the warwick programme

Transcription

1 outline of the warwick programme specialist training in trauma & orthopaedics clinical excellence educational innovation academic distinction programme director Professor Damian Griffin web address Warwick Orthopaedics Clinical Science Research Institute Warwick Medical School Clifford Bridge Road Coventry CV2 2DX Version 1.1 [08/06]

2 introduction The Warwick Programme is one of the West Midlands Deanery Higher Surgical Training schemes. It is a six-year specialist training programme in Trauma and Orthopaedic Surgery. This new programme has been created following a reorganisation of orthopaedic training in the West Midlands. It was stimulated by the building of a brand new University teaching hospital in Coventry, and the increasing recognition of Warwick Medical School as a centre of excellence for orthopaedic training and the development of orthopaedic research in the United Kingdom. The programme is closely supervised with 24 Specialist Trainees. But it has some of the best clinical facilities and the most rapidly developing academic Orthopaedic Department in the country, as well as a wide variety of consultant orthopaedic surgeons who are nationally and internationally recognised for expertise and innovation in their sub-specialities. The Warwick Programme was initially established by the transfer of hospitals and trainees from the Birmingham Programme. This has created a geographically coherent rotation, with a full range of specialist training opportunities, and a group of enthusiastic trainers and trainees from SpR1 to SpR6. Trainees receive excellent clinical training in the generality of orthopaedic surgery with a clear focus on the SAC curriculum and the FRCS(Tr and Orth) examination. They are also trained in subspecialities of their interest, spend time on at least one overseas Fellowship (several of which are closely linked with the programme) and usually complete a higher degree in orthopaedic research or teaching whilst doing their Orthopaedic training. The Programme is directed by Professor Damian Griffin, Chair of Trauma and Orthopaedic Surgery at the University of Warwick. He is supported by a Mr Matt Costa, Senior Lecturer, and by Mr Giles Pattison, a consultant with a special interest in medical education, as well as a large group of orthopaedic surgeons, all enthusiastic about Specialist Trainee teaching. As a new programme, we have had the opportunity to design many aspects from scratch, and have chosen to focus on clinical excellence, educational innovation and academic distinction. Each of these are described in more detail on the following pages.

3 clinical excellence The Warwick programme provides excellent clinical training in both trauma and elective orthopaedics. This section describes the clinical training in outline, and then the opportunities in each of the Programme hospitals in detail. outline of clinical training Trainees rotate yearly, spending three years in the University Hospital and a year in each of three District General Hospitals, selected from Alexandra Hospital in Redditch, Heartlands Hospital and Solihull Hospital in east Birmingham, South Warwickshire Hospital in Warwick, and Worcestershire Royal Hospital in Worcester. In the first year trainees start at the University Hospital where the emphasis is on gaining sound elective and trauma skills. In Years 2 and 3, trainees are allocated to two of the excellent District General Hospitals on the Programme. During these years the trainee will further develop his or her trauma and elective skills. By the end of Year 3, trainees will have been exposed to the full breadth of trauma and orthopaedic surgery. For Years 4 and 5, trainees rotate back to the University Hospital for more advanced speciality training and for exam preparation. Current arrangements for the FRCS (Tr & Orth) are such that most trainees will sit the first part of the exam in July at the end of their fourth year and the second part in November early in the fifth year. Year 6 is spent completing sub-speciality training, usually in District General Hospitals. Most trainees on the Warwick Programme will complete an overseas Fellowship in a sub-speciality of their choice. Planning for this begins in Year 2, and includes opportunities to take up one of a number of posts linked to the Warwick Programme. These include a wide range of elective sub-specialities and trauma, and are scattered across the world in cities such as Melbourne, Dallas, Seattle, Vancouver, Toronto, Paris, Rome, Cape Town, and Auckland. Fellowships can be in Year 6, or (especially to fit in with southern hemisphere timetables) from the middle of Year 5 to the middle of Year 6. year 1 year 2 year 3 year 4 year 5 year 6 aug-jul aug-jul aug-jul aug-jul aug-jul aug-jul University Hospital DGH DGH University Hospital DGH 3 x 4 month attachments: trauma and two elective firms. Emphasis on basic skills 2 x 6 month attachments 2 x 6 month attachments 6 x 4 month attachments, two in trauma including complex trauma surgery and four in tertiary referral subspecialities. Preparation for final exam Final training in subspeciality of choice Accumulate experience in a range of subspecialities Fellowship FRCS(Tr&Orth) Exam Parts 1 & 2

4 University Hospital The University Hospitals of Coventry and Warwickshire NHS Trust includes a brand new University teaching hospital in Coventry and an elective orthopaedic centre in Rugby. The University Hospital opened in July It is has 1,250 beds and 28 operating theatres. Facilities are to the most modern standard, including for example, 3 CT scanners, a conventional MRI, open MRI and a 3T high-resolution MRI, and a PET-CT. All the surgical specialities are housed under one roof and configured as a regional Level 1 trauma unit. There is a very large emergency department with a CT scanner adjoining the trauma room. The emergency department is served by the Warwickshire and Northamptonshire Air Ambulance which lands on a purpose built helipad immediately outside. There is a separate adjoining children s emergency department. There are two orthopaedic wards on the fifth floor that include a study centre for orthopaedic Specialist Trainees. The Trust provides tertiary services to Coventry and Warwickshire and beyond. Regional and supraregional services include: the Midlands Pelvic and Acetabular fracture service; a departmental special interest in sports surgery, especially cartilage repair; a regional paediatric service; and a national hip arthroscopy service. Rugby St Cross Hospital has 5 theatres and 140 beds and is located in Rugby, 15 miles to the east of the University Hospital. It provides a separate elective orthopaedic facility, unaffected by the emergency admissions to the main University Hospital. All inpatient trauma surgery is managed at University Hospital. Elective surgery is split between University Hospital and Rugby St Cross, with University Hospital concentrating on more complex surgery, such as revision joint replacement and major spine surgery and on childrens orthopaedics. The clinical training at the University Hospital and Rugby St Cross is arranged as four-month attachments. One attachment in a typical year is spent doing exclusively trauma surgery as part of a trauma team, and most of the on-call work falls within this period. Maximum exposure to trauma surgery and close consultant supervision have increased both the quality of training and the number of cases that each trainee experiences. The four-month elective attachments are each to a firm of two consultants with similar specialised practice to allow focused learning. There is only occasional weekend on-call work during elective attachments and this allows the trainee to concentrate on developing elective skills. Mr M. Costa Trauma Miss I. Dunn, Mr A. Gaffey, Mr G. Pattison Paediatric Orthopaedics Mr M. Margetts General and Paediatrics Miss A. Edwards Upper Limb and Paediatrics Mr S. Drew, Mr S. Turner Shoulder Mr R. Cherry, Mr P. Wade Hand Mr W. Merriam, Mr N. Shergill, Mr. R. Sneath Spine Professor D. Griffin Pelvic and acetabular fractures, young hip surgery Mr M. Blakemore Pelvic and acetabular fractures, lower limb Mr S. Krikler Trauma and hip arthroplasty Mr U. Prakash, Mr P. Foguet Hip and knee arthroplasty Mr T. Spalding, Mr M. Taylor, Mr P. Thompson Knee surgery and sports injuries [New appointment] Foot and ankle Heart of England NHS Trust This Trust includes two hospitals with orthopaedic facilities: Birmingham Heartlands and Solihull. The Heartlands site is purely a trauma unit with three wards. Injured patients are admitted to this unit via the Accident and Emergency Departments of both hospitals. A comprehensive trauma service is provided, including management of multiply-

5 injured patients. There is a dedicated trauma theatre with planned trauma lists seven days a week. No in-patient elective orthopaedic surgery is undertaken on this site. The Solihull site is dedicated to elective orthopaedics. There are two operating theatres with clean air enclosures. A full spectrum of orthopaedic surgery is performed with an emphasis on joint replacement surgery. There are outpatient and fracture clinics on both sites. Mr T. Lawrence Primary and Revision Hip Arthroplasty & Knee Surgery Mr H. Rahman Lower Limb Arthroplasty Mr S. Brooks Primary and Revision Knee Arthroplasty, Sports Injuries of the Knee Mr A. Sambatakakis Primary Revision Knee Arthroplasty, Sports Injuries of the Knee Mr J. Ramos Foot and Ankle Surgery, Primary Knee Arthroplasty & Knee Arthroscopy Mr S. Bryan Shoulder Surgery, General Upper Limb Surgery Mr M. Shrivastava Shoulder Surgery, Lower Limb Arthroplasty Mr S. Hughes Pathological Fractures, Lower Limb Arthroplasty Mr V. Goswami Sports Injury of the Shoulder and Knee, Lower Limb Arthroplasty Alexandra Hospital, Redditch Part of the Worcester Acute Hospitals NHS Trust, this is a busy district general hospital in Redditch. There are eight orthopaedic consultants working full time and responsible for elective and trauma admissions. Each consultant, in addition to their direct involvement in the management of trauma cases, has a special interest including surgery of the rheumatoid upper and lower limbs, hand surgery, major joint arthroplasties and back pain surgery. Mr M. Arafa Hand and upper Limb Surgery Mr K. Bell Knee Surgery Mr R. Knebel Lower Limb Arthroplasty Mr K. Mathur Knee and Shoulder Surgery Ms A. Moon Hand Surgery Mr M. Pereira Foot & Ankle Surgery Mr A. Reading Hip Surgery Mr D. Selvey Shoulder and Elbow Surgery Worcestershire Royal Hospital Part of the Worcester Acute Hospitals NHS Trust, this is a newly opened district general hospital in Worcester. It has superb postgraduate and teaching facilities. He provides a comprehensive trauma and elective orthopaedic service with a wide variety of subspecialist interests among consultants. D. O Dwyer Hip arthroplasty D. Robinson Shoulder M. Trevitt Foot and ankle E. Rouholamin Knee N. Aslam Hip and knee M. Grainger Spine P. Ratcliffe Hands Warwick Hospital There are seven consultant orthopaedic and trauma surgeons in this hospital. All aspects of general orthopaedics and trauma are covered but there is considerable experience in joint replacement surgery, revision surgery, arthroscopic surgery, foot surgery and upper limb surgery. There is excellent supervision of training both on routine and elective lists and with trauma lists each week. Mr S. Young Hip Surgery Mr P. Binfield, Mr S Farooqui Foot Surgery Mr I. Nwachukwu, Mr M. Stanislas Upper Limb Surgery Mr T. Robertson, Mr K. Shah Hip and Knee Surgery

6 educational innovation The Warwick Programme is at the forefront of modern teaching methods in orthopaedics. We have produced and are continuing to develop an innovative educational programme. Surgical education has undergone great changes in the last few years. As a new Specialist Training scheme, the Warwick Programme is particularly well placed to take account of new educational practices required for the modern environment. The West Midlands have been both pre-pilot and pilot for the F1, F2 and ST1/2 programmes and we are well placed for the advent of modern run-through training. Those entering the Specialist Training Programme will be less experienced than the traditional registrar. Every training opportunity needs to be utilised. Our training programme is fundamentally based on the trainee/trainer relationship and our trainers understand the need for formalising the relationship. Presently all trainee and trainers are engaged in the Orthopaedic Competency Assessment Project (OCAP); this is likely to evolve and we anticipate the introduction of the SAC s competency based curriculum and in the Inter-collegiate Surgical Project (ICSP). As well as encouraging and nurturing high quality trainer/trainee partnerships, we have an innovative Core Curriculum Programme. The core programme delivers the entire orthopaedic curriculum over a two year period. In each year there are two semesters, consisting of 12 sessions. Each session consists of 10 hours of study time spread over two weeks. Six and a half hours of this take the form of reading and exercises. There is a self-assessment pre-test to allow trainees to assess that they have acquired this knowledge to an appropriate level. The remaining three and a half hours are delivered in a teaching afternoon which takes place on alternate Wednesdays in the Clinical Sciences Building at the University Hospital. Each teaching afternoon begins with an hour of clinical examination training. This is small group teaching on patients with appropriate physical signs. The second hour is a small group session supervised by consultant faculty. Specialist trainees confirm their understanding of the prereading material by discussion. Specific learning objectives are explored, based on the faculty s previous knowledge of those areas which trainees usually find difficult. The third hour seeks to bring together all of the activities up to that point ie knowledge acquisition, clinical examination training and discussion of difficult areas. This small group work is based around clinical problems and will allow the trainees to integrate the previously acquired knowledge and skills to a high level. The last half hour of the afternoon is dedicated to an assessment test and a summary session. Some core curriculum sessions are skill-based and include practical workshops. The basic science sessions have a different structure but are, again, based on sound educational principles. The Warwick Programme s educational activity is new and innovative: we are sure that it will prove second to none.

7 academic distinction We believe that training in research methodology and medical education are important parts of the professional development of an orthopaedic surgeon, and that these will be significant factors in consultant appointments in the future, especially in larger hospitals. Warwick Orthopaedics, the trauma and orthopaedic research group in Warwick Medical School, provides the major opportunity for research by Specialist Trainees on the Programme. The research focus of this group is Evidence-Based Trauma and Orthopaedic Surgery. We design and perform research that addresses the questions of which surgical treatments work, and which are most cost effective. Warwick Orthopaedics is becoming a nationally and internationally important source of robust information on the clinical and cost effectiveness of treatments in trauma and orthopaedic surgery. The group is led by Professor Damian Griffin. Mr Matthew Costa is the Clinical Senior Lecturer. There are six Honorary Senior Lecturers, three Postdoctoral Research Fellows, six Clinical Research Fellows, a team of Research Nurses and Research Physiotherapists, and administrative staff. In response to the Walport Report ( mmc.nhs.uk/download/medically-and-dentally- Qualified-academic-staff-recommendations-Report. pdf), The Warwick Programme has been awarded five Clinical Academic Fellows posts and two Clinical Lecturers posts. These are the first, and currently the only, Academic Specialist Training posts in orthopaedics in the country. These trainees will have a formal academic training. However, all of the trainees on the Warwick Programme are encouraged to participate fully in the research agenda of the department. Each trainee has the opportunity to spend four months in a full-time academic post as part of their rotation. All can be trained in research methods and critical appraisal as part of the MSc in Evidence-Based Musculoskeletal Care at Warwick University and will play an active role in one any of the following four linked research themes: primary clinical effectiveness studies We design, lead and perform studies to provide primary evidence of the effectiveness and cost effectiveness of treatments. We intend to be at the centre of national networks to perform multicentre, publicly-funded observational studies and trials to measure and compare the clinical effectiveness of operations and other interventions. We have extensive international collaborations to achieve greater breadth and generalisability. Cost effectiveness and best design of health care systems are included in studies in collaboration with Professors of Health Economics and Social Science at Warwick Medical School. secondary studies We perform systematic reviews of evidence of effectiveness and cost effectiveness from the existing primary literature, and synthesis of this evidence with that from new primary studies. methodology We perform theoretical and empirical research to develop novel approaches to primary and secondary research in musculoskeletal medicine and surgery, with special emphasis on solving

8 the problems of performing high quality clinical outcome research in orthopaedic surgery. research into practice We develop methods to summarise and disseminate evidence of effectiveness in a clinically applicable form, and to influence clinicians to use it in everyday practice. Warwick Orthopaedics has extensive teaching commitments at all levels, from medical students, to junior doctors, to professional development for consultants. This provides tremendous opportunities for Specialist Trainees to practice techniques of medical education, under supervision, and backed up by University courses in education up to and including a Masters Degree in Medical Education. Each trainee will also be expected to play a full part in the extensive teaching commitments of the Department. This includes teaching and examining Medical Students, Foundation Doctors and Allied Health Professionals. Finally, Warwick Orthopaedics runs a wide range of external courses and meetings which are open to the Specialist Trainees. In collaboration with the University of Warwick, we have recently organised an international Sports Knee Surgery and Sports Hip Surgery symposia, a Knee Arthroscopy Course and a National Seminar on Minimally Invasive Joint Replacement. The University Hospital Department also runs nationally advertised ATLS courses and encourages trainees to become instructors.