Forgot your password ?

SICOT e-Newsletter

 Issue No. 32 - May 2011

Editorial by H.K.T. Raza - President, Asia Pacific Orthopaedic Association & Past President, Indian Orthopaedic Association

Need for Global Training in Orthopaedics

Introduction

There has been a remarkable progress in all medical fields in the last two decades. With the advent of the internet, dissemination of knowledge and exchange of ideas is only a mouse-click away. The world has shrunk to become a virtual global village. However, one must be aware of the fact that there is a wide disparity of access to knowledge and training methodologies across the world. In surgical specialties such as Orthopaedics, just a mere gain in knowledge is insufficient. Proper guidance and practice of psychomotor skills is exceedingly important. With the galloping pace at which new technologies, procedures and instrumentation are evolving, there is a need for the young orthopaedic surgeon to be properly trained and equipped to serve humanity. The developed world, mainly, the Western countries, was the traditional destination for surgeons aspiring to be further trained in the art and science of orthopaedic practice. The scenario is rapidly changing. Many countries in the Asia Pacific Region now boast of world class facilities, and are increasingly contributing to orthopaedic research and development. There is much to learn from even the developing countries where there is a wealth of experience in the management of Orthopaedic infections (including tuberculosis) - so important in these days of the HIV juggernaut. It is therefore not enough for a young orthopaedist to be trained in his/her own institution/city/state/country. New avenues for training and service should be made available to him/her. With rapid globalisation, future orthopaedic training should certainly become more diversified.

With the development of international and regional orthopaedic societies/associations, we must now start a process of developing a system in which we can train a young orthopaedic surgeon to be a global citizen fully equipped to serve anywhere in the world. The future trends would be, and should be, in this direction.

Current Scenario

At present there is a wide disparity in training standards across the world. As an example, I would like to mention the status of training in the Asia Pacific region based on a questionnaire I circulated in September 2010. Questions included the qualification required to join a basic training/certification programme for Orthopaedic Surgery, the mechanism of selection, the duration of the training programme, whether there was any rotation of the candidates through different institutions, subspecialty units, evaluation methodology – formative and summative, etc.

In some countries a basic graduate course of four years is required before you enter medical school for basic training. After four years of this basic medical school a lengthy 3-4 years' rotating internship is required before one can join a fellowship course of 4 years for certification as an Orthopaedic Surgeon. Subspecialty interests can only then be addressed. This would take another two years. In other countries there is no need for a general graduate degree before entering medical school. Candidates qualify for the entry after Twelfth Standard grade of school. The 4-5 years of medical school is followed by one year of internship. The subsequent orthopaedic training programme may be as short as three years as in India. However, in other countries training is rightfully of four years' duration. Candidates in some countries are trained only in the same institution while in some countries they are rotated through other institutions in the city. Some countries have a curriculum which offers the candidate a choice of extra postings in the subspecialty of his choice within the four-year training period. Many developing countries lack centres of excellence for training in subspecialties.

Global Need for Exchange Programmes

The exchange of orthopaedic trainees and young (and not so young) orthopaedic surgeons will help in the following ways:

  1. Exchange of experiences.
  2. Identification of changing trends and changing requirements due to advances in the medical field.
  3. Curriculum planning and revision based on (a) & (b).
  4. Global co-operation and co-ordination.
  5. Developing strategies for implementation of programmes.

Strategy for Starting and Implementing an Exchange Programme

  1.  Identification of beneficiaries:
    1. Postgraduate trainees.
    2. Freshly qualified orthopaedic surgeons.
    3. Orthopaedic surgeons below 45 years desiring training in Orthopaedics.
    4. Senior orthopaedic surgeons desiring further exposure in a specific subspecialty in centres of excellence.
      Training modules of short and long duration may need to be developed for each category. These should be adjustable to suit individual requirements.
  2. Identification of Agencies:
    SICOT is a globally recognised organisation with membership across the world. It is pertinent for it to take a lead by first building bridges of friendship and co-operation amongst other regional orthopaedic associations like EFORT, APOA, and others. Through the regional associations pilot projects may be started for exchange of orthopaedic trainees amongst countries/institutions capable of, and who are prepared to host exchange fellows. The national orthopaedic associations can be of great help and SICOT should try to directly involve them in the programme.
  3. Identification of Resources:
    1. Funds: This will be the main stumbling block. The best working principle is to request the candidate to pay for the air travel while the accommodation/meals/training is provided by the local host institution. The national orthopaedic associations may provide for the air travel plus a token of pocket money for sundry expenses.
    2. Host countries/associations/institutions: SICOT could advertise for national associations/institutions to volunteer for this training programme. A simple memorandum of understanding may be signed for the exchange programme to work as an ongoing project.
    3. Co-Ordinating Body: A committee nominated by SICOT could co-ordinate the exchange programme amongst nations/institutions.
  4. Identification of Activities:
    SICOT could be a facilitator for exchange programmes which are directly run through its auspices or could also help in developing exchange fellowships amongst national orthopaedic associations and institutions. Dissemination of information of the exchange fellowships could also be undertaken through the SICOT Newsletter.

How to Make a Beginning

A small core committee can be nominated to work on the project to:

  1. Determine whether SICOT would want to be the leader for this activity.
  2. Determine feasibility of the project.
  3. Identify and correspond with interested national orthopaedic associations and centres of excellence.
  4. Prepare a short report for the SICOT Executive Committee to decide further line of action.

Conclusion

I hope this small article will help sensitise all like-minded colleagues from across the world to join hands and offer better training opportunities to our youngsters than in the past. The exchange programmes are sure to bring about a better quality and uniformity of Orthopaedic training and would be an eye-opener for those lagging behind in terms of World Orthopaedics.