident will
rotate in the surgical sub-specialties to complement and meet the requirements of the
Masters in Orthopedic Surgery curriculum. These subspecialty rotations will occur
during PGY 1 and PGY 2. The resident will spend a specified time attached exclusively to
each specialty service, however may have the flexibility of meeting the learning
objectives for that specialty over a longer period of time. See Appendix 10 for details on
subspecialty rotations.

Course Certification
Each resident will be required to be complete and be certified in the following courses in
order to be eligible for graduating the Masters in Orthopedic Surgery program:

Advanced Cardiac Life Support (ACLS)

Advanced Trauma Life Support (ATLS) – Trinidad/ Trauma Team Training.
Essential Surgical Skills (ESS) – PGY 1 – Caribbean
Pediatric Advanced Life Support (PALS)

Final Masters in Orthopedic Surgery Exam (PGY 4)

Please see Appendix 11 for eligibility criteria, format and pass criteria for this
culminating exam.

MASTERS IN ORTHOPEDICS AND TRAUMATOLOGY – ASSESSMENT SUMMARY

Assessment Description Timing

Global Rating Assessment of Core Competencies: The Every 3 months (Orthopedics)
Form (Appendix Resident will undergo a global evaluation Twice during the subspecialty
2) of the competencies above every three rotations
months based on the Orthopedics
Resident Global Rating Form. The resident
will be evaluated by the consultant in
collaboration with his team that has
worked directly with the resident. The
resident will also be evaluated twice
during their subspecialty rotations, once
at the beginning and another towards the
end of their rotation.
Module MCQ Every 3 months

12
Exam
There will be a quarterly exam (MCQs),
where the residents will be tested on the
content of the preceding modules. The
resident needs to score at least an average
of 80% for these quarterly tests
(cumulatively), before being eligible to sit
the End of Year Exam.
End of Academic There will be an end of year exam Once per year
Year Exam (ABSITE), which along with other End of Academic Year
formative evaluations will determine the
Resident’s eligibility to progress to the
next year of training. There will bs case
based discussion [Case based discussion
form in appendix 11].
Tutorial Module At the end of each module the supervisor At the end of each module
Evaluation Form will submit a formative evaluation of each Usually once per week
(Appendix 12) resident
Evaluation of At the end of each module the resident At the end of each module
Faculty Form will submit an evaluation of the module Usually once per week
(Appendix 13) supervisor
Operative The practical (operative) component of Each Resident is encouraged
Performance the Masters of Orthopedic Surgery will to present for evaluation of
Based follow the guidelines of the Taught the core procedures after
Assessment component of the curriculum. The their 3rd, 6th and 12th time
(Appendix 5) Resident will be required to become perform the procedure.
proficient in at least 25 core surgical
procedures by the completion of their
program. Other required procedures
would be assessed with a generalized
Performance based assessment form.

This component of the curriculum will be

assessed using the Resident Performance
Assessment form in conjunction with the
Resident’s Surgical Case Logbook.
Surgical Case Each resident is to maintain a Logbook Reviewed every 3 months by
Logbook detailing the procedures and the program director.
presentations they have done throughout This will be used along with
their residency other parameters to ascertain
whether a resident is meeting
the appropriate program
milestones
Annual Evaluation These milestones are not meant to be Annually, at the end of each
Resident absolute benchmarks, but however, may academic year
Performance impact progression from one year to
Form (Appendix another. At the end of each academic year
7) the resident will be evaluated using the

13
 Annual Evaluation Resident Performance
form with a final comment on whether the
candidate should progress to their next
year of training.
Scholarly Projects Each resident is required to complete at 6 months before final
(Appendix 8) least one project (audit and protocol). examination.
Each resident will be required have a final
research project, held to a standard
publishable by a peer-reviewed journal
before the completion of their program.
Each Resident will have a research
supervisor to monitor their progress and
assist where necessary. The project will be
evaluated and graded by a recommended
research body, Also the project must be
presented at an international conference,
Conferences, Each resident is responsible for presenting Ongoing
Journal Club at least once per month. Resident Formal review with Logbook
(Appendix 9] presentations may include: case every 3 months
presentations, topic presentations,
research presentations.
There will be a monthly Journal Club
where faculty will assign articles from
established Orthopedic journals.
Residents will be assigned to summarize
articles and/or will be asked to categorize
the methodology of the study (e.g., case
series, controlled, blinded, etc.),
appropriateness of the statistical analysis,
and alternative study designs that might
better answer the hypothesis presented
by the authors.
Internationally Each resident will be required to be Needs to be completed by
Certified Courses complete and be certified in the following each resident before the end
courses in order to be eligible for of the MASTERS Program
graduating the Masters Orthopedics
program:
• Advanced Cardiac Life Support (ACLS)
• Advanced Trauma Life Support (ATLS)
• Essential Surgical Skills (ESS)
• Pediatric Advanced Life Support (PALS)
Final Masters Will comprise: A final Culminating Exam for
Orthopedics Exam MCQ the MASTERS program
(Appendix 13) Short answer questions PGY 4
Oral Exam

14
All Resident assessment outcomes will be presented for Faculty Evaluation routinely on a
quarterly basis for approval and a summary later presented to the Post Graduate Education
Committee (PGEC) for ratification.

15
MMed in ORTHOPEDICS and TRAUMATOLOGY –
Faculty

Name Designation

Dr .Fawcett Jeffrey Consultant, Orthopedics, Guyana

Dr. Roy Samlall Consultant, General Surgery, Guyana

Dr. Ravi Motilall Senior Registrar, General Surgery, Guyana

Dr. Kaleshwar Ramcharran Senior Registrar, Orthopedics, Guyana

Dr. Kishore Persaud Consultant, Nephrology, Guyana

Dr. Samuel Parmar Podiatrist, USA

Dr. Cheetanand Mahadeo Consultant, General Surgery, Guyana

Dr. Carlos Martin Senior Registrar, General Surgery, Guyana

Dr. Shilindra Rajkumar Consultant, Plastic Surgery, Guyana

Dr. Navindranauth Rambaran Consultant, General Surgery, Guyana

Dr. Claude Scott Consultant, Pediatric Orthopedics, USA

Dr. Hyder Khan Consultant, Orthopedics, Guyana

Dr. Akintunde Watson Senior Registrar, Orthopedics, Guyana

Ron Chase Consultant, Medicine, USA

Dr. Marisa Seepersaud Consultant, Pediatrics Surgery, Guyana

Dr. Rita Gobin

Dr. Pheona Mohamed Director, GPHC Laboratory

Rambaran

16
Dr. Shamdeo Persaud Chief Medical Officer of Guyana

Dr. Shawn Legall Senior Registrar, ENT, Guyana

Dr. Sheik Amir Consultant, General Surgery, Guyana

Dr. Deepa Bose Consultant, Orthopedics (Traumatology), UK

Dr.Samantha Tross Consultant, Orthopedics (Arthroplasty) UK

Dr. Derick Mcdowel Consultant, Orthopedics, Jamaica

Dr. David Samaroo Consultant, Orthopedics, Guyana

Visiting Chinese Team Consultant, Orthopedics, China

17
Dr. David Samaroo Consultant, Orthopedics, Guyana

Admission Requirements:

1. Bachelor of Medicine; Bachelor of Surgery (MBBS) or its equivalent from a recognized

Medical School that is accepted by the Guyana Medical Council and full Registration
from the Guyana Medical Council.

2. In addition, all applicants must have a minimum of one (1) year post full registration
experience; preferably 6 months of Internal Medicine and 6 months of A & E.

3. Persons with a Diploma in Orthopedics and Traumatology would be enrolled into the
program from the beginning of year two.

4. Interviews would take the form of OSCE with four stations Anatomy, Critical care,
interpersonal skill and clinical decision making. These stations would be manned by one
faculty and one external interviewer.

5. Two professional referees, one of whom had interaction with within the last three (3)
years
6. Medical school transcripts.
7. Competent in spoken and written English language.
8. A maximum of three residents would be accepted in this program per year.

18
Vacation Leave
Each resident will be entitled to two (2) weeks’ vacation leave per year.

Recommended Reading:

Books:
ACS Surgery: Principles and Practice, 6th edition
Campbell’s Operative Orthopaedics Ed. Terry Canale 12th ed (2012)
Rationale of Operative Fracture Care Schatzker & Tile 3rd ed (2010)
Miller’s Review of Orthopaedics Mark Miller 7th ed (2016)
Basic Orthopaedic Sciences Manoj Ramachandran 2nd ed (2017)
Lovell & Winter’s Pediatric Orthopaedics
Stuart Weinstein (2013)
Orthopaedic Trauma: The Stanmore & Royal London Guide
Sebastian Dawson-Bowling (2014)

Journals:
Bone & Joint Journal (British)
Journal of Bone & Joint surgery (American)
Journal of the American Academy of Orthopaedic Surgeons
Injury
Journal of Orthopaedic Trauma
Clinical Orthopaedics & Related Research
Journal of Paediatric Orthopaedics

Delivery Infrastructure of MASTERS Orthopedics

and Traumatology
The key persons involved in the Administration and delivery of the Masters in Orthopedic and
Traumatology Surgery program are: Program director (PD), assigned educational supervisor
(AES), clinical supervisor (CS), assessor and resident. Please see Appendix 12 for detailed
description of each role above.

19
The activities of the program will be further monitored by the Postgraduate Education
Committee (PGEC) which will have responsibility for development and review of all educational
activities undertaken at Georgetown Public Hospital. Please see Appendix 13 for details on
constitution and responsibilities of the PGEC.

20
APPENDIX
APPENDIX 1: Masters in Orthopedic and Traumatology.
The MASTERS in Orthopedics and Traumatology will ensure that residents become competent at
the level expected of a surgical practitioner as outlined in the six areas below:

1. Patient Care
Residents must be able to provide patient care that is compassionate, appropriate, and effective
for the treatment of health problems and the promotion of health. Orthopedic residents must:
• demonstrate manual dexterity appropriate for training level
• be able to develop and execute patient care plans appropriate for the resident’s level

Specific Knowledge
Residents obtain knowledge through daily patient care and observation of the faculty, who are
role models for providing the standard of practice. Didactic conferences provide the knowledge
base required to execute patient care plans.

Skills
Manual dexterity skills are taught through clinical activities in the operating room, minor
operation room, bed side procedures and outpatient clinics. Through supervised, progressive
operative experience, the resident performs more complex operative procedures as he/she
advances in training. At the senior level, the resident performs complex surgical procedures with
faculty supervision.

Attitudes Required
The qualified surgeon must exhibit compassion, integrity, industry, and interpersonal skills. The
resident works with the faculty to admit patients, order diagnostic and therapeutic
interventions, perform daily rounds, participate in the operating room, and provide
postoperative care. The resident meets with families and interacts with social service, discharge
planning, and other care providers. These activities enable the resident to develop the ability to
execute patient care plans.

Educational Experience
Education in manual dexterity and the development of patient care plans occurs through patient
care activities on the clinical services. These activities occur in the patient units, operating room,
and outpatient offices or clinics.

Assessment
Progress in obtaining knowledge related to patient care is measured through global ratings at
the end of each rotation as well as a summative evaluation by examinations. the department
heads. The annual resident oral examination provides an assessment of the resident’s
knowledge related to patient care. The Program Director monitors development of manual

21
dexterity through global ratings at the completion of each rotation and the summative
evaluation. The resident operative log provides measurable data regarding the resident’s
progress, along with the portfolio the resident generates throughout the year.

2. Medical Knowledge
Residents must demonstrate knowledge of established and evolving biomedical, clinical, and
cognate (e.g. epidemiological and social behavioral) sciences and the application of this
knowledge to patient care. Orthopedic residents are expected to critically evaluate and
demonstrate knowledge of pertinent scientific information.

Specific Knowledge
Through the curriculum modules, the components of basic science related to surgery, as well as
the clinical components, are taught. Pre- and Post-operative care of patients, especially in the
critical care units, provides a basis for teaching biomedical science. Continuing Medical
Education activities, Mortality & Morbidity meetings, visiting faculty lectures and bedside
teaching, journal club, and specialty modules provide additional forums for obtaining medical
knowledge. Clinical research is an integral part of the program. By developing background
information and completing a project each year, the residents develop the ability to critically
evaluate scientific information.

Skills
The curriculum modules and journal clubs provide a structured environment for developing
study skills and acquisition of needed scientific information. During rotations on clinical services,
the residents synthesize the scientific knowledge obtained through the didactic program.
Supervised patient care reinforces this knowledge. The scholarly activity program enables
residents to critically evaluate the literature and assimilate information related to a specific
clinical topic.

Attitude
The attitude required to acquire scientific knowledge is facilitated by open inquiry through the
structured and informal teaching environment. The residents are encouraged to seek and teach
information as part of daily patient care.

Educational Experience
Education occurs through activities on the clinical services along with the curriculum modules,
department conferences, and scholarly activity. The residents also attend regional and national
educational conferences and CMEs.

a. Biomedical knowledge is provided through the basic science and clinical curricula. In addition
to an assigned reading program biomedical science is taught during patient care rounds.

b. Clinical knowledge is taught during daily patient care activities of the clinical teams. The
patient’s pathophysiology is discussed, and in-depth clinical knowledge is conveyed on rounds
and in the operating room.

22
Assessment
Acquisition and application of medical knowledge is evaluated through the annual in-training
and oral examinations, global ratings at the end of each rotation, and a summative evaluation by
the department heads. Attendance records are maintained and monitored in the Department of
Orthopedics.

3. Practice-Based Learning and Improvement

Residents must demonstrate the ability to investigate and evaluate their care of patients, to
appraise and assimilate scientific evidence, and to continuously improve patient care based on
constant self-evaluation and life-long learning. Residents are expected to develop skills and
habits to be able to meet the following goals:

• Identify strengths, deficiencies and limits in one’s knowledge and expertise

• Set learning and improvement goals
• Identify and perform appropriate learning activities
• Systematically analyze practice using quality improvement methods, and implement changes
with the goal of practice improvement
• Incorporate formative evaluation feedback into daily practice
• Locate, appraise, and assimilate evidence from scientific studies related to their patients’
health problems
• Use information technology to optimize learning, and
• Participate in the education of patients, families, students, residents and other health
professionals.

Orthopedic residents are expected to:

• critique personal practice outcomes
• demonstrate recognition of the importance of lifelong learning in surgical practice

Specific Knowledge
The resident evaluates his/her personal performance and clinical outcomes as part of daily
patient care activities. This includes seeking information on patients under their care in
appropriate textbooks and journal articles. Discussions of cases presented at M&M meetings
enhance the resident’s knowledge of patients under his/her care. The value of lifelong learning
using the practice-based format occurs through the role modeling of surgical faculty, peer
instruction, and preparation summative evaluations.

Skills
Skills for practice-based learning are taught to the residents through lectures, journal club,
teaching on patient care rounds, and by faculty example. The oral examination and required
certification in ACLS and ATLS (TTT) encourage lifelong learning. The in-training examination sets
a standard for educational achievement as resident advances through the program.

23
Attitudes
The attitude needed to establish practice-based learning is achieved through the environment
created within the department by the faculty and by the residents in the program.

Educational Experience
Clinical rotations, in conjunction with standard teaching modules provide the educational milieu
in which practice-based learning can be achieved. The residents participate actively in these
events.

Assessment
Evidence of practice-based learning by the residents is documented through their portfolios, in-
training and oral examinations, and global ratings based on performance during teaching
rounds.

4. Interpersonal and Communication Skills

Residents must demonstrate interpersonal and communication skills that result in the effective
exchange of information and collaboration with patients, their families, and other health
professionals. Residents are expected to:

• Communicate effectively with patients, families, and the public, as appropriate, across a broad
range of socioeconomic and cultural backgrounds
• Communicate effectively with physicians, other health professionals, and health related
agencies
• Work effectively as a member or leader of a health care team or other professional group
• Act in a consultative role to other physicians and health professionals, and
• Maintain comprehensive, timely, and legible medical records.

Specific Knowledge
Effective communication is defined for the residents as the ability to interact verbally and in
writing to facilitate the patient’s care. Communication includes personal and telephone
conversations, chart documentation, and record keeping. Teaming with the patient, family, and
other health professionals is accomplished in a considerate manner by recognizing the other
participants as competent, capable individuals who participate in the process of returning the
patient to his/her family in good health.

Skills
Clarity in written and verbal communication is essential. Communication must be provided in a
timely manner with respect and compassion for the patient, his/her family, and members of the
health care team. Effective communication requires honesty and regard for the patient’s
understanding of medical vocabulary. The development of empathy and consideration for the
patient and his/her family are crucial to effective collaboration with the patient, family, and
health professionals. Accurate and prompt information must be provided through both written
and verbal communication to facilitate the care of the patient.

24
Attitudes
Effective communication requires a humanistic attitude using both secular and religious
philosophies. Communication must be tailored appropriately for the particular patient and
circumstance.

Educational Experience
The educational experience occurs through the resident’s participation with the patient care
team. In the daily care of patients, effective verbal communication opportunities arise through
interaction with nurses, therapists, and families. Experience in written communication is
obtained through daily chart notes, operative note dictation, and discharge summary
preparation. The didactic educational experience is provided through the general surgery
curriculum.

Assessment
Global evaluations at the end of each clinical rotation provide an assessment of the resident’s
development. Resident portfolios also assess the development of interpersonal and
communication skills. Maintaining his/her operative log on a timely basis is another measure of
effective communication by the resident.

5. Professionalism

Residents must demonstrate a commitment to carrying out professional responsibilities and an

adherence to ethical principles. Residents are expected to demonstrate:
• Compassion, integrity, and respect for others
• Responsiveness to patient needs that supersedes self-interest
• Respect for patient privacy and autonomy
• Accountability to patients, society and the profession, and
• Sensitivity and responsiveness to a diverse patient population, including but not limited to
diversity in gender, age, culture, race, religion, disabilities, and sexual orientation.

Specific Knowledge
Specific knowledge regarding ethical behavior is gained through formal and informal meetings
with the program director and the hospital leadership (eg. Director of Health Education). The
ethical standard of behavior for the surgical resident is to conduct himself with a level of
integrity that will earn the respect of peers, the community, and the profession. Continuity of
care is taught to surgical residents through the organization of the resident teams and their daily
activities. Continuity of care is defined as the daily attendance to the preoperative and
postoperative needs of patients, as well as participation in outpatient evaluation and
postoperative follow-up. Specific knowledge regarding sensitivity to age, gender, and culture is a
standard that all residents are expected to maintain. Residents must be cognizant of the special
needs of others with attention to individual sensitivities.

Skills
The following skills are taught to the surgical resident regarding professionalism.

a. The resident is instructed to interact with his/her patients and fellow health care workers in
an honest, considerate manner appropriate for his/her position as a physician.

25
b. Making daily rounds and evaluating patients with the team is an essential part of the
educational program. The resident learns documentation through chart notes and personal
communication with the attending surgeon. Residents are instructed in outpatient surgical
management through participation in outpatient surgical clinics and private offices.
c. Respect for patient and peer sensitivities is taught through interaction and active use of the
literature to assure consideration of specific patients’ needs and concerns.

Attitudes
The residents are expected to develop an attitude that brings to their patients a caring, honest
countenance at all times, regardless of the patients’ varying personal characteristics.

Educational Experience
The development of professionalism occurs through the resident’s participation with a clinical
team caring for patients. The resident applies the skills that he/she has developed during
inpatient and outpatient interactions. Mentoring and role modeling by attending faculty is
critical in this educational process. As a member of the team, the resident can observe the
faculty in a close one-on-one relationship. The general surgery residency curriculum addresses
the issues of ethics, care of the elderly patient, and care of the pediatric age group through
journal club, curriculum topics, and rounds. Consideration for the culture of patients is expected
on all surgical services in which the resident participates. In addition, the residents see
underprivileged members of our community in the clinic setting. This population includes
individuals of varying ethnic and cultural backgrounds. The residents develop the skills to
interact with these individuals and respond to their specific need.

Assessment
The development of professionalism is monitored through several evaluation tools, including
the global rating at the end of each clinical. Resident portfolios will be used to evaluate
development of professionalism. Participation in office hours and the outpatientclinic, as a
demonstration of professionalism, is monitored.

6. Systems-Based Practice

Residents must demonstrate an awareness of and responsiveness to the larger context and
system of health care, as well as the ability to call effectively on other resources in the system to
provide optimal health care. Residents are expected to:
• Work effectively in various health care delivery settings and systems relevant to their clinical
specialty
• Coordinate patient care within the health care system relevant to their clinical specialty
• Incorporate considerations of cost awareness and risk-benefit analysis in patient and/or
population-based care as appropriate
• Advocate for quality patient care and optimal patient care systems
• Work in inter-professional teams to enhance patient safety and improve patient care quality,
and
• Participate in identifying system errors and implementing potential systems solutions.

26
Specific Knowledge
The cost of various therapies is discussed with residents in the clinical and conference settings,
providing specific knowledge in delivering high quality, cost-effective care. Risk-benefit analysis
occurs daily on the clinical services as decisions are made regarding diagnostic tests or
treatment for a patient. This same process occurs in the operating room as decisions are made
during the surgical procedure. Patient management is conducted as a team effort on all clinical
services with appropriate use of specialists and other health professionals to optimize patient
care (i.e., physical therapy, social service).

Skills
The efficacy as well as cost of alternatives to care for patients on the residents’ clinical services
is part of the daily discussion on rounds. This data is assimilated by the residents throughout
their training. The development of decision-making skills is a major goal of the program. The
Residents are expected to develop these skills through active role modeling of the attending
faculty as well as integrating the knowledge they have gained in the formal program curriculum.
The surgical resident must learn the skills that can be brought to patient care by various
appropriate specialists and recognize the benefit to their patients through the appropriate use
of other members of the health care team.

Attitude
The resident is expected to develop a team approach to patient care, recognizing the value of a
group effort to obtain the optimum outcome for the patients. The residents are instructed in the
integration of their personal role into this team, recognizing that they must assume the
leadership role as a responsible physician while respecting the skills of other members of the
patient care group.

Educational Experience
Education occurs through the clinical rotations to which the residents are assigned. On a daily
basis, the residents participate in a systems-based practice. Through consultation with
specialists and conferences with health care providers involved in a patient’s care, the residents
learn the skills necessary to focus on the individual’s needs.

Assessment

Evaluation of the learning of systems-based practice is conducted by the annual oral

examination, the global evaluations, the resident’s portfolio and the in-training examination.

27
APPENDIX 2: GLOBAL RATING FORM

28
NB: Overall comments should include any area of unsatisfactory, satisfactory and superior
performances.

29
APPENDIX 3: TEACHING MODULES

APPLIED CLINICAL KNOWLEDGE

APPLIED CLINICAL (BASIC) SCIENCE

Year One
General Orthopaedics and Trauma

Module # 1: Anatomy
Clinical and functional anatomy with pathological and operative relevance
Surgical approaches to the limbs and axial skeleton
Embryology of musculoskeletal system
Structure and function of connective tissue
Bone
Cartilage - articular, meniscal
Muscle and tendon
Synovium
Ligament
Nerve
Intervertebral disc

Module # 2: Pathology
Thromboembolism and prophylaxis
Principles of fracture healing
Biology of wound healing
Tendon and ligament injury and healing
Nerve injury and regeneration
Shock - types, physiology, recognition and treatment
Metabolism and hormonal regulation
Metabolic and immunological response to trauma
Blood loss in trauma/surgery, fluid balance and blood transfusion Osteoarthritis
Osteoporosis
Metabolic bone disease
Rheumatoid arthritis and other arthropathies (inflammatory, crystal, etc.) Haemophilia
Inherited musculoskeletal disorders
Neuromuscular disorders - inherited and acquired
Mechanisms and classification of failure of joint replacement and of periprosthetic fractures:
Osteonecrosis
Osteochondrities
Heterotopic ossification
Infection of bone, joint, soft tissue, including tuberculosis, and their prophylaxis
Prosthetic infection

30
Surgery in high risk and immuno- compromised patients

Module # 3: Prostheses and Orthoses

Principles of design
Prescription and fitting of standard prostheses
Principles of orthotic bracing for control of disease, deformity and instability

Module # 4: Pain
Anaesthesia - principles and practice of local and regional anaesthesia and principles of general
anaesthesia
Pain management programmes and management of complex regional pain:
Pain and pain relief
Behavioural dysfunction and somatization

Module # 5: Musculoskeletal oncology

Presentation, radiological features, pathological features, treatment and outcome for common
benign and malignant tumours
Principles of management of patients with metastatic bone disease in terms of investigation,
prophylactic and definitive fixation of pathological fractures and oncological management
Presenting features, management and outcome of soft tissue swellings, including sarcomas

Module # 6: Biomechanics & Biomaterials

Bone grafts, bone banking and tissue transplantation
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)
Biomaterials

Module # 7: Genetics and cell biology

Application/relevance of modern genetics to orthopaedic disease and treatment
Molecular genetics and molecular biology in T&O
Cell biology in T&O
Cellular and molecular basis of wound healing

Module # 8: Diagnostics
Musculoskeletal imaging: x-ray, contrast studies, CT, MR, ultrasound, radioisotope studies
Assessment of bone mass and fracture risk
Effects of radiation
Blood tests
Kinematics and gait analysis
Electrophysiological investigations

Module # 9: Clinical Environment

Theatre Design
Design of theatres
Equipment Design and Use
Tourniquets

31
Sterilisation
Infection prevention and control
Patient warming methods and rationale
Skin preparation

Module # 10: Medical Ethics

Duty of care
Informed consent

Module # 11: Evidence Management

Data Analysis
Data analysis and statistics - principles and applications
Principles of epidemiology
Clinical Trials
Design and conduct of clinical trials
Critical appraisal of literature

Module # 12: Quality improvement

Quality improvement projects including principles, methods and reporting
Audit
Clinical governance

Module # 13: TRAUMA

Basic Science (Regional)
Anatomy
Regional anatomy for trauma
Surgical approaches for bone and soft tissue injuries
Approaches for hip fractures
Approaches for Weber B ankle fractures

Physiology
Physiological response to trauma

Pathology
Delayed and non-union
Fractures in abnormal bone

Deformity
Mal-union of fractures

Pain
Pain relief in trauma patients

Biomechanics & Biomaterials

Principles of open reduction and internal fixation/external fixation of fractures
Splintage and traction
Principles of casting

32
Investigations
Radiological investigations to assess the injured patient

Critical Conditions
Compartment syndrome
Neurovascular injuries
Physiological response to trauma

Assessments
Initial clinical assessment of the injured patient
Priorities of treatment and identification of life/limb-threatening injuries

Treatments
The trauma team

Operative
Fracture management (closed, open and pathological)
Soft tissue management
Amputation

Non operative
Non-operative management of fractures
Rehabilitation of the injured patient

Complications
Reconstructive surgery in non-unions/mal-unions

Specific fracture areas:

Spine
The acute fracture and dislocation
Spinal shock and cord syndromes

Pelvis
Pelvic/acetabular fracture stabilisation
Recognition of visceral/neurovascular damage

Shoulder
Clavicle fractures
Proximal humeral fractures
The dislocated shoulder
Brachial plexus and other nerve injuries
Humeral shaft fractures

Elbow
Proximal ulnar fractures
Distal humeral fractures
Proximal radial injuries
Radius and ulnar shaft fractures

33
Wrist
Distal radius fractures
Scaphoid fractures
Carpal injuries

Hand
Metacarpal and digital injuries
The mangled hand

Proximal femur
Proximal femoral fractures
Femoral shaft fractures
Knee and lower leg
Periarticular fractures around the knee
Tibial shaft fractures

Ankle
Periarticular fractures around the ankle
Weber B ankle fractures

Foot
Hindfoot injuries
Midfoot injuries
Forefoot injuries
The crushed foot

Peri-prosthetic fractures
Management of fractures around prostheses and implants

Year Two

Module # 14: PAEDIATRIC ORTHOPAEDIC SURGERY

Basic Science
Anatomy
Growth of bones, physeal anatomy and its application to fracture types and pathological
processes and infection in particular
Anatomy of bones and joints in the growing child and its application to growth and
deformity
Neurological processes involved in the production of deformity e.g. spina bifida,
cerebral palsy and muscular dystrophy

Clinical Assessment
History and examination of the child
Involving the parents in the assessment

34
 Assessing the disabled child

Investigations
Indications for plain x-ray, arthrogram, CT, MRI and interpretation of images
Indications for the use of ultrasound and nuclear imaging
Limitations of investigations in paediatric practice

Critical Conditions
The painful hip in a child

Treatment

Operative
Fractures (including non-accidental injury) and growth plate injuries and their
sequelae
Bone and joint infection
Common childhood orthopaedic conditions, e.g. irritable hip, anterior knee pain
Slipped epiphysis
Perthes' disease
Developmental dysplasia of the hip
Talipes
Scoliosis
Forefoot deformities
Congenital hand abnormalities
Osteogenesis imperfecta
Skeletal dysplasias
Tarsal coalitions
Torticollis
Leg length discrepancy

Non-operative
The treatment of normal variants such knock knees, flat feet, femoral anteversion
Orthoses
Rehabilitation of the child
Determining physical disability
Screening for congenital abnormalities

At the end of their training the resident would cover the foregoing topics via interactive, clinical
and non-clinical sessions supervised members of the faculty and senior staff within the
department of Orthopedics.

35
Module # 15: SPINE

Basic Science (Regional)

Anatomy
Development of the spine, spinal cord and nerve roots
Anatomy and principles of surgical approaches: anterior and posterior at each level
and endoscopic access

Physiology
Physiology of nerve function affecting the spinal cord and emerging nerves
Spinal shock and associated secondary problems

Pathology
The aging spine and degenerative disease
Acute and chronic infections of the spine
Metabolic conditions affecting the spine
Neurological conditions affecting the spine

Deformity
Congenital and acquired conditions causing deformity around the spine e.g. scoliosis
and kyphosis

Pain
Causes of the acutely painful back, including referred pain e.g. acute prolapsed disc

Neoplasia
Primary and secondary tumours of the spine

Biomechanics & Biomaterials

Biomechanics of the cervical and lumbar spine
Spinal instability as applied to trauma, tumour, infection and spondylolysis/listhesis
Spinal deformity
Spinal instrumentation and internal fixation devices
Use of spinal bracing

Investigations
Radiological investigations (and their interpretation) used to assess common spine
conditions
Role of diagnostic and therapeutic injections
Role of biopsy including routes and complications
Blood tests
Electrophysiological studies (including cord monitoring)

Critical Conditions
Cauda equina syndrome
Spinal trauma - assessment, immediate care and appropriate referral
Infections e.g. tuberculosis 1 4 4

36
 Important complications of inflammatory spinal conditions - rheumatoid
instability and ankylosing spondylitis
Metastatic spinal cord compression
The painful spine in the child

Assessments
History and examination of the painful and injured spine including special clinical
tests
Examinations of conditions causing referred symptoms to the spine (e.g. renal pain)
Recognition of somatisation
Assessment of patients after failed spinal surgery for deformity and reconstruction
for non-degenerative disease

Treatments
Operative
Indications, options and complications for compressive conditions
Indications, options and complications of instability of the spine
Principles of management of tumours around the spine
Principles of management of deformity of the spine
Principles of the application of spinal bracing

Non operative
Non-operative treatment of disorders such as low back pain, sciatica
Management of spinal fractures e.g. osteoporotic fractures
Principles of interventional radiology in the management of spinal problems
Initial and ward care of the paralysed patient

Complications
Management of failed spinal surgery
Management of consequences of delayed surgery

Year 3

Module # 16: KNEE

Basic Science (Regional)

Anatomy of the knee joint and related structures

Surgical approaches to the knee and arthroscopic access

Physiology of nerve function around the knee.

37
Inflammatory, degenerative and infective conditions of the knee
Instability of the knee, including the patellofemoral joint

Deformity
Acquired and developmental deformities of the knee

Pain
Causes of the painful knee

Neoplasia
Benign and malignant conditions in the knee and surrounding structures

Biomechanics & Biomaterials

Biomechanics of the knee
Biomechanics of knee arthroplasty

Investigations
Radiological investigation to assess the knee
Diagnostic and therapeutic injections
Examination under anaesthetic and arthroscopy
Neurophysiology in knee disorders

Critical Conditions
Neurovascular injuries

Assessments
History and examination of the knee joint including special clinical tests

Treatments
Operative
Arthroplasty of the knee
Arthroscopy of the knee
Ligamentous instability of the knee
Patello-femoral disorders
Meniscal pathology
Degenerative and inflammatory arthritis
Principles of revision surgery for failed arthroplasty
Techniques available to repair and replace articular cartilage
Management of tendon, ligament and nerve injuries
Non-operative
Orthoses
Rehabilitation of the knee

Complications
Failed arthroplasty and soft tissue surgery

38
Module # 17: HIP

Basic Science (Regional)

Anatomy
Anatomy of the hip and pelvic region and related structures
Surgical approaches to the hip including arthroscopic access

Physiology
Physiology of nerve function affecting the hip

Pathology
Inflammatory, degenerative and infective conditions of the hip
Impingement disorders
Primary and Secondary Tumours around the Hip

Deformity
Acquired and developmental deformity around the hip

Pain
The painful hip

Biomechanics & Biomaterials

Biomechanics of the hip
Biomechanics of hip arthroplasty

Investigations
Radiological investigations to assess the hip
Diagnostic and guided injections
Hip arthroscopy
Neurophysiology in hip disorders

Assessments
History and examination of hip including special clinical tests

Treatments
Operative
Arthroplasty of the hip
Arthroscopy of the hip
Soft tissue surgery, osteotomy, osteoplastyand arthrodesis of the hip
Management of tendon, ligament and nerve injuries
Non-operative
Orthoses

39
Complications
Failed arthroplasty and soft tissue surgery

Year 4

Module # 18: FOOT AND ANKLE:

Basic Science (Regional)

Anatomy of the foot and ankle and related structures

Surgical approaches: ankle, subtalar joint, mid-tarsal joint and forefoot and
arthroscopic access
Surgical approach to Weber B ankle fractures

Physiology of nerve function around the foot and ankle

Inflammatory, degenerative and infective conditions of the foot and ankle

Instability of the foot and ankle
The neuropathic foot

Acquired and developmental deformities of the foot and ankle

Causes of foot pain

Biomechanics of the foot and ankle

Biomechanics of tendon transfer techniques
Biomechanics of the various types of ankle and first ray prostheses including the
factors influencing design, wear and loosening
The functional role of orthotic devices

Radiological investigations to assess foot and ankle conditions

Role of diagnostic and guided injections of the foot and ankle

40
 Role of examination under anaesthetic and diagnostic arthroscopy
Neurophysiology in foot and ankle disorders

Compartment syndrome

History and examination of the foot and ankle including special clinical tests

Treatments
Operative
Prosthetic replacement in the foot and ankle
Arthroscopy of the foot and ankle
Amputations in the foot and ankle
Arthrodesis in the foot and ankle
Excision arthroplasty
First ray surgery
Lesser toe surgery
Ligament reconstruction in the foot and ankle
The rheumatoid foot and ankle
The neuropathic foot
Management of tendon, ligament and nerve injuries

Non-operative
Footwear modifications, orthoses and total contact casting
Rehabilitation of the foot and ankle

Complications
Management of failed arthroplasty and management of failed soft tissue surgery

Module # 19: HAND

Basic Science (Regional)

Anatomy
Anatomy of the wrist and hand region and related structures
Surgical approaches in the hand and wrist and arthroscopic access

Physiology
Physiology of nerve function around the hand

Pathology
Inflammatory, degenerative and infective conditions of the hand and wrist

41
 Dupuytren's disease

Deformity
Acquired and developmental deformity around the hand and wrist

Pain
The painful hand and wrist

Biomechanics & Biomaterials

Biomechanics of the hand and wrist
Biomechanics of hand and wrist arthroplasty

Investigations
Radiological investigations to assess the hand and wrist
Neurophysiology of the hand and wrist
Diagnostic and guided injections
Examination under anaesthetic and arthroscopy

Critical Conditions
Compartment syndrome

Assessments
History and examination of the hand and wrist including special clinical tests

Treatments
Operative
Prosthetic replacement in the hand and wrist
Excision arthroplasty in the hand and wrist
Arthroscopy of the hand and wrist
Arthrodesis in hand and wrist
Entrapment neuropathies
The rheumatoid hand and wrist
The congenital hand
Dupuytren's disease

Non operative
Rehabilitation of the hand and wrist
Orthoses

Complications
Failed arthroplasty and soft tissue surgery

Module # 20: ELBOW

Basic Science (Regional)

Anatomy
Anatomy of the elbow region and related structures

42
 Surgical approaches to the elbow and arthroscopic access

Physiology
Physiology of nerve function around the elbow

Pathology
Compressive neurological problems around the elbow
Instability around the elbow
Inflammatory, degenerative and infective conditions of the elbow
Causes of elbow stiffness

Deformity
Acquired and developmental deformity around the elbow

Pain
The painful elbow

Biomechanics & Biomaterials

Biomechanics of the elbow
Biomechanics of elbow arthroplasty

Investigations
Radiological investigations to assess the elbow
Diagnostic and guided injections
Examination under anaesthetic and arthroscopy
Neurophysiology in elbow disorders

Assessments
History and examination of the elbow including special clinical tests

Treatments
Operative
Arthroplasty of the elbow
Arthroscopy of the elbow
Ligamentous instability
Entrapment neuropathy
Degenerative and inflammatory arthritis
Soft tissue conditions
The rheumatoid elbow
Non-operative
Rehabilitation of the elbow
Orthoses

Complications
Management of the failed arthroplasty and soft tissue surgery

43
Module # 21: SHOULDER

Basic Science (Regional)

Anatomy
Anatomy of the shoulder girdle and related structures
Surgical approaches to the shoulder girdle including arthroscopic access

Physiology
Physiology of nerve function around the shoulder

Pathology
Impingement and rotator cuff disorders
Instability and labral pathology of the shoulder
Inflammatory, degenerative and infective conditions of the shoulder girdle
Shoulder stiffness

Deformity
Acquired and developmental deformity around the shoulder

Pain
The painful shoulder

Biomechanics & Biomaterials

Biomechanics of the shoulder girdle
Biomechanics of shoulder arthroplasty

Investigations
Radiological investigations to assess the shoulder
Diagnostic and guided injections
Examination under anaesthetic and arthroscopy
Neurophysiology in shoulder and brachial plexus disorders

Assessments
History and examination of the shoulder girdle, including special clinical tests
Examination of the brachial plexus

Treatments
Operative
Arthroplasty of the shoulder
Arthroscopy of the shoulder
Soft tissue disorders of the shoulder girdle
Arthrodesis, osteotomy and excision arthroplasty
Reconstructive surgery for brachial plexus and other neurological disorders
Non operative
Rehabilitation of the shoulder
Orthoses

Complications

44
Management of failed arthroplasty and soft tissue surgery

45
APPENDIX 4: OPERATIVE PROCEDURES
PROCEDURES PGY
Measurement of compartment pressures Fasciotomy for compartment syndrome (any site) 1
Evacuation of hematoma 1
Excision/ablation of ingrown nail 1
Iliac crest bone graft harvesting 1
Removal of foreign body from skin/subcutaneous tissue 1
Incision and drainage of abscess 1
Irrigation and debridement native joint for infection 1
Application of external fixator 1
Application of skeletal traction 1
Application of spanning external fixator 1
Removal of external fixator or frame 1
Removal of K wires or skeletal traction 1
Removal of Osteosynthetic material 1
Tendon repair 1
Wound debridement 1
Aspiration/ injection ankle joint 1
Aspiration/ injection elbow joint 1
Aspiration/ injection foot joint 1
Aspiration/ injection hip joint 1
Aspiration/ injection hand and wrist 1
Aspiration/ injection knee joint 1
Aspiration/ injection shoulder joint 1
Botulinum toxin injection-musculoskeletal 1
Benign tumor excision (not exostosis) 1
Biopsy bone-needle 1
Biopsy bone- open 1
Curettage pin sites 1
Biopsy soft tissue 1
Bursa excision 1
Ganglion excision 1
Muscle biopsy 1
Below elbow amputation 1
Finger amputation 1
Above knee amputation 1
Below knee amputation 1
Ray/ toe amputation 1
Application halo/ tong traction cervical spine 1
MUA fracture/ dislocation cervical spine 1
Fracture shaft radius/ ulna Manipulation under anaesthesia & Plaster of paris 1
Arthrotomy elbow 1
Fracture distal radius- closed non-op 1
Fracture distal radius external fixation 1
Fracture distal radius MUA & percutaneous wires 1

46
Application of spanning external fixator 1
Carpal fracture / dislocation manipulation under anesthesia & percutaneous wires 1
Carpal fracture/ dislocation manipulation under anesthesia and plaster of Paris 1
Irrigation and debridement prosthesis for infection-wrist 1
Scaphoid fracture non-operative 1
Scaphoid fracture manipulation under anesthesia & percutaneous wires 1
1st ray fracture/dislocation external fixation 1
1st ray fracture/dislocation manipulation under anesthesia & percutaneous wires 1
1st ray fracture/dislocation manipulation under anesthesia & plaster of paris 1
5th ray fracture/dislocation external fixation 1
5th ray fracture/dislocation manipulation under anesthesia & percutaneous wires 1
5th ray fracture/dislocation manipulation under anesthesia & plaster of paris 1
Metacarpal Phalangeal Joint fracture/dislocation external fixation 1
Metacarpal Phalangeal Joint fracture/dislocation manipulation under anesthesia & 1
percutaneous wires
Metacarpal Phalangeal Joint fracture/dislocation manipulation under anesthesia +/- plaster 1
of paris
Metacarpal fracture (not 1st or 5th) non-op 1
Metacarpal fracture (not 1st or 5th) manipulation under anesthesia & percutaneous wires 1
Metacarpal fracture (not 1st or 5th) manipulation under anesthesia +/- plaster of paris 1
Metacarpal fracture (not 1st or 5th) external fixation 1
Inter Phalangeal Joint fracture/dislocation external fixation 1
Inter Phalangeal Joint fracture/dislocation manipulation under anesthesia & percutaneous 1
wires
Inter Phalangeal Joint fracture/dislocation manipulation under anesthesia +/- plaster of paris 1
Phalangeal fracture non-op 1
Phalangeal fracture manipulation under anesthesia & percutaneous wires 1
Phalangeal fracture manipulation under anesthesia +/- plaster of paris 1
Fingertip terminalisation 1
Nail bed repair 1
Hand compartment syndrome decompression 1
Excision/ ablation of ingrown nail 1
High pressure injection injuries 1
Infection hand drainage (not tendon sheath) 1
Infection tendon sheath drainage 1
Removal foreign body from skin/ subcutaneous tissue 1
Tendon repair extensor zone 2-4 1
Tendon repair flexor zone 1 1
Tendon repair flexor zone 2 1
Tendon repair flexor zone 3-5 1
Delayed primary or secondary 1
Wound debridement 1
Carpel tunnel decompression 1
De Quervain’s decompression 1
Ganglion excision at wrist 1
Carpel tunnel decompression 1
Trigger finger release 1

47
Trigger thumb release 1
Dislocated hip (no prosthesis) – closed reduction 1
Dislocated hip hemiarthroplasty- closed reduction 1
Dislocated total hip replacement- closed reduction 1
Irrigation and debridement native joint for infection- hip 1
Irrigation and debridement prosthesis for infection- hip 1
Diaphyseal femur fracture application of external fixator 1
Diaphyseal femur fracture Spica cast application 1
1
Sacrococcygeal joint injection/ manipulation under anesthesia 1
Sacro-iliac joint injection 1
Arthrotomy hip 1
Aspiration/ injection hip joint 1
Application of spanning external fixator 1
Irrigation and debridement native joint for infection (open or arthroscopic)- knee 1
Knee manipulation under anesthesia +/- plaster of paris 1
Supracondylar femur fracture (not intra-articular) manipulation under anesthesia & plaster 1
of paris
Diaphyseal tibial fracture external fixation (including frame)s 1
Diaphyseal tibial fracture intramedullary nailing 1
Diaphyseal tibial fracture manipulation under anesthesia & plaster of paris 1
1
Manipulation under anesthesia knee 1
Ankle fracture/ dislocation manipulation under anesthesia & plaster of paris 1
Irrigation and debridement native joint for infection- ankle 1
Irrigation and debridement prosthesis for infection- ankle 1
Amputation toe/ ray for trauma 1
Metatarsal fracture Open Reduction Internal Fixation 1
Phalangeal fracture manipulation under anesthesia +/- K wire +/- Open Reduction Internal 1
Fixation
Removal foreign body from skin/ subcutaneous tissue 1
Mid-tarsal fracture/ dislocation Open Reduction Internal Fixation 1
Sub-tarsal fracture/ dislocation Open Reduction Internal Fixation 1
Achilles tendon repair 1
Tendon repair in foot 1
Arthrotomy ankle 1
Aspiration/ injection ankle joint 1
Amputation toe/ ray 1
Aspiration/ injection foot joint 1
Supracondylar elbow fracture manipulation under anesthesia +/- percutaneous wires 1
Manipulation and plaster of paris forearm 1
Manipulation and K wire forearm 1
Drainage of septic arthritis of the hip 1
Application of hip Spica 1
Application of Ilizarov frame 2
Arterial repair +/- graft 2
Nerve repair 2

48
Full thickness skin graft 2
Muscle flap 2
Pedicle flap 2
Split skin graft 2
Transposition flap 2
Cyst bone curettage +/- bone graft 2
Epiphysiodesis 2
Exostosis/ osteochondroma excision 2
Injection of bone cyst 2
Tendon lengthening 2
Above knee amputation 2
Hindfoot amputation 2
Midfoot amputation 2
Anterior column reconstruction cervical spine 2
Anterior fixation fracture/ dislocation cervical spine 2
Non-classifiable cervical spine trauma procedure 2
Posterior column reconstruction cervical spine 2
Posterior fixation fracture/ dislocation cervical spine 2
Anterior column reconstruction thoracic spine 2
Anterior decompression / fixation thoracic spine 2
Anterior decompression thoracic spine 2
Posterior column reconstruction thoracic spine 2
Posterior decompression / fixation thoracic spine 2
Posterior decompression thoracic spine 2
Anterior column reconstruction lumbar spine 2
Anterior decompression / fixation lumbar spine 2
Anterior decompression lumbar spine 2
Posterior column reconstruction lumbar spine 2
Posterior decompression / fixation lumbar spine 2
Posterior decompression lumbar spine 2
Cervical laminectomy 2
Biopsy cervical spine 2
Discogram 2
Epidural 2
Osteomyelitis excision including sequestrectomy 2
Biopsy thoracic spine 2
Fracture shaft radius/ ulna intra medullary nailing 2
Fracture shaft radius/ ulna Open Reduction Internal Fixation 2
Galeazzi fracture Open Reduction Internal Fixation 2
Monteggia fracture Open Reduction Internal Fixation 2
Excision radial head +/- synovectomy 2
OK procedure 2
Fracture distal radius Open Reduction Internal Fixation 2
Arterial repair- wrist 2
Vein repair- wrist 2
Nerve repair- wrist 2
Carpel fracture/ dislocation Open Reduction Internal Fixation 2

49
Scaphoid fracture Open Reduction Internal Fixation 2
1st ray fracture/ dislocation Open Reduction Internal Fixation 2
5th ray fracture / dislocation Open Reduction Internal Fixation 2
Metacarpal Phalangeal Joint fracture/ dislocation Open Reduction Internal Fixation 2
Metacarpal fracture (not 1st / 5th) Open Reduction Internal Fixation 2
IPJ fracture/ dislocation Open Reduction Internal Fixation 2
Phalangeal fracture Open Reduction Internal FIxation 2
Fingertip reconstruction-advancement flap 2
Fingertip reconstruction- cross finger flap 2
Fingertip reconstruction -homodigital neurovascular island flap 2
Arterial repair +/- graft hand/ digit 2
Vein repair +/- graft hand/ digit 2
Full thickness skin graft 2
Pedicle flap 2
Reversed radial forearm flap 2
Split skin graft 2
Transposition flap 2
Tangential excision of hand burns 2
Spaghetti wrist 2
Excision distal ulna 2
Ulnar nerve decompression at wrist 2
Congenital hand operation – clinodactyly 0 1 2
Congenital hand operation-complex reconstruction of congenital hand deformity 2
Congenital hand operation- camptodactyly 2
Congenital hand operation- correction of radial club hand 2
Congenital hand operation- lengthening procedures 2
Congenital hand operation- removal supernumerary digits 2
Congenital hand operation-separation of syndactyly 2
Dupuytren’s contracture operation- dermofasciectomy 2
Dupuytren’s contracture operation- primary multiple digits 2
Dupuytren’s contracture operation- primary single digit 2
Dupuytren’s contracture operation- recurrent multiple digits 2
Dupuytren’s contracture operation- recurrent single digit 2
Excision synovial cyst 2
Tendon graft hand 2
Pelvic fracture external fixator application 2
Extracapsular fracture Dynamic Compression Screw/Dynamic Hip Screw 2
Extracapsular fracture intramedullary fixation 2
Extracapsular fracture other fixation 2
Intracapsular fracture bipolar hemiarthroplasty 2
Intracapsular fracture hemiarthroplasty excluding bipolar 2
Intracapsular fracture internal fixation 2
Diaphyseal femur fracture intramedullary nailing 2
Diaphyseal femur fracture plate/screw fixation 2
Femoral non-union (application of frame) +/- bone grafting 2
Sub-trochanteric fracture intramedullary nailing 2
Sub-trochanteric fracture plate/screw fixation 2

50
Adductor tenotomy-hip 2
Core decompression for femoral head for Avascular Necrosis 2
Iliopsoas release/ lengthening 2
Osteotomy corrective (not for Development Dysplasia of the hip) 2
Intraarticular fracture distal femur Open Reduction Internal Fixation 2
Irrigation and debridement prosthesis for infection- knee 2
Patella dislocation closed reduction +/- open repair 2
Patella fracture Open Reduction Internal Fixation 2
Acute ligament repair 2
Patella tendon repair 2
Quadriceps tendon repair 2
Supracondylar fracture (not intraarticular) Dynamic Compression Screws/ blade plate etc. 2
Supracondylar femur fracture (not intraarticular) external fixation 2
Supracondylar femur fracture (not intraarticular) intramedullary fixation 2
Tibial plateau fracture arthroscopically assisted 2
Tibial plateau fracture Open Reduction Internal Fixation with plates & screws 2
Tibial shaft plating 2
Tibial non-union circular frame management 2
Tibial non-union intramedullary nailing +/- bone grafting 2
Tibial non-union Open Reduction Internal Fixation +/- bone grafting 2
Patella realignment 2
Release contracture knee 2
Ankle fracture/ dislocation Open Reduction Internal Fixation 2
Application of spanning external fixator 2
Pilon fracture ex-fix 2
Pilon fracture Open Reduction Internal Fixation 2
Pilon fracture treatment with circular frame 2
Calcaneal fracture 2
Calcaneal fracture ex-fix 2
Calcaneal fracture Open Reduction Internal Fixation 2
Lisfranc fracture Open Reduction Internal Fixation 2
Tarsometatarsal arthrodesis 2
Arthrodesis ankle (open/ arthroscopic) 2
Tendo-achilles lengthening 2
First Metatarsal Phalangeal Joint arthrodesis 2
First Metatarsal Phalangeal Joint soft tissue correction 2
Tibialis posterior reconstruction 2
Supracondylar elbow fracture open reduction 2
Titanium elastic nailing paediatric long bone 2
Dunn procedure for slipped upper femoral epiphysis 2
Slipper upper femoral epiphysis percutaneous cannulated screw fixation 2
Open Reduction Internal Fixation paediatric ankle fracture 2
Adductor tenotomy- hip 2
Hamstring lengthening 2
Iliopsoas release/ lengthening 2
Metatarsal Phalangeal Joint arthrodesis 2
Arthrodesis for recurrence for Congenital Tallipas Equino Varius 2

51
Bony release for recurrence for Congenital Tallipas Equino Varius 2
Percutaneous tendo-achilles release for Congenital Tallipas Equino Varius 2
Posterior release for Congenital Tallipus Equino Varius 2
Posterio-medial release for Ccngenital Tallipus Equino Varius 2
Soft tissue release for recurrence for Congenital Tallipus Equino Varius 2
Tibialis anterior transfer for Congenital Tallipus Equino Varius 2
Hip Manipulation Under Anesthesia 2
Open reduction for Developmental Dysplasia of the Hip. 2
General Anesthesia change of Plaster of Paris 2
Open Reduction Internal Fixation of periprosthetic fracture 3
Tendon transfer 3
Tenodesis 3
Through knee amputation 3
Ligament repair hand excluding thumb Metacarpal Phalangeal Joint ulnar collateral ligament 3
Thumb Metacarpal Phalangeal Joint ulnar collateral repair 3
Nerve decompression/ neurolysis 3
Scaphoid fracture non-union Open Reduction Internal Fixation +/- graft (excluding 3
vascularized graft)
Nerve repair hand/ digit 3
Arthrodesis wrist (includes partial arthrodesis) 3
Decompression/ synovectomy tendons 3
Denervation wrist 3
Proximal row carpectomy 3
Radial shortening 3
Repair Triangular Fibrocartilage Complex- open 3
Ulna shortening 3
Proximal Interphalangeal Joint replacement- hand (other) 3
Proximal Interphalangeal Joint replacement- hand (silastic) 3
Soft tissue reconstruction- hand 3
Tendon transfer- hand 3
Tenolysis hand tendon 3
Acetabular fracture Open Reduction Internal Fixation 3
Pelvic fracture Open Reduction Internal Fixation 3
Dislocated hip (no prosthesis)- open reduction +/- fixation 3
Dislocated hip hemiarthroplasty- open reduction 3
Dislocated total hip replacement- open reduction 3
Intracapsular fracture Total Hip Replacement 3
Femoral non-union (without frame) +/- bone grafting 3
Reconstruction of avulsed proximal hamstrings 3
Arthrodesis hip 3
Excision arthroplasty hip (e.g. Girdlestone) 3
Vascular graft femoral head for Avascular Necrosis 3
Total Hip Replacement cemented 3
Total Hip Replacement hybrid 3
Total Hip Replacement uncemented 3
Femoral malunion correction/ other deformity 3
Patellectomy 3

52
Repair of tibial spine 3
Tibial plateau fracture treatment with circular frame 3
Patella resurfacing alone 3
Patella-femoral joint replacement 3
Total Knee Replacement 3
Finger malunion correction or other deformity 3
Fusion of Metacarpal Phalangeal Joint or Inter Phalangeal Joint 3
Metacarpal Phalangeal Joint replacement 3
Synovectomy 3
Tibial or fibular malunion correction or other deformity 3
Talar subtalar or midtarsal fracture/ dislocation 3
Arthroplasty ankle 3
Decompression tendons at ankle 3
Gastrocnemius lengthening 3
Tendo-achilles reconstruction for neglected rupture 3
Akin osteotomy of proximal phalanx great toe 3
Ankle cheilectomy 3
Calcaneal osteotomy 3
Excision Haglund’s deformity 3
Excision of accessory navicular 3
Excision of tarsal coalition 3
Pantalar arthrodesis 3
First metatarsal osteotomy- basal 3
First metatarsal osteotomy- distal 3
First metatarsal osteotomy- other 3
First metatarsal osteotomy- scarf 3
First Metatarsal Phalangeal Joint cheilectomy 3
First Metatarsal Phalangeal Joint excision arthroplasty 3
Ingrown toenail operation 3
Lesser metatarsal osteotomy 3
Lesser toe excision part/ all phalanx 3
Metatarsal Phalangeal Joint cheilectomy- not 1st 3
Excision of Moron’s neuroma 3
Fifth toe soft tissue correction 3
Lesser toe tenotomy 3
Plantar fascia release 3
Tendon decompression or repair 3
Tendon transfer foot 3
Repair of avulsion of tibial eminence 3
Patella realignment 3
Steindler’s release 3
Tendon transfer not hand/foot 3
Osteotomy hip- pelvic for Development Dysplasia of the Hip 3
Osteotomy hip- proximal femoral for Development Dysplasia of the Hip 3
Sternomastoid release (torticollis) 3
Tibial lengthening 3
Open Reduction Internal FIxation osteochondral fragment in joint 4

53
Forequarter amputation 4
Hindquarter amputation 4
Exploration/ repair/ grafting brachial plexus 4
Exploration of brachial plexus 4
Repair +/- grafting brachial plexus 4
Cervical laminoplasty 4
Cervical vertebrectomy for myelopathy 4
Excision hemivertebra 4
Anterior decompression +/- fixation/ fusion (C2-C7) 4
Atlantoaxial fixation +/- fusion 4
C1 pedicle screw and C2 fusion 4
Occipital cervical fusion 4
Occipito-cervical fusion +/- fixation 4
Posterior decompression +/- fixation/ fusion (C2-C7) 4
Trans-articular screws C1/C2 4
Osteotomy for spine sagittal plain imbalance 4
Posterior column reconstruction cervical spine 4
Revision cervical discectomy 4
Excision cervical/ 1st rib 4
Thoracic outlet release (not excision cervical/ 1st rib) 4
Costoplasty 0 1 excision hemivertebra 4
Fixation or fusion procedures 4
Anterior decompression +/- fixation/ fusion 4
Posterior decompression +/- fixation/ fusion 4
Kyphoplasty corpectomy 4
Kyphosis correction- anterior and posterior 4
Kyphosis correction- anterior only 4
Posterior column reconstruction thoracic spine 4
Scoliosis correction- anterior release +/- instrumentation 4
Scoliosis correction- posterior fusion +/- instrumentation 4
Anterior release + posterior fusion and instrumentation for Scoliosis 4
Growing rods for Scoliosis 4
Arthrolysis elbow (open/ arthroscopic) 4
Replantation of hand 4
Revascularization of hand 4
Scapho-lunate ligament reconstruction 4
Scaphoid fracture non-union using vascularized graft 4
Revascularization finger 4
Replantation finger 4
Surgery for chronic carpal instability 4
Endoprosthectic replacement for malignant bone tumor – not femur/ humerus/ tibia 4
Malignant tumour excision 4
Sacroiliac joint percutaneous screw fixation 4
Sacrum Open Reduction Internal FIxation 4
ORIF of periprosthetic fracture- hip 4
Revision Total Hip Replacement for periprosthetic fracture of hip 4
Arthroscopy hip- diagnostic 4

54
Arthroscopy hip- therapeutic 4
Open hip debridement for femoroacetabular impingement syndrome 4
Osteotomy pelvis- not for Development Dysplasia Hip 4
1 stg of 2 stg rev infected Total Hip Replacement- removal of prosthesis +/- insertion of 4
cement spacer/ antibiotic beads
2 stg of 2 stg rev infected Total Hip Replacement- removal of spacer/beads 4
Single stage revision Total Hip Replacement acetabular component 4
Single stage revision Total Hip Replacement both components 4
Single stage revision Total Hip Replacement femoral component 4
Endoprosthetic replacement for malignant bone tumour- femur 4
Acute arthroscopy for knee trauma 4
Open Reduction Internal Fixation of periprosthetic fracture- knee 4
Revision Total Knee Replacement for periprosthetic fracture of knee 4
Arthroscopic partial meniscectomy 4
Arthroscopic procedures 4
Arthroscopic excision of Hoffa’s fat pad 4
Arthroscopic lateral release 4
Arthroscopic meniscectomy 4
Arthroscopic removal loose bodies knee 4
Arthroscopic synovectomy 4
Meniscal repair (arthroscopic) 4
Cartilage regeneration procedures 4
Abrasion arthroplasty/ microfracture-knee 4
Mosaicplasty- knee 4
Patella tendon decompression (open/ arthroscopic) 4
1 stg of 2 stg rev infected Total Knee Replacement- removal of prosthesis +/- insertion of 4
cement spacer/ antibiotic beads
2 stg of 2 stg rev infected Total Knee Replacement- removal of spacer/beads 4
Single stage revision Total Knee Replacement 4
Anteriorcruciate Ligament reconstruction- arthroscopic 4
Reconstruction of posterolateral corner of knee 4
Posteriorcruciate Ligament reconstruction 0 2 revision Anteriorcruciate Ligament 4
reconstruction
Endoprosthetic replacement for malignant bone tumour- tibia 4
Talectomy 4
Arthrodesis ankle- arthroscopic 4
Arthroscopy ankle diagnostic 4
Arthroscopy ankle therapeutic 4
Ankle- lateral ligament reconstruction 4
Ankle- lateral ligament repair 4
Ankle- medial ligament repair 4
First Metatarsal Phalangeal Joint replacement arthroplasty (silastic or other) 4
Forefoot arthroplasty (Mann Thompson/ Stainsby/ other) 4
talectomy 4
Wedge tarsectomy 4
Brachial plexus injury: exploration/ repair/ grafting 4
Distraction lengthening of bone upper limb 4

55
Excision of physeal bar (Langenskjold procedure) 4
Femoral lengthening 4
Repair of avulsion of tibial eminence (child) 4

56
 APPENDIX 5 PROCEDURE BASED ASSESSMENT

Resident Evaluator: Date:

Start time: End time: Duration:

Operation more difficult than usual? Yes / No (If yes, state reason)

Score
Competencies and Definitions N/U/ Comments
S
Consent
C1 Demonstrates sound knowledge of indications and contraindications
C2 Demonstrates awareness of consequences of taking action operatively
C3 Demonstrates sound knowledge of complications of surgery
Explains the perioperative process to the patient and/or relatives and checks
C4
understanding
C5 Explains likely outcome and time to recovery and checks understanding
C6 Checks in theatre that consent has been obtained
Pre operative planning
Demonstrates recognition of anatomical and pathological abnormalities and
PL1
operative strategy to deal with these
Ability to make reasoned choice of appropriate equipment, materials or devices
PL2
(if any) taking into account appropriate investigations e.g. x-rays
PL3 Checks materials, equipment and device requirements with operating room staff
PL4 Where applicable ensures the operation site is marked
PL5 Checks patient records
PL6+ See specific PBA’s
Pre operative preparation
PR1 Ensures proper and safe positioning of the patient on the operating table
Ensures supporting equipment and materials are deployed safely and
PR2
appropriate drugs administered (e.g. catheter, diathermy, tourniquet)
Arranges for and deploys specialist supporting equipment (e.g. image
PR3
intensifiers) effectively
PR4 Gives effective briefing to theatre team
PR5 Demonstrates careful aseptic technique with little risk of compromising sterility
PR6+ See specific PBA’s
Exposure and closure

57
 Score
Competencies and Definitions N/U/ Comments
S
E1 Demonstrates knowledge of optimum skin incision
Achieves an adequate exposure through purposeful dissection in correct tissue
E2
planes and identifies all structures correctly
E3 Completes a sound wound repair
E4 Protects the wound with dressings, splints and drains
E5+ See specific PBA’s

Score
Competencies and Definitions N/U/ Comments
S
Intra Operative Technique
IT1 Follows an agreed, logical sequence or protocol for the procedure
IT2 Consistently handles tissue well with minimal damage
IT3 Controls bleeding promptly by an appropriate method
IT4 Knots and sutures demonstrate a sound technique
IT5 Appropriate and safe use of instruments
IT6 Proceeds at appropriate pace with economy of movement
IT7 Anticipates and responds appropriately to variation
IT8 Deals calmly and effectively with untoward events/complications
IT9 Uses assistant(s) to the best advantage at all times
IT10 Communicates with scrub nurse clearly and professionally
IT11+ See specific PBA’s
Post operative management
PM1 Ensures the patient is transferred safely from the operating table to bed
PM2 Constructs a clear operation note
PM3 Records clear and appropriate post-operative instructions
PM4+ See specific PBA’s

N= Not observed or not appropriate

U= Unsatisfactory
S= Satisfactory

Global Summary (based on the observed/relevant parts of this procedure only)

Tick as
Comments
appropriate
Insufficient evidence observed to support a
Level 0
judgement

58
 Unable to perform the entire procedure under
Level 1
supervision

Able to perform the procedure under

Level 2
supervision

Does not usually require supervision but may

Level 3
need help occasionally

Competent to perform the procedure and can

Level 4
deal with complications

Signatures:
Resident: Consultant: Other:

APPENDIX 6: MILESTONES
GOALS AND OBJECTIVES BY YEAR OF TRAINING

The following general educational objectives apply to residents at all levels and characterize the
general requirements for successful completion of the residency program. A continuum of
achievement in accomplishing these goals throughout residency training will serve as one
marker of satisfactory progress.

The ability to evaluate patients, including recognition of medical or surgical emergencies, which
threaten life or limb and require initiation of emergency medical or surgical care.
The ability to develop, defend and carry out a rational plan of care for surgical patients.
The ability to understand and participate in surgical education and research. All residents are
expected to develop proficiency in use of surgical literature. Categorical residents are expected
to complete one project that is accepted for publication in a peer-reviewed journal or presented
at a major surgical meeting prior to completion of residency training.
Demonstration of a humane and considerate approach to patients and family members.

59
Proficiency in written and oral communication in bedside care, case presentations, the medical
record and manuscripts.
Satisfactory and timely completion of medical record responsibilities.

The following yearly educational objectives characterize specific expectations for the
professional maturation of residents. Promotion (or program completion in the case of PGY4
residents) will generally be dependent on satisfactory achievement of these objectives.

PGY-1 residents are expected to accomplish and maintain the following objectives:

Establish basic proficiency in the evaluation of patients under routine and emergency
circumstances (recognizes surgical emergencies, performs a history and physical examination,
orders appropriate basic ancillary studies, effectively communicates findings to other physicians.

Establish basic proficiency in providing pre-operative and post-operative care (writes

appropriate pre-op and post-op orders for patients, handles nursing calls appropriately,
manages most routine postoperative care with minimal intervention by supervisors).
Develop a working knowledge of common problems in general orthopedics, orthopedic
oncology and trauma.
Acquire basic operative skills necessary to perform less complex surgical procedure in
traumatology, soft tissue procedures and minor outpatient surgery.
Develop personal values and interpersonal skills appropriate for the surgical resident (is
available at required times, gives patient care needs highest priority).
Begin a regular program of reading and study, using a major surgical textbook
Perform comprehensive histories and physicals. Communicate findings to senior residents and
other team members
Evaluate laboratory and radiographic studies by directly viewing these studies and
communicating results to senior residents
Arrive in the operating room on time and prepared with a knowledge of the applicable anatomy
and physiology.
Providing care for patients assigned, follow up on issues, and communicating issues with the
senior residents and attendings
Provide for the day-to-day care of patients
Assist in the operating room
Begin to learn surgical technique under the direct supervision of attending surgeons
Learn the basics of postoperative care in the hospital and in the clinic
Teach rotating medical students
Develop interpersonal skills to optimize patient care among all members of the healthcare team.

Master basic pathophysiology of surgical disease

Familiarize themselves with the M&M meeting, through increasing participation in discussions
and presentations at this weekly conference.

PGY-2 residents are expected to accomplish and maintain the following objectives:

60
Develop enhanced proficiency in the provision of pre-operative and post- operative care
(manages pre-operative and post-operative care of complex patients with minimal intervention
by supervisors).
Establish a knowledge base and skill proficiency for the management of complex trauma cases
,plastic surgery procedures and paediatric orthopedics
Develop organizational and teaching skills necessary for basic management of a surgical service
(attends to organizational duties of service such as organizing rounds and teaching sessions).
Increased skill in operative technique required for procedures of increasing surgical complexity,
such as DHS, DCS,IM nailing} and complex soft-tissue surgery ( able to perform these operations
with minimal assistance).
Develop interpersonal skills in the joint management of patients in the ICU
Continue a program of regular study of a basic textbook of surgery
Perform comprehensive histories and physicals
Convey appropriate information to senior residents
Formulate plans of care based on acquired information
Understand decision making processes used in the care of surgical patients
Understand the anatomy of surgical procedures. Know the procedure well the night before and
arrive in the OR on time and well prepared.
Develop a postoperative plan of care with the senior residents and attendings and help
implement that plan.
Provide day-to-day care of patients
Teach interns and rotating medical students

PGY-3 residents are expected to accomplish and maintain the following objectives:

Continues to develop technical skills necessary for the performance of more complex surgical
procedures in spine and arthroplasty.
Acquire proficiency in spine surgical techniques, arthroplasty and complex trauma.
Establish a knowledge base, judgment and interpersonal skills necessary to function as a surgical
registrar (successfully manages consults with help).
Develop enhanced skills in the management of a surgical service (manages service
administrative duties).
Proficiency in the rational use of surgical literature and evidence-based medicine (defends
discussions and recommendation with scientific evidence).
Develop knowledge and skills necessary to function as the trauma team leader for both adult
and pediatric patients (successfully directs trauma resuscitation).
Teach junior residents in the emergency room, and on rounds
Continue a program of reading and study of basic surgical material, as well as one or two
journals on a regular basis
Refine interpersonal skills
Learn more advanced surgical techniques
Teach rotating medical students

PGY-4 residents are expected to accomplish and maintain the following objectives:

61
Continues to develop technical skills necessary for the performance of arthroscopy, complex
trauma, complex pediatrics, arthroplasty and spine
Acquire proficiency in spine surgical techniques, arthroplasty and complex trauma.
Establish a knowledge base, judgment and interpersonal skills necessary to function as a surgical
consultant (successfully manages consults with minimal help).

62
APPENDIX 7: ANNUAL EVALUATION FORM

63
APPENDIX 8: SCHOLARLY PROJECT MODULE (RESEARCH)
Each resident is required to complete at least research project before the end of their
programme. The main goal of this project is to “instruct residents in the process of scientific
inquiry”. Other goals include developing problem-solving abilities, learning the art of medical
writing, exposure to research, and focus on an area of expertise. The definition of the scholarly
project focuses more on the process than the final product.

Objectives:

Facilitate the development of competencies in Scientific Inquiry

Facilitate the development of skills for medical problem solving using scientific databases.
Facilitate the development of skills for critical appraisal of the scientific literature
Facilitate the development of the medical writing skills
Facilitate exposure to research
Facilitate a culture of continuing medical education

The Scholarly Project will begin in the second year of postgraduate training and be completed by
the end of the third year of training.

Scholarly Project 1: Year2 –

Deliverables for year 2:
Development of hypothesis
Completion of literature review,
Project proposal development
Submission of project proposal for ethical review.

Scholarly Project 2: Year 3 –

Deliverables for year 3:
Completion of formative research
Completion of data collection

Scholarly Project 3: Year4 –

Deliverables for year 4:
Data analysis
Project report submission – written and poster
Submission of results for scientific poster presentation and publication

The Research Project will begin in the second year and will be submitted by the middle of the
fourth year of training. Each resident will be assigned a research supervisor. The research
project will be developed by the resident with their supervisor and submitted for approval
byThe committee will set the standards that must be met to receive a satisfactory grade for
each project.

64
APPENDIX 9: Morbidity and Mortality Meetings
Background: The morbidity and mortality meeting (M&M) is a useful component to all training
programs. Unlike typical case conferences, M&M participants analyze a case with an adverse (or
near adverse) outcome to identify contributing factors. This process allows for learning, not just
in the providers responsible for the case, but for all others in the department so that similar
events are avoided in the future. M&Ms offer the potential to collaborate across departments
and specifically target quality improvement efforts where they are most needed. Successful
M&M meetings require preparation, collaboration, and a non-threatening environment.

Purpose of M&M Conference:

To review the trends for admissions and deaths in the department of Orthopedics monthly with
aims to improve reporting and data collection.
To provide a structured venue for physicians in the department to identify areas in need of
improvement, and promote professionalism, ethical integrity and transparency in assessing and
improving patient care.
To incorporate the six core ACGME competencies (Patient Care, Medical Knowledge, Practice-
based learning, Systems-based practice and Improvement, Communication, and
Professionalism)
To provide education and practice implementation of root cause analysis and quality
improvement skills.
To foster a climate of openness and discussion about medical errors.
Stimulate research ideas and projects in quality improvement

Structure of M&M Meetings

Introduction: Assigned residents will obtain and consolidate data obtained from medical records
on the admissions to general surgery, diagnoses, deaths, and causes of death.
Announcements, updates, and issues requiring attention in the department may also be
presented here. Persons wishing to raise issues must submit to the organizing resident within
one week of conference.
Reports: Persons assigned specific follow-up tasks at prior M&M meetings will provide report
and updates on progress.
Case Discussions: Each Resident is required to present a case at least once every month that
they have been involved in managing. Each Resident Presentation must have a supervisor.
Action Planning: Proposals for improvements will be assigned to specific attendees for follow-up
which may entail written communication, committee formation, collaboration with QI
department, etc…

Case Finding: Case selection should be in keeping with purpose of M&M and should be chosen
for their ability to promote learning and systems analysis. The following are considerations for
ideal cases for presentation at M&M
Any unexpected negative outcome (e.g. death, injury, disability, delay in care)
Errors in medical management (with or without bad outcome)
Complex case with diagnostic or management dilemmas

65
Unusual cases – unusual presentations of common conditions or usual presentations of rare
disorders

Role of the Supervisor

Ensure that case is selected and assigned for presentation
Review case with the presenter before conference with attention to review of healthcare matrix
Propose solutions and improvement initiatives
Attend M&M conference and provide discussion points during presentations

Role of the Resident

Maintain confidentiality of patient and specific doctors involved. The focus of M&M is to identify
ways to improve care, not place blame on individuals or services.
Be prepared – review the presentation with consultant prior to presentation with specific
attention to the application of healthcare matrix
Seek to understand WHY the outcome of interest happened.
Be the expert, know the details of the case better than anyone in the room
Do your research – review the complete chart, speak to all parties involved (other physicians,
consultants, pharmacy, nursing, radiology, etc.)
Focus on learning points > the all of the clinical details of the case (follow presentation format)

Presentation Format:

The case presentation will follow the template below:

Brief Overview of case: (no more than 10 minutes)
rationale for selection of the case, diagnosis, and complications
Timeline of Key Events
All potential causes of complications
How complications could have been prevented, ameliorated, or managed
What we would have done differently
Any evidence-based literature that is applicable
Application of the Health Care Matrix to identify key systems-based issues that affected patient
safety. Discussion from the group should be elicited.
Proposal for solutions and improvements to processes to avoid similar situations in the future
Take home points

66
APPENDIX 10: SUBSPECIALTY ROTATIONS

180 weeks in 8 weeks 8 weeks 4 weeks

General Plastic 4 weeks
Orthopedic Surgery. Surgery Pediatric
Surgery ICU
Surgery

67
APPENDIX 11: FINAL EXAM – MASTER’S in ORTHOPEDIC SURGERY

GPHC-MASTER’S IN ORTHOPEDIC SURGERY

Rules and Regulations regarding final examination
(based on UG Diploma regulations approved by UG 2008)

1. University of Guyana regulations:

a. Each candidate must meet the University regulations with regards to
registration and examination fees and any other requirement.
b. Surgery final examination Rules and Regulations will be approved by the Surgical
Postgraduate Education Committee (SPEC), and submitted to the University.
c. The approved Rules and Regulations will be provided to the candidates.
d. The University’s requirements for written examinations will be provided to the
candidates

2. Eligibility to sit the examinations:

a. Candidates for the examination must have satisfactorily completed all the
tutorial modules and clinical rotations during their two year residency,
including submission of all clinical in-training evaluations.
b. Candidates must submit their completed case logbook, with a summary of the
numbers of operative cases attended.
c. Residents who have not completed these requirements by the deadline would
not be eligible to sit the final examination. Their progress will be reviewed by the SPEC,
and remediation will be recommended.
d. Eligibility to sit the final examination would have to be approved by SPEC.

3. Structure of the examination for the MASTER in ORTHOPEDIC Surgery:

a. The final examination will take place once annually.
b. The examination will take the form of written (short answer and multiple choice
questions) and a focused oral examination.
c. The purpose of the examination is to determine whether the candidates have
met the requirements of the program and are competent to work independently as safe
surgeons within their expected scope of practice.
d. The Examiner’s Board will include the internal and external examiners, and
must approve the examination papers before they are administered.
4. Components of the written examination:
a. MCQ paper – a three-hour paper of 100 multiple choice questions, with no minus
marking for wrong answers.
b. SAQ paper – a three-hour paper of short answer questions.
c. Both papers will be based on the content covered during the tutorial modules and
will be approximately 60% from Orthopedics and 40% from the relevant subspecialties.
d. The internal examiners will mark the papers and submit them to the
external examiner for review. The marks awarded by the external examiner will
be final.
e. The minimum pass mark for each paper is 60

68
 f. Candidates must pass each component of the examination.

5. Format of the oral examination:

a. A series of structured oral examination questions will be developed in
conjunction with the external examiners.
b. The Examining Panel will consist of at least 6 examiners including at least 3 external
examiner.
c. Each candidate will have one one-hour oral examination.
d. Candidates whose performance is borderline on the oral examination may be
recalled for a second oral examination at the discretion of the Examiners’ Board.
e. The minimum pass mark for the oral examination is 60. The determination of the
final grade on the oral examination will be made by the entire Examiners’ Board.

6. Appeals and remediation:

a. The decision of the Examiners’ Board will be final.
b. The Board will recommend remediation activities for unsuccessful candidates.
c. Unsuccessful candidates may apply to the Surgical Postgraduate Education Committee
to sit the examination the following year.

APPENDIX 12: MMed IN ORTHOPEDICS AND TRAUMATOLOGY –

DELIVERY FRAMEWORK
Structure of the MMed IN ORTHOPEDIC AND TRAUMATOLOGY
Programme
Who is Involved in training?
The key roles involved in teaching and learning are programme director (PD), assigned
educational supervisor (AES), clinical supervisor (CS), assessor and resident.
Programme Director
The majority of programme directors (PDs) manage specialty programmes; there are, however,
a number of programme directors who manage core surgical training programmes PD (CST).
PDs are responsible for:
Organising, managing and directing the training programmes, ensuring that the programmes
meet curriculum requirements;
Identifying, appointing and supporting local faculty (i.e. AES, CS) including their training where
necessary;
Overseeing progress of individual trainees through the levels of the curriculum; ensuring that
appropriate levels of supervision, training and support are in place;
Help manage trainees who are running into difficulties by identifying remedial placements and
resources where required;
Ensuring that University of Guyana administrative support are knowledgeable about curriculum
delivery and are able to work with the Colleges, trainees and trainers;

69
Administering and chairing an annual assessment outcome process.
Assigned Educational Supervisor
Educational supervision is a fundamental conduit for delivering teaching and training. It takes
advantage of the experience, knowledge and skills of expert clinicians / consultant trainers and
their familiarity with clinical situations. It ensures interaction between an experienced clinician
and a trainee. This is the desired link between the past and the future of surgical practice, to
guide and steer the learning process of the trainee. Clinical supervision is also vital to ensure
patient safety and the high-quality service of trainees. The curriculum requires trainees reaching
the end of their training to demonstrate competence in clinical supervision before the award of
Master in Orthopedic Surgery. The IHSE also acknowledges that the process of gaining
competence in supervision must start at an early stage in training with trainees supervising
more junior trainees. The example set by the educational supervisor is the most powerful
influence upon the standards of conduct and practice of a trainee.
The Assigned Educational Supervisor (AES) is responsible for between 1 and 4 trainees at any
time. The number will depend on factors such as the size of the unit and the availability of
support such as a Clinical Supervisors (CSs) or Clinical Tutors (CTs). The role of the Assigned
Educational Supervisor is to:
Have overall educational and supervisory responsibility for the trainee in a given placement;
Ensure that an induction to the unit (where appropriate) has been carried out;
Ensure that the trainee is familiar with the curriculum and assessment system relevant to the
level/stage of training and undertakes it according to requirements;
Ensure that the trainee has appropriate day-to-day supervision appropriate to their stage of
training;
Act as a mentor to the trainee and help with both professional and personal development;
Agree a learning agreement, setting, agreeing, recording and monitoring the content and
educational objectives of the placement;
Discuss the trainee’s progress with each trainer with whom a trainee spends a period of training
and involve them in the formal report to the annual review process;
Undertake regular formative/supportive appraisals with the trainee (typically one at the
beginning, middle and end of a placement) and ensure that both parties agree to the outcome
of these sessions and keep a written record;
Regularly inspect the trainee’s learning portfolio and ensure that the trainee is making the
necessary clinical and educational progress;
Ensure patient safety in relation to trainee performance by the early recognition and
management of those doctors in distress or difficulty.
Inform trainees of their progress and encourage trainees to discuss any deficiencies in the
training programme, ensuring that records of such discussions are kept;
Keep the Programme Director informed of any significant problems that may affect the trainee’s
training;
Provide an end of placement AES report.
In order to become an Assigned Educational Supervisor, a trainer must have a demonstrated an
interest and ability in teaching, training, assessing and appraising. They must have appropriate
access to teaching resources and time for training allocated to their job plan.
Clinical Supervisor
Clinical supervisors (CS) are responsible for delivering teaching and training under the delegated
authority of the AES. They:
Carry out assessments as requested by the AES or the trainee. This will include delivering
feedback to the trainee and validating assessments;
Ensure patient safety in relation to trainee performance;

70
Liaise closely with other colleagues, including the AES, regarding the progress and performance
of the trainee with whom they are working during the placement. .
Keep the AES informed of any significant problems that may affect the trainee’s training;
Contribute to the AES’s end of placement report for the ARCP.
Evaluator
Evaluator will carry out a range of assessments and provide feedback to the trainee and the AES,
which will support judgements made about a trainee’s overall performance. Assessments during
training will usually be carried out by clinical supervisors (consultants) and other members of
the surgical team.
Resident
The trainee is required to take responsibility for his/her learning and to be proactive in initiating
appointments to plan, undertake and receive feedback on learning opportunities. The trainee is
responsible for ensuring that
a learning agreement is put in place,
opportunities to discuss progress are identified
assessments are undertaken
Evidence is recorded in the learning portfolio in good time.
Teaching
The detail of clinical placements will be determined locally by Programme Directors (PD). In
order to provide sufficient teaching and learning opportunities, the placements need to be in
units that:
Are able to provide sufficient clinical resource;
Have sufficient trainer capacity.
The PDs and AESs define the parameters of practice and monitor the delivery of training to
ensure that the trainee has exposure to:
A sufficient range and number of cases in which to develop the necessary technical skills
(according to the stage of training) and professional judgement (to know when to carry out the
procedure and when to seek assistance);
Managing the care of patients in the case of common conditions that are straightforward,
patients who display well known variations to common conditions, and patients with ill-defined
problems;
Detailed feedback.
Development of professional practice can be supported by a wide variety of teaching and
learning processes, including role modelling, coaching, mentoring, reflection, and the
maximizing of both formal and informal opportunities for the development of expertise on the
job.

71
APPENDIX 13: POST GRADUATE EDUCATION COMMITTEE (PGEC)
POST GRADUATE EDUCATION COMMITTEE

Post Graduate Education Committee:

Director, Medical Education (GPHC), Chairman.
Director, Medical & Professional Services (GPHC)
Chief Executive Officer (GPHC)
Program Directors
Medical Director. (UG School of Medicine)
Dean Faculty of Health Sciences (U.G.)
Chief Medical Officer, MOH
Director, Regional Health Services, MOH

Responsibilities of Surgical Postgraduate Education Committee

a. Establish general policies of residency education;

b. Establish and maintain appropriate liaison mechanisms with the directors of other programs
and the administrators of affiliated institutions;
c. Conduct internal reviews of the surgical programs to ensure compliance with the
Committee’s policies and objectives.
d. Ensure appropriate distribution of the resources necessary for effective education in
the residency programs.
e. Establish and supervise policies for the selection, evaluation, promotion, and dismissal of
residents in the programs.
f. Establish and maintain an appeal mechanism for matters related to postgraduate medical
education decisions.
g. Ensure a proper educational environment free of harassment and intimidation with
mechanisms in place to deal with such issues as they arise.
h. Ensure that there are adequate opportunities for faculty development.

i. Establish policies to ensure adequate supervision of residents in order to protect and preserve
the best interests of the patient, the attending physician and the resident. Recognizing the
principle of increasing professional responsibility in residency education, the medical education
committee must ensure that there are adequate guidelines for the supervision of residents.

The components of resident supervision include:

i. a mechanism of disclosure of the fact that residents are involved in patient care, and for
patient consent for such participation.
ii. Assurance of progressive competence of the resident for graded independent performance.
iii. Policies for notification of, and discussion with the attending physician by the resident
regarding decisions in patient care.

72
iv. Policies regarding the physical presence of the attending physician during acts or procedures
performed by the resident;
j. Ensure that the program addresses the required general skills of medical practice including:
i. Biomedical ethics and medico-legal concerns;
ii. quality assurance/improvement;
iii. management skills;

iv. health care advocacy;

v. communication skills; and

vi. equity issues related to age, gender, culture and ethnicity; and
The functions of the Surgical Education committee may be facilitated by means of
subcommittees.
The committee and subcommittees, if any, must meet regularly and minutes must be kept.

APPENDIX 14
University of Guyana / Georgetown Public Hospital Corporation
Orthopedic Surgery Master’s Program

TUTORIAL MODULE EVALUATION

[to be completed for each resident at End of module]

Name of resident: _________________________________ Date of

evaluation:_________________

Tutorial module: ___________________________ Dates of

module:__________________________

Faculty Supervisor(s): _______________________________________

Rank the resident on scale of 1-5 poor = 1 2 3 4 5=

outstanding

Attendance / punctuality 1 2 3 4 5
[note 95% attendance required by UG]

Preparation for tutorials 1 2 3 4 5

Contributions to discussion 1 2 3 4 5

73
Leadership in tutorials 1 2 3 4 5

(Expectation is that graduating residents will achieve at least 3/5 on each criterion.)

Score on Module Test: ________ [1st sitting] ________ [repeat]

[80% is the minimum pass mark]

Comments:

FINAL TUTORIAL EVALUATION: SATISFACTORY / NOT SATISFACTORY

Signed by Faculty supervisor: _______________________________ Date: ____________

Unsatisfactory Satisfactory Superior NA

Reviewed with resident? Yes / No

Signed by resident: _______________________________ Date: ____________

APPENDIX 15: EVALUATION OF FACULTY

(This form must be submitted in confidence to the Program Director)

Faculty:________________________________________________________________________
_____
Course:________________________________________________________________________
____
Resident:
___________________________________________________________________________
Date:__________________________________________________________________________
_____
Please rate the program faculty member in the following areas

Unsatisfactory = Several Behaviors performed inadequately or missed ( Rating 1,2 or 3)

Satisfactory = Most Behaviors performed acceptably (Rating 4,5 or 6)
Superior = All Behaviors performed very well (Rating 7, 8 or 9)

74
Interest in Teaching 1 2 3 4 5 6 7 8 9

Commitment to education
1 2 3 4 5 6 7 8 9
program

Ability to motivate 1 2 3 4 5 6 7 8 9

Approachability 1 2 3 4 5 6 7 8 9

Receptiveness to questions 1 2 3 4 5 6 7 8 9

Clinical Knowledge 1 2 3 4 5 6 7 8 9

Overall value to residency

1 2 3 4 5 6 7 8 9
program

Comments:

75
76
77
78
79