KURIKULUM
PENDIDIKAN DOKTER SPESIALIS ORTHOPAEDI DAN TRAUMATOLOGI
KOLEGIUM ORTHOPAEDI DAN TRAUMATOLOGI INDONESIA
PERHIMPUNAN DOKTER SPESIALIS ORTHOPAEDI DAN TRAUMATOLOGI INDONESIA
JAKARTA, JUNI 2012
TIM PENYUSUN DAN EDITOR Penanggung Jawab
:
Prof. dr. Errol U Hutagalung, SpB, SpOT(K) - (Ketua Kolegium Orthopaedi dan Traumatologi Indonesia ) Prof Dr. dr. Moh. Hidayat, SpB, SpOT(K) - (Wakil Ketua)
Ketua Komisi Kurikulum: Sekretaris Komisi : Anggota :
Prof. Dr. dr. Putu Astawa, MKes. SpB, SpOT (K) Dr. dr. Nucki N Hidajat, MKes, SpOT(K) Prof. Dr. dr. Moh Hidajat, SpB, SpOT(K) - Staf Pengajar PPDS Orthopaedi dan Traumatologi FKUB dr. Ifran Saleh, SpOT(K) - KPS PPDS Orthopaedi dan Traumatologi FKUI Dr. dr. Ismail, SPOT ( K ) - SPS PPDS Orthopaedi dan Traumatologi FKUI Dr. dr. Ferdiansyah, SpOT(K) - Ka Dept. Orthopaedi & Traumatologi FK UNAIR /RSU Dr.Soetomo
-
Dr. dr. Dwikora Novembri Utomo, SpOT(K) - KPS PPDS Orthopaed dan Traumatologi FUNAIR
-
dr. Mouli Edward, SpOT(K) - KPS PPDS Orthopaed dan Traumatologi FKUNAIR Dr. dr. Hermawan Nagar Rasyid, SpOT(K), MT(BME), PhD - KPS PPDS Orthopaedi dan Traumatologi FK UNPAD dr. Yoyos Dias Ismiarto, SpOT(K) - SPS PPDS Orthopaedi dan Traumatologi FK UNPAD Prof. Dr. dr. H.R. Agung Saifullah, SpB,SpOT(K) - KPS PPDS Orthopaedi dan Traumatolohi FK UNHAS dr. M. Ruksal Saleh, SpOT(K), PhD - SPS PPDS Orthopaedi danTraumatologi FK UNHAS dr. Ismail Mariyanto, SpOT(K) - KPS PPDS Orthopaedi dan Traumatologi FK UNS
i
dr. Mujaddid Idulhaq, M.Kes, SpOT - SPS PPDS Orthopaedi dan Traumatologi FK UNS Dr. dr. Rahadyan Magetsari, SpOT(K) - KPS PPDS Orthopaedi dan Traumatologi FKUGM Dr. dr. Puntodewo, M.Kes, SpOT(K) - SPS PPDS Orthopaedi dan Traumatologi FKUGM Prof. Dr. dr. I Ketut Siki Kawiyana, SpB, SpOT(K) - KPS PPDS Orthopaedi dan Traumatologi FK UNUD dr. I Ketut Suyasa, SpB, SpOT (K) - SPS PPDS Orthopaedi dan Traumatologi FK UNUD Dr. dr. Edi Mustamsir, SpOT (K) - KPS/Ka. SMF Orthopaedi dan Traumatologi FKUB dr. Istan Irmansyah, SpOT (K) - SPS PPDS Orthopaedi dan Traumatologi FKUB Editor
:
Prof. Dr. dr. Putu Astawa, MKes, SpOT(K) - Staf Pengajar PPDS Orthopaedi dan Traumatologi FK UNUD Dr. dr. Nucki N Hidajat, MKes, SpOT(K) - Kepala Dept. Orthopaedi dan Traumatologi FK UNPAD /RS Dr. Hasan Sadikin
iii
KATA PENGANTAR Syukur Alhamdulillah kita panjatkan ke hadirat Allah SWT, bahwa telah bisa diterbitkan buku kurikulum Progam Pendidikan Dokter Spesialis (PPDS) Orthopaedi dan Traumatologi oleh Kolegium Orthopadi dan Traumatologi edisi tahun 2012 ini, Buku ini merupakan revisi dan perubahan format serta penambahan di beberapa bagian dari edisi 2007, hal ini dilakukan atas dasar bahwa ilmu Orthopaedi dan Traumatologi merupakan cabang ilmu kesehatan yang terus bergerak secara dinamis sesuai dengan kebutuhan masyarakat maupun perkembangan ilmu teknologi kedokteran sendiri. Penambahan yang paling signifikan adalah dalam aspek kompetensi afektif rujukan
adalah
serta bidang sport injury, yang menjadi sumber
Kurikulum
pendidikan
dari
British
Orthopaedic
Assossiation (BOA) yang disesuaikan dengan kondisi situasional local dan tingkatan kompetensi dari KKI (Konsil Kedokteran Indonesia). Kami sangatlah menyadari buku kurikulum ini jauh dari kesempurnaan sehingga merupakan keniscayaan adanya asupan dan kritikan yang dapat membuat buku ini menjadi lebih baik.
Wassalam. Editor.
.
v
KATA SAMBUTAN Ketua Kolegium Orthopaedi dan Traumatologi Indonesia Dokter Spesialis Orthopaedi dan Traumatologi adalah dokter yang telah mencapai kemampuan tertentu dan secara professional mengkhususkan diri dalam pelayanan bidang Orthopaedi dan trauma muskuloskeletal dan mempunyai kemampuan menyerap, mengembangkan serta mentransformasikan keilmuannya. Penerbitan Buku Kurikulum Pendidikan Dokter Spesialis Orthopaedi dan Traumatologi edisi tahun 2012 merupakan hasil penyempurnaan cetakan sebelumnya, Pada edisi ini dimasukan berbagai informasi baru yang merupakan hasil pengembangan dan pendalaman serta penyelarasan dari berbagai sumber. Buku kurikulum ini disusun oleh Kolegium dan menjadi paduan bagi seluruh pimpinan, pendidik, tenaga kependidikan, dan paserta didik program dokter spesialis Orthopaedi dan Traumatologi di Indonesia, untuk dapat dilaksanakan secara konsisten. Disamping itu, untuk melengkapi buku ini diterbitkan pula buku Standar Penyelenggaraan Pendidikan Profesi Dokter spesialis Orthopaedi dan Traumatologi. Kami mengucapkan terima kasih dan penghargaan setinggi-tingginya kepada Editor, Tim komisi Kurikulum kolegium Orthopaedi dan Traumatologi, dan anggota Kolegium lainya yang telah bekerja keras untuk
menuangkan
informasi yang
relevan
dan
terkini serta
melakukan kajian-kajian secara berkesinambungan dalam penyusunan buku ini.
vii
Saran dan kritik untuk penyempurnaan buku kurikulum ini dapat ditujukan kepada Tim kurikulum kolegium Orthopaedi dan Traumatologi Indonesia. Semoga Allah Subhanahu Wata’ala memberikan bimbingan, petunuk, dan kekuatan kepada kita. Aamiin.
Jakarta, Juni 2012 Ketua Kolegium Orthopaedi & Traumatologi Indonesia (Periode Nopember 2010 – Nopember 2012)
Prof. dr. Errol Untung Hutagalung, SpB, SpOT(K)
viii
SURAT KEPUTUSAN PENGGUNAAN BUKU SURAT KEPUTUSAN Nomor : 013/Koleg-IOT/XII/2012 Kolegium Orthopaedi dan Traumatologi Indonesia Tentang PELAKSANAAN PEMAKAIAN BUKU KURIKULUM PENDIDIKAN DOKTER SPESIALIS ORTHOPAEDI DAN TRAUMATOLOGI KOLEGIUM ORTHOPAEDI DAN TRAUMATOLOGI Menimbang
: 1.
2.
Mengingat
: 1.
2.
Memutuskan
: 1.
2. 3.
Bahwa untuk menjalankan kegiatan Pendidikan Dokter Spesialis Orthopaedi dan Traumatologi diperlukan Buku Kurikulum Pendidikan Dokter Spesialis Orthopaedi dan Traumatologi. AD / ART BAB 1. Pasal 13.2 Tentang Tugas Kolegium Orthopaedi dan Traumatologi Indonesia yaitu ayat 13.2.12 : Menyusun katalog pendidikan profesi dokter spesialis dan spesialis konsultan Orthopaedi dan Traumatologi Indonesia. SK Kolegium Orthopaedi dan Traumatologi Indonesia mengenai Koordinator Pelaksana Komisi Kurikulum Kolegium Orthopaedi dan Traumatologi Indonesia tanggal 23 Desember 2009 yaitu menugaskan Komisi Kurikulum untuk merevisi Kurikulum dan Standarisasi Seleksi Nasional Peserta Didik, yang diharapkan revisi Kurikulum sudah dapat digunakan pada Januari 2011. Untuk menjalankan kegiatan Pendidikan Dokter Spesialis Orthopaedi dan Traumatologi diperlukan Buku Kurikulum Pendidikan Dokter Spesialis Orthopaedi dan Traumatologi. Bahwa hasil revisi Buku Kurikulum Pendidikan Dokter Spesialis Orthopaedi dan Traumatologi dapat mulai digunakan sebagai buku pegangan Program Studi Orthopaedi dan Traumatologi Indonesia. Surat keputusan ini berlaku sejak tanggal ditetapkan. Bila kemudian hari ada kekeliruan, SK ini dapat diperbaiki sebagaimana mestinya.
ix
CARA PENGGUNAAN BUKU Buku ini terdiri atas 4 Bab. Bab I, Pendahuluan mengambarkan filosofi yang mendasari disusunnya Kurikulum dan beberapa pengertian tentang istilah yang dipergunakan didalamnya. Pada Bab II, Menjelaskan tentang isi atau kontain yang terbagi dalam bidang Kognitif, Psikomotor, dan Afektif. Bidang kognitif dikelompokkan berdasarkan kombinasi antara region anatomis (Spine, Hip, Knee, Ankle Foot, Shoulder Elbow, Hand), Diseases (Oncology, Paediatrik, Sport Injuri, dan Trauma), dan Ilmuilmu Dasar (Basic science, General Orthopaedi). Bidang Psikomotor dikelompokkan dalam Trauma Hard Tissue dan Soft Tissue (General, Upper limb, Pelvic girdle, Lower limb, spine), dan Non trauma dengan pembagian sesuai dengan regionya. Bidang Afektif di bagi kedalam 6 kelompok, yaitu Perilaku Profesional, Komunikator yang baik, mengajar dan melatih, Keeping Up to date, Menjadi manajer yang baik, Promoting Good Health, Etika. Bab III, Menjelaskan secara sistematika tahapan pencapaian Kompetensi, dan ruang lingkup yang harus di bahas maupun dikerjakan. Tingkat Kompetensi yan dipakai dalam buku ini adalah sesuai dengan standar dari KKI, yang matrikulasi semua ini dijabarkan di dalam lampiran 1, 2 dan 3. Bab IV, Dalam bab ini dijelaskan secara sistematis cara melaksanakan Kurikulum dari ketiga aspek Pendidikan, Prasyarat, serta Ketentuan-ketentuan yang harus dipenuhi, serta bagaimana cara memonitor dan evaluasinya.
xi
DAFTAR ISI Tim Penyusun dan Editor……………………………………………. Kata Pengantar ...................................................................................... Kata Sambutan Ketua Kolegium …………………………………….. Surat Keputusan Penggunaan Buku Kurikulum...................................... Cara penggunaan buku ........................................................................... Daftar isi ................................................................................................ BAB I 1.1
i iii iv Vi Vii viii 1
1.2
PENDAHULUAN............................................................ Pengertian Kurikulum Ilmu Orthopaedi dan Traumatologi Indonesia ………………………………... Model Kurikulum……………………………………….
BAB II 2.1 2.2 2.3
ISI KURIKULUM............................................................ Bidang Kognitif (Applied Clinical Knowledge Syllabu).... Bidang Psikomotor (Applied Clin Procedures Syllabus. Bidang Afektif (Professional & Management and Good
3 6 25
Clinical Practice)…………………………………………….
34
2 2
3.1. 3.2
TINGKAT KOMPETENSI DAN LINGKUP BAHASAN……………………………………………... Tingkat Kompetensi……………………………………. Tahapan Pencapaian Kompetensi………………...……..
BAB IV 4.1 4.2 4.3 4.4 4.5 4.6
PELAKSANAAN KURIKULUM................................... Cara Pelaksanaan ………………………………………. Modul tambahan Kursus ………………………………. Karya Ilmiah Wajib…………………………………….. Pelaksanaan Stase………………………………………. Monitor dan Evaluasi …………………………………... Buku Acuan Wajib ……………………………………..
47 47 47 48 48 50 52
DAFTAR PUSTAKA............................................................................
53
LAMPIRAN........................................................................................... Lampiran 1 Tingkat Kompetensi Kognitif Peserta didik berdasarkan Topik dan Thapan Pendidikan…………… Lampiran 2 Tingkat Kompetensi Psikomotor Peserta Didik berdasarkan Topik dan Tahapan…………………......... Lampiran 3 Tingkat Kompetensi Afektif Berdsarkan Topik dan Tahapan Pendidikan ………………………………… Lampiran 4 Modul-modul ……………………………………….....
54
BAB III
41 41 43
54 75 84 91
xiii
BAB I PENDAHULUAN Pencapaian kesehatan yang optimal sebagai hak asasi manusia masyarakat perlu mendapat perhatian. Pelayanan yang baik dan bermutu merupakan dambaan masyarakat Indonesia. Untuk mendapatkan itu perlu dihasilkan pelayan kesehatan yang baik termasuk perawat, dokter umum dan juga dokter sepesialis. Dokter sebagai salah satu komponen utama pemberi pelayanan kesehatan masyarakat
mempunyai peran yang sangat penting sehingga
Pendidikan Kedokteran akan menjadi penting.
Untuk memberikan perlindungan kepada pasien dan mempertahankan mutu
pelayanan kesehatan pemerintah dengan
Undang-undang RI No. 20 tahun 2003 tentang Sistem Pendidikan Nasional
dan
Undang-Undang RI No. 29 tahun 2004 tentang
Praktik Kedokteran menekankan Standar Pendidikan Kedokteran dam memberi kepastian hukum kepada masyarakat dan Dokter.
Asosiasi Institusi Pendidikan Kedokteran berkoordinasi dengan Organisasi Profesi, Kolegium, Asosiasi Rumah Sakit Pendidikan, Departemen Pendidikan Nasional dan Departemen Kesehatan
Kolegium
kedokteran
dalam
menyusun
standar
Pendidikan Profesi Dokter berkoordinasi dengan Organisasi Profesi, Asosiasi Institusi Pendidikan, Departemen Pendidikan Nasional dan Departemen Kesehatan 1
1.1. Pengertian Kurikulum Ilmu Orthopaedi dan Traumatologi Indonesia Kurikulum merupakan seperangkat rencana dan pengaturan pendidikan yang meliputi tujuan pendidikan, isi, bahan pelajaran, cara pencapaian dan penilaian, yang digunakan sebagai pedoman penyelenggaraan Pendidikan Ilmu Orthopaedi dan Traumatologi
1.2. Model Kurikulum Model Kurikulum berbasis Kompetensi dilakukan dengan pendekatan terintegrasi baik horizontal maupun vertikal, serta berorientasi pada masalah kesehatan individu, keluarga dan masyarakat dalam konteks pelayanan kesehatan paripurna
2
.
BAB II ISI KURIKULUM
Isi Kurikulum meliputi prinsip-prinsip metode ilmiah, biomedik, ilmu kedokteran klinik dalam hal ini Ilmu Orthopaedi dan Traumatologi, Ilmu humaniora yang disesuaikan dengan Standar Kompetensi
yang ditetapkan. Prinsip-prinsip metode
ilmiah meliputi metodologi penelitian, filsafat ilmu, berpikir kritis, biostatistik dan evidence-based medicine.
Ilmu biomedik meliputi anatomi, biokimia, histologi, biologi sel dan molekuler, fisiologi, mikrobiologi, imunologi, parasitologi, patologi, dan farmakologi. Ilmu biomedik dijadikan dasar ilmu kedokteran klinik dalam hal ini Ilmu Orthopaedi dan Traumatologi sehingga anak didik mempunyai pengetahuan yang cukup untuk memahami konsep dan praktik kedokteran klinik.
Ilmu-ilmu humaniora meliputi ilmu perilaku, psikologi kedokteran, sosiologi kedokteran dan profesionalisme. Menurut Dr. Victor Neufeldt, satu kunci konsep kurikulum baru adalah “…that
it is not only the sum total of residents’ experience, planned or unplanned. A broader view is needed, and the curriculum should be seen as an activity where residents and faculty learn and work together…”
3
Kurikulum berdasarkan Kompetensi terdiri atas dua komponen utama yaitu Core Kurikulum dan Non Core Kurikulum (miss program of special study, local content.) Core Kurikulum sangat penting yang harus dikuasai oleh semua residen dan terdiri dari : 1. Bidang Kognitif (Applied Clinical Knowledge Syllabus) 2. Psikomotor (Applied clinical Procedure Syllabus) 3. Afektif (Professional and Management and Good Clinical
Practice) Core Curriculum dapat disederhanakan menjadi General Core Curriculum kemudian komponen Kurikulum sehingga memudahkan Peserta Didik untuk mengikuti proses belajar mengajar.
4
Curriculum communication
resident
Management of change Resident & faculty support systems
How to learn
What to learn
(Methods –
(content)
strategies)
Assessment
Education competency
Fostering conducive environment Curriculum renewal
Gambar 1.1. Skema Tujuan Komprehensif Kurikulum
5
2.1. Bidang Kognitif (Applied Clinical Knowledge Syllabus) 1.
BASIC SCIENCE
No. 1A
General Core Curriculum Anatomy:
1B.
Tissues:
1C
Physiology, Biochemistry & Genetics:
1D.
Biomechanics & Bioengineering:
2.
Komponen Curriculum Clinical and functional anatomy with pathological and operative relevance Anatomy (and embryology) of nervous and vascular systems Surgical approaches to the limbs and axial skeleton Anatomy (and embryology) of musculo-skeletal system Bone - Structure & Function Cartilage - articular, meniscal - Structure & Function Muscle and tendon - Structure & Function Synovium - Structure & Function Ligament - Structure & Function Nerve - Structure & Function Intervertebral disc - Structure & Function Structure and function of connective tissues Application/relevance of modern genetics to orthopaedic disease and treatment 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 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) Kinematics and gait analysis
BONE, JOINT DISEASE & GENERAL ORTHOPAEDIC
2A
6
General:
Osteoarthritis Osteoporosis Metabolic bone disease Rheumatoid arthritis and other (inflammatory, crystal, etc) Haemophilia Inherited musculoskeletal disorders
arthropathies
No. 2A
General Core Curriculum General: (Cont.)
2B
Investigations:
2C
Operative Topics:
2D
Miscellanous:
2E
Prosthetics & Orthotics:
2E
Research & Audit:
2F
Medical Ethics:
No.
General Core
Komponen Curriculum
Neuromuscular disorders - inherited and acquired Osteonecrosis Osteochondritides Heterotopic ossification Blood tests Musculoskeletal imaging: x-ray, contrast studies ( myelography, arthrography), CT, MR, ultrasound, radioisotope studies Effects of radiation Bone densitometry Electrophysiological investigations Tourniquets Principles of Sterilization Design of theatres & Skin preparation Anaesthesia - principles and practice of local and regional anaesthesia and principles of general anaesthesia Principle treatment of musculoskeletal tumor Principle surgery of musculoskeletal tumor Infection, Thromboembolism & Pain: Infection of bone, joint, soft tissue, including tuberculosis , and their prophylaxis Thromboembolism and prophylaxis Behavioural dysfunction and somatization AIDS and surgery in high-risk patients Management of Pain and pain relief Complex regional pain syndromes e.g. Reflex Sympathetic Dystrophy and Causalgia Principles of design Prescription and fitting of standard prostheses Principles of orthotic bracing for control of disease, deformity and instability Design and conduct of clinical trials Data analysis and statistics - principles and applications Principles of Epidemiology Audit Duties of care Informed consent Medical negligence Komponen Curriculum
7
Curriculum 3. HAND & MICRORECONSRUCTION 3A.
Anatomy of:
3B.
Pathology:
3C.
Clinical Assessment:
8
The wrist/MCP/PIP/DIP joints and CMC joint of the thumb The flexor and extensor mechanism of the fingers including interaction between extrinsic and intrinsic mechanism The posture of the thumb in pinch, power and key grip The nerve supply to the hand The closed compartments of forearm and hand An understanding of the special circum-stances associated with swelling and the effects of rising pressure in a closed compartment secondary to infection and injury An understanding of the special circum-stances in which oedema causes fibrosis and permanent stiffness Tendon injury and healing Nerve injury and healing An appreciation of the imbalances and deformities associated with inflammatory arthritis A classification system for congenital hand disorders Langers lines Hand tumours (e.g. ganglion/enchondroma) Dupuytren's disease
History of examination of hand and wrist in the assessment of tendons, distal radioulnar and radiocarpal joints Ability to elicit median, ulnar and radial nerve function and disorders Recognition of patterns of presentation of common compressive neuropathies and brachial neuralgia Assessment of intrinsic and extrinsic motors in digits and recognition of common deformities and deficiencies Awareness of presentation of work-related hand disorders Ability to examine and assess common rheumatoid hand deformities, e.g.: inferior radioulnar subluxation and carpal translo-cation; MCP subluxation and ulnar drift; digital Boutonniere and swan neck; thumb Boutonniere deformity and CMC disease Ability to recognise and assess focal hand swellings
No. 3D.
General Core Curriculum Investigations:
3E.
Treatment:
Komponen Curriculum Interpretation of plain and stress x-rays of wrist. A knowledge of other views Awareness of role of MRI/bone scan/ arthrography/arthroscopy Place and interpretation of nerve conduction studies
Knowledge of a strategy of management for the osteoarthritic rheumatoid hand. Understanding of the place of soft tissue reconstruction, joint fusion, interposition and excision arthroplasty in the treatment of the arthritic hand and wrist. Knowledge of the management of stenosing tenovaginitis Knowledge of the principles of treatment for common flexor and extensor tendon injuries and of the common surgical approaches to the digital flexor and extensor compartments Fractures of metacarpals and phalanges Familiarity with the surgical treatment of Dupuytren’s disease Awareness of the principles of tendon transfer for the reconstruction of mediun, ulnar and radial nerve palsy and familiarity with simple transfers, e.g. indicis to EPL Knowledge of splinting techniques and rehabilitation principles Ability to plan management for finger tip injuries and undertake closed management Knowledge of surgical approach to digits with particular regard to the restoration of function and prevention of stiffness Knowledge of the levels for digital amputation Injuries of ulnar collateral ligament of thumb Dislocations of carpus and carpal instability Knowledge of closed and operative options of treatment for fractures of distal radius and common carpal injuries including scaphoid non union. Familiarity with the surgical treatment of common compressive neuropathy Ability to manage common hand infections
9
No.
General Core Curriculum
Komponen Curriculum
4. KNEE 4A.
Anatomy:
4B.
Biomechanics:
4C.
Pathology:
Knowledge of regional anatomy of the knee, including: Surface anatomy Neural and vascular structures and their relations with particular reference to standard anterior and posterior surgical approaches Knowledge of regional anatomy of the knee, including: Surface anatomy Neural and vascular structures and their relations with particular reference to standard anterior and posterior surgical approaches Bones and joints Functional anatomy of ligaments and supporting muscles Innervation of the knee including controlling musculature The extent and function of the synovium and bursae of the knee The structure and function of the menisci, and articular cartilage The mechanics of the patello-femoral mechanism The medial and lateral weight-bearing joints and their inter-relationship The cruciate and collateral ligaments and other ligamentous and muscular supports Menisci and articular cartilage The mechanism of ligamentous, bony and combined trauma to the knee and healing potential A complete knowledge of arthritides, including degenerate wear, ageing changes and traumatic damage Pathology of inflammatory disease and infection affecting the knee The response of synovium to debris Benign and malignant conditions in the knee and surrounding structures including recognised classification where appropriate
4D.
10
Clinical Assessment:
A sound knowledge and understanding of: History and examination of the knee to include relevant surrounding structures The standard clinical signs of the knee and relevant adjacent structures and competent skill in describing these
No. 4D.
4E.
4F.
General Core Curriculum Clinical Assessment: (Cont.) Investigations:
Treatment:
Komponen Curriculum A critical understanding of rating and outcome measures in common use
Indications for and interpretations of: Radiographs – standard and specialised Blood investigation Aspiration Special investigations including CT, MRI and radioisotope scanning Arthroscopy Biomechanical testing A sound knowledge of conservative and surgical management, including the indications for referral to a specialist of: Paediatric disorders, including deformity, dislocations, epiphyseal disorders, osteochondritis and discoid meniscus Adolescent disorders including patello femoral and meniscal dysfunction, osteochondritis dissecans Young adult disorders including patello femoral and meniscal injuries, instability and ligament deficiency, synovial disorders, benign and malignant tumours Degenerative and inflammatory arthritis, including a balanced understanding of conservative and surgical options,including osteotomy, arthrodesis and arthroplasty Traumatic disorders including skin and soft tissue injuries, fractures and dislocations of patella, tibia and femoral components, ligament ruptures and internal derangement of the knee. Conservative and surgical indications and detailed .Methods of treatment. Outcomes of conservative and operative management
Infections, particularly infections and inflammations of the bursae, intra-articular sepsis, prevention and management of sepsis in implant surgery A sound working knowledge of the range of arthroplasties for primary and revision surgery for patello femoral, unicompartmental and total replacement of the knee with particular reference to secure bone anchorage, alignment, ligament stability and optimising range of movement; a good knowledge of post-operative complications, their Sprophylaxis and management
11
No. 4F.
General Core Curriculum Treatment (cont):
Komponen Curriculum A knowledge of the indications and techniques of revision surgery particularly for aseptic and septic loosening A knowledge of simple arthroscopic surgery including meniscectomy, trimming and shaving An appreciation of complex arthroscopic procedures An appreciation of medical and surgical techniques available to repair and replace articular cartilage
5. ANKLE & FOOT
5A.
Anatomy:
5B.
Biomechanics:
5C.
Pathology:
5D. 1)
Ability to recognise and assess the following diseases of the ankle and foot: Neurological Charcot joint disorders: Morton's neuroma Nerve entrapment Neurological foot deformity Trauma: Evaluation of skin and soft tissue injury Compartment syndrome Recognition of all fractures and dislocations Ankle and hindfoot disorder:
2)
12
Bones and articulations Ligamentous structures – ankle/hindfoot/ midfoot Plantar fascia and MTP anatomy Surface markings of neural and vascular structures Tendon anatomy Muscle compartments of the foot Function of the lower limb and foot in gait Ankle and subtalar joint Plantar fascia mechanisms Tendon function Orthoses and footwear Arthritides Degenerative joint disease Rheumatoid foot disease Neuropathy Neuropathic joint and skin changes Tumours E.g. osteoid osteoma and plantar fibroma Clinical Assessment: History and clinical examination of the foot and ankle in order to assess pain, joint function, deformity, nerve, muscle and tendon function
No. 2)
General Core Curriculum Trauma: (Cont.)
3)
Forefoot disorders:
4)
Tumours:
5E.
Investigations: Radiograph: CT, MRI and Scintigraphy:
5F.
EMG: Treatment Non-operative: Operative:
Komponen Curriculum
Hindfoot pain Ankle instability Heel pain Degenerative disease of the ankle Rheumatoid arthritis Osteochondritis dissecans of talus Hallux valgus Hallux rigidus Lesser toe deformities Metatarsalgia Inflammatory arthritis Ability to recognise and assess local foot swellings Diabetic foot: Complex foot deformity Flatfoot deformity - mobile and rigid Cavus deformity Residual congenital foot deformity
Standard foot and ankle views Knowledge of role of these ancillary investigations in certain specific conditions e.g. infection, tumour, tibialis posterior rupture, osteonecrosis Relevance to foot and ankle disorders Knowledge of rational basis for the use of footwear modifications, orthoses and total contact casting Detailed knowledge of closed and operative methods for management of fractures and dislocations of ankle, hindfoot and forefoot, including knowledge of common reconstructive surgical procedures for foot deformity including hallux valgus, lesser toe deformity, acquired flat-foot, to include arthrodesis, osteotomy and softtissue reconstruction
Knowledge of common amputations through foot and ankle Knowledge of common reconstructive surgical procedures for degenerative and inflammatory disorders of ankle and foot including arthrodesis, arthroplasty, excision arthroplasty procedures to first ray both proximal and distally for management of hallux valgus and rigidus 13
No.
General Core Curriculum 6. HIP JOINT 6A. Anatomy: 6B. Basic knowledge of the regional anatomy of the hip including:
Komponen Curriculum
6C.
Biomechanics:
Development of the hip joint Relationship of bony elements Blood supply of the femoral head Anatomical course of all major regional vessels and nerves The capsule, labrum and related ligaments An understanding of the action, anatomy and innervation of the regional musculature Detailed knowledge of the applied anatomy of common surgical approaches to the hip (medial, anterior, lateral and posterior) An understanding of the lever arms, muscles and body weight forces that produce the joint reaction force in both normal and abnormal hips
An understanding of the application of these principles to the rationale of both pelvic and femoral osteotomies, and replacement arthroplasty
6D.
Pathology:
6E.
Clinical Assessment:
14
Knowledge of the tribological properties of materials used for articulating surfaces Knowledge of the biocompatibility and mechanical properties of materials in common use in total hip arthroplasty Basic knowledge of the pathology of pyogenic and non-pyogenic arthritis, slipped upper femoral epiphysis [SUFE], Perthes' disease and hip dysplasia Mechanism and pattern of common fractures and fracture dislocations around the hip (intracapsular, extracapsular, acetabular and periacetabular, femoral head, etc) Knowledge of the pathology of osteoarthritis, rheumatoid arthritis and the seronegative arthritides at the hip and of osteonecrosis of the femoral head Familiarity with current theories of the aetiopathogenesis of osteoarthritis An understanding of the microbiological rationale for the prevention of sepsis in total hip arthroplasty A sound knowledge of clinical assessment of the hip, lumbosacral spine and knee. Particular reference should be paid to the gait, the Trendelenberg sign, limb length, loss of movement and deformity at the joint
No. 6E.
General Core Curriculum
Komponen Curriculum
The trainee needs to be well informed of current opinion regarding aetiopathogenesis, clinical presentation and appropriate investigation of: Proximal femoral fractures (intracapsular, extracapsular) and simple fracture dislocations of the hip Osteoarthritis and the inflammatory arthropathies
Perthes' disease Slipped upper femoral epiphysis Septic arthritis Osteonecrosis Soft tissue conditions around the hip (snapping hip, gluteus medius tendonitis, etc)
A working knowledge of the clinical presentations and investigations of:
6F.
Investigation:
The sequelae of CDH and hip dysplasia The sequelae of SUFE Juvenile chronic arthritis Non pyogenic arthritis The painful total hip replacement
A working knowledge of the interpretation of plain radiographs, dynamic arthrography, CT, bone scintigraphy and MRI of the hip region A working classification of proximal femoral and periacetabular fractures. Also, mechanisms and classification of failure of joint replacement and of periprosthetic fractures
6G.
Treatment:
Non-operative An understanding of the principles of traction, bracing and spica immobilisation An understanding of the non operative aspects of the management of hip pathology Operative A thorough knowledge of soft tissue surgery, osteotomy, arthrodesis and arthroplasty (excision and replacement). A sound knowledge of anterior, anterolateral, lateral and posterior approaches to the hip and of the complications associated with each A sound knowledge of: internal fixation of proximal femoral fractures, hemiarthroplasty for intracapsular fractures, primary total hip replacement for OA and inflammatory arthropathies in the elderly, simple proximal femoral osteotomies. Familiarity with potential complications (i.e. thromboembolism, sepsis, dislocation, etc) and be aware of current opinion on the prevention and management of these complications
A knowledge of the indications for, and principles of, complex proximal femoral osteotomies, hip arthroscopy, reconstruction of the hip in young adults (JCA and hip dysplasia, etc), complex hip revision surgery
15
No. 6G.
General Core Curriculum Treatment (Cont.)
7. THE SPINE 7A. Anatomy:
7B.
Biomechanics:
Komponen Curriculum An appreciation of complex acetabular and pelvic fractures, complex periacetabular osteotomies An understanding of the place of modern technologies such as, joint resurfacing procedures minimally invasive hip replacements and computer assisted implantation in the management of hip pathology and the attendant risks and complications
Development of the spine, spinal cord and nerve roots Surgical anatomy of the cervical, dorsal and lumbosacral spine Anterior and posterior surgical approaches to the spine at each level Basic knowledge of the biomechanics of the cervical and lumbosacral spines An understanding of the biomechanics of spinal instability as applied to trauma, tumour, infection and spondylolysis/listhesis
7C.
Pathology:
7D.
Clinical Assessment:
Biomechanics of spinal deformity A knowledge of the basic mechanics of spinal instrumentation Pathophysiology of the ageing spine and degenerative disc disease Acute and chronic infections of the spine Pathology of spinal deformity Pathology of the acutely prolapsed cervical and lumbar disc Recognition of patterns of spinal injury and associated cord and nerve root damage Tumours of the spine A thorough knowledge of general and orthopaedic history-taking and examination
A knowledge of the assessment of spinal deformity An understanding of the assessment of thoracic pain A sound knowledge of clinical assessment of the spine for low back pain, sciatica, spinal claudication, neck pain, radiating arm pain, spinal injury and incipient myelopathy
A knowledge of the assessment of spinal tumour A basic knowledge of the assessment of a patient after failed spinal surgery
16
No. 7E.
7F.
General Core Curriculum Investigation:
Treatment: Non-operative
Operative
8. TRAUMA 8A. Anatomy:
8B.
Biomechanics:
Komponen Curriculum A thorough knowledge of the basic investigations required in spinal surgery, specifically: blood tests, plain radiographs, bone scintigraphy, discography, electrophysiological studies [including cord monitoring], CT scanning, MRI scanning A thorough knowledge of how each of these investigations contributes to the diagnosis and management of each of the major areas of spinal disease A knowledge of the non-surgical methods available for the treatment of low back pain, sciatica, claudication, neck pain, spinal deformity, instability, tumour, infection and fracture to include: Analgesics and NSAIDs, physiotherapeutic regimes, pain clinic techniques, bracing, use of radiotherapy and chemotherapy, non-operative management of spinal injuries A sound knowledge of the indications for and operative surgical management of the acute prolapsed lumbar intervertebral disc, spinal stenosis, lumbar spinal instability due to spondylolysis/listheses A knowledge of the indications for, and operative surgical management of the acutely prolapsed cervical disc, cervical stenosis, spinal injury and the surgery of spinal infection A basic knowledge of the surgery of spinal deformity and tumours of the spine Applied to diagnosis and surgical treatment of common bone, joint and soft tissue injuries Knowledge of those anatomical structures particularly at risk from common injuries or in surgical approaches Physeal anatomy and its application to injury Application to open reduction and internal fixation of fractures and external skeletal fixation
Applied to fracture formation and fracture treatment both operative and non-operative Biomechanics of implants and fracture fixation systems, including their material properties Epidemiology and Research Methods: Research and audit methods including the design of clinical trials
17
No. 8C.
General Core Curriculum Pathophysiology & Pathology:
Komponen Curriculum Applied to fracture and soft tissue healing, including skin, muscle, tendon and neurological structures Classification systems for fractures and dislocations Pathology of non-union of fractures Response of the body, and local musculoskeletal tissues to infection Systemic response of body to major injury Mechanisms underlying Acute Respiratory Distress Syndrome and similar life threatening conditions Science of fluid replacement therapy in the acutely injured including application to the treatment of burns
8D.
Clinical Assessment:
8E.
Investigations:
8F.
Management:
18
Science of treatment of compartment syndrome Response of infants, children and the elderly to injury Initial clinical assessment of the patient with severe injury, including spinal cord injury, soft tissue injury, burns and head injury Assessment of all types of fracture and dislocation, their complications, early and late Identification of life threatening/ limb threatening injuries. Understanding priorities of treatment Knowledge of the principles, application and side effects of commonly used investigations, including radiographs, CT and MRI scans, radio-isotope imaging, ultrasound scans and electrophysiological investigations Knowledge of different treatment options for musculoskeletal injury, both non-operative and operative. Ability to analyse the pros and cons for each method Ability to manage the overall care of the severely injured Ability to undertake the complete treatment of all types of common fracture and dislocation including the bone and soft tissue treatment of open fractures and the treatment of pathological fractures Where common injuries are normally treated by a sub specialist (e.g. spinal injury, arterial injury or intra cranial haemorrhage) there should be ability to manage the initial treatment of the patient and know the principles of the specialist treatment Principles of reconstructive surgery for the injured, including treatment of non-union and malunion of fractures, bone defects, chronic post-traumatic osteomyelitis and delayed treatment of nerve injury; principles of soft tissue reconstruction The principles of amputation in the injured and the rehabilitation of such patients
No.
General Core Komponen Curriculum Curriculum 9. PAEDIATRIC ORTHOPAEDIC 9A Basic Science: Detailed knowledge of the growth of bones, physeal anatomy and its application to fracture types and pathological processes and infection in particular Knowledge of the anatomy of bones and joints in the growing child and its application to growth and deformity Knowledge of the neurological processes involved in the production of deformity e.g. spina bifida, cerebral palsy and muscular dystrophy
9B
Clinical Assessment:
9C
Investigations:
9D
Treatment:
Core knowledge should be at least that of a general orthopaedic textbook 'Expert' knowledge, i.e. the level of the speciality journal is required for those wishing to pursue a career in children's orthopaedics The trainee must be able to clinically examine a child competently and to relate effectively with the family The trainee must be able to make proper management decisions in paediatric practice and to refer appropriately for treatment Knowledge of the indications for plain x-ray, arthrogram, CT, MRI and the ability to interpret the images Knowledge of the indications for the use of ultrasound and nuclear imaging Awareness of the limitations of certain investigations in paediatric practice A sound knowledge of normal variants, e.g. knock knees, bow legs and flat feet A detailed knowledge of the treatment for: o Fractures (including non-accidental injury) and growth plate injuries and recognise the sequelae o Bone and joint infection o Common childhood orthopaedic conditions, e.g. irritable hip, anterior knee pain A working knowledge of the treatment for: o Slipped epiphysis o Perthes' disease o Developmental dysplasia of the hip o Talipes o Scoliosis o Simple foot deformities (e.g. hallux valgus, metatarsus varus)
19
No. 9D
General Core Curriculum Treatment (Cont.):
9E
A knowledge of:
Komponen Curriculum o Simple congenital hand abnormalities (e.g. trigger thumb) o Osteogenesis imperfecta o Skeletal dysplasias o Tarsal coalitions o Torticollis o Leg length discrepancy Screening services for congenital abnormalities Assessment of physical disability
10. SHOULDER & ELBOW 10A.
Anatomy: Basic knowledge of the regional anatomy of the shoulder including:
10B.
Biomechanics:
10C.
Pathology:
Detailed anatomy of the sternoclavicular, acromioclavicular, glenohumeral and elbow joints to include the connecting bones, muscles and tendons acting across them, neurovascular supply, bursae and relationships to local structures Surgical approaches: deltopectoral and posterior approaches to glenohumeral joint; superior (McKenzie) approach to rotator cuff; and surgical approaches to the acromioclavicular and sternoclavicular joints Structure and function of the above joints; a clear understanding of the static and dynamic stabilisers of the glenohumeral and elbow joints Biomechanics of the shoulder and elbow to the level of the currently published specialist journals Knowledge of the various types of shoulder and elbow prostheses including the factors influencing design, wear and loosening to the level of the currently published specialist journals Sound knowledge of all commonly encountered benign and malignant conditions affecting the shoulder girdle, elbow and surrounding soft tissues
20
A basic understanding of the pathology of: Impingement and rotator cuff disorders Instability of the shoulder and the elbow Inflammatory and degenerative conditions affecting the articular cartilage and synovium Infection Adhesive capsulitis of the shoulder The pathology of the stiff elbow Disorders such as ulnar neuritis and tennis or golfer’s elbow
No. 10D.
10E.
General Core Curriculum Clinical Assessment:
Investigation:
Komponen Curriculum Detailed history and examination of the painful, stiff or unstable shoulder or elbow Knowledge of clinical tests used specifically to assess instability of the shoulder and elbow, rotator cuff disorders, the stiff shoulder or elbow and the use of local anaesthetic in assessment. Examples are the apprehension tests for shoulder instability, impingement signs and tests, Gerber’s lift off test, Napoleon's sign, elbow instability tests, ulnar nerve assessment Knowledge of conditions causing referred symptoms to the shoulder and elbow (e.g. cervical spine diseases, entrapment neuropathies and thoracic outlet disorders) Knowledge to the level of a basic specialist shoulder textbook of common conditions affecting the shoulder including instability, impingement, rotator cuff tears, adhesive capsulitis, osteoarthritis, rheumatoid disease, avascular necrosis, biceps tendon disorders, fractures of the proximal humerus and clavicle, and disorders of the acromioclavicular and sternoclavicular joints and scapula Knowledge to the level of a basic specialist elbow textbook of common conditions affecting the elbow including instability, osteoarthritis, rheumatoid arthritis, causes of stiffness, soft tissue problems such as medial and lateral epicondylitis, neuropathies and fractures around the elbow Knowledge of plain radiographs as used to assess shoulder and elbow disorders. This should include a knowledge of those special views (e.g. Modified axial, Stryker notch, Supraspinatus Neer outlet and cubital tunnel views) required to assess adequately the conditions which commonly affect the shoulder and elbow. The ability to recognise correctly normal and abnormal abnormalities on plain radiographs Knowledge of the value of ultrasound, arthrography, CT and MRI as used to assess the shoulder and elbow. An ability to identify straightforward abnormalities on CT and MRI (e.g. full thickness and partial thickness rotator cuff tears on MRI and the pathological anatomy of fractures around the shoulder and elbow using CT) Knowledge of the use and abuse of arthroscopy of the shoulder and elbow including a knowledge of normal and abnormal arthroscopic findings
21
No. 10F. 1)
2)
2)
General Core Curriculum Treatment: Non-operative
Operative
Operative (cont.)
Komponen Curriculum An ability to supervise the non-operative management of fractures, dislocations and soft tissue injuries around the shoulder and elbow An in-depth knowledge of the management of straightforward fractures and dislocations of the shoulder girdle and elbow. Knowledge of the treatment options for more complex fractures with an understanding that these might more appropriately be referred to someone with a special interest; examples of these might include four part fractures of the proximal humerus and complex intraarticular fractures of the distal humerus. An ability to recognise upper limb injuries involving injuries to the brachial plexus and refer on as appropriate A knowledge of injection techniques for both the shoulder and the elbow Knowledge of both the non-operative and operative treatment of common disorders such as recurrent anterior traumatic instability of the shoulder, rotator cuff impingement and small rotator cuff tears, adhesive capsulitis, acromioclavicular joint pain A knowledge of the management of soft tissue elbow disorders such as lateral and medial epicondylitis and ulnar neuropathy Knowledge of the indications, options and complications for prosthetic replacement of the shoulder and elbow. A detailed knowledge of the surgical techniques is not required Knowledge of the indications and benefits of arthroscopy of the shoulder and elbow. An ability to perform an arthroscopic assessment of the shoulder is expected but a knowledge of the techniques of arthroscopic surgery procedures is not required Understanding the principles of management of tumours around the shoulder and elbow
11. ORTHOPEDIC ONCOLOGY 11A
22
Basic
Knowledge of the presentation, radiological features, pathological features, treatment and outcome for common benign and malignant bone tumours Knowledge of the presenting features, management and outcome of soft tissue swellings, including sarcomas benign and malignant Understanding of the principles of management of patients with metastatic bone disease in terms of investigation, prophylactic and definitive fixation of pathological fractures and oncological management
No.
General Core Curriculum
11B 11C
Staging
11D
Treatment
11E
Specific Tumours Bone
Metastases Soft Tissues Tumor
12. SPORT INJURY Arthroscopy 12A
12B
Komponen Curriculum
Classification benign/malignant Tissue of origin Investigations Enneking Classification Biopsy techniques Basic Histopathologal Interpreatation Principles surgical treatment Incisional Excision Marginal Excision Wide Excision Radical Excision Radiotherapy Chemotherapy-principles of action Treatment of pathological fracturres Palliative treatment
Primary Osteoid Osteoma Osteoblastoma Osteosarcoma Ewing sarcoma Giant cell sarcoma Chondrosarcoma MFH Fibrosarcoma Multiple myeloma General Features General features
Principles of Arthroscopy Common indication of arthroscopy Standard and additional portals for knee, shoulder arthroscopy Complication of arthroscopy Pathoanatomy of ACL/PCL injuries and their management Pathoanatomy of MCL/LCL injueris and their management Pathoanatomy of meniscal injuries and management Patella-femoral disorder and various causes of anterior knee pain Causes and management of PF maltracking/ Instability
23
No.
General Core Curriculum
12B
Cont.:
12C
Shoulder
12D
Ankle
24
Komponen Curriculum
Types and synovials plicae and treatment Management of knee dislocation and multiple ligaments injury Pathoanatomy of recurrent shoulder dislocation and management Types of shoulder impingement syndrome and ita management Rotator cuff arthropathy Types of AC joint dislocation Acute and chronic ankle ligaments injury Impingement syndrome and meniscoid lesion Tendon archilles rupture
2.2. NO.
Bidang Psikomotor (Applied Clinical Procedures Syllabus) TOPIC
1.
TRAUMA
1A
Trauma General
1B
Axial Sceleton
1)
Cervical Spine
2)
Thoraco-lumbal Spine
3)
Pelvis
PROCEDURE
Free flap Full thickness skin graft Muscle flap Nerve repair Pedicle flap Removal external fixator or frame Removal foreign body from skin / subcutaneous tissue Removal K wires or skeletal traction Split skin graft Transpositional flap Wound closure, delayed primary or secondary Wound Debridement Internal Fixation of Long Bone Internal fixation of complex fracture External fixation Periarticuler fracture Tendon repair Vascular repair Casting and splinting
Anterior fixation fracture / dislocation cervical spine Application halo / tong traction cervical spine MUA fracture / dislocation cervical spine Posterior fixation fracture / dislocation cervical spine Posterior decompression / fixation thoracic spine Lumbar Spine Anterior decompression / fixation lumbar spine Posterior decompression / fixation lumbar spine Simple acetabular fracture ORIF Complex acetabular fracture ORIF Pelvic fracture: Pelvic fracture external fixator application Simple pelvic fracture ORIF Complex pelvic fracture ORIF
25
NO.
TOPIC
1C
Upper Limb
1) 2)
Brachial Plexus Clavicle
3)
Shoulder Joint
4)
Humerus
5)
Elbow Joint
6)
26
Forearm
PROCEDURE
Exploration / repair / grafting brachial plexus ORIF clavicle fracture ORIF non-union clavicle fracture Anterior dislocation shoulder Anterior dislocation shoulder closed reduction Anterior dislocation shoulder open reduction +/- fixation Acromioclavicular joint dislocation acute ORIF Fracture proximal humerus ORIF Glenoid fracture ORIF Posterior dislocation shoulder closed reduction Fracture diaphysis humerus non-op: Non-union ORIF +/- bone grafting Fracture diaphysis humerus IM nailing Fracture diaphysis humerus MUA +/- POP Fracture diaphysis humerus ORIF plating Dislocated elbow +/- fracture: Dislocated elbow +/- fracture closed reduction Dislocated elbow +/- fracture open reduction +/- fixation Intraarticular distal humerus fracture ORIF Lateral condyle fracture ORIF Medial condyle / epicondyle fracture MUA / K wire / ORIF Olecranon fracture ORIF Dislocated elbow +/- fracture: Radial head / neck fracture MUA +/- K wire Radial head / neck fracture ORIF Radial head replacement for fracture Supracondylar fracture:
Supracondylar fracture MUA +/- K wires Supracondylar fracture ORIF Fasciotomy for compartment syndrome Fracture distal radius: Fracture distal radius – closed non-op Fracture distal radius external fixation Fracture distal radius MUA & percutaneous wires Fracture distal radius MUA & POP Fracture distal radius ORIF Fracture shaft radius / ulna: Fracture shaft radius / ulna IM nailing Fracture shaft radius / ulna MUA & percutaneous wires Fracture shaft radius / ulna MUA & POP Fracture shaft radius / ulna ORIF
NO.
TOPIC
7)
Wrist
8)
Hand:
9)
Tendon repair:
PROCEDURE
Carpal fracture / dislocation: Carpal fracture / dislocation MUA & percutaneous wires Carpal fracture / dislocation MUA & POP Carpal fracture / dislocation ORIF Scaphoid fracture non-op Scaphoid fracture ORIF Scaphoid fracture MUA & percutaneous wires Scaphoid fracture non-union ORIF +/- graft Carpal fracture / dislocation: 5th metacarpal fracture / dislocation non-op 5th metacarpal fracture / dislocation MUA & percutaneous wires 5th metacarpal fracture / dislocation MUA & POP 5th metacarpal fracture / dislocation ORIF Finger tip reconstruction Infection: Infection hand drainage (not tendon sheath) Infection tendon sheath drainage IPJ fracture / dislocation: IPJ fracture / dislocation MUA & percutaneous wires IPJ fracture / dislocation MUA +/- POP IPJ fracture / dislocation ORIF Ligament repair hand Metacarpal fracture (not 1st or 5th) non-op Metacarpal fracture (not 1st or 5th) MUA & Percutaneous wires Metacarpal fracture (not 1st or 5th) MUA +/- POP Metacarpal fracture (not 1st or 5th) ORIF Phalangeal fracture non-op Phalangeal fracture MUA & percutaneous wires Phalangeal fracture MUA +/- POP Phalangeal fracture ORIF Tendon repair extensor Tendon repair flexor MCPJ fracture / dislocation: MCPJ fracture / dislocation MUA & Percutaneous wires MCPJ fracture / dislocation MUA +/- POP MCPJ fracture / dislocation ORIF
27
NO.
TOPIC
1D
Lower Limb
1) 1a)
Hip joint Dislocated hip:
1b)
Extracapsular fracture:
2)
Femur Diaphyseal fracture closed:
2a)
2b)
Subtrochanteric fracture:
2c)
Supracondylar fracture (not intraarticular):
3)
Knee Joint
PROCEDURE
Dislocated hip closed reduction Acute dislocated hip open reduction +/- fixation Neglected dislocated hip open reduction +/fixation Extracapsular fracture CHS / DHS Extracapsular fracture intramedullary fixation Extracapsular fracture other fixation Intracapsular fracture: Intracapsular fracture hemiarthroplasty Intracapsular fracture internal fixation Intracapsular fracture intracapsular fracture THR Diaphyseal fracture traction or spica in child Diaphyseal fracture intramedullary nailing Diaphyseal fracture plate/screw fixation Fasciotomy for compartment syndrome Subtrochanteric fracture intramedullary fixation Subtrochanteric fracture plate/screw fixation Supracondylar fracture (not intraarticular) DCS / blade plate etc Supracondylar fracture (not intraarticular) intramedullary fixation Acute haemarthrosis arthroscopy Acute ligament repair Intraarticular fracture distal femur ORIF Patella dislocation closed reduction +/- open repair Patella fracture ORIF Patella tendon repair Quadriceps tendon repair Simple tibial plateau fracture Complex tibial plateau fracture Tibial plateau fracture arthroscopically assisted fixation
Tibial plateau fracture ORIF with plates & screws Tibial plateau fracture treatment with circular frame
28
NO. 4)
TOPIC Tibia & Fibula
Tibial union: 5)
non-
Diaphyseal tibial fracture external fixation (including frame) Diaphyseal tibial fracture intramedullary nailing Diaphyseal tibial fracture MUA & POP Tibial shaft plating Fasciotomy for compartment syndrome Tibial non-union circular frame management Tibial non-union intramedullary nailing +/- bone grafting
Ankle Ankle fracture / dislocation: Pilon fracture:
6)
PROCEDURE
Ankle fracture / dislocation MUA & POP Ankle fracture / dislocation ORIF Simple pilon fracture ORIF Complex pilon fracture ORIF Pilon fracture with circular frame Tendoachilles repair
Foot Amputation toe / ray for trauma Simple calcaneal fracture ORIF Complex calcaneal fracture ORIF Metatarsal fracture ORIF Phalangeal fracture MUA +/- K wire +/- ORIF Talar, subtalar or midtarsal fracture / disloc: Talar, subtalar or midtarsal fracture / dislocation MUA +/-POP +/- K wires Talar, subtalar or midtarsal fracture / dislocation ORIF Achilles Tendon Repair
2. ELECTIVE (NON TRAUMA) 2A
Non Specific Site Aspiration / injection joint Benign tumour excision (not exostoses) Biopsy bone - needle Biopsy bone - open Bursa excision Cyst bone curettage +/- bone graft Epiphysiodesis Malignant tumour excision
29
NO.
TOPIC
2B
Axial Sceleton
1)
Cervical Spine
1)
Cervical Spine (cont)
2)
Thoracic Spine
PROCEDURE
Anterior decompression +/- fixation / fusion (C2-C7) Atlantoaxial fixation +/- fusion Biopsy cervical spine Excision cervical / 1st rib Nerve root / facet joint injection cervical spine Occipito-cervical fusion +/- fixation Posterior decompression +/- fixation / fusion (C20C7) Anterior decompression +/- fixation / fusion Biopsy thoracic spine Posterior decompression +/- fixation / fusion Scoliosis correction - anterior release +/- instrumentation Scoliosis correction - posterior fusion +/- instrumentation
3)
Lumbar Spine
4)
Pelvis
5)
Brachial Plexus
2C
Upper Limb Shoulder
1)
30
Caudal epidural injection Decompression lumbar spine with fusion +/- fixation Decompression lumbar spine without fusion (not disectomy alone) Discectomy open / micro Nerve root / facet joint injection lumbar spine Salter Innominate Osteotomy Reconstruction Acetabulum Excision Sacrum Exploration / repair / grafting brachial plexus Neurolysis Acromioclavicular joint excison - arthroscopic / open / lateral clavicle Acromioclavicular joint reconstruction (e.g. Weaver Dunn) Acromioplasty open Anterior repair for instability arthroscopic Anterior repair for instability open including capsular shift Arthroscopic subacromial decompression Arthroscopy diagnostic Rotator cuff repair (open or arthroscopic) +/acromioplasty Total shoulder replacement
NO.
TOPIC
2)
Elbow
3)
Wrist
4)
Hand
2D
Lower Limb Hip Joint
1)
Slipped upper femoral epiphysis:
PROCEDURE
Arthrolysis elbow (open/arthroscopic) Arthroscopy elbow diagnostic Arthoscopy elbow therapeutic Arthrotomy elbow Excision radial head +/- synovectomy Radial head replacement Tennis / golfer elbow release Total elbow replacement Ulnar nerve decompression / transposition Arthrodesis wrist (includes partial arthrodesis) Arthroscopy wrist Carpal tunnel decompression De Quervain's decompression Excision distal ulna Ganglion excision at wrist Ulna shortening Ulnar nerve decompression at wrist Dupuytrens contracture operation Excision synovial cyst Fusion of MCPJ or IPJ MCPJ replacement Soft tissue reconstruction hand Tendon transfer hand Trapezium excision or replacement Trigger finger release Trigger thumb release
Arthrodesis hip Arthrogram hip Arthroscopy hip – diagnostic Arthroscopy hip – therapeutic Arthrotomy hip Excision arthroplasty hip (e.g. Girdlestone) Open reduction for DDH Osteotomy hip – pelvic for DDH Osteotomy hip – proximal femoral for DDH Osteotomy pelvis – not for DDH Slipped upper femoral epiphysis open reduction Slipped upper femoral epiphysis pinning
31
NO.
TOPIC
Total Hip Replacement:
2)
Femur
3)
Knee Joint
4)
Tibia & Fibula
5)
Ankle Joint:
32
PROCEDURE
THR cemented THR hybrid THR surface replacement THR uncemented Revision THR acetabular component Revision Total Hip Replacement Revision THR both components Revision THR femoral component Amputation above knee Femoral lengthening Osteotomy corrective (not for DDH) Open ACL reconstruction Injection & aspiration Joint Arthroscopy ACL reconstruction Arthroscopic lateral release Arthroscopic partial meniscectomy Arthroscopic removal loose bodies knee Arthroscopic synovectomy Arthroscopic knee diagnostic Osteotomy distal femoral Osteotomy proximal tibial Patella realignment Patella resurfacing alone Revision TKR TKR Unicompartmental knee replacement Amputation below knee Tibial lengthening Harvesting Fibular Graft Arthrodesis ankle Arthroplasty ankle Arthroscopy ankle diagnostic Arthroscopy ankle therapeutic Arthrotomy ankle Decompression tendons at ankle Tendoachilles lengthening
NO.
6)
TOPIC
Foot
PROCEDURE
Amputation toe / ray Calcaneal osteotomy CTEV correction Fifth toe soft tissue correction First metatarsal osteotomy First MTPJ arthrodesis First MTPJ excision arthroplasty First MTPJ soft tissue correction Hindfoot arthrodesis Ingrowing toenail operation Lesser metatarsal osteotomy Lesser toe arthrodesis Lesser toe excision part/all phalanx Lesser toe tenotomy Tendon decompression or repair Tendon transfer foot Wedge tarsectomy
33
2.3. Bidang Afektif (Professional & Management and Good
Clinical Practice) 1. Professional Behaviour The Objective 1
2 3
4 5 6 7 8
9 10 11 12
To achieve an excellent level of care for the individual patient a. to elicit a relevant focused history b. to perform focused, relevant and accurate clinical examination c. to formulate a diagnostic and therapeutic plan for a patient based upon the clinic findings d. to prioritise the diagnostic and therapeutic plan e. to communicate a diagnostic and therapeutic plan appropriately To produce timely, complete and legible clinical records to include case-note records, handover notes, and operation notes. To prescribe, review and monitor appropriate therapeutic interventions relevant to clinical practice including non – medication based therapeutic and preventative indications. To prioritise and organise clinical and clerical duties in order to optimise patient care. To make appropriate clinical and clerical decisions in order to optimise the effectiveness of the clinical team resource. To prioritise the patient’s agenda ncompassing their beliefs, concerns expectations and needs To prioritise and maximise patient safety. To understand that patient safety depends on; a. The effective and efficient organization of care b. Health care staff working well together c. Safe systems, individual competency and safe practice To understand the risks of treatments and to discuss these honestly and openly with patients To systematic ways of assessing and minimizing risk To ensure that all staff are aware of risks and work together to minimise risk To manage and control infection in patients, Including; a. Controlling the risk of cross-infection b. Appropriately managing infection in individual patients c. Working appropriately within the wider community to manage the risk posed by communicable diseases
Examples and Descriptors Patient assessment a. Introducing self clearly to patients and indicates own place in team b. Checks that patients comfortable and willing to be seen c. Informs patients about elements of examination and any procedures that the patient will undergo
34
Examples and Descriptors(Cont.) Clinical reasoning a. In a straightforward clinical case develops a provisional diagnosis and a differential diagnosis on the basis of the clinical evidence, institutes an appropriate investigative and therapeutic plan, seeks appropriate support from others and takes account of the patients Wishes Record keeping a. Is able to format notes in a logical way and writes legibly b. Able to write timely, comprehensive, informative letters to patients and to GPs Time management a. Works systematically through tasks and attempts to prioritise b. Discusses the relative importance of tasks with more senior colleagues. c. Understands importance of communicating progress with other team members Patient safety a. Participates in clinical governance processes b. Respects and follows local protocols and guidelines c. Takes direction from the team members on patient safety d. Discusses risks of treatments with patients and is able to help patients make decisions about their treatment e. Ensures the safe use of equipment f. Acts promptly when patient condition deteriorates g. Always escalates concerns promptly Infection control a. Performs simple clinical procedures whilst maintaining full aseptic precautions b. Follows local infection control protocols c. Explains infection control protocols to students and to patients and their relatives b. Aware of the risks of nosocomial infections.
2. Being A Good Communicator The objective 1
Communication with patients a. To establish a doctor/patient relationship characterised by understanding, trust, respect, empathy and confidentiality b. To communicate effectively by listening to patients, asking for and respecting their views about their health and responding to their concerns and preferences c. To cooperate effectively with healthcare professionals involved in patient care
d. To provide appropriate and timely information to patients and their families 2
Breaking bad news a. To deliver bad news according to the needs of individual patients
35
3
Communication with Colleagues a. To recognise and accept the responsibilities and role of the doctor in relation to other healthcare professionals. b. To communicate succinctly and effectively with other professionals as appropriate c. To present a clinical case in a clear, succinct and systematic manner
Examples and Descriptors a. Conducts a simple consultation with due empathy and sensitivity and writes accurate records thereof b. Recognises when bad news must be imparted. c. Able to break bad news in planned settings following preparatory discussion with seniors d. Accepts his/her role in the healthcare team and communicates appropriately with all relevant members thereof
3. Teaching and Training The objective 1 2 3 4
To teach to a variety of different audiences in a variety of different ways To assess the quality of the teaching To train a variety of different trainees in a variety of different ways To plan and deliver a training programme with appropriate assessments
Examples and Descriptors a. b. c. d.
Prepares appropriate materials to support teaching episodes Seeks and interprets simple feedback following teaching Supervises a medical student, nurse or colleague through a simple procedure Plans, develops and delivers small group teaching to medical students, nurses or colleagues
4. Keeping Up to Date The Objective
36
1 2
To understand the results of research as they relate to medical practice To participate in medical research
3 4 5 6
To use current best evidence in making decisions about the care of patients To construct evidence based guidelines and protocols To complete an audit of clinical practice At actively seek opportunities for personal development
7
To participate in continuous professional development activities
Examples and Descriptors
a. Defines ethical research and demonstrates awareness of GMC guidelines b. Differentiates audit and research and understands the different types of research approach e.g. qualitative and quantitative c. Knows how to use literature databases d. Demonstrates good presentation and writing skills e. Participates in departmental or other local journal club f. Critically reviews an article to identify the level of evidence g. Attends departmental audit meetings h. Contributes data to a local or national audit i. Identifies a problem and develops standards for a local audit j. Describes the audit cycle and take an audit through the first steps k. Seeks feedback on performance from clinical supervisor / mentor / patients / careers / service users 5. Good Manager The Objective
1
2
Self awareness and self management a. To recognise and articulate one’s own values and principles, appreciating how these may b. differ from those of others c. To identify one’s own, limitations and the impact of their behaviour d. To identify their own emotions and prejudices and understand how these can affect their judgment and behaviour e. To obtain, value and act on feedback from a variety of sources f. To manage the impact of emotions on behaviour and actions g. To be reliable in fulfilling responsibilities and commitments to a consistently high standard h. To ensure that plans and actions are flexible, and take into account the needs and requirements of others i. To plan workload and activities to fulfill work requirements and commitments with regard to their own personal health Team working a. To identify opportunities where working with others can bring added benefits b. To work well in a variety of different teams and team settings by listening to others, sharing information, seeking the views of others, empathising with others, communicating well, gaining trust, respecting roles and expertise of others, encouraging others,managing differences of opinion, adopting a team approach 37
3
4
5
Leadership a. To develop the leadership skills necessary to lead teams effectively. These include: b. Identification of contexts for change c. Application of knowledge and evidence toproduce an evidence based challenge to systems and processes d. Making decision by integrating values with evidence e. Evaluating impact of change and taking corrective action where necessary Principles of quality and safety improvement a. To recognise the desirability of monitoring performance, learning from mistakes and adopting no blame culture in order to ensure high standards of care and optimise patient safety b. To critically evaluate services c. To identify where services can be improved d. To support and facilitate innovative service e. Improvement Management and NHS culture a. To organise a task where several competing priorities may be involved b. To actively contribute to plans which achieve service goals b. To manage resources effectively and safely c. To manage people effectively and safely d. To manage performance of themselves and others e. To understand the structure of the NHS and the management of local healthcare systems in order to be able to participate fully in managing healthcare provision
Examples and Descriptors 1. Self awareness and self management a. Obtains 360° feedback as part of an assessment b. Participates in peer learning and explores leadership styles and preferences c. Timely completion of written clinical notes d. Through feedback discusses and reflects on how a personally emotional situation affected e. communication with another person f. Learns from a session on time management 2. Team working a. Works well within the multidisciplinary team and recognises when assistance is required from the relevant team member b. Invites and encourages feedback from patients c. Demonstrates awareness of own contribution to patient safety within a team and is able to outline the roles of other team members. d. Keeps records up-to-date and legible and relevant to the safe progress of the patient. e. Hands over care in a precise, timely and effective manner f. Supervises the process of finalising and submitting operating lists to the theatre suite
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3. Leadership a. Complies with clinical governance requirements of organisation b. Presents information to clinical and service managers (e.g. audit) c. Contributes to discussions relating to relevant issues e.g. workload, cover arrangements using clear and concise evidence and information 4. Quality and safety improvement a. Understands that clinical governance is the over-arching framework that unites a range of quality improvement activities b. Participates in local governance processes c. Maintains personal portfolio d. Engages in clinical audit e. Questions current systems and processes 5. Management and NHS Structures a. Participates in audit to improve a clinical service b. Works within corporate governance structures c. Demonstrates ability to manage others by teaching and mentoring juniors, medical students and others, delegating work effectively, d. Highlights areas of potential waste
6. Promoting Good Health The Objective 1 2 3
To demonstrate an understanding of the determinants of health and public policy in relation to individual patients To promote supporting people with long term conditions to self-care To develop the ability to work with individuals and communities to reduce levels of ill health and to remove inequalities in healthcare provision
Examples and descriptors 1. Understands that “quality of life” is an important goal of care and that this may have different meanings for each patient 2. Promotes patient self care and independence 3. Helps the patient to develop an active understanding of their condition and how they can be involved in self management 4. Discusses with patients those factors which could influence their health 5. Understands that “quality of life” is an important goal of care and that this may have different meanings for each patient 6. Promotes patient self care and independence 7. Helps the patient to develop an active understanding of their condition and how they can be involved in self management 8. Discusses with patients those factors which could influence their health
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7. Probity and Ethics The Objective 1
To uphold personal, professional ethics and values, taking into account the values of the organisation and the culture and beliefs of individuals 2 To communicate openly, honestly and inclusively 3 To act as a positive role model in all aspects of communication 4 To take appropriate action where ethics and values are compromised 5 To recognise and respond the causes of medical error 6 To respond appropriately to complaints 7 To know, understand and apply appropriately the principles, guidance and laws regarding medical ethics and confidentiality as they apply to surgery 8 To understand the necessity of obtaining valid consent from the patient and how to obtain 9 To understand the legal framework within which healthcare is provided 10 To recognise, analyse and know how to deal with unprofessional behaviours in clinical practice, taking into account local and national regulations 11 To understand ethical obligations to patients and colleagues 12 To appreciate an obligation to be aware of personal good health
Examples and descriptors a. b. c. d. e. f. g. h. i. j.
Reports and rectifies an error if it occurs Participates in significant event audits Participates in ethics discussions and forums Apologises to patient for any failure as soon as an error is recognised Understands and describes the local complaints procedure Recognises need for honesty in management of complaints Learns from errors Respect patients’ confidentiality and their autonomy Understand the Data Protection Act and Freedom of Information Act Consult appropriately, including the patient, before sharing patient information k. Participate in decisions about resuscitation status, withholding or withdrawing treatment l. Obtains consent for interventions that he/she is competent to undertake m. Knows the limits of their own professional capabilities
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BAB III TINGKAT KOMPETENSI DAN LINGKUP BAHASAN 3.1. Tingkat Kompetensi Menurut Standar Pendidikan Dokter Indonesia, Pendidikan Dokter harus mempunyai 7 Standar Kompetensi Dokter yaitu: 1. Mempunyai keterampilan berkomunikasi secara efektif 2. Memiliki Keterampilan Klinik Dasar dan Lanjut 3. Mampu menerapkan Ilmu Kedokteran Dasar dalam praktek Kedokteran 4. Mampu mengelola masalah kesehatan individu dan keluarga dalam konteks pelayanan kesehatan paripurna. 5. Mampu memanfaatkan, mengelola Teknologi Informasi 6. Mawasdiri dan mampu mengembangkan diri dengan belajar sepanjang hayat 7. Mampu mempertimbangkan moral dan etika dalam praktek Kedokteran Sebelum mencapai Kompetensi sebagai Spesialis Orthopedi & Traumtologi (SpOT) secara lengkap, para Peserta Didik dalam proses Pendidikan harus melalui Tahapan Kompetensi sesuai kategori sebagai berikut, 1. Kompetensi tingkat Ilmu Dasar Bedah (IDB) 2. Kompetensi tingkat Orthopedi Dasar (OD) 3. Kompetensi tingkat Orthopaedi Lanjut 1 dan 2 (OL1 & OL2) 4. Kompetensi tingkat Chief Residen (CR)
3.1.1. Kompetensi Spesialis Orthopaedi dan Traumatologi Dasar, mencakup: 1) Mampu memberikan penyuluhan, pelayanan dan perawatan pasca tindakan terhadap penyakit yang tergolong harus dikuasai sampai tingkat pemula. 41
2) Mampu mendiagnosis dan melakukan tindakan Orthopaedi dan Traumatologi terhadap penyakit di bidang Orthopaedi dan Traumatogi pada tingkat Kompetensi B2, C1 3) Mampu merencanakan dan melaksanakan kerjasana antar Disiplin 4) Siap mengantisipasi kemajuan dalam bidang Orthopaedi & Traumatologi
3.1.2. Kompetensi Spesialis Orthopaedi dan Traumatologi Lanjut 1 dan 2 mencakup: 1) Mampu memberikan penyuluhan, pelayanan dan perawatan pasca tindakan terhadap penyakit yang tergolong harus dikuasai sampai tingkat magang dalam proses Pendidikan Dokter Spesialis Orthopaedi dan Traumatologi (tingkat Kompetensi KKI : A3,B3,C2) 2) Siap mengembangkan Kompetensi terhadap penyakit yang penguasaan dalam proses Pendidikan Spesialis Orthopaedi dan Traumatologi tergolong hanya sampai Tingkat Mandiri sesuai dengan tahap Kurikulumnya. 3) Mampu mendiagnosis dan melakukan tindakan Orthopaedi dan Traumatologi terhadap penyakit di bidang Orthopaedi dan Traumatogi pada tingkat Kompetensi B3, C2 4) Mampu mengadakan penelitian dalam bidang Orthopaedi dan Traumatologi 5) Mampu merencanakan dan melaksanakan kerjasama antar Disiplin 6) Dapat menjadi Pendidik/Fasilitator Ilmu Orhopaedi dan Traumatologi di Program S1
3.1.3. Kompetensi Spesialis Orthopaedi dan Traumatologi Chief Residen, mencakup: 1) Mampu memberikan penyuluhan, pelayanan dan perawatan pasca tindakan terhadap penyakit yang tergolong harus dikuasai sampai Tingkat Mandiri dalam proses Pendidikan Dokter Spesialis Orthopaedi dan Traumatologi (tingkat Kompetensi KKI : A3,B4,C3) 42
2) Siap mengembangkan Kompetensi terhadap penyakit yang penguasaan dalam proses Pendidikan Spesialis Orthopaedi dan Traumatologi tergolong hanya sampai Tingkat Mandiri sesuai dengan tahap Kurikulumnya. 3) Mampu mendiagnosis dan melakukan tindakan Orthopaedi dan Traumatologi terhadap penyakit di bidang Orthopaedi dan Traumatogi pada tingkat Kompetensi B4, C3 4) Mampu mengadakan penelitian dalam bidang Orthopaedi dan Traumatologi 5) Mampu merencanakan dan melaksanakan kerjasama antar Disiplin 6) Dapat menjadi Pendidik/Fasilitator Ilmu Orhopaedi dan Traumatologi di Program S1 7) Siap mengantisipasi kemajuan dalam bidang Orthopaedi dan Traumatologi, baik teknik operasi maupun diagnostik canggih 8) Siap meningkatkan profesionalisme dalam sikap dan perilaku
3.2. Tahapan Pencapaian Kompetensi Tahapan Pendidikan Orthopaedi dan Traumatologi dilakukan dalam beberapa tahap yaitu: 1. 2. 3. 4. 5.
Tahap Pra Ilmu Dasar Bedah Tahap Ilmu Dasar Bedah Tahap Orthopaedi Dasar Tahap Orthopaedi Lanjut 1 dan 2 Tahap Chief Residen
Dari Core Kurikulum yang telah disebutkan diatas dijabarkan lagi sesuai dengan tahapan Pendidikan sebagai berikut.
3.2.1. Tahap Pra Ilmu Dasar Bedah Tahap Pra Bedah Dasar diselenggarakan bersama dengan Peserta Didik dari Program Studi Bedah lainnya selama 3 sampai 6 bulan, dengan mengikuti beberapa modul sebagai berikut dibawah ini dan isi modul secara lengkap dapat dilihat pada lampiran 4
43
Module Module Module Module
1 2 3 4
: : : :
Module 5
:
Module 6
:
Module 7 Module 8 Module 9
: : :
Basic Science Common Surgical Conditions Basic Surgical Skill The Assesment & Management Of The Surgical Patient Peri operative Care The Assesment & Management Of patients with Trauma (Including the Multiply Injured Patient) Surgical Care of The Paediatric Patient Management of The Dying Patient Organ & Tissue Transplantation
3.2.2. Tahap Ilmu Dasar Bedah (semester I-II) Tahap Ilmu Dasar Bedah dilakukan selama sembilan bulan, merupakan kegiatan stase magang di beberapa divisi atau subbagian yang berada di Departemen Bedah Umum, yaitu; A. Bedah Plastik B. Bedah Urologi C. Bedah Thorax/Vaskuler D. Bedah Digestif E. Bedah Anak F. Intensive Care Unit
3.2.3.Tahap Orthopaedi & Traumatologi Dasar (semester III-IV) Tahap Orthopaedi dan Traumatologi Dasar dilaksanakan di Program Studi Orthopaedi dan Traumatologi pada semester ke-3 dan 4, dengan topik bahasan sebagai berikut; 1) 2) 3) 4) 5) 6) 44
Biologi selular dan molecular musculoskeletal Pembentukan, Pertumbuhan dan Dasar Genetik Kelainan Muskuloskeletal Surgical Anatomy and Approach Biomekanik Muskuloskeletal dan Biomaterial Inflamasi, Degenerasi dan Neoplasma Muskuloskeletal Imaging Orthopaedi
7) Dasar Traumatologi Muskuloskeletal 8) Komplikasi Trauma Muskuloskeletal 9) Dasar Osteosintesa 10) Orthopaedic research (Methodology and statistic). Lingkup bahasan dan tingkat Kompetensi secara terperinci seperti tercantum dalam lampiran 1 untuk Kognitif, lampiran 2 untuk Psikomotor, dan lampiran 3 untuk Afektif.
3.2.4.Tahap Orthopaedi & Traumatologi Lanjut 1 dan 2 ( semester V-VIII) Lingkup bahasan dalam Kompetensi Kognitif pada tahap Orthopaedi dan Traumatologi Lanjut 1 dan 2 adalah seperti yang tercantum dalam lampiran 1, dengan level Kompetensi yang harus dicapai sesuai tingkat sebagai berikut; A1: Dapat mengetahui dan mengingat materi A2: Dapat memahami dan mengerti materi A3: Dapat menerapkan, menganalisa, mengevaluasi dan merumuskan B1: Mampu mendiagnosis dan merujuk B2: Mampu mendiagnosis dan memberi terapi sementara dan merujuk B3: Mampu mendiagnosis dan memberi terapi paripurna B4: Mampu mendiagnosis, terapi dan rawat bersama Lingkup bahasan dalam Kompetensi Psikomotor pada tahap Orthopaedi dan Traumatologi Lanjut 1 dan 2 adalah seperti yang tercantum dalam lampiran 2, dengan level Kompetensi yang harus dicapai sesuai tingkat sebagai berikut; C1 : Melihat dan asimilasi C2 : Mengerjakan dengan bimbingan C3 : Mengerjakan mandiri dengan pengawasan
45
Lingkup bahasan dalam Kompetensi Afektif pada tahap Orthopaedi dan Traumatologi Lanjut 1 & 2 adalah seperti yang tercantum dalam lampiran 3.
3.2.5. Tahap Chief Residen (Semester IX) Lingkup bahasan dalam Kompetensi Kognitif pada tahap Orthopaedi dan Traumatologi Chief Residen adalah seperti yang tercantum dalam lampiran 1, dan Lingkup bahasan dalam Kompetensi Psikomotor pada tahap Orthopaedi dan Traumatologi Chief Residen adalah seperti yang tercantum dalam lampiran 2, Kompetensi Afektif seperti tercantum pada lampiran 3.
3.2.6. Tahap Penyelesaian Akhir Semua Peserta Didik melakukan rotasi Nasional, mempresentasikan Thesis/Penelitian Akhir, dan melaksanakan Ujian Institusi dan Ujian Nasional Board.
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BAB IV PELAKSANAAN KURIKULUM 4.1. Cara Pelaksanaan Kurikulum dilaksanakan dengan pendekatan/strategi SPICES (Student-centred, Problem-based, Integrated, Community-based, Elective/ Early clinical Exposure Systematic). Dengan cara belajar mengajar sbb.: 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13.
Lectures Standard textbook reading Journal reading Journal review Symphosia and seminar COE (Continuing Orthopaedic Education) Clinical ward work Bed side teaching /PBL Out patient department work Out patient clinic Operation theatre Rehabilitation Whorkshop/Courses
4.2. Modul tambahan Kursus Untuk memenuhi Kompentensinya setiap Peserta Didik diperlukan pelatihan dalam bentuk kursus yang telah diakui dan ditetapkan oleh Kolegium di setiap Tahapan Pendidikan dan harus dibuktikan dengan dilampirkanya sertifikat. Kursus tersebut adalah; 1. Kursus di Tahap Bedah Dasar - Basic Surgical Skill (BSS) (optional) 2. Kursus di Tahap Orthopaedic Dasar - Basic Orthopaedic Skill (BOS) - Perioperative Course 3. Kursus di Tahap Orthopaedic Lanjut - Basic Osteosynthesis Course (BOC)
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4.3. Karya Ilmiah Wajib/Thesis (Penelitian Akhir) Setiap Peserta Didik diwajibkan untuk menyusun Karya Ilmiah yang dipublikasikan dalam forum Ilmiah tingkat Nasional, penyusunan Karya Ilmiah tersebut harus diketahui oleh Ketua Program Studi dan dibimbing oleh sekurang-kurangnya dua Staf Pendidik dengan level penilai atau pendidik. Tata cara penyusunan Karya Ilmiah harus mengikuti Buku Pedoman Penulisan Karya Ilmiah yang diterbitkan oleh Kolegium. Karya Ilmiah tersebut terbagi dalam dua bentuk yaitu, 1. Laporan Serial Kasus 2. Penelitian bidang Orthopaedi dan Traumatologi (Thesis/Penelitian Akhir)
4.4. Pelaksanaan dalam Stase Pada pelaksanaan pencapaian Kompetensi setiap Tahapnya dapat dilakukan dalam bentuk stase di Departemen atau Divisi (Sub-Bagian) sesuai dengan Time Table Proses Belajar Mengajar Terintegrasi sebagai berikut; Tahun 1
Semester 1 Pra Bedah Dasar Kuliah Magister (Combined Degree)
Tahun 2
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Semester 3 Tahap Orthopaedi Dasar (Tutorial 10 topik)
Semester 2 Tahap Bedah Dasar Stase magang di : 1. Plastik 2. Urologi 3. Digestive 4. Thorax 5. Bedah Anak 6. Anestesi/ICU Semester 4 Tahap Orthopaedi dasar (Stase divisi) : 1. Trauma 1 2. Hand 1 3. Onco 1 4. Spine 1 5. Pediatric 6. Hip knee / recons 1
Tahun 3
Tahun 4
Tahun 5
Semester 5 Tahap Orthopaedi dan Traumatologi lanjut 1
Semester 6 Tahap Orthopaedi dan Traumatologi lanjut 1
1. Trauma 2 2. Hand 2 3. Onco 2 4. Spine 2 5. Pediatric 2 6. Hip knee/recons 2 Semester 7 Tahap Orthopaedi dan Traumatologi lanjut 2
1. Trauma 3 2. Hand 3 3. Onco 3 4. Spine 3 5. Pediatric 3 6. Hip knee / recons Semester 8 Tahap Orthopaedi dan Traumatologi lanjut 2
1. Trauma 4 2. Hand 4 3. Onco 4 4. Spine 4 5. Pediatric 4 6. Hip knee/recons 4 Semester 9 Chief Resident
1. Trauma 5 2. Hand 5 3. Onco 5 4. Spine 5 5. Pediatric 5 6. Hip knee/recons 5 Semester 10 Rotasi Nasional
1. 2. 3. 4. 5. 6.
Karya akhir
Trauma 6 Hand 6 Onco 6 Spine 6 Pediatric 6 Hip knee/recons 6
Ujian Institusi Ujian Nasional Board
Catatan : Kurikulum integrated learning baik horizontal maupun vertical adalah proses pembelajaran dengan menyatukan Ilmu-ilmu Dasar Orthopaedi dan Ilmu Orthopaedi Klinik yang kedalamannya sesuai dengan tingkat semester. Masing masing pengampu Seksi/Divisi di PS menyesuaikan dengan hubungan antara Pokok Bahasan,Tahapan Pendidikan dan Tingkat Kompetensi Kognitif dan Afektif.
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4.5. Monitor dan Evaluasi: Monitor dan evaluasi pencapaian Kompetensi Kognitif, Psikomotor dan Afektif Peserta Didik dilakukan secara berkala sesuai dengan Tahap Pendidik dengan mengikuti prinsip umum assement, yaitu valid, objektif, dan reliable. Assessment, meliputi penilaian formative, berkelanjutan, dan summative (final) dilaksanakan dalam bentuk teori dan juga dalam bentuk praktik/klinik. Evaluasi Karya Ilmiah dan Thesis (Penelitian akhir) akan dinilai secara terpisah.
4.5.1. Formative Assessment
Formative assessment dilakukan secara berkelanjutan sesuai dengan tahapan tingkat Kompetensi. Penilaian dilakukan berdasarkan feedback dari Senior Residen dan Konsulen. Asessment dilakukan pada setiap akhir semester. Formative assessment tidak menentukan apakah seorang kandidat lulus/tidak lulus, tetapi dapat digunakan untuk memberikan feedback terhadap kandidat yang bersangkutan, untuk lebih maju. 4.5.2. Internal Assessment Performa dari kandidat selama masa Pendidikan harus dimonitor sepanjang Pendidikan dan dicatat dalam suatu Logbook sebagai bukti untuk kemampuan dan pekerjaan yang telah dilakukan sehari-hari. dengan komposisi sebagai berikut:
1. 2. 3. 4.
Personal Attributes Clinical Work (Operative dan Non-Operative Logbook) Academic Activities ( Logbook ) End of Term theory examination (MCQ, OSCE, Essay) baik UTS maupun UAS 5. End of Term practical examination
Logbook (Clinical work) yang sudah disetujui oleh Ketua 50
Program Studi harus diserahkan sebelum Ujian Akhir, Logbook harus berisi informasi : Nama dan Medical Record Diagnosis yang relevan Tanggal, prosedur tindakan, dan peranan sebagai asisten, operator bimbingan, atau mandiri Catatan : Passing level dipergunakan nilai 70 setiap kenaikan semester. Bila tidak lulus dilakukan remedy 1 kali.
4.5.3. Penghentian Pendidikan Bila 2 kali berturut–turut tidak naik dalam jenjang yang sama dilakukan ujian ke-3 untuk menentukan ybs bisa lanjut/diberhentikan dari proses Pendidikan. Bila masa studi melebihi 1 ½ kali masa studi normal, juga akan dilakukan penghentian masa studi. Penghentian Pendidikan dapat dilakukan bila ybs tersangkut masalah atitude dan etika.
4.5.4. Summative Evaluasi akhir pencapaian Kompetensi Peserta Didik dilaksanakan dalam dua tahap, yaitu; Ujian Institusi diselenggarakan oleh Program Studi dengan pengawasan dari Kolegium Ujian Board Nasional diselengarakan oleh Kolegium Evaluasi akhir pencapaian (Summative) ini dilaksanakan dalam dua sesi, Sesi I merupakan Ujian Tulis, sesi II Ujian Long Case untuk kasusTrauma dan Non Trauma (Elective), dan VIVA short case untuk masing-masing Divisi yaitu, Hand, Spine, Paediatric Orthopaedic, Oncology Orthopaedic, Adult Reconstruction. Passing level dipergunakan nilai 70.
4.6. Buku dan Jurnal Acuan Wajib 51
Buku bacaan yang dijadikan bahan acuan dalam pendidikan program ini adalah: 1. 2. 3.
4. 5.
6. 7. 8. 9. 10.
11.
12. 13.
14.
Louis Solomon, David Warwick, Sevadurai Nayagam. Apley’s System of Orthopaedics & Fractures, 9th Ed. Hodder Arnold, UK, 2010. W. C. Campbell, S. Terry Canale, James H. Beaty. Campbell’s Operative Orthopaedics 11th Ed. Mosby/Elsevier, California, 2008. Stanley Hoppenfeld, Piet deBoer, Richard Buckley. Surgical Exposures in Orthopaedics: The Anatomic Approach, 4 th Ed. Lippincott Williams & Wilkins, Philadelphia, 2009. Ronald McRae. Clinical Orthopaedic Examination 5th Ed. Churchill Livingstone, Michigan, 2004. Hamilton Bailey, John Stuart Penton Lumley. Hamilton Bailey’s Physical Signs: Demonstration of Physical Signs in Clinical Surgery, 18th Ed. Butterworth Heinemann, Boston, 1997. Richard S. Snell. Clinical Anatomy by Regions 9th Ed. Lippincott Willians & Wilkins, Philadelphia, 2011. R. B. Duthie. Mercer’s Orthopaedic Surgery. Hodder General Publishing Division, UK, 1996. Anonymus. Pye’s Surgical Handicraft. Biblio Bazaar, Llc, 2010. Stewart L. McCurdy. Manual of Orthopaedic Surgery: Atreatise on Deformities and Diseases of Joints and Bones. Nabu Press, 2011. Robert W. Bucholz, James D. Heckman, Paul Tornetta. Rockwood and Green’s Fractures in Adults, 7th Ed. Lippincott Williams & Wilkins, Philadelphia, 2009. James H. Beaty, Charles A. Rockwood. Rockwood and Wilkins’ Fractures in Children, 7th Ed. Lippincott Williams & Wilkins, Philadelphia, 2009. Michael W. Chapman. Chapman’s Orthopaedic Surgery, 3rd Ed. Lippincott Williams & Wilkins, Philadelphia, 2001. Stuart L. Weinstein, Joseph A. Buckwalter. Turek’s Ortho-paedics: Principles and Their Application. Lippincott Williams & Wilkins, Philadelphia, 2005. Ronald McRae, Max Esser. Practical Fracture Management, 4th Ed. Churchill Livingstone, Michigan University, 2002.
15. John W. Insall, W. Norman Scott. Insall and Scott Surgery of The 52
Knee, 4th Ed. Churchill Livingstone/Elsevier, North-western University, 2006. 16. Mark D. Miller, Brian J. Cole. Textbook of Arthroscopy, vol . 355. Elsevier Health Serviced, USA, 2004. 17. John A. Herring, Mihran O. Tachdjian. Tachdjian’s Pediatric Orthopaedics 4th Ed. Saunders/Elsevier, Minnesota, 2008. Dalam pelaksanaan proses pendidikan peserta didik diwajibkan untuk menyusun karya tulis ilmiah berupa laporan kasus atau penelitian yang mana diperlukan tambahan bahan acuan untuk itu yang lebih up todate, sehingga diperlukan jurnal dibidang ini. Jurnal yang dijadikan bahan acuan dasar adalah: 1. Journal Bone and Joint Surgery, edisi Amerika dan British 2. Majalah Orthopaedi Indonesia 3. Cllinical Orthopaedic and Related Research 4. International Orthopedics 5. Journal of Orthopaedic Trauma 6. Orthopedics 7. Journal AAOS 8. Orthopaedic clinics of north America 9. Acta orthopaedica scandinavica
KEPUSTAKAAN 1. 2. 3. 4. 5. 6. 7. 8. 9.
Standar Pendidikan Dokter Indonesia Standar Kompetensi Dokter Indonesia Kolegium Orthopaedi & Traumatologi Indonesia, Kurikulum Orthopaedi Dan Traumatologi Indonesia 2008 Buku Standar Pendidikan Profesi Dokter Spesialis Orthopaedi dan Traumatologi Indonesia 2008 A Practical Guide For Medical Teacher Specialist Training in Trauma and Orthopaedic ( British Orthopaedic Association) 2009 Curriculum MS orthopaedics (India ) Guidesline for Competency Base Post graduates Training Programme for diploma in orthopaedic (Amerika ) Guidelines to the Masters of Orthopaedic Surgery Programme University of Malaya
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LAMPIRAN 1 Tingkat Kompetensi Kognitif Peserta Didik Berdasarkan Topik dan Tahapan Pendidikan A1: Dapat mengetahui dan mengingat materi A2: Dapat memahami dan mengerti materi A3: Dapat menerapkan, menganalisa, mengevaluasi dan merumuskan
B1: Mampu mendiagnosis dan merujuk B2: Mampu mendiagnosis dan memberi terapi sementara dan merujuk B3: Mampu mendiagnosis dan memberi terapi paripurna B4: Mampu mendiagnosis, terapi dan rawat bersama
Keterangan : OD : Tahap Orthopaedi dan TraumatologiDasar OL1: TahapOrthopaedi dan Traumatologi Lanjut 1 OL2: Tahap Orthopaedi dan Traumatologi Lanjut 2 CR : Tahap Chief Residen
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Tingkat Kompetensi Kognitif Peserta Didik Berdasarkan Topik dan Tahapan Pendidikan TOPIC
OD
OTL1
OTL2
CR
A2B3
A2B2
A2B3
A3B4
A2B3
A2B2
A2B3
A3B4
A2B2
A2B2
A2B3
A3B4
A2B3
A2B2
A2B3
A3B4
1. BASIC SCIENCE 1.1. Anatomy: Clinical and functional anatomy with pathological and operative relevance Anatomy (and embryology) of nervous and vascular systems Surgical approaches to the limbs and axial skeleton Anatomy (and embryology) of musculo-skeletal system
1.2. Tissues: Bone - Structure & Function Cartilage - articular, meniscal - Structure & Function Muscle and tendon - Structure & Function Synovium - Structure & Function Ligament - Structure & Function Nerve - Structure & Function Intervertebral disc - Structure & Function
A2B3
A2B2
A2B3
A3B4
A2B3
A2B2
A2B3
A3B4
A2B3 A2B3 A2B3 A2B3 A2B2
A2B2 A2B2 A2B2 A2B2 A2B2
A2B3 A2B3 A2B3 A2B3 A2B3
A3B4 A3B4 A3B4 A3B4 A2B3
A2B2
A2B2
A2B3
A2B3
A2B2
A2B2
A2B3
A2B3
A2B3
A2B2
A2B3
A3B4
A2B3
A2B2
A2B3
A3B4
A2B3
A2B2
A2B3
A3B4
A3B4
A2B2
A2B3
A3B4
A2B3
A2B2
A2B3
A3B4
A2B2 A2B3 A2B1
A2B2 A2B2 A2B2
A2B3 A2B3 A2B3
A2B3 A3B4 A2B3
A2B1
A2B2
A2B3
A3B4
A2B1 A2B1
A2B2
A2B3
A2B3 A2B3
1.3. Physiology, Biochemistry & Genetics: Structure and function of connective tissues Application/relevance of modern genetics to orthopaedic disease and treatment 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 Bone grafts, bone banking and tissue transplantation 1.4. Biomechanics & Bioengineering: 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) Kinematics and gait analysis Biomaterials
55
TOPIC
OD
OTL1
OTL2
A2B2
A2B2
A2B3
A3B4
A2B1
A2B2
A2B3
A3B4
A2B2
A2B2
A2B3
A3B4
A2B2 A2B2 A2B2
A2B2 A2B2 A2B2
A2B3 A2B3 A2B3
A3B4 A3B4 A3B4
A2B2
A2B2
A2B3
A3B4
A2B1 A2B1 A2B1 A2B2 A2B2 A2B2
A2B2 A2B2 A2B2 A2B2 A2B2 A2B2
A2B3 A2B3 A2B3 A2B3 A2B3 A2B3
A3B4 A3B4 A2B3 A3B4 A2B3 A2B3
A2B3 A2B2
A2B2
A2B3
A3B4 A3B4
A2B2
A2B3
A3B4 A2B2 A2B2
A2B2 A2B2 A2B2
A2B3 A2B3 A2B3
A3B4 A2B3 A2B3
A2B3 A2B2
A2B2 A2B2
A2B3 A2B3
A3B4 A2B3
A2B2
A2B2
A2B3
A2B2
A2B2
A2B2
A2B3
A3B4
A2B2 A2B2
A2B2 A2B2
A2B3 A2B3
A2B3 A3B4
CR
2. BONE & JOINT DISEASE 2.1. Orthopaedic Oncology: Knowledge of the presentation, radiological features, pathological features, treatment and outcome for common benign and malignant bone tumours Knowledge of the presenting features, mana-gement and outcome of soft tissue swellings, including sarcomas benign and malignant Understanding of the principles of management of patients with metastatic bone disease in terms of investigation, prophylactic and definitive fixation of pathological fractures and onco-logical management
2.2. General: Osteoarthritis Osteoporosis Metabolic bone disease Rheumatoid arthritis and other arthro-pathies (inflammatory, crystal, etc) Haemophilia Inherited musculoskeletal disorders Neuromuscular disorders - inherited and acquired Osteonecrosis Osteochondritides Heterotopic ossification 2.3. Investigations: Blood tests Musculoskeletal imaging: x-ray, contrast studies (myelography, arthrography), CT, MR, ultrasound, radioisotope studies Effects of radiation Bone densitometry Electrophysiological investigations 2.4. Operative Topics: Tourniquets Design of theatres Anaesthesia - principles and practice of local and regional anaesthesia and principles of general anaesthesia 2.5. Principle treatment of musculoskeletal tumor 2.6. Infection, Thromboembolism & Pain:
Infection of bone, joint, soft tissue, including tuberculosis, and their prophylaxis Sterilisation Thromboembolism and prophylaxis
56
TOPIC
OD
OTL1
OTL2
A2B2 A2B2 A2B2 A2B2
A2B3 A2B3 A2B3 A2B3
A2B3 A3B4 A2B3 A3B4
A2B2
A2B3
A2B3
A2B2 A2B2
A2B3 A2B3
A2B3 A2B3
A2B2
A2B3
A2B3
A2B2
A2B3
A2B3
A2B2
A2B3
A2B2
A2B2 A2B2
A2B3 A2B3
A2B2 A3B4
A2B2 A2B2 A2B2
A2B3 A2B3 A2B3
A3B4 A3B4 A3B4
A2B3
A2B2
A2B3
A3B4
A2B3
A2B2
A2B3
A3B4
A2B3
A2B2
A2B3
A3B4
A2B3 A2B2
A2B2 A2B2
A2B3 A2B3
A3B4 A3B4
A2B3
A2B2
A2B3
A3B4
A2B3
A2B2
A2B3
A3B4
A2B3 A3B4
A2B2 A2B2
A2B3 A2B3
A3B4 A3B4
A2B1
A2B2
A2B3
A3B4
Behavioural dysfunction and somatization A2B2 AIDS and surgery in high-risk patients A2B2 Pain and pain relief A2B3 Skin preparation A3B4 Complex regional pain syndromes e.g. Reflex A2B2 Sympathetic Dystrophy and Causalgia 2.7. Prosthetics & Orthotics: Principles of design A2B1 Prescription and fitting of standard prostheses A2B1 Principles of orthotic bracing for control of disease, A2B1 deformity and instability 2.8. Research & Audit: Design and conduct of clinical trials A2B1 Data analysis and statistics - principles and A2B1 applications Principles of Epidemiology A2B1 Audit A2B3 2.9. Medical Ethics: Duties of care A2B3 Informed consent A2B3 Medical negligence A2B3 3. HAND & MICRORECONSRUCTION SURGERY
CR
3.1. BASIC SCIENCE Anatomy of: The wrist/MCP/PIP/DIP joints and CMC joint of the thumb The flexor and extensor mechanism of the fingers including interaction between extrinsic and intrinsic mechanism The posture of the thumb in pinch, power and key grip The nerve supply to the hand The closed compartments of forearm and hand 3.2. Pathology: An understanding of the special circum-stances associated with swelling and the effects of rising pressure in a closed com-partment secondary to infection and injury An understanding of the special circum-stances in which oedema causes fibrosis and permanent stiffness Tendon injury and healing Nerve injury and healing An appreciation of the imbalances and deformities associated with inflammatory arthritis
57
TOPIC
OD
OTL1
OTL2
CR
n/a
A2B2
A2B3
A3B4
A2B3 A2B1 A2B1
A2B2 A2B2 A2B2
A2B3 A2B3 A2B3
A3B4 A3B4 A3B4
A2B3
A2B2
A2B3
A3B4
A2B3
A2B2
A2B3
A3B4
A3B4
A2B2
A2B3
A3B4
A2B2
A2B2
A2B3
A3B4
A2B2
A2B2
A2B3
A3B4
A2B1
A2B2
A2B3
A3B4
A2B2
A2B2 A2B2
A2B3 A2B3
A3B4
A2B2
A2B2
A2B3
A3B4
A2B1
A2B2
A2B3
A3B4
A2B1
A2B2
A2B3
A3B4
3.2. Pathology: (Cont.)
A classification system for congenital hand disorders Langers lines Hand tumours (e.g. ganglion/enchondroma) Dupuytren's disease 3.3. Clinical Assessment: History of examination of hand and wrist in the assessment of tendons, distal radioulnar and radiocarpal joints Ability to elicit median, ulnar and radial nerve function and disorders Recognition of patterns of presentation of common compressive neuropathies and brachial neuralgia Assessment of intrinsic and extrinsic motors in digits and recognition of common deformities and deficiencies Awareness of presentation of work-related hand disorders Ability to examine and assess common rheu-matoid hand deformities, e.g.: inferior radio-ulnar subluxation and carpal translocation; MCP subluxation and ulnar drift; digital Bou-tonniere and swan neck; thumb Boutonniere deformity and CMC disease Ability to recognise and assess focal hand swellings Investigations: Interpretation of plain and stress x-rays of wrist. A knowledge of other views Awareness of role of MRI/bone scan/arthrography/arthroscopy Place and interpretation of nerve conduction studies
3.4. Treatment: Knowledge of a strategy of management for the osteo arthritic rheumatoid hand.
Understanding of the place of soft tissue reconstruction, joint fusion, interposition and excision arthroplasty in the treatment of the arthritic hand and wrist. Knowledge of the management of stenosing tenovaginitis Knowledge of the principles of treatment for common flexor and extensor tendon injuries and of the common surgical approaches to the digital flexor and extensor compartments
58
A2B1
A2B2
A2B3
A3B4
A2B1
A2B2
A2B3
A3B4
A2B3
A2B2
A2B3
A3B4
TOPIC
OD
OTL1
OTL2
A2B3
A2B2
A2B3
A3B4
A2B1
A2B2
A2B3
A3B4
A2B1
A2B2
A2B3
A3B4
A2B3
A2B2
A2B3
A3B4
A2B3
A2B2
A2B3
A3B4
A2B3
A2B2
A2B3
A3B4
A2B3 A2B3 A2B1
A2B2 A2B2 A2B2
A2B3 A2B3 A2B3
A3B4 A3B4 A3B4
A3B4
A2B2
A2B3
A3B4
A2B3
A2B2
A2B3
A3B4
A2B3
A2B2
A2B3
A3B4
A2B3 A2B3
A2B2 A2B2
A2B3 A2B3
A3B4 A3B4
A2B3
A2B2
A2B3
A3B4
A2B3
A2B2
A2B3
A3B4
A2B3
A2B2
A2B3
A3B4
A2B3
A2B2
A2B3
A3B4
A2B3
A2B2
A2B3
A3B4
A2B3
A2B2
A2B3
A3B4
A2B1
A2B2
A2B3
A3B4
A2B2
A2B2
A2B3
A3B4
CR
3.4. Treatment (cont.): Fractures of metacarpals and phalanges Familiarity with the surgical treatment of Dupuytren’s disease Awareness of the principles of tendon transfer for the reconstruction of mediun, ulnar and radial nerve palsy and familiarity with simple transfers, e.g. indicis to EPL Knowledge of splinting techniques and rehabilitation principles Ability to plan management for finger tip injuries and undertake closed management Knowledge of surgical approach to digits with particular regard to the restoration of function and prevention of stiffness Knowledge of the levels for digital amputation Injuries of ulnar collateral ligament of thumb Dislocations of carpus and carpal instability Knowledge of closed and operative options of treatment for fractures of distal radius and common carpal injuries including scaphoid non union. Familiarity with the surgical treatment of common compressive neuropathy Ability to manage common hand infections
4. KNEE 4.1. BASIC SCIENCE Anatomy: Knowledge of regional anatomy of the knee, including: Surface anatomy Neural and vascular structures and their relations with particular reference to standard anterior and posterior surgical approaches Bones and joints Functional anatomy of ligaments and supporting muscles Innervation of the knee including controlling musculature The extent and function of the synovium and bursae of the knee The structure and function of the menisci, and articular cartilage
4.2. Biomechanics: The mechanics of the patello-femoral mechanism The medial and lateral weight-bearing joints and their inter-relationship
59
TOPIC 4.2. Biomechanics: (Cont.) The cruciate and collateral ligaments and other ligamentous and muscular supports Menisci and articular cartilage 4.3. Pathology: The mechanism of ligamentous, bony and combined trauma to the knee and healing potential A complete knowledge of arthritides, including degenerate wear, ageing changes and traumatic damage Pathology of inflammatory disease and infection affecting the knee The response of synovium to debris Benign and malignant conditions in the knee and surrounding structures including recognised classification where appropriate 4.4. Clinical Assessment: A sound knowledge and understanding of: History and examination of the knee to include relevant surrounding structures The standard clinical signs of the knee and relevant adjacent structures and competent skill in describing these A critical understanding of rating and outcome measures in common use 4.5. Investigations: Indications for and interpretations of: Radiographs – standard and specialised Blood investigation Aspiration Special investigations including CT, MRI and radioisotope scanning Arthroscopy Biomechanical testing
OD
OTL1
OTL2
CR
A2B1
A2B2
A2B3
A3B4
A2B3
A2B2
A2B3
A3B4
A2B3
A2B2
A2B3
A3B4
A2B2
A2B2
A2B3
A3B4
A2B2
A2B2
A2B3
A3B4
A2B2
A2B2
A2B3
A3B4
A2B2
A2B2
A2B3
A3B4
A2B2
A2B3
A2B3
A2B2
A2B3
A3B4
A2B3
A2B2
A2B3
A3B4
A2B1
A2B2
A2B3
A3B4
A2B1 A2B1 A2B3
A2B2 A2B2 A2B2 A2B2
A2B3 A2B3 A2B3 A2B3
A3B4 A3B4 A3B4
A2B3
A2B2
A2B3
A3B4
A2B2 A2B1
A2B2 A2B2
A2B3 A2B3
A3B4 A3B4
4.6. Treatment: A sound knowledge of conservative and surgical management, including the indications for referral to a specialist of: Paediatric disorders, including deformity, dislocations, epiphyseal disorders, osteochondritis and discoid meniscus Adolescent disorders including patello femoral and meniscal dysfunction, osteochondritis dissecans
60
A2B2
A2B2
A2B3
A3B4
A2B2
A2B2
A2B3
A3B4
TOPIC
OD
OTL1
OTL2
A2B2
A2B2
A2B3
A3B4
A2B2
A2B2
A2B3
A3B4
A2B3
A2B2
A2B3
A3B4
A2B3
A2B2
A2B3
A3B4
A2B2
A2B2
A2B3
A3B4
n/a
A2B2
A2B3
A3B4
A2B2
A2B2
A2B3
A3B4
A2B1
A2B2
A2B3
A3B4
A2B1
A2B2
A2B3
A3B4
A2B3 A2B3 A2B3 A2B3 A2B3 A3B4
A2B2 A2B2 A2B2 A2B2 A2B2 A2B2
A2B3 A2B3 A2B3 A2B3 A2B3 A2B3
A3B4 A3B4 A3B4 A3B4 A3B4 A3B4
CR
4.6. Treatment: (Cont.) Young adult disorders including patello femoral and meniscal injuries, instability and ligament deficiency, synovial disorders, benign and malignant tumours Degenerative and inflammatory arthritis, including a balanced understanding of conservative and surgical options, including osteotomy, arthrodesis and arthroplasty Traumatic disorders including skin and soft tissue injuries, fractures and dislocations of patella, tibia and femoral components, ligament ruptures and internal derangement of the knee. Conservative and surgical indications and detailed methods of treatment. Outcomes of conservative and operative management Infections, particularly infections and inflammations of the bursae, intra-articular sepsis, prevention and management of sepsis in implant surgery A sound working knowledge of the range of arthroplasties for primary and revision surgery for patello femoral, unicompartmental and total replacement of the knee with particular reference to secure bone anchorage, alignment, ligament stability and optimising range of movement; a good knowledge of post-operative complications, their prophylaxis and management A knowledge of the indications and techniques of revision surgery particularly for aseptic and septic loosening A knowledge of simple arthroscopic surgery including meniscectomy, trimming and shaving An appreciation of complex arthroscopic procedures An appreciation of medical and surgical techniques available to repair and replace articular cartilage
5. ANKLE & FOOT SURGERY 5.1. BASIC SCIENCE Anatomy: Bones and articulations Ligamentous structures-ankle/hindfoot/ midfoot Plantar fascia and MTP anatomy Surface markings of neural and vascular structures Tendon anatomy Muscle compartments of the foot
61
TOPIC
OD
OTL1
OTL2
A2B2 A2B2 A2B2 A2B2 A2B2
A2B3 A2B3 A2B3 A2B3 A2B3
A2B1
A2B2 A2B2 A2B2 A2B2 A2B2
A2B3 A2B3 A2B3 A2B3 A2B3
A2B1
A2B2
A2B3
A3B4
A2B3
A2B2
A2B3
A3B4
CR
5.2. Biomechanics: Function of the lower limb and foot in gait Ankle and subtalar joint Plantar fascia mechanisms Tendon function Orthoses and footwear
A2B2 A2B2 A2B2 A2B2 A2B2
A3B4 A3B4 A3B4 A3B4 A3B4
5.3. Pathology: Arthrities Degenerative joint disease Rheumatoid foot disease Neuropathy Neuropathic joint and skin changes Tumours E.g. osteoid osteoma and plantar fibroma
A2B2 A2B1
A3B4 A3B4 A3B4
5.4. Clinical Assessment: History and clinical examination of the foot and ankle in order to assess pain, joint function, deformity, nerve, muscle and tendon function
Ability to recognise and assess the following diseases of the ankle and foot:
Neurological disorders: Charcot joint Morton's neuroma Nerve entrapment Neurological foot deformity
A2B1 A2B2 A2B2 A2B2
A2B2 A2B2 A2B2 A2B2
A2B3 A2B3 A2B3 A2B3
A3B4 A3B4 A3B4 A3B4
A3B4 A3B4 A2B3
A2B2 A2B2 A2B2
A2B3 A2B3 A2B3
A3B4 A3B4 A3B4
A2B1 A2B1 A2B1 A2B1 A2B1 A2B2
A2B2 A2B2 A2B2 A2B2 A2B2 A2B2
A2B3 A2B3 A2B3 A2B3 A2B3 A2B3
A3B4 A3B4 A3B4 A3B4 A3B4 A3B4
A2B1 A2B1 A2B1 A2B1 A2B2
A2B2 A2B2 A2B2 A2B2 A2B2
A2B3 A2B3 A2B3 A2B3 A2B3
A3B4 A3B4 A3B4 A3B4 A3B4
Trauma: Evaluation of skin and soft tissue injury Compartment syndrome Recognition of all fractures and dislocations
Ankle and hindfoot disorder: Hindfoot pain Ankle instability Heel pain Degenerative disease of the ankle Rheumatoid arthritis Osteochondritis dissecans of talus
Forefoot disorders: Hallux valgus Hallux rigidus Lesser toe deformities Metatarsalgia Inflammatory arthritis
62
TOPIC Tumours: Ability to recognise and assess local foot swellings Diabetic foot: Complex foot deformity Flatfoot deformity - mobile and rigid Cavus deformity Residual congenital foot deformity Investigations: Radiograph: Standard foot and ankle views CT, MRI and Scintigraphy: Knowledge of role of these ancillary investigations in certain specific conditions e.g. infection, tumour, tibialis posterior rupture, osteonecrosis EMG: Relevance to foot and ankle disorders 5.5. Treatment: Non-operative: Knowledge of rational basis for the use of footwear modifications, orthoses and total contact casting Operative: Detailed knowledge of closed and operative methods for management of fractures and dislocations of ankle, hindfoot and forefoot, including knowledge of common reconstructive surgical procedures for foot deformity including hallux valgus, lesser toe deformity, acquired flatfoot, to include arthrodesis, osteotomy and softtissue reconstruction Knowledge of common amputations through foot and ankle Knowledge of common reconstructive surgical procedures for degenerative and inflammatory disorders of ankle and foot including arthrodesis, arthroplasty, excision arthroplasty procedures to first ray both proximal and distally for management of hallux valgus and rigidus
OD
OTL1
OTL2
CR
A2B1
A2B2
A2B3
A3B4
A2B2
A2B3 A2B3 A2B3 A2B3 A2B3
A3B4
A2B1 A2B1 A2B1
A2B2 A2B2 A2B2 A2B2 A2B2
A3B4
A2B2
A2B3
A3B4
A2B2
A2B2
A2B3
A3B4
A2B1
A2B2
A2B3
A3B4
A2B1
A2B2
A2B3
A3B4
A2B3
A2B2
A2B3
A3B4
A2B3
A2B2
A2B3
A3B4
A2B1
A2B2
A2B3
A3B4
A3B4 A3B4 A3B4
63
TOPIC
OD
OTL1
OTL2
A2B3
A2B2
A2B3
A3B4
A2B3 A2B3 A2B3
A2B2 A2B2 A2B2
A2B3 A2B3 A2B3
A3B4 A3B4 A3B4
A2B3
A2B2
A2B3
A3B4
A2B3
A2B2
A2B3
A3B4
A2B3
A2B2
A2B3
A3B4
A2B3
A2B2
A2B3
A3B4
A2B2
A2B2
A2B3
A3B4
A2B1
A2B2
A2B3
A3B4
A2B1
A2B2
A2B3
A3B4
A2B1
A2B2
A2B3
A3B4
A2B2
A2B2
A2B3
A3B4
A2B3
A2B2
A2B3
A3B4
A2B2
A2B2
A2B3
A3B4
A2B1
A2B2
A2B3
A3B4
A2B3
A2B2
A2B3
A3B4
CR
6. HIP 6.1. BASIC SCIENCE Anatomy: Basic knowledge of the regional anatomy of the hip including: Development of the hip joint Relationship of bony elements Blood supply of the femoral head Anatomical course of all major regional vessels and nerves The capsule, labrum and related ligaments An understanding of the action, anatomy and innervation of the regional musculature Detailed knowledge of the applied anatomy of common surgical approaches to the hip (medial, anterior, lateral and posterior) 6.2. Biomechanics: An understanding of the lever arms, muscles and body weight forces that produce the joint reaction force in both normal and abnormal hips An understanding of the application of these principles to the rationale of both pelvic and femoral osteotomies, and replacement arthroplasty Knowledge of the tribological properties of materials used for articulating surfaces Knowledge of the biocompatibility and mechanical properties of materials in common use in total hip arthroplasty 6.3. Pathology: Basic knowledge of the pathology of pyogenic and non-pyogenic arthritis, slipped upper femoral epiphysis [SUFE], Perthes' disease and hip dysplasia Mechanism and pattern of common fractures and fracture dislocations around the hip (intracapsular, extracapsular, acetabular and periacetabular, femoral head, etc) Knowledge of the pathology of osteoarthritis, rheumatoid arthritis and the seronegative arthritides at the hip and of osteonecrosis of the femoral head Familiarity with current theories of the aetiopathogenesis of osteoarthritis An understanding of the microbiological rationale for the prevention of sepsis in total hip arthroplasty
64
TOPIC 6.4. Clinical Assessment: A sound knowledge of clinical assessment of the hip, lumbosacral spine and knee. Particular reference should be paid to the gait, the Trendelenberg sign, limb length, loss of movement and deformity at the joint The trainee needs to be well informed of current opinion regarding aetiopathogenesis, clinical presentation and appropriate investigation of: Proximal femoral fractures (intracapsular, extracapsular) and simple fracture dislocations of the hip Osteoarthritis and the inflammatory arthropathies
Perthes' disease Slipped upper femoral epiphysis Septic arthritis Osteonecrosis Soft tissue conditions around the hip (snapping hip, gluteus medius tendonitis, etc)
OD
OTL1
OTL2
CR
A2B3
A2B2
A2B3
A3B4
A2B2
A2B2
A2B3
A3B4
A3B4
A2B2
A2B3
A3B4
A2B2
A2B2
A2B3
A3B4
A2B2 A2B2 A2B3 A2B3
A2B2 A2B2 A2B2 A2B2
A2B3 A2B3 A2B3 A2B3
A3B4 A3B4 A3B4 A3B4
A2B2
A2B2
A2B3
A3B4
A working knowledge of the clinical presentations and investigations of: The sequelae of CDH and hip dysplasia The sequelae of SUFE Juvenile chronic arthritis Non pyogenic arthritis The painful total hip replacement
Investigation: A working knowledge of the interpretation of plain radiographs, dynamic arthrography, CT, bone scintigraphy and MRI of the hip region A working classification of proximal femoral and periacetabular fractures. Also, mechanisms and classification of failure of joint replacement and of periprosthetic fractures 6.5. Treatment: Non-operative An understanding of the principles of traction, bracing and spica immobilisation An understanding of the non operative aspects of the management of hip pathology
A2B1 A2B3 A2B1 A2B2 A2B1
A2B2 A2B2 A2B2 A2B2 A2B2
A2B3 A2B3 A2B3 A2B3 A2B3
A3B4 A3B4 A3B4 A3B4 A3B4
A2B2
A2B2
A2B3
A3B4
A2B3
A2B2
A2B3
A3B4
A2B3
A2B2
A2B3
A3B4
A2B3
A2B2
A2B3
A3B4
65
TOPIC Operative A thorough knowledge of soft tissue surgery, osteotomy, arthrodesis and arthroplasty (excision and replacement). A sound knowledge of anterior, anterolateral, lateral and posterior approaches to the hip and of the complications associated with each A sound knowledge of: internal fixation of proximal femoral fractures, hemiarthroplasty for intracapsular fractures, primary total hip replacement for OA and inflammatory arthropathies in the elderly, simple proximal femoral osteotomies. Familiarity with potential complications (i.e. thromboembo-lism, sepsis, dislocation, etc) and be aware of current opinion on the prevention and management of these complications A knowledge of the indications for, and principles of, complex proximal femoral osteotomies, hip arthroscopy, reconstruction of the hip in young adults (JCA and hip dysplasia, etc), complex hip revision surgery An appreciation of complex acetabular and pelvic fractures, complex periacetabular osteotomies An understanding of the place of modern technologies such as, joint resurfacing procedures minimally invasive hip replace-ments and computer assisted implantation in the management of hip pathology and the attendant risks and complications
OD
OTL1
OTL2
CR
A2B3
A2B2
A2B3
A3B4
A2B3
A2B2
A2B3
A3B4
A2B1
A2B2
A2B3
A3B4
A2B3
A2B2
A2B3
A3B4
A2B2
A2B2
A2B3
A3B4
A2B3
A2B2
A2B3
A3B4
A2B3
A2B2
A2B3
A3B4
A2B3
A2B2
A2B3
A3B4
7. THE SPINE 7.1. BASIC SCIENCE Anatomy: Development of the spine, spinal cord and nerve roots Surgical anatomy of the cervical, dorsal and lumbosacral spine Anterior and posterior surgical approaches to the spine at each level
66
TOPIC
OD
OTL1
OTL2
CR
A2B2
A2B2
A2B3
A3B4
A2B1
A2B2
A2B3
A3B4
A2B1
A2B2
A2B3
A3B4
A2B1
A2B2
A2B3
A3B4
A2B3
A2B2
A2B3
A3B4
A2B1 A2B1
A2B2 A2B2
A2B3 A2B3
A3B4 A3B4
A2B2
A2B2
A2B3
A3B4
A2B3
A2B2
A2B3
A3B4
A2B1
A2B2
A2B3
A3B4
A2B3
A2B2
A2B3
A3B4
A2B1 A2B1
A2B2 A2B2
A2B3 A2B3
A3B4 A3B4
A2B2
A2B2
A2B3
A3B4
A2B2
A2B2
A2B3
A3B4
A2B1
A2B2
A2B3
A3B4
A2B2
A2B2
A2B3
A3B4
A2B2
A2B2
A2B3
A3B4
Biomechanics: Basic knowledge of the biomechanics of the cervical and lumbosacral spines An understanding of the biomechanics of spinal instability as applied to trauma, tumour, infection and spondylolysis/listhesis
7.2. Biomechanics Biomechanics of spinal deformity A knowledge of the basic mechanics of spinal instrumentation
7.3. Pathology: Pathophysiology of the ageing spine and degenerative disc disease Acute and chronic infections of the spine Pathology of spinal deformity Pathology of the acutely prolapsed cervical and lumbar disc Recognition of patterns of spinal injury and associated cord and nerve root damage Tumours of the spine
7.4. Clinical Assessment: A thorough knowledge of general and orthopaedic history-taking and examination A knowledge of the assessment of spinal deformity An understanding of the assessment of thoracic pain A sound knowledge of clinical assessment of the spine for low back pain, sciatica, spinal claudication, neck pain, radiating arm pain, spinal injury and incipient myelopathy A knowledge of the assessment of spinal tumour A basic knowledge of the assessment of a patient after failed spinal surgery
Investigation: A thorough knowledge of the basic investigations required in spinal surgery, specifically: blood tests, plain radiographs, bone scintigraphy, discography, electrophysiological studies [including cord monitoring], CT scanning, MRI scanning A thorough knowledge of how each of these investigations contributes to the diagnosis and management of each of the major areas of spinal disease
67
TOPIC
OD
OTL1
OTL2
A2B2
A2B2
A2B3
A3B4
A2B1
A2B2
A2B3
A3B4
A sound knowledge of the indications for and operative surgical management of the acute prolapsed lumbar intervertebral disc, spinal stenosis, lumbar spinal instability due to spondylolysis/listheses
A2B2
A2B2
A2B3
A3B4
A knowledge of the indications for, and operative surgical management of the acutely prolapsed cervical disc, cervical stenosis, spinal injury and the surgery of spinal infection A basic knowledge of the surgery of spinal deformity and tumours of the spine
A2B2
A2B2
A2B3
A3B4
A2B1
A2B2
A2B3
A3B4
A3B4
A2B2
A2B3
A3B4
A3B4
A2B2
A2B3
A3B4
A2B3
A2B2
A2B3
A3B4
A2B3
A2B2
A2B3
A3B4
A2B3
A2B2
A2B3
A3B4
A2B3
A2B2
A2B3
A3B4
A2B2
A2B2
A2B3
A2B3
CR
7.5. Treatment: Non-operative A knowledge of the non-surgical methods available for the treatment of low back pain, sciatica, claudication, neck pain, spinal deformity, instability, tumour, infection and fracture to include: Analgesics and NSAIDs, physiotherapeutic regimes, pain clinic techniques, bracing, use of radiotherapy and chemotherapy, non-operative management of spinal injuries
Operative
TRAUMA 8.1. BASIC SCIENCE Anatomy: Applied to diagnosis and surgical treatment of common bone, joint and soft tissue injuries Knowledge of those anatomical structures particularly at risk from common injuries or in surgical approaches Physeal anatomy and its application to injury
8.2. Biomechanics: Application to open reduction and internal fixation of fractures and external skeletal fixation Applied to fracture formation and fracture treatment both operative and non-operative Biomechanics of implants and fracture fixation systems, including their material properties
8.3. Epidemiology and Research Methods: Research and audit methods including the design of clinical trials
68
TOPIC
OD
OTL1
OTL2
CR
A2B2
A2B2
A2B3
A3B4
A3B4
A2B2
A2B3
A3B4
A2B3
A2B2
A2B3
A3B4
A3B4
A2B2
A2B3
A3B4
A3B4
A2B2
A2B3
A3B4
A3B4
A2B2
A2B3
A3B4
A3B4
A2B2
A2B3
A3B4
A3B4
A2B2
A2B3
A3B4
A3B4
A2B2
A2B3
A3B4
A3B4
A2B2
A2B3
A3B4
A3B4
A2B2
A2B3
A3B4
A3B4
A2B2
A2B3
A3B4
A3B4
A2B2
A2B3
A3B4
A2B3
A2B2
A2B3
A3B4
A2B3
A2B2
A2B3
A3B4
A2B3
A2B2
A2B3
A3B4
8.4. Pathology: A knowledge of the non-surgical methods available for the treatment of low back pain, sciatica, claudication, neck pain, spinal deformity, instability, tumour, infection and fracture to include: Applied to fracture and soft tissue healing, including skin, muscle, tendon and neurological structures Classification systems for fractures and dislocations Pathology of non-union of fractures Response of the body, and local muscu-loskeletal tissues to infection Systemic response of body to major injury Mechanisms underlying Acute Respiratory Distress Syndrome and similar life threatening conditions Science of fluid replacement therapy in the acutely injured including application to the treatment of burns Science of treatment of compartment syndrome Response of infants, children and the elderly to injury
8.5. Clinical Assessment: Initial clinical assessment of the patient with severe injury, including spinal cord injury, soft tissue injury, burns and head injury Assessment of all types of fracture and dislocation, their complications, early and late Identification of life threatening/limb threatening injuries. Understanding priorities of treatment
Investigations: Knowledge of the principles, application and side effects of commonly used investigations, including radiographs, CT and MRI scans, radio-isotope imaging, ultrasound scans and electrophysiological investigations
Treatment: Knowledge of different treatment options for musculoskeletal injury, both non-operative and operative. Ability to analyse the pros and cons for each method Ability to manage the overall care of the severely injured
69
TOPIC
OD
OTL1
OTL2
CR
Treatment (Cont.): Ability to undertake the complete treatment of all types of common fracture and dislocation including the bone and soft tissue treatment of open fractures and the treatment of pathological fractures
A2B3
A2B2
A2B3
A3B4
Where common injuries are normally treated by a sub specialist (e.g. spinal injury, arterial injury or intra cranial haemorrhage) there should be ability to manage the initial treatment of the patient and know the principles of the specialist treatment
A2B3
A2B2
A2B3
A3B4
Principles of reconstructive surgery for the injured, including treatment of non-union and malunion of fractures, bone defects, chronic post-traumatic osteomyelitis and delayed treatment of nerve injury; principles of soft tissue reconstruction
A2B3
A2B2
A2B3
A3B4
The principles of amputation in the injured and the rehabilitation of such patients
A2B3
A2B2
A2B3
A3B4
A2B2
A2B2
A2B3
A3B4
A2B2
A2B2
A2B3
A3B4
A2B2
A2B2
A2B3
A3B4
A2B2
A2B2
A2B3
A3B4
A2B2
A2B2
A2B3
A3B4
A2B2
A2B2
A2B3
A3B4
A2B2
A2B2
A2B3
A3B4
9. PAEDIATRIC ORTHOPAEDIC SURGERY 9.1. BASIC SCIENCE Detailed knowledge of the growth of bones, physeal anatomy and its application to fracture types and pathological processes and infection in particular Knowledge of the anatomy of bones and joints in the growing child and its application to growth and deformity Knowledge of the neurological processes involved in the production of deformity e.g. spina bifida, cerebral palsy and muscular dystrophy
9.2. Clinical Assessment: Core knowledge should be at least that of a general orthopaedic textbook 'Expert' knowledge, i.e. the level of the speciality journal is required for those wishing to pursue a career in children's orthopaedics The trainee must be able to clinically examine a child competently and to relate effectively with the family The trainee must be able to make proper management decisions in paediatric practice and to refer appropriately for treatment
70
TOPIC Investigations: Knowledge of the indications for plain xray, arthrogram, CT, MRI and the ability to interpret the images Knowledge of the indications for the use of ultrasound and nuclear imaging Awareness of the limitations of certain investigations in paediatric practice 9.3. Treatment: A sound knowledge of normal variants, e.g. knock knees, bow legs and flat feet A detailed knowledge of the treatment for: Fractures (including non-accidental injury) and growth plate injuries and recognise the sequelae Bone and joint infection Common childhood orthopaedic conditions, e.g. irritable hip, anterior knee pain A working knowledge of the treatment for: Slipped epiphysis Perthes' disease Developmental dysplasia of the hip Talipes Scoliosis Simple foot deformities (e.g. hallux valgus, metatarsus varus) Simple congenital hand abnormalities (e.g. trigger thumb) Osteogenesis imperfecta Skeletal dysplasias Tarsal coalitions Torticollis Leg length discrepancy A knowledge of: Screening services for congenital abnormalities Assessment of physical disability
OD
OTL1
OTL2
CR
A2B1
A2B2
A2B3
A3B4
A2B1
A2B2
A2B3
A3B4
A2B1
A2B2
A2B3
A3B4
A2B1
A2B2
A2B3
A3B4
A2B3
A2B2
A2B3
A3B4
A2B3
A2B2
A2B3
A3B4
A2B1
A2B2
A2B3
A3B4
A2B2 A2B1 A2B1 A2B1 A2B1
A2B2 A2B2 A2B2 A2B2 A2B2
A2B3 A2B3 A2B3 A2B3 A2B3
A3B4 A3B4 A3B4 A3B4 A3B4
A2B1
A2B2
A2B3
A3B4
A2B1
A2B2
A2B3
A3B4
A2B2 A2B1 A2B1 A2B1 A2B1
A2B2 A2B2 A2B2 A2B2 A2B2
A2B3 A2B3 A2B3 A2B3 A2B3
A3B4 A3B4 A3B4 A3B4 A3B4
A2B1
A2B2
A2B3
A3B4
A2B1
A2B2
A2B3
A3B4
71
TOPIC
OD
OTL1
OTL2
CR
10. SHOULDER & ELBOW 10.1. BASIC SCIENCE Anatomy: Basic knowledge of the regional anatomy of the shoulder including: Detailed anatomy of the sternoclavicular, acromioclavicular, glenohumeral and elbow joints to include the connecting bones, muscles and tendons acting across them, neurovascular supply, bursae and relationships to local structures
A2B3
A2B2
A2B3
A3B4
Basic knowledge of the regional anatomy of the shoulder including (cont.): Surgical approaches: deltopectoral and posterior approaches to glenohumeral joint; superior (McKenzie) approach to rotator cuff; and surgical approaches to the acromioclavicular and sternoclavicular joints Structure and function of the above joints; a clear understanding of the static and dynamic stabilisers of the glenohumeral and elbow joints
A2B3
A2B2
A2B3
A3B4
A2B3
A2B2
A2B3
A3B4
A2B2
A2B2
A2B3
A3B4
A2B1
A2B2
A2B3
A3B4
A2B1
A2B2
A2B3
A3B4
A2B2 A2B2
A2B2 A2B2
A2B3 A2B3
A3B4 A3B4
A2B2
A2B2
A2B3
A3B4
A2B2 A2B2 A2B2
A2B2 A2B2 A2B2
A2B3 A2B3 A2B3
A3B4 A3B4 A3B4
A2B2
A2B2
A2B3
A3B4
10.2. Biomechanics: Biomechanics of the shoulder and elbow to the level of the currently published specialist journals Knowledge of the various types of shoulder and elbow prostheses including the factors influencing design, wear and loosening to the level of the currently published specialist journals
10.3. Pathology: Sound knowledge of all commonly encountered benign and malignant conditions affecting the shoulder girdle, elbow and surrounding soft tissues
A basic understanding of the pathology of: Impingement and rotator cuff disorders Instability of the shoulder and the elbow Inflammatory and degenerative conditions affecting the articular cartilage and synovium Infection Adhesive capsulitis of the shoulder The pathology of the stiff elbow Disorders such as ulnar neuritis and tennis or golfer’s elbow
72
TOPIC
OD
OTL1
OTL2
A2B3
A2B2
A2B3
A3B4
A2B2
A2B2
A2B3
A3B4
A2B3
A2B2
A2B3
A3B4
A2B3
A2B2
A2B3
A3B4
A2B3
A2B2
A2B3
A3B4
A2B3
A2B2
A2B3
A3B4
A2B3
A2B2
A2B3
A3B4
A2B2
A2B2
A2B3
A3B4
CR
10.4.Clinical Assessment: Detailed history and examination of the painful, stiff or unstable shoulder or elbow Knowledge of clinical tests used specifically to assess instability of the shoulder and elbow, rotator cuff disorders, the stiff shoulder or elbow and the use of local anaesthetic in assessment. Examples are the apprehension tests for shoulder instability, impingement signs and tests, Gerber’s lift off test, Napoleon's sign, elbow instability tests, ulnar nerve assessment Knowledge of conditions causing referred symptoms to the shoulder and elbow (e.g. cervical spine diseases, entrapment neuropathies and thoracic outlet disorders) Knowledge to the level of a basic specialist shoulder textbook of common conditions affecting the shoulder including instability, impingement, rotator cuff tears, adhesive capsulitis, osteoarthritis, rheumatoid disease, avascular necrosis, biceps tendon disorders, fractures of the proximal humerus and clavicle, and disorders of the acromioclavicular and sternoclavicular joints and scapula Knowledge to the level of a basic specialist elbow textbook of common conditions affecting the elbow including instability, osteoarthritis, rheumatoid arthritis, causes of stiffness, soft tissue problems such as medial and lateral epicondylitis, neuropathies and fractures around the elbow
Investigation: Knowledge of plain radiographs as used to assess shoulder and elbow disorders. This should include a knowledge of those special views (e.g. Modified axial, Stryker notch, Supraspinatus Neer outlet and cubital tunnel views) required to assess adequately the conditions which commonly affect the shoulder and elbow. The ability to recognise correctly normal and abnormal abnormalities on plain radiographs
Knowledge of the value of ultrasound, arthrography, CT and MRI as used to assess the shoulder and elbow. An ability to identify straightforward abnormalities on CT and MRI (e.g. full thickness and partial thickness rotator cuff tears on MRI and the pathological anatomy of fractures around the shoulder and elbow using CT) Knowledge of the use and abuse of arthroscopy of the shoulder and elbow including a knowledge of normal and abnormal arthroscopic findings
73
LAMPIRAN 2 TOPIC
OD
OTL1
OTL2
A2B3
A2B2
A2B3
A3B4
A2B3
A2B2
A2B3
A3B4
A2B2
A2B2
A2B3
A3B4
A2B2
A2B2
A2B3
A3B4
A2B2
A2B2
A2B3
A3B4
A2B2
A2B2
A2B3
A3B4
A2B1
A2B2
A2B3
A3B4
A2B1
A2B2
A2B3
A3B4
CR
10.5. Treatment: Non-operative An ability to supervise the non-operative management of fractures, dislocations and soft tissue injuries around the shoulder and elbow An in-depth knowledge of the management of straightforward fractures and dislocations of the shoulder girdle and elbow. Knowledge of the treatment options for more complex fractures with an understanding that these might more appropriately be referred to someone with a special interest; examples of these might include four part fractures of the proximal humerus and complex intraarticular fractures of the distal humerus. An ability to recognise upper limb injuries involving injuries to the brachial plexus and refer on as appropriate
A knowledge of injection techniques for both the shoulder and the elbow Knowledge of both the non-operative and operative treatment of common disorders such as recurrent anterior traumatic instability of the shoulder, rotator cuff impingement and small rotator cuff tears, adhesive capsulitis, acromioclavicular joint pain
Operative A knowledge of the management of soft tissue elbow disorders such as lateral and medial epicondylitis and ulnar neuropathy Knowledge of the indications, options and complications for prosthetic replacement of the shoulder and elbow. A detailed knowledge of the surgical techniques is not required Knowledge of the indications and benefits of arthroscopy of the shoulder and elbow. An ability to perform an arthroscopic assessment of the shoulder is expected but a knowledge of the techniques of arthroscopic surgery procedures is not required Understanding the principles of management of tumours around the shoulder and elbow
74
LAMPIRAN 2 Tingkat Kompetensi Psikomotor Peserta Didik Berdasarkan Topik dan Tahapan Tingkat Kompetensi C1 : Melihat dan asimilasi C2 : Mengerjakan dengan bimbingan C3 : Mengerjakan mandiri dengan pengawasan
TOPIC
OD
OL1
CR
OL 2 TRAUMA TRAUMA GENERAL Free flap Full thickness skin graft Muscle flap Nerve repair Pedicle flap Removal external fixator or frame Removal foreign body from skin / subcutaneous tissue Removal K wires or skeletal traction Split skin graft Transpositional flap Wound closure, delayed primary or secondary Wound Debridement Internal Fixation of Long Bone Internal fixation of complex fracture External fixation Periarticuler fracture Tendon repair Vascular repair Casting and splinting
C1 C1 C1 C1 C1 C2 C2 C3 C1 C1 C3 C2 C2 C2 C2 C1 C2 C1 C2
C1 C2 C1 C2 C1 C3 C3 C3 C2 C1 C3 C3 C3 C3 C3 C2 C3 C2 C3
C1 C3 C3 C3 C3 C3 C3 C3 C3 C3 C3 C3 C3 C3 C3 C3 C3 C3 C3
C1 C1 C1 C1
C1 C2 C2 C2
C2 C2 C2 C2
OD
OL1
CR
AXIAL SKELETON: Cervical Spine Anterior fixation fracture/dislocation cervical spine
Application halo / tong traction cervical spine MUA fracture / dislocation cervical spine Posterior fixation fracture/dislocation cervical spine
TOPIC
75
OL 2 Thoracic Spine Anterior decompression / fixation thoracic spine Posterior decompression / fixation thoracic spine Lumbar Spine Anterior decompression / fixation lumbar spine Posterior decompression / fixation lumbar spine Pelvis Simple acetabular fracture ORIF Complex acetabular fracture ORIF Pelvic fracture: Pelvic fracture external fixator application Simple pelvic fracture ORIF Complex pelvic fracture ORIF UPPER LIMB: Brachial Plexus Exploration / repair / grafting brachial plexus Clavicle ORIF clavicle fracture ORIF non-union clavicle fracture Shoulder Anterior dislocation shoulder Anterior dislocation shoulder closed reduction Anterior dislocation shoulder open reduction +/- fixation Acromioclavicular joint dislocation acute ORIF Fracture proximal humerus ORIF Glenoid fracture ORIF Posterior dislocation shoulder closed reduction Humerus Fracture diaphysis humerus non-op: Non-union ORIF +/- bone grafting Fracture diaphysis humerus IM nailing Fracture diaphysis humerus MUA +/- POP Fracture diaphysis humerus ORIF plating Elbow Dislocated elbow +/- fracture: Dislocated elbow +/- fracture closed reduction Dislocated elbow +/- fracture open reduction +/- fixation
Intraarticular distal humerus fracture ORIF Lateral condyle fracture ORIF Medial condyle / epicondyle fracture MUA / K wire / ORIF
Olecranon fracture ORIF
76
C1 C1
C2 C2
C3 C3
C1 C1
C2 C2
C3 C3
C1 C1
C2 C2
C3 C2
C1 C1 C1
C2 C2 C2
C3 C3 C2
C1
C1
C2
C1 C1
C2 C2
C3 C3
C2 C1 C1 C2 C1 C2
C3 C2 C2 C2 C2 C3
C3 C3 C3 C3 C3 C3
C3 C1 C1 C2 C2
C3 C2 C2 C3 C3
C3 C3 C3 C3 C3
C2 C2 C2 C2 C2 C2
C3 C2 C2 C2 C3 C3
C3 C3 C3 C3 C3 C3
TOPIC Dislocated elbow +/- fracture: Radial head / neck fracture MUA +/- K wire Radial head / neck fracture ORIF Radial head replacement for fracture Supracondylar fracture: Supracondylar fracture MUA +/- K wires Supracondylar fracture ORIF Forearm Fasciotomy for compartment syndrome Fracture distal radius: Fracture distal radius – closed non-op Fracture distal radius external fixation Fracture distal radius MUA & percutaneous wires Fracture distal radius MUA & POP Fracture distal radius ORIF Fracture shaft radius / ulna: Fracture shaft radius / ulna IM nailing Fracture shaft radius / ulna MUA & percutaneous wires Fracture shaft radius / ulna MUA & POP Fracture shaft radius / ulna ORIF
OD
OL1 OL 2
CR
C2 C2 C1
C3 C3 C2
C3 C3 C3
C2 C1
C2 C2
C3 C3
C1
C3
C3
C1 C2 C2 C2 C2
C2 C2 C2 C3 C2
C3 C3 C3 C3 C3
C1 C2 C2 C2
C2 C3 C3 C3
C3 C3 C3 C3
C2 C2 C1 C2 C1 C1 C1
C2 C4 C2 C3 C2 C2 C2
C3 C3 C3 C3 C3 C3 C3
C2 C2
C3 C3
C3 C3
C2 C2 C2
C3 C3 C3
C3 C3 C3
C2 C2
C3 C3
C3 C3
Wrist Carpal fracture / dislocation: Carpal fracture / dislocation MUA & percutaneous wires
Carpal fracture / dislocation MUA & POP Carpal fracture / dislocation ORIF Scaphoid fracture non-op Scaphoid fracture ORIF Scaphoid fracture MUA & percutaneous wires Scaphoid fracture non-union ORIF +/- graft Hand Carpal fracture / dislocation: 5th metacarpal fracture / dislocation non-op 5th metacarpal fracture / dislocation MUA & percu-taneous wires
5th metacarpal fracture / dislocation MUA & POP 5th metacarpal fracture / dislocation ORIF Finger tip reconstruction Infection: Infection hand drainage (not tendon sheath) Infection tendon sheath drainage
77
OD
OL1 OL 2
CR
C2 C2 C2 C2 C2 C2
C3 C3 C3 C2 C3 C3
C3 C3 C3 C3 C3 C3
C2 C2 C2 C2 C2 C2
C3 C3 C3 C3 C3 C2
C3 C3 C3 C3 C3 C3
Tendon repair extensor Tendon repair flexor CPJ fracture / dislocation:
C2 C2
C3 C3
C3 C3
MCPJ fracture / dislocation MUA & Percutaneous wires
C2 C2 C2
C2 C2 C2
C3 C3 C3
C2 C1 C1
C3 C2 C2
C3 C3 C2
C2 C2 C2
C3 C3 C3
C3 C3 C3
C2 C2 C2
C3 C3 C2
C3 C3 C3
C1 C2 C2 C2
C2 C3 C3 C3
C3 C3 C3 C3
TOPIC IPJ fracture / dislocation: IPJ fracture / dislocation MUA & percutaneous wires IPJ fracture / dislocation MUA +/- POP IPJ fracture / dislocation ORIF Ligament repair hand Metacarpal fracture (not 1st or 5th) non-op Metacarpal fracture (not 1st or 5th) MUA & Percutaneous wires Metacarpal fracture (not 1st or 5th) MUA +/- POP Metacarpal fracture (not 1st or 5th) ORIF Phalangeal fracture non-op Phalangeal fracture MUA & percutaneous wires Phalangeal fracture MUA +/- POP Phalangeal fracture ORIF
Tendon repair:
MCPJ fracture / dislocation MUA +/- POP MCPJ fracture / dislocation ORIF
LOWER LIMB: Hip Dislocated hip: Dislocated hip closed reduction Acute dislocated hip open reduction +/- fixation Neglected dislocated hip open reduction +/- fixation Extracapsular fracture: Extracapsular fracture CHS / DHS Extracapsular fracture intramedullary fixation Extracapsular fracture other fixation Intracapsular fracture: Intracapsular fracture hemiarthroplasty Intracapsular fracture internal fixation Intracapsular fracture intracapsular fracture THR
Femur Diaphyseal fracture closed: Diaphyseal fracture traction or spica in child Diaphyseal fracture intramedullary nailing Diaphyseal fracture plate/screw fixation Fasciotomy for compartment syndrome
78
TOPIC Subtrochanteric fracture: Subtrochanteric fracture intramedullary fixation Subtrochanteric fracture plate/screw fixation Supracondylar fracture (not intraarticular): Supracondylar fracture (not intraarticular) DCS / blade plate etc
Supracondylar fracture (not intraarticular) intra-medullary fixation Knee Acute haemarthrosis arthroscopy Acute ligament repair Intraarticular fracture distal femur ORIF Patella dislocation closed reduction +/- open repair Patella fracture ORIF Patella tendon repair Quadriceps tendon repair Simple tibial plateau fracture Complex tibial plateau fracture Tibial plateau fracture arthroscopically assisted fixation Tibial plateau fracture ORIF with plates & screws Tibial plateau fracture treatment with circular frame Tibia & Fibula Diaphyseal tibial fracture external fixation (including frame) Diaphyseal tibial fracture intramedullary nailing Diaphyseal tibial fracture MUA & POP Tibial shaft plating Fasciotomy for compartment syndrome Tibial non-union: Tibial non-union circular frame management Tibial non-union intramedullary nailing +/- bone grafting Ankle
OD
OL1 OL 2
CR
C2 C2
C3 C3
C3 C3
C2 C2
C2 C2
C3 C3
C1 C1 C1 C2 C2 C2 C2 C1 C1 C1 C1 C1
C2 C2 C2 C3 C3 C3 C3 C2 C2 C2 C2 C2
C3 C3 C3 C3 C3 C3 C3 C3 C2 C3 C3 C3
C2
C2
C3
C2 C2 C2 C1
C3 C3 C2 C2
C3 C3 C3 C3
C1 C1
C2 C2
C3 C3
C2 C2
C3 C3
C3 C3
C1 C1 C1 C2
C2 C2 C2 C3
C3 C2 C3 C3
C2 C1
C3 C2
C3 C3
Ankle fracture / dislocation: Ankle fracture / dislocation MUA & POP Ankle fracture / dislocation ORIF Pilon fracture: Simple pilon fracture ORIF Complex pilon fracture ORIF Pilon fracture with circular frame Tendoachilles repair Foot Amputation toe / ray for trauma Simple calcaneal fracture ORIF
79
TOPIC Complex calcaneal fracture ORIF Metatarsal fracture ORIF Phalangeal fracture MUA +/- K wire +/- ORIF Talar, subtalar or midtarsal fracture / disloc: Talar, subtalar or midtarsal fracture / dislocation MUA +/POP +/- K wires Talar, subtalar or midtarsal fracture / dislocation ORIF
Achilles Tendon Repair ELECTIVE ELECTIVE SITE NON SPECIFIC Aspiration / injection joint Benign tumour excision (not exostoses) Biopsy bone - needle Biopsy bone - open Bursa excision Cyst bone curettage +/- bone graft Epiphysiodesis Malignant tumour excision AXIAL SKELETON: Cervical Spine Anterior decompression +/- fixation / fusion (C2-C7) Atlantoaxial fixation +/- fusion Biopsy cervical spine Excision cervical / 1st rib Nerve root / facet joint injection cervical spine Occipito-cervical fusion +/- fixation Posterior decompression +/- fixation / fusion (C20C7)
Thoracic Spine Anterior decompression +/- fixation / fusion Biopsy thoracic spine Posterior decompression +/- fixation / fusion Scoliosis correction - anterior release +/- instrumentation Scoliosis correction - posterior fusion +/- instrumentation
Lumbar Spine Caudal epidural injection Decompression lumbar spine with fusion +/- fixation Decompression lumbar spine without fusion (not disectomy alone) Discectomy open / micro Nerve root / facet joint injection lumbar spine
80
OD
OL1 OL 2
CR
C1 C2
C3 C3
C3 C3
C1
C2
C3
C1 C1
C2 C2
C3 C3
C2 C2 C1 C1 C2 C1 n/a C1
C3 C3 C3 C3 C3 C3 C2 C2
C3 C3 C3 C3 C3 C3 C3 C2
n/a n/a n/a n/a n/a n/a n/a
C1 C1 C2 C1 C1 C1 C1
C2 C2 C3 C2 C3 C2 C2
n/a n/a n/a n/a n/a
C1 C1 C2 C1 C1
C2 C2 C3 C2 C2
n/a n/a n/a
C2 C2 C2
C3 C3 C3
C1 C1
C2 C2
C3 C3
TOPIC Brachial Plexus Exploration / repair / grafting brachial plexus UPPER LIMB: Shoulder Acromioclavicular joint excison - arthroscopic /open/lateral clavicle
Acromioclavicular joint reconstruction (e.g. Weaver Dunn) Acromioplasty open Anterior repair for instability arthroscopic Anterior repair for instability open including capsular shift
Arthroscopic subacromial decompression Arthroscopy diagnostic Rotator cuff repair (open or arthroscopic) +/- acromioplasty
Total shoulder replacement UPPER ARM:
OD
OL1 OL 2
CR
C1
C1
C2
n/a n/a n/a n/a n/a n/a C1 n/a C1
C2 C2 C2 C2 C3 C2 C3 C2 C2
C3 C3 C3 C3 C3 C3 C3 C3 C3
n/a n/a C1 C2 C1 C1 C1 C1 C1
C2 C2 C2 C3 C2 C2 C2 C2 C3
C3 C3 C3 C3 C3 C3 C3 C3 C3
n/a n/a C1 C1 C1 C2 C1 C1
C2 C1 C3 C3 C2 C3 C2 C3
C3 C2 C3 C3 C3 C3 C3 C3
C1 C1 C1 n/a C1 C1 n/a C1 C1
C2 C3 C2 C2 C2 C2 C2 C3 C3
C3 C3 C3 C3 C3 C3 C3 C3 C3
Elbow Arthrolysis elbow (open/arthroscopic) Arthroscopy elbow diagnostic Arthoscopy elbow therapeutic Arthrotomy elbow Excision radial head +/- synovectomy Radial head replacement Tennis / golfer elbow release Total elbow replacement Ulnar nerve decompression / transposition
FOREARM: Wrist Arthrodesis wrist (includes partial arthrodesis) Arthroscopy wrist Carpal tunnel decompression De Quervain's decompression Excision distal ulna Ganglion excision at wrist Ulna shortening Ulnar nerve decompression at wrist
Hand Dupuytrens contracture operation Excision synovial cyst Fusion of MCPJ or IPJ MCPJ replacement Soft tissue reconstruction hand Tendon transfer hand Trapezium excision or replacement Trigger finger release Trigger thumb release
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TOPIC LOWER LIMB: HIP Arthrodesis hip Arthrogram hip Arthroscopy hip - diagnostic Arthroscopy hip - therapeutic Arthrotomy hip Excision arthroplasty hip (e.g. Girdlestone) Open reduction for DDH Osteotomy hip - pelvic for DDH Osteotomy hip - proximal femoral for DDH Osteotomy pelvis - not for DDH Revision Total Hip Replacement Revision THR acetabular component Revision THR both components Revision THR femoral component Slipped upper femoral epiphysis: Slipped upper femoral epiphysis open reduction Slipped upper femoral epiphysis pinning Total Hip Replacement: THR cemented THR hybrid THR surface replacement THR uncemented Femur Amputation above knee Femoral lengthening Osteotomy corrective (not for DDH) Knee Open ACL reconstruction Arthroscopy ACL reconstruction Arthroscopic lateral release Arthroscopic partial meniscectomy Arthroscopic removal loose bodies knee Arthroscopic synovectomy Arthroscopic knee diagnostic Osteotomy distal femoral Osteotomy proximal tibial Patella realignment Patella resurfacing alone Revision TKR TKR Unicompartmental knee replacement
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OD
OL1 OL 2
CR
n/a n/a n/a n/a C2 n/a n/a n/a n/a n/a n/a n/a n/a n/a
C1 C1 C1 C1 C3 C2 C2 C2 C2 C2 C2 C2 C2 C2
C2 C3 C3 C3 C3 C3 C3 C3 C3 C3 C3 C3 C3 C3
n/a n/a
C2 C2
C2 C2
C1 C1 C1 C1
C3 C3 C2 C2
C3 C3 C3 C3
C1 n/a n/a
C3 C2 C2
C3 C3 C3
C1
C2
C3
C1 C1 C1 C1 C2 n/a n/a n/a n/a n/a n/a n/a
C2 C2 C2 C2 C3 C2 C2 C2 C2 C2 C3 C2
C3 C3 C3 C3 C3 C3 C3 C3 C3 C3 C3 C3
TOPIC Tibia & Fibula Amputation below knee Tibial lengthening Ankle Arthrodesis ankle Arthroplasty ankle Arthroscopy ankle diagnostic Arthroscopy ankle therapeutic Arthrotomy ankle Decompression tendons at ankle Tendoachilles lengthening Foot Amputation toe / ray Calcaneal osteotomy CTEV correction Fifth toe soft tissue correction First metatarsal osteotomy First MTPJ arthrodesis First MTPJ excision arthroplasty First MTPJ soft tissue correction Hindfoot arthrodesis Ingrowing toenail operation Lesser metatarsal osteotomy Lesser toe arthrodesis Lesser toe excision part/all phalanx Lesser toe tenotomy Tendon decompression or repair Tendon transfer foot Wedge tarsectomy
OD
OL1 OL 2
CR
C1 n/a
C3 C2
C3 C3
C1 n/a n/a n/a n/a n/a n/a
C2 C2 C2 C2 C3 C3 C3
C3 C3 C3 C3 C3 C3 C3
C1 n/a n/a n/a n/a n/a n/a n/a n/a C2 n/a n/a n/a n/a n/a n/a n/a
C3 C2 C2 C2 C3 C3 C3 C3 C2 C3 C2 C3 C3 C3 C3 C2 C2
C3 C3 C3 C3 C3 C3 C3 C3 C3 C3 C3 C3 C3 C3 C3 C3 C3
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LAMPIRAN 3 Tingkat Kompetensi Afektif Peserta Didik Berdasarkan Topik dan Tahapan Pendidikan
Profesionl Behaviour 1.Patient assessment 1. Obtains, records and presents accurate clinical history and physical examination relevant to the clinical presentation, including an indication of patient’s views 2. Uses and interprets findings adjuncts to basic examination appropriately e.g. internal examination, blood pressure measurement, pulse oximetry, peak flow 3. Responds honestly and promptly to patient questions 4. Knows when to refer for senior help 5. Is respectful to patients by: a. Introducing self clearly to patients and indicates own place in team b. Checks that patients comfortable and willing to be seen c. Informs patients about elements of examination and any procedures that the patient will undergo Clinical reasoning 1. In a straightforward clinical case develops a provisional diagnosis and a differential diagnosis on the basis of the clinical evidence, institutes an appropriate investigative and therapeutic plan, seeks appropriate support from others and takes account of the patients Wishes Record keeping 1. Is able to format notes in a logical way and writes legibly 2. Able to write timely, comprehensive, informative letters to patients and to GPs Time management 1. Works systematically through tasks and attempts to prioritise 2. Discusses the relative importance of tasks with more senior colleagues. 3. Understands importance of communicating progress with other team members
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OD
OL 1-2
CR
Profesionl Behaviour
OD
OL 1-2
CR
Patient safety 1. Participates in clinical governance processes 2. Respects and follows local protocols and guidelines 3. Takes direction from the team members on patient safety 4. Discusses risks of treatments with patients and is able to help patients make decisions about their treatment 5. Ensures the safe use of equipment 6. Acts promptly when patient condition deteriorates 7. Always escalates concerns promptly Infection control 1. Performs simple clinical procedures whilst maintaining full aseptic precautions 2. Follows local infection control protocols 3. Explains infection control protocols to students and to patients and their relatives 6. Aware of the risks of nosocomial infections. 2. Being a good communicator Objective Communication with patients 1. To establish a doctor/patient relationship characterised by understanding, trust, respect, empathy and confidentiality 2. To communicate effectively by listening to patients, asking for and respecting their views about their health and responding to their concerns and preferences 3. To cooperate effectively with healthcare professionals involved in patient care 4. To provide appropriate and timely information to patients and their families
Breaking bad news 1. To deliver bad news according to the needs of individual patients Communication with Colleagues 1. To recognise and accept the responsibilities and role of the doctor in relation to other healthcare professionals. 2. To communicate succinctly and effectively with other professionals as appropriate 3. To present a clinical case in a clear, succinct and systematic manner
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Profesionl Behaviour Descriptors
1. Conducts a simple consultation with due empathy and sensitivity and writes accurate records thereof 2. Recognises when bad news must be imparted. 3. Able to break bad news in planned settings following preparatory discussion with seniors 4. Accepts his/her role in the healthcare team and communicates appropriately with all relevant 5. members thereof
3.Teaching and Training 1. To teach to a variety of different audiences in a variety Objectives
Descriptors
of different ways 2. To assess the quality of the teaching 3. To train a variety of different trainees in a variety of different ways 4. To plan and deliver a training programme with appropriate assessments 1. Prepares appropriate materials to support teaching episodes 2. Seeks and interprets simple feedback following teaching 3. Supervises a medical student, nurse or colleague through a simple procedure 4. Plans, develops and delivers small group teaching to medical students, nurses or colleagues
4. Keeping up to date 1. To understand the results of research as they relate to Objective medical practise 2. To participate in medical research 3. To use current best evidence in making decisions about the care of patients 4. To construct evidence based guidelines and protocols 5. To complete an audit of clinical practice 6. At actively seek opportunities for personal development 7. To participate in continuous professional development activities 8. To understand the results of research as they relate to medical practise 9. To participate in medical research 10. To use current best evidence in making decisions about the care of patients 11. To construct evidence based guidelines and protocols 12. To complete an audit of clinical practice 13. At actively seek opportunities for personal development 14. To participate in continuous professional development activities
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OD
OL 1-2
CR
Profesionl Behaviour
OD
OL 1-2
CR
4. Keeping up to date 1. Defines ethical research and demonstrates awareness of Descriptors GMC guidelines 2. Differentiates audit and research and understands the different types of research approach e.g. qualitative and quantitative 3. Knows how to use literature databases 4. Demonstrates good presentation and writing skills 5. Participates in departmental or other local journal club 6. Critically reviews an article to identify the level of evidence 7. Attends departmental audit meetings 8. Contributes data to a local or national audit 9. Identifies a problem and develops standards for a local audit
10. Describes the audit cycle and take an audit through the first steps 11. Seeks feedback on performance from clinical supervisor / patients / careers / service users
5. Manager Objective
Self awareness and self management 1. To recognise and articulate one’s own values and principles, appreciating how these may differ from those of others 2. To identify one’s own strengths, limitations and the impact of their behaviour 3. To identify their own emotions and prejudices and understand how these can affect their judgment and behavior 4. To obtain, value and act on feedback from a variety of sources 5. To manage the impact of emotions on behaviour and actions 6. To be reliable in fulfilling responsibilities and commitments to a consistently high standard 7. To ensure that plans and actions are flexible, and take into account the needs and requirements of others 8. To plan workload and activities to fulfill work requirements and commitments with regard to their own personal health Team working 1. To identify opportunities where working with others can bring added benefits 2. To work well in a variety of different teams and team settings by listening to others, sharing information, seeking the views of others, 3. empathising with others, communicating well, gaining trust, respecting roles and expertise of 4. others, encouraging others, managing differences of opinion, adopting a team approach
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Profesionl Behaviour Objective (cont.)
Leadership 1. To develop the leadership skills necessary to lead teams effectively. These include: 2. Identification of contexts for change 3. Application of knowledge and evidence toproduce an evidence based challenge to systems and processes 4. Making decision by integrating values withevidence 5. Evaluating impact of change and taking corrective action where necessary Principles of quality and safety improvement 1. To recognise the desirability of monitoring performance, learning from mistakes and adopting no blame culture in order to ensure high standards of care and optimise patient safety 2. To critically evaluate services 3. To identify where services can be improved 4. To support and facilitate innovative service improvement Management and NHS culture 1. To organise a task where several competing priorities may be involved 2. To actively contribute to plans which achieve service goals 3. To manage resources effectively and safely 4. To manage people effectively and safely 5. To manage performance of themselves and others 6. To understand the structure of the NHS and the management of local healthcare systems in order to be able to participate fully in managing healthcare provision.
Descriptors
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Self awareness and self management 1. Obtains 360° feedback as part of an assessment 2. Participates in peer learning and explores leadership styles and preferences 3. Timely completion of written clinical notes 4. Through feedback discusses and reflects on how a personally emotional situation affected communication with another person 5. Learns from a session on time management
OD
OL 1-2
CR
Profesionl Behaviour Descriptors (Cont.)
OD
OL 1-2
CR
Team working 1. Works well within the multidisciplinary team and recognises when assistance is required from the relevant team member 2. Invites and encourages feedback from patients 3. Demonstrates awareness of own contribution to patient safety within a team and is able to outline the roles of other team members. 4. Keeps records up-to-date and legible and relevant to the safe progress of the patient. 5. Hands over care in a precise, timely and effective manner 6. Supervises the process of finalising and submitting operating lists to the theatre suite Leadership 1. Complies with clinical governance requirements of organisation 2. Presents information to clinical and service managers (e.g. audit). 3. Contributes to discussions relating to relevant issues e.g. workload, cover arrangements using clear and concise evidence and information Quality and safety improvement 1. Understands that clinical governance is the overarching framework that unites a range of quality improvement activities 2. Participates in local governance processes 3. Maintains personal portfolio 4. Engages in clinical audit 5. Questions current systems and processes Management and NHS Structures 1. Participates in audit to improve a clinical service 2. Works within corporate governance structures 3. Demonstrates ability to manage others by teaching and mentoring juniors, medical students and others, delegating work effectively 4. Highlights areas of potential waste
6. Promoting good health Objectives
1. To demonstrate an understanding of the determinants of health and public policy in relation to individual patients 2. To promote supporting people with long term conditions to self-care
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Profesionl Behaviour Descriptors
1. Understands that “quality of life” is an important goal of care and that this may have different meanings for each patient 2. Promotes patient self care and independence 3. Helps the patient to develop an active understanding of their condition and how they can be involved in self management 4. Discusses with patients those factors which could influence their health
7.Probity and Ethics 1. To uphold personal, professional ethics and values, taking into Objective account the values of the organisation and the culture and beliefs of individuals 2. To communicate openly, honestly and inclusively 3. To act as a positive role model in all aspects of communication 4. To take appropriate action where ethics and values are compromised 5. To recognise and respond the causes of medical error 6. To respond appropriately to complaints 7. To know, understand and apply appropriately the principles, guidance and laws regarding medical ethics and confidentiality as they apply to surgery 8. To understand the necessity of obtaining valid consent from the patient and how to obtain 9. To understand the legal framework within which healthcare is provided 10. To recognise, analyse and know how to deal with unprofessional behaviours in clinical practice, taking into account local and national regulations 11. Understand ethical obligations to patients and colleagues 12. To appreciate an obligation to be aware of personal good health
Descriptors
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1. 2. 3. 4.
Reports and rectifies an error if it occurs Participates in significant event audits Participates in ethics discussions and forums Apologises to patient for any failure as soon as an error is recognised 5. Understands and describes the local complaints procedure 6. Recognises need for honesty in management of complaints 7. Learns from errors 8. Respect patients’ confidentiality and their autonomy 9. Understand the Data Protection Act andFreedom of Information Act 10. Consult appropriately, including the patient, before sharing patient information 11. Participate in decisions about resuscitation status, withholding or withdrawing treatment 12. Obtains consent for interventions that he/she is competent to undertake 13. Knows the limits of their own professional capabilities
OD
OL 1-2
CR
LAMPIRAN 4 MODUL-MODUL MODUL 1: BASIC SCIENCE 1. Objective
To acquire and demonstrate underpinning basic science knowledge appropriate for the practice of surgery, including: o Applied anatomy: Knowledge of anatomy appropriate for surgery o Physiology: Knowledge of physiology relevant to surgical practice o Pharmacology: Knowledge of pharmacology relevant to surgical practice centred around safe prescribing of common drugs o Pathology: Knowledge of pathological principles underlying system specific pathology o Microbiology: Knowledge of microbiology relevant to surgical practice
Imaging: o Knowledge of the principles, strengths and weaknesses of various diagnostic and interventional imaging methods
1. Knowledge
Applied anatomy: o Development and embryology o Gross and microscopic anatomy of the organs and other structures o Surface anatomy o Imaging anatomy This will include anatomy of thorax, abdomen, pelvis, perineum, limbs, spine, head and neck as appropriate for surgical operations that the trainee will be involved with during coretraining (see Module 2). Physiology: o General physiological principles including: Homeostasis Thermoregulation Metabolic pathways and abnormalities Blood loss and hypovolaemic shock Sepsis and septic shock Fluid balance and fluid replacement therapy Acid base balance Bleeding and coagulation Nutrition
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o
This will include the physiology of specific organ systems relevant to surgical care including the cardiovascular, respiratory, gastrointestinal, urinary, endocrine and neurological systems.
Pharmacology: o The pharmacology and safe prescribing of drugs used in the treatment of surgical diseases including analgesics, antibiotics, cardiovascular drugs, antiepileptic, anticoagulants, respiratory drugs, renal drugs, drugs used for the management of endocrine disorders (including diabetes) and local anaesthetics. o The principles of general anaesthesia o The principles of drugs used in the treatment of common malignancies
Pathology: o General pathological principles including: Inflammation Wound healing Cellular injury Tissue death including necrosis and apoptosis Vascular disorders Disorders of growth, differentiation and morphogenesis Surgical immunology Surgical haematology Surgical biochemistry Pathology of neoplasia Classification of tumours Tumour development and growth including metastasis Principles of staging and grading of cancers Principles of cancer therapy including surgery, chemotherapy, immunotherapy and hormone therapy Principles of cancer registration Principles of cancer screening
radiotherapy,
The pathology of specific organ systems relevant to surgical care including cardiovascular pathology, respiratory pathology, gastrointestinal pathology, genitourinary disease, breast, exocrine and endocrine pathology, central and peripheral, neurological systems, skin, lymphoreticular and musculoskeletal systems
Microbiology: o Surgically important micro organisms including blood borne viruses o Soft tissue infections including cellulitis, abscesses, necrotising fasciitis, gangrene o Sources of infection o Sepsis and septic shock
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Microbiology: (Cont.) o Asepsis and antisepsis o Principles of disinfection and sterilisation o Antibiotics including prophylaxis and resistance o Principles of high risk patient management o Hospital acquired infections
Imaging: o Principles of diagnostic and interventional imaging including x-rays, ultrasound, CT, MRI. PET, radiounucleotide scanning
MODULE 2 : COMMON SURGICAL CONDITIONS This section assumes that candidates have general medical competencies consistent with a doctor leaving Foundation in the UK. It also assumes an ongoing commitment to keeping these skills and knowledge up to date as laid out in GMP. It is predicated on the value that surgeons are doctors who carry our surgery and require competencies. Objective To demonstrate understanding of the relevant basic scientific principles for each of these surgical conditions and to be able to provide the relevant clinical care as defined in modules assessment and management as defined in Modules 1 and 4. 2. Knowledge Presenting symptoms or syndromes o Abdominal pain o Gastrointestinal haemorrhage o Rectal bleeding o To include the following conditions Appendicitis Adhesions Abdominal hernias Peritonitis Intestinal perforation Presenting symptoms or syndromes Peripheral vascular disease Presenting symptoms or syndrome o Chronic and acute limb ischaemia o Transient ischaemic attacks o Varicose veins o Leg ulceration o To include the following conditions Atherosclerotic arterial disease Embolic and thrombotic arterial disease
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o
To include the following conditions (Cont.) Venous insufficiency Diabetic ulceration Cardiovascular and pulmonary Disease To include the following conditions o Coronary heart disease o Space occupying lesions of the chest Genitourinary disease Presenting symptoms or syndrome o Haematuria o Lower urinary tract symptoms o Urinary retention o Renal failure o Scrotal swellings Trauma and orthopaedics Presenting symptoms or syndrome o Traumatic limb and joint pain and deformity o Chronic limb and joint pain and deformity o Back pain o To include the following conditions Simple fractures and joint dislocations Fractures around the hip and ankle Basic principles of Degenerative joint disease Basic principles of inflammatory joint disease including bone and joint infection Compartment syndrome Spinal nerve root entrapment and spinal cord compression Metastatic bone cancer Common peripheral neuropathies and nerve injuries
MODULE 3 : BASIC SURGICAL SKILLS 1. Objective • Preparation of the surgeon for surgery • Safe administration of appropriate local anaesthetic agents • Acquisition of basic surgical skills in instrument and tissue handling. • Understanding of the formation and healing of surgical wounds • Incise superficial tissues accurately with suitable instruments. • Close superficial tissues accurately. • Tie secure knots. • Safely use surgical diathermy • Achieve haemostasis of superficial vessels. • Use suitable methods of retraction. • Knowledge of when to use a drain and which to choose. • Handle tissues gently with appropriate instruments. • Assist helpfully, even when the operation is not familiar.
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1. Objective (Cont.) • Understand the principles of anastomosis • Understand the principles of endoscopy 2. Knowledge Principles of safe surgery • Preparation of the surgeon for surgery • Principles of hand washing, scrubbing and gowning • Immunisation protocols for surgeons and patients Administration of local anaesthesia • Choice of anaesthetic agent • Safe practise Surgical wounds • Classification of surgical wounds • Principles of wound management • Pathophysiology of wound healing • Scars and contractures • Incision of skin and subcutaneous tissue: o Langer’s lines o Choice of instrument o Safe practice • Closure of skin and subcutaneous tissue: o Options for closure o Suture and needle choice • Safe practice • Knot tying o Range and choice of material for suture and ligation o Safe application of knots for surgical sutures and ligatures • Haemostasis: o Surgical techniques o Principles of diathermy • Tissue handling and retraction: o Choice of instruments • Biopsy techniques including fine needle aspiration cytology • Use of drains: o Indications o Types o Management/removal • Principles of anastomosis • Principles of surgical endoscopy
3. Clinical Skills
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Preparation of the surgeon for surgery • Effective and safe hand washing, gloving and gowning • Administration of local anaesthesia • Accurate and safe administration of local anaesthetic agent Preparation of a patient for surgery • Creation of a sterile field • Antisepsis • Draping 4. Technical Skills and Procedures Preparation of the surgeon for surgery • Effective and safe hand washing, gloving and gowning Administration of local anaesthesia • Accurate and safe administration of local anaesthetic agent • Incision of skin and subcutaneous tissue: o Ability to use scalpel, diathermy and scissors • Closure of skin and subcutaneous tissue: o Accurate and tension free apposition of wound edges • Knot tying: o Single handed o Double handed o Instrument o Superficial o Deep • Haemostasis: o Control of bleeding vessel (superficial) o Diathermy o Suture ligation o Tie ligation o Clip application o Transfixion suture • Tissue retraction: • Tissue forceps • Placement of wound retractors • Use of drains: o Insertion o Fixation o Removal • Tissue handling: • Appropriate application of instruments and respect for tissues • Biopsy techniques • Skill as assistant: • Anticipation of needs of surgeon when assisting
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MODULE 4: THE ASSESSMENT AND MANAGEMENT OF THE SURGICAL PATIENT MODULE 4 1. Objective To demonstrate the relevant knowledge, skills and attitudes in assessing the patient and manage the patient, and propose surgical or non-surgical management. 2. Knowledge The knowledge relevant to this section will be variable from patient to patient and is covered within the rest of the syllabus – see common surgical conditions in particular (Module 2). As a trainee develops an interest in a particular speciality then the principles of history taking and examination may be increasingly applied in that context. 3. Clinical Skills • Surgical history and examination (elective and emergency) • Construct a differential diagnosis • Plan investigations • Clinical decision making • Team working and planning • Case work up and evaluation; risk management • Active participation in clinical audit events • Appropriate prescribing • Taking consent for intermediate level intervention; emergency and elective • Written clinical communication skills • Interactive clinical communication skills: patients • Interactive clinical communication skills: colleagues
MODULE 5 : PERI-OPERATIVE CARE 1. Objective
To assess and manage preoperative risk To manage patient care in the peri-operative period To conduct safe surgery in the operating theatre environment To assess and manage bleeding including the use of blood products To care for the patient in the post-operative period including the assessment of common complications To assess and plan perioperative nutritional management
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2. Knowledge Pre-operative assessment and management: • Cardiorespiratory physiology • Diabetes mellitus and other relevant endocrine disorders • Fluid balance and homeostasis • Renal failure • Pathophysiology of sepsis – prevention and prophylaxis • Thromboprophylaxis • Laboratory testing and imaging • Risk factors for surgery and scoring systems • Pre-medication and other preoperative prescribing • Principles of day surgery Intraoperative care: • Safety in theatre including patient positioning and avoidance of nerve injuries • Sharps safety • Diathermy, laser use • Infection risks • Radiation use and risks • Tourniquet use including indications, effects and complications • Principles of local, regional and general anaesthesia • Principles of invasive and non-invasive monitoring • Prevention of venous thrombosis • Surgery in hepatitis and HIV carriers • Fluid balance and homeostasis Post-operative care: • Post-operative monitoring • Cardiorespiratory physiology • Fluid balance and homeostasis • Diabetes mellitus and other relevant endocrine disorders • Renal failure • Pathophysiology of blood loss • Pathophysiology of sepsis including SIRS and shock • Multi-organ dysfunction syndrome • Post-operative complications in general • Methods of postoperative analgesia To assess and plan nutritional management: • Post-operative nutrition • Effects of malnutrition, both excess and depletion • Metabolic response to injury • Methods of screening and assessment of nutritional status • Methods of enteral and parenteral nutrition
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2. Knowledge (cont.) Haemostasis and Blood Products: • Mechanism of haemostasis including the clotting cascade • Pathology of impaired haemostasis e.g. haemophilia, liver disease, massive haemorrhage • Components of blood • Alternatives to use of blood products • Principles of administration of blood products • Patient safety with respect to blood products Coagulation, deep vein thrombosis and embolism: • Clotting mechanism (Virchow Triad) • Effect of surgery and trauma on coagulation • Tests for thrombophilia and other disorders of coagulation • Methods of investigation for suspected thromboembolic disease • Principles of treatment of venous thrombosis and pulmonary embolism including anticoagulation • Role of V/Q scanning, CTpulmonary angiography, D-dimer and thrombolysis • Place of pulmonary embolectomy • Prophylaxis of thromboembolism: • Risk classification and management of DVT • Knowledge of methods of prevention of DVT, mechanical and pharmacological Antibiotics: • Common pathogens in surgical patients • Antibiotic sensitivities • Antibiotic side-effects • Principles of prophylaxis and treatment Metabolic and endocrine disorders in relation perioperative management • Pathophysiology of thyroid hormone excess and deficiency and associated risks from surgery • Causes and effects of hypercalcaemia and hypocalcaemia • Complications of corticosteroid therapy • Causes and consequences of Steroid insufficiency • Complications of diabetes mellitus • Causes and effects of hyponatraemia • Causes and effects of hyperkalaemia and hypokalaemia 3. Clinical Skills Pre-operative assessment and management: • History and examination of a patient from a medical and surgical standpoint • Interpretation of pre-operative investigations
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3. Clinical Skills (cont.) • Management of co morbidity • Resuscitation • Appropriate preoperative prescribing including premedication Intra-operative care: • Safe conduct of intraoperative care • Correct patient positioning • Avoidance of nerve injuries • Management of sharps injuries • Prevention of diathermy injury • Prevention of venous thrombosis Post-operative care: • Writing of operation records • Assessment and monitoring of patient’s condition • Post-operative analgesia • Fluid and electrolyte management • Detection of impending organ failure • Initial management of organ failure • Principles and indications for Dialysis • Recognition, prevention and treatment of post-operative complications Haemostasis and Blood Products: • Recognition of conditions likely to lead to the diathesis • Recognition of abnormal bleeding during surgery • Appropriate use of blood products • Management of the complications of blood product transfusion Coagulation, deep vein thrombosis and embolism • Recognition of patients at risk • Awareness and diagnosis of pulmonary embolism and DVT • Role of duplex scanning, venography and d-dimer measurement • Initiate and monitor treatment of venous thrombosis and pulmonary embolism • Initiation of prophylaxis Antibiotics: • Appropriate prescription of antibiotics Assess and plan preoperative nutritional management • Arrange access to suitable artificial nutritional support, preferably via a nutrition team including Dietary supplements, Enteral nutrition and Parenteral nutrition Metabolic and endocrine disorders • History and examination in patients with endocrine and electrolyte disorders • Investigation and management of thyrotoxicosis and hypothyroidism • Investigation and management of hypercalcaemia and hypocalcaemia
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3. Clinical Skills (cont.) • Peri-operative management of patients on steroid therapy • Peri-operative management of diabetic patients • Investigation and management of hyponatraemia • Investigation and management of hyperkalaemia and hypokalaemia 4. Technical Skills and Procedures • Central venous line insertion • Urethral catheterization
MODULE 6: ASSESSMENT AND MANAGEMENT OF PATIENTS WITH TRAUMA (INCLUDING THE MULTIPLY INJURED PATIENT) 1. Objective Assess and initiate management of patients with chest trauma • who have sustained a head injury • who have sustained a spinal cord injury • who have sustained abdominal and urogenital trauma • who have sustained vascular trauma • who have sustained a single or multiple fractures or dislocations • who have sustained traumatic skin and soft tissue injury • who have sustained burns • Safely assess the multiply injured patient. • Contextualise any combination of the above • Be able to prioritise management in such situation as defined by ATLS, APLS etc
2. Knowledge General • Scoring systems for assessment of the injured patient • Major incident triage • Differences In children Shock • Pathogenesis of shock • Shock and cardiovascular physiology • Metabolic response to injury • Adult respiratory distress syndrome • Indications for using uncross matched blood
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2. Knowledge (cont.) Wounds and soft tissue injuries • Gunshot and blast injuries • Stab wounds • Human and animal bites • Nature and mechanism of soft tissue injury • Principles of management of soft tissue injuries • Principles of management of traumatic wounds • Compartment syndrome Burns • Classification of burns • Principle of management of burns Fractures • Classification of fractures • Pathophysiology of fractures • Principles of management of fractures • Complications of fractures • Joint injuries Organ specific trauma • Pathophysiology of thoracic trauma • Pneumothorax • Head injuries including traumatic intracranial haemorrhage and brain injury • Spinal cord injury • Peripheral nerve injuries • Blunt and penetrating abdominal trauma • Including spleen • Vascular injury including iatrogenic injuries and intravascular drug abuse • Crush injury • Principles of management of skin loss including use of skin grafts and skin flaps 3. Clinical Skills General • History and examination • Investigation • Referral to appropriate surgical subspecialties • Resuscitation and early management of patient who has sustained thoracic, head, spinal, abdominal or limb injury according to ATLS and APLS guidelines • Resuscitation and early management of the multiply injured patient
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3. Clinical Skills (cont.) Specific problems • Management of the unconscious patient • Initial management of skin loss • Initial management of burns • Prevention and early management of the compartment syndrome 4. Technical Skill and Procedures • Central venous line insertion • Chest drain insertion • Diagnostic peritoneal lavage • Urethral catheterisation • Suprapubic catheterization
MODULE 7: SURGICAL CARE OF THE PAEDIATRIC PATIENT 1. Objective To assess and manage children with surgical problems, understanding the similarities and differences from adult surgical patients To understand the issues of child protection and to take action as appropriate 2. Knowledge • Physiological and metabolic response to injury and surgery • Fluid and electrolyte balance • Thermoregulation Safe prescribing in children • Principles of vascular access in children • Working knowledge of trust and Local Safeguarding Children Boards (LSCBs) and Child Protection Procedures • Basic understanding of child protection law • Understanding of Children's rights • Working knowledge of types and categories of child maltreatment, presentations, signs and other features (primarily physical, emotional, sexual, neglect, professional) • Understanding of one personal role, responsibilities and appropriate referral patterns in child protection • Understanding of the challenges of working in partnership with children and families • Recognise the possibility of abuse or maltreatment • Recognise limitations of own knowledge and experience and seek appropriate expert advice • Urgently consult immediate senior in surgery to enable referral to paediatricians
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2. Knowledge (cont.) • Keep appropriate written documentation relating to child protection matters • Communicate effectively with those involved with child protection, including children and their families 3. Clinical Skills • History and examination of the neonatal surgical patient • History and examination of paediatric surgical patient • Assessment of respiratory and cardiovascular status • Undertake consent for surgical procedures (appropriate to the level of training) in paediatric patients
MODULE 8: MANAGEMENT OF DYING PATIENT 1. Objective : Ability to manage the dying patient appropriately. Palliative Care: Good management of the dying patient in consultation with the palliative care team. 2. Knowledge Palliative Care: • Care of the terminally ill • Appropriate use of analgesia, antiemetics and laxatives Principles of organ donation: • Circumstances in which consideration of organ donation is appropriate • Principles of brain death Understanding the role of the coroner and the certification of death 3. Clinical Skills Palliative Care: • Symptom control in the terminally ill patient Principles of organ donation: • Assessment of brain stem death • Certification of death
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MODULE 9: ORGAN AND TISSUE TRANPLANTATION 1. Objective To understand the principles of organ and tissue transplantation 2. Knowledge • Principles of transplant immunology including tissue typing, acute, hyperactute and chronic rejection • Principles of immunosuppression • Tissue donation and procurement • Indications for whole organ transplantation
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