International Orthopaedic Education International Orthopaedic - - PowerPoint PPT Presentation

International Orthopaedic Education International Orthopaedic Education Global Orthopaedic Residency Training Programs Global Orthopaedic Residency Training Programs

• Prof. Syed Muhammad Awais (S.I.)

y ( )

Dean and Chairman Orthopaedic Surgery. King Edward Medical University , Lahore, Pakistan Member, Pakistan Medical and Dental Council (PMDC). National Delegate, Editorial Secretary, Member Board of Directors of International Society of Orthopaedics and Traumatology. (SICOT). Asstt Editor, International Orthopedics, Editor, Annals of King Edward Medical University Chairman, Medical and Dental Journals Committee of PMDC Former Pro Vice Chancellor, King Edward Medical University, Lahore Past President: Pakistan Orthopaedic Association. (POA) Past Editor: Journal of Pakistan Orthopaedic Association. (JPOA)

8/31/2011 1

LAHORE

International Orthopaedic Education p Global Orthopaedic Residency Training Programs

Vision Vision “Improve Quality of Orthopaedic Health Care by Improve Quality of Orthopaedic Health Care by Improving Education of Orthopaedic Surgery” and and

• Improve Quality of Life of Orthopaedic Care

P id d P ti t d th f th i t Providers and Patients and thus of the society

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Goals Goals

1 To Develop Global Orthopaedic Education lay down uniform:

• 1. To Develop Global Orthopaedic Education, lay down uniform:

1.1 Rules & Regulations (Framework) of Programs, 1.2. Curriculum/Training Manual (Learning Objectives) 1.3. Requirements for Teaching Hospitals. 1.3. Requirements for Teaching Hospitals. 1.4. Processes for Quality Assurance. 1.5. Policy to encourage ethical practices 2. Prepare all possible hospitals to meet standards. 3 Enroll maximum number “Residents” no slot vacant 3. Enroll maximum number Residents no slot vacant. 4. Thus provide high quality Orthopaedic Care. 5. Encourage Research and Development and discover new knowledge, techniques and technology.

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Introduction Introduction

1 H lth i i t ti l 1. Health is international. 2. The patients have right to access to a high quality of Health Care all over the world. 3. The number and competencies of orthopaedic surgeons and

• rthopaedic hospitals in various countries (especially Asia and

Africa) are not uniformly satisfactory. 4. The developed ‐industrialized countries are raising standards of

• rtrhopaedic health care very rapid. Whereas, the standards in

developing countries are not improving. 5. All stake holders must pay immediate attention to develop Uniform International Standards and make them available to the developing countries of the world to narrow the gap in quality. 6. This can be achieved by training required number of competent

• rthopaedic surgeons of Global Quality.

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Orthopaedic Surgery in Pakistan Orthopaedic Surgery in Pakistan

• Population

160 millions

• Population;

160 millions

• Universities & DAI

Medical (9), General (15), DIA “CPSP” (1), PGMI (8)

• Medical Colleges: 78
• Medical Colleges: 78
• Hospitals:

Teaching (82) Non Teaching District (80), Tehsil Hospitals (128)

• Hospital Beds 78/ 100 000 people
• Hospital Beds 78/ 100,000 people
• MGraduate Drs. 120,000. (against 300,000)
• Postgraduate Resident Capacity NOT CALCULATED.

d i li ( i )

• Postgraduate Specialists: 20,000 (against 200,000)
• Medical Teachers ; 4500 (against 30,000)
• Orthopaedic Surgeons; 450 (against 6,000)
• edical Students intake 5000 per year
• Quality Assurance; Individual Teacher/Student based (against Systems)
• 8/31/2011

6

Orthopaedic Education in Pakistan Orthopaedic Education in Pakistan

1 Nurses : Orthopaedic Surgery in Curriculum 1. Nurses : Orthopaedic Surgery in Curriculum On Job Training 2. MBBS : Orthopaedic Surgery in Curriculum 2. MBBS : Orthopaedic Surgery in Curriculum 3. Postgraduate Diploma (2 years) 4. Postgraduate Terminal Qualifications; M.S. / FCPS (Orth) 5‐yrs g ( ) y 5. PhD (Orth) 6. CME (For Family Physicians, Orthopaedic Surgeons) 7. Public Seminars

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Global/National/Individual Capital (W l h) (Wealth)

Moral Capital •Behaviors

• Attitudes

Knowledge

Attitudes

• Knowledge

Order

Knowledge Capital

g

• Skills

ame O

Economic Capital

• Kind
• Cash

The S

Capital

• Cash

In

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Social Capital‐ “Quality of Life” of the society.

Social/Economic Growth of Society Social/Economic Growth of Society

.Natural Resources

1 Time National Resources

• 1. Human Resource
• 1. Time
• 2. Life
• 2. Physical Structures

MENPOWER

• 3. Soil
• 4. Air
• 3. Products & Services
• 1. Morals
• 2. Knowledge
• 5. Water
• 3. Funds
• 6. Light
• 7. Energy & Minerals

Health Care Services In the Field of Orthopaedic Surgery

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Transformation of Knowledge into Economy & Well Being of Society

given s”.

Money Improves

dge is g al Skills

Quality of Life

Knowled Practica

Skills/Services bring Money

etical K n the “P

Knowledge is converted into Skills/ Services

e Theor to learn

into Skills/ Services

• The

Only t

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WHAT IS EDUCATION?

Education is not I f ti B t Information But Formation

i i i i i i Education is Teaching + Training of Mind & Character

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“Properly planned and carefully conducted Properly planned and carefully conducted medical education is the foundation of a comprehensive health care” comprehensive health care .

Report of the Inter‐Departmental p p Committee on Medical Schools (The Goodenough Report) London, HMSO; 1944 g p ) , ;

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N i l H l h C S National Health Care Systems

Health Care Delivery Organizations Health Care Providers Organizations Providers

Curative How Trained

g, Allied Medical ary, rimary

H

Nursing nd Para M ed, Terti ry and P

Preventive How Regulated

Medical, Health an HCPs. Specializ Secondar HCDOs

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M H H S S H

The size of the “National Health Care Systems is determined by the size of the population” and the level of technical standards is based on the available funds.

Knowledge Capital of the Society Knowledge Capital of the Society

X‐Axis:

• No. of Subjects in all Disciplines

Axis

• ..

n :Y‐ A

• 1. X multiply Y

= 2 Edu Delivery Org to Population Ratio =

cialties in

• 2. Edu. Delivery Org to Population Ratio =
• 3. Education Providers to Population Ratio =
• 4. Students to Population Ratio

=

per Spec ect

p

• 5. Publications/yr to Population Ratio
• 6. Innovations & Patents to Population Ratio
• No. of Sup

ach subj

• 1. No. of Orthopaedic Surgeons and Super‐

Specialista determine the knowledge

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N e

Specialista determine the knowledge Capital of Orthopaedic Surgery in World

Framework of Education

• The “framework” means legal boundaries

( l d l i ) i hi hi h h (rules and regulations) within which the higher education systems, particularly the institutions, faculty may freely operate.

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Academic Standards Academic Standards

• The statements of learning objectives to be

The statements of learning objectives to be attained by the learners during a program are known as “Academic Standards” known as Academic Standards .

To improve the standards improve the statement.

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Academic Quality Academic Quality

• The measurement of the effectiveness of

The measurement of the effectiveness of the academic standards in a program is known as “Academic Quality” as Academic Quality .

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Framework of Uniform Standards of Orth Education

All selected universities, institutions, hospitals will run uniform; 1. Framework of Learning Levels with duration and their corresponding g p g qualifications 2. Uniform Learning Objectives of Programs of same level (Curriculum/Training manual) 3 E t R i t 3. Entry Requirements. 4. Criteria of No of Seats in a Program. (Bed and Student Teacher Ratio) 5. Criteria to Become Supervisors/Trainers. 6 Evaluations/Progression/Examination 6. Evaluations/Progression/Examination 7. Log Book/Portfolio to record day to day learning. 8. Compulsory Research in Program 9 Quality Assurance 9. Quality Assurance 10. Student Exchange 11. Program Administration 12. Credit Accumulation and Transfer System (EU Based) and Blooms Taxonomy of 12. Credit Accumulation and Transfer System (EU Based) and Blooms Taxonomy of Learning Levels (USA Based) 13. Criteria to accept past training experience. 14. Policy for Faculty development and Faculty Exchange. 15. Minimum Standards of Teaching Hospitals

Framework of Learning Levels with Duration and their Corresponding Qualifications

l l d l f Level No Level description Duration Qualification 1 Undergraduate Certificate Months to Years Certificate 2 Graduate 6 7years MBBS/MD 2 Graduate 6 ‐7years MBBS/MD 3 Postgraduate Intermediate Qualification 2‐Years Diploma (Orth) 4 Postgraduate Terminal Qualification 5‐Years MS/MD/FCPS 5 Super Specialization Fellowships 2‐years Fellowships 6 Research Doctorate 4‐5 Years after PhD 6 Research Doctorate 4 5 Years after Level 2 Qualification PhD

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Common List of Sub Specialties Common List of Sub Specialties

• 1. Arthroscopy and

Sports Medicine

• 6. Spine
• 7. Traumatology
• 2. Arthroplasty
• 3. Hand Surgery

8. 9

• 3. Hand Surgery
• 4. Musculoskeletal

Oncology 9. 10. Oncology

• 5. Pediatric Orthopaedics

11. 12.

Entry/Admission Requirements Entry/Admission Requirements. .

• 1. Graduate Degree (MBBS/MD)
• 1. Graduate Degree (MBBS/MD)
• 2. License to Practice Medicine in the country
• 3. Pass Entry Test

4 Accepted By Program Director

• 4. Accepted By Program Director

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Criteria of No of Seats in a Program. (Bed and Student Teacher Ratio)

• One Resident each year against 10 beds
• One Resident each year against each

trainer/supervisor / p

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Criteria to Become Supervisors/Trainers Criteria to Become Supervisors/Trainers.

Consultant holding; 1 T i l Q lifi i & PhD

• 1. Terminal Qualification & PhD
• 2. Terminal Qualification and Fellowship
• 3. Terminal Qualification

In same order of Preference In same order of Preference.

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Curriculum /training manual

• Learning Objectives of;
• 1. Certificate Programs.

2 G d t P (MBBS/MD)

• 2. Graduate Program (MBBS/MD)
• 3. Intermediate Program. (Diploma)
• 4. Terminal Qualification. (MS/MD/Boards/FCPS)
• 5. Super Specialization Fellowships
• 6. PhD
• In which followings are closely Integrated

1. Theoretical Learning and Technical Skills 2 Preventive Health and Curative Health 2. Preventive Health and Curative Health 3. Clinical Medical Sciences and Basic Medical Sciences

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Log Book/Portfolio to record day to day learning.

• Record of the Learning Experiences;

1 In Patients

• 1. In Patients.
• 2. Out Patients.

3 Accident & Emergency

• 3. Accident & Emergency
• 4. Operation Theaters

5 Laboratories

• 5. Laboratories
• 6. Conference Seminars

7 Others

• 7. Others
• Recommendation: Adopt The US Portfolio System

8/31/2011 25

Learning Strategies Learning Strategies

1.

• 1960s. Student‐Centered‐Learning (SCL),

2.

• 1970s. Problem –Based‐Learning (PBL),

3.

• 1980s. Integrated Teaching (IT),

4 1985 Community‐based‐education (CBE) 4.

• 1985. Community‐based‐education (CBE),

5.

• 1990s. Task‐based‐learning (TBL),

6.

• 1995. Team Based Learning (TBL), and

7.

• 2000s. Evidence‐Based‐Learning (EBL).

8.

• 2002. Best Evidence Medical Education (BEME)

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Taxonomy of Levels of Learning y g

(Bloom’s Taxonomy)

• 1. Cognitive. Mental Skills (Theory)
• 2. Psychomotor. Manual or Physical Skills

3.

• Affective. Feelings / Emotional (Attitudes)

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Credit Accumulation & Transfer System Credit Accumulation & Transfer System

A credit accumulation and transfer system is a systematic way of describing an educational program by attacking y g p g y g credits to its components. Credit Hour is basically the academic currency of the academic activities i.e. units, modules, semesters or programs. modules, semesters or programs.

• 1. In Europe

d kl d i h

• 2. One year Study workload is 1500‐1800 hrs.
• 3. Credit Hours in one year are 60

4 One credit stands for around 25 to 30 working hours

• 4. One credit stands for around 25 to 30 working hours

This is the most convenient system of recording credit of This is the most convenient system of recording credit of learning in Transcript.

8/31/2011 28

Uniform Research Uniform Research

• Rules and regulations for writing

g g proposal/synopsis, collecting data and writing final; final;

• 1. Case Reports
• 2. Dissertations
• 3. Thesis
• Guide Lines/Training Material for Supervisors.

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Uniform Examinations Uniform Examinations

• Global Entry/Admission Examination
• Global in‐training Annual Examination

Global in training Annual Examination

• Global End of Program Examination
• Written Papers

Written Papers Clinical and oral Examinations

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Program(s) Administration Program(s) Administration

1.

At each Institution/Teaching Hospital; Program Faculty Committee for each Program headed by the Program Director . 2 In each Country: 2. In each Country: Program Coordination Committee of each program with all Program Directors as members having elected Chairman. 3. At Global Level; “I i l B d f O h di Ed i ” i h i “International Board of Orthopaedic Education” with its Organs.

8/31/2011 31

Quality Assurance Quality Assurance

f i i

• 1. Of Institution.
• 2. Of Program

g

• Levels / Cycles of Quality Assurance
• Levels / Cycles of Quality Assurance.
• 1. Monitoring.

2 Peer Review / Internal Review

• 2. Peer Review / Internal Review.
• 3. Accreditation / External Review.

PIF (US Program Information File) can be most useful

8/31/2011 32

Scheme of Diploma (Orth) –Intermediate Qualification

Exit‐ Examination‐ Written (Global) and Oral (Local) Exit Examination Written (Global) and Oral (Local)

Years Curriculum Content Training Portfolio Research Assessments Progression 2

YEAR-1,2

• 1. Adult Trauma
• 2. Hand and Neuromuscular Disorders
• 3. Joints affections and Infections

Learning Record; Education in Research Biostats. End of year 1 (Global) Written MCQ 1

• 4. Spine, Foot and Ankle, Sports Medicine
• 5. Amputations, Prosthetics and Orthotics

and Rehabilitation

• 6. Tumors (Paediatric and adult)
• 7. Metabolic Disorders and Pain

Record;

• 1. In Pts.
• 2. Out Pts.

Biostats. Writing Report of 25 Written MCQ Assessments and Progression 1

• 8. Congenital Disorders
• 9. Paediatric Traum
• 3. A & E
• 4. O.T.
• 5. Labs

p Cases

• 6. Others

Entry – Examination ‐ Written (Global) and Interview (Local)

8/31/2011 33

Scheme of Residency Program‐ Terminal Qualification

Exit‐ Examination‐ Written (Global) and Oral (Local) Exit Examination Written (Global) and Oral (Local)

Years Curriculum Content Training Portfolio Research Others Assessments Progression 5

YEAR-1 Introduction to Orth. Principals of Surgery

Learning Record; Education in Research Rotation In Other Related End of year 1,2,3,4 (Global) 4

YEAR-2,3,4,5

• 1. Adult Trauma
• 2. Hand and Neuromuscular

Disorders

• 3. Joints affections and Infections

Record;

• 1. In Pts.
• 2. Out Pts.

Research Biostats. Proposal Related Specialties Conferences (Global) Written MCQ Assessments and 4 3

• 4. Spine, Foot and Ankle, Sports

Medicine

• 5. Amputations, Prosthetics and

Orthotics and Rehabilitation 6 Tumors (Paediatric and adult)

• 3. A & E
• 4. O.T.
• 5. Labs

p writing Data Other Institutions Progression 2 1

• 6. Tumors (Paediatric and adult)
• 7. Metabolic Disorders and Pain
• 8. Congenital Disorders
• 9. Paediatric Traum
• 6. Others

Writing 1

E t E i ti W itt (Gl b l) d I t i (L l) Entry – Examination ‐ Written (Global) and Interview (Local)

8/31/2011 34

PhD Orthopaedics PhD Orthopaedics

• In Pakistan
• Enrolment after Residency (terminal qualifications)
• In USA/EU/China/Japan/India
• Enrolment During Residency

Enrolment During Residency

8/31/2011 35

Final Recommendations Final Recommendations

Establish “International Board of Orthopaedic p Education” (IBOE) with following organs. 1 Ad i i B d

• 1. Admission Board
• 2. Curriculum Board
• 3. Examination Board

4 Research dissertation/Thesis Evaluation Board

• 4. Research dissertation/Thesis Evaluation Board
• 5. Quality assurance Board

8/31/2011 36

SICOT‐WOC Seminar on Postgraduate Training in O th di S d T t l Orthopaedic Surgery and Traumatology 19th February 2010, Pokhra, Nepal

J i l S d b i i i C i

• Jointly Supported by

1. Nepal Orthopaedic Association (NOA)

• Participating Countries

1 Thailand

• Association. (NOA)

2. Japan Orthopaedic Association (JOA) 1. Thailand 2. Nepal 3 India 3. International Society of Orthopaedics and Traumatology (SICOT) 3. India 4. Japan 5. Bangladesh Traumatology (SICOT) 4. World Orthopaedic Concern (WOC) 5. Bangladesh 6. Pakistan Concern (WOC) 5. Orthopaedic Societies of SAARC Countries (OASAC)

8/31/2011 37

Framework: 1‐ Entry Requirements.

S C i i i ddi i l i Sr. No. Country Existing Practices Additional Requirements 1 Thailand 12 years of School Education Govt Service for 3 years with Biology and Science 6 years of Medical Graduation 2 Nepal Same Experience of 2 years p p y 3 India Same Entry Test 4. Japan Same Small Hospital Service for 2 yrs. 5 Bangladesh Same 6 Pakistan same Entry Test Recommendations:

• 1. Higher School for 12 years with Biology and Science Subjects.
• 2. Entry Test . (where licensing examination practiced, it can act as entry test.
• 3. Additional requirements of service may remain optional with the countries.

Framework: 2‐Duration of Levels of Education Recommendation. All Degree Awarding Institutions may arrange All Degree Awarding Institutions may arrange education in the field of Orthopaedic Surgery as under as under.

Education Level Minimum D i Nomenclature Additional O i i Duration Opportunities 1 6 MBBS/MD 2 2 Diploma 2 2 Diploma 3 4 MS/Fellowship/ National Board PhD 4 2 Sub specialty Fellowship PhD

Framework: 3‐Learning Objectives.

i G id i k h d Learning Guide Line Log Book Research Mandatory Workshops (a) Cases Load for each of A Uniform (a) Thesis or Common List the subspecialties may be made for practical training. Logbook may be developed so that residents may find Dissertation

• f Level of

M.Phil. and Curriculum must be developed so (b) SICOT Training Manual may be adapted for Cognitive Learning and b i di i d convenient to fill even when working abroad. OR (a) Minimum

• ne research

P that residents may attend in

• ther

i i i may be indigenized. Paper institutions.

The Learning Objectives, Training Manual, Log Book, Guide Lines for Research and List of Mandatory Workshops along with their Learning Objectives may be laid down at Asian Level Objectives may be laid down at Asian Level

Framework: 4‐Examinations

Recommendations

• 1. Regular Assessments, Assignments, Work Load Experience carried out

and recorded in the Log Book. 2 Yearly Examination and Log Book Evaluation Ethical Practices General

• 2. Yearly Examination and Log Book Evaluation, Ethical Practices, General

Relationship with others‐ Record constitute basis for promotion to next year. 3 Intermediate Examination if any may be passed any time before final

• 3. Intermediate Examination, if any may be passed any time before final

examination.

• 4. Research Dissertation, Thesis , or publication of Research Paper must be

li h d b f th Fi l E i ti accomplished before the Final Examination. 5. Final Exit examination subjected three certificates. A‐ Completion of Residency Training. B‐ Approval of the Log Book C‐ Approval of the Research Work.

• 6. Exit Examination will be written and Oral

Framework: 5 Certification of Training Hospitals Framework: 5‐ Certification of Training Hospitals

• Recommendations
• There maybe an Global Minimum

i f i i f hi Requirements for Recognition of a Teaching Hospital and a Teaching Department for “Recognition” of Training Hospitals and Departments to run Diploma/ Residency / Departments to run Diploma/ Residency / PhD/ Fellowship (one or all) Program.

End Thank you

07‐09‐09 Ziauddine University, Karachi 45