POSTING: ORTHOPAEDICS & TRAUMA I - UniSHAMS

Orthopaedics and Trauma I PPS64406

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STUDY GUIDE POSTING:

ORTHOPAEDICS & TRAUMA I (PPS64406)


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CONTENTS

COORDINATOR AND LECTURERS AIMS

NAME PHONE NO EMAIL ADDRESS

Items Pages

1. Directory of Coordinator and Lecturers 2

2. Aims of Orthopaedics, Traumatology and Rehabilitation Posting 3

3. Teaching - Learning Objectives 3

4. Course Synopsis 3

5. Learning Outcomes 4

6. Teaching - Learning Methodology (Delivery Systems) 4

7. Teaching Guidelines 5

8. Tutorial And Task Based Topics in Orthopaedics 5

9. Case Write Up in Orthopaedics (Template of Case Write Up added in Log Book) 8

10. Core Knowledge in Orthopaedics, Traumatology and Rehabilitation 8

11. Assessment System 11

12. List of Recommended Textbooks and Websites 14


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AIMS This will be a 6 week orthopedic posting in year IV and 4 week Orthopaedic posting in year V whereby students will be exposed to various aspects of clinical training (history taking, physical examination, investigations, patient management) either through small-group workshops or task-based discussions. COURSE OBJECTIVES The objectives of the course are as follows:

1. Provide the basic core knowledge in Orthopaedics, Traumatology and Rehabilitation Provide the students with the clinical skills of history taking and physical examination.

2. Correlate the clinical findings in formulating provisional and differential diagnoses. 3. Introduce the basic investigations including interpretation of the results and principles of

management. 4. Expose the students to the basic orthopaedic procedures. 5. Inculcate professionalism. 6. Incorporate Islamic values and ethics in the management patients

COURSE SYNOPSIS The course is the first direct exposure for the students to real life clinical setting in the orthopaedic ward. This course introduces the student to the basic clinical methods involving history taking, clinical examination techniques and formulation of diagnosis in orthopaedic patients. The course will be conducted both in the in-patient and out-patient settings in which there will be direct contact of the students with patients, other health-care professionals and support team under the supervision of our lecturers. Strategies include bedside-teachings, teaching in the out-patient clinics, tutorials, ward-rounds, on-calls and sessions in operating theatre. These teaching-learning methods will provide and strengthen the basic core knowledge and skills. As one of the medical discipline core courses in the clinical years, our focus is to produce physicians who can apply scientific methods with exemplary high moral qualities. This is done by imparting knowledge, teaching clinical skills and promoting good attitudes which are the basic ingredients in the development of a competent physician.


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LEARNING OUTCOMES At the end of the course, students must be able to:

1. Correlate knowledge of altered normal states with diseases. 2. Communicate effectively. 3. Obtain a comprehensive history and perform a thorough physical examination to detect

physical signs. 4. Formulate diagnosis and order appropriate investigations for confirmation. 5. Recognize and differentiate between orthopaedic and non orthopaedic problems. 6. Recognize or diagnose acute/chronic orthopaedic problems. 7. Interpret basic investigation results. 8. Propose appropriate plan of management. 9. Establish good interpersonal relationship with the health-care professionals at various

levels. 10. Perform/observe basic procedures done in orthopaedic ward

TEACHING-LEARNING METHODOLOGY (DELIVERY SYSTEMS)

Utilizes multiple and combined approaches which include:

- Active learning- Lectures - Bedside teaching - Seminar - Tutorials and task based learning - Ward round / ward works/ Procedure practices - On call - Attending ambulatory clinic care/ Orthopaedic Outpatient clinic

Other teaching sessions:

- Night round and attending A& E (Accident and Emergency) with lecturer and medical officers

- Procedures with the nurses and medical officers


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BEDSIDE TEACHING Students are divided into groups supervised by a lecturer for each group. There will be a minimum of two sessions per week whereby students will be *trained in the basic clinical skills from clerking, physical examination and patient management. The lecturers are encouraged to be innovative in their approach. Students are required to participate in presenting cases and will be assessed based on their participation and attendance in these sessions. The students are expected to have acquired the basic skills in Year 1 and 2 which will be reinforced. SEMINARS – ORTHOPAEDIC SPECIALTY There will be seminars. These seminars will focus on the common and important topics. It will be clinically oriented involving actual cases and with emphasis on the basic clinical examination and approach to these patients. These seminars are part of the group activities. The presentation need to cover wide range of issues related the topic picked by the group. The students are encouraged to approach the seminar using bio-psycho-social model. TUTORIALS AND TASK BASED LEARNING These learning activities are aimed to inculcate self-directed learning by giving them problem-based scenarios beforehand. The students are expected to do some simple and basic research in order to be able to complete the assignments. Students are required to actively participate in the discussions while being observed by a moderator. Students are required to be competent in understanding and performing basic laboratory investigations. TEACHING GUIDELINES WORD ROUND/ WARD WORKS/ PROCEDURES PRACTICE

This is a structured self learning module for the students. The main objectives of the training are: a. To improve clerking techniques (history taking, physical examination, formulation of

diagnosis, requesting appropriate investigations and basic principle of therapy). With regular


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daily practice of case clerking, constant efforts to identify mistake and sincere attempt to

correct it, students will eventually developed good clerking techniques.

b. To acquire medical knowledge by personal experience of seeing as many relevant cases / conditions as possible. Medical knowledge covers basic sciences knowledge, basic clinical knowledge and clinical pathophysiological knowledge i.e. linking clinical

knowledge with basic science.

c. To stimulate analytical thinking and the ability to solve clinical problems. Students are considered as junior medical staffs, responsible for the care the patient allocated to them from the time the patients were admitted to the time they were discharged. This will give students the opportunity to think and work out the patient’s condition themselves, with guidance and constant supervision from more senior members of the

clinical team.

d. Improve the skills of performing medical procedure by regular practice under supervision and discussion with medical staffs. Procedures such as blood taking, administering

nebulised drugs, inserting Steinmann’s pin etc).

e. Improve communication skills with parents, families and the patients themselves, as well as communication with the various groups of the medical staffs. Discussing ethical

issues.

f. Learn the concept of team work.

The emphasis of these teaching sessions is on the techniques, history taking, physical examination, clinical pathophysiological correlation, and formulation of provisional and differential diagnosis, ability to request appropriate investigations and basic principle of therapy. Cases for presentation will be either selected by the lecturer or student presenting pre-selected cases. The students thus, have to know all the cases allocated to them in detail. If the students fail to present or did not know the cases for no valid reason, they will be given a failure mark in the presentation section of their log book.


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ON-CALL Students will be divided into small groups in each clinical ward and the A&E. They will do on call in their current ward to ensure continuity of patient care. On call time is from 6.00 pm till 10.00 pm. Students are expected to:

i. Clerk all patients admitted / transferred from 6.00pm – 10.00pm.

ii. Know ill / unstable patients in the wards.

iii. Review patient and other patients with illness.

iv. Actively participate in patient’s management especially in emergencies.

v. Perform / witness / assist procedures.

vi. Meet and discuss cases admitted to their ward medical officers and lecturer on call.

Students on call are expected also to be in the accidents and emergency department when there are emergency cases. On call provides good opportunity for the students to see interesting cases as well as to improve their skills in various procedures. Students should work with the medical officers hand in hand. Unannounced ward rounds from time may be conducted by the lecturers or / and the medical officers.

ORTHOPAEDIC OUTPATIENT CLINIC POSTING/AMBULATORY CLINIC CARE

Students will sit in with a clinician / specialist but they are encouraged to clerk new cases (history, physical examination, diagnosis, investigation and appropriate management). Learning the techniques and skills of case clerking in a clinic setting is one of the main objectives of this posting. The students will also learn and acquire communication skills and techniques. SUPERVISION A group of students will be assigned to one lecturer. Their supervision will involve staff nurses, head nurses, medical officers and other healthcare team members.


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CASE WRITE UP IN ORTHOPAEDICS CASE REPORTS (template below)

- 2 cases – submitted to the coordinator at the end of third (3rd) and fifth (5th) week year 4 and 2nd and 3rd week in year 5

- The university template should be included (added in Log book) - It should contain these elements:-

Core Clinical Component:

1. History 2. Physical Examination 3. Investigations 4. Provisional And Differential Diagnosis 5. Community Health Issues 6. Summary 7. Management With Prescription 8. Progress 9. Referral Letter 10. References 11. Progress

CORE KNOWLEDGE IN ORTHOPAEDICS:

CONTENTS / TOPICS 1. Fractures : Definition, Classification, healing of fractures and complications of fractures 2. Open fractures - types and principles in management. 3. Fracture of the clavicle, dislocation of the shoulder 4. Fractures around the Elbow, Forearm (Both bones of forearm, Galleazi and Monteggia

fracture-dislocation) 5. Fracture of the pelvis, Hip dislocations 6. Fracture shaft - femur, Fractures of the tibia and fibula 7. Injuries around the Ankle 8. Fractures of the Spine – Paraplegia 9. Tuberculosis (TB) - arthritis, spine 10. Backache- IVDP, Spondylosis, Spondylolisthesis, Spinal Canal Stenosis 11. Avascular Necrosis of bone: Perthes’ disease and other osteochondritis 12. Congenital anomalies-CTEV,DDH


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DSL/SMALL GROUP LEARNING/PBL/SEMINARS/GROUP DISCUSSIONS 1. Diabetic foot - Complications, pathophysiolgy in formation of an ulcer, classification,

complications and treatment. 2. Fracture of the shaft of humerus, supracondylar fracture of humerus & complications 3. Fractures around the wrist and hand 4. Ligament Injuries-knee (Meniscal / cruciate / collateral) 5. Infection – Osteomyelitis – acute & chronic and septic arthritis 6. Orthopaedic Radiology: Trauma 7. Special tests in Examination of the joints 8. Surface Anatomy, Plaster of Paris, Tractions and Splints 9. Orthopaedic Radiology:Cold 10. Surface Anatomy, Plaster of Paris, Tractions and Splints 11. Internal fixation, External Fixation, Tourniquet, Amputation, Orthosis, Prosthesis and

Bone grafting 12. Deformities of the limb and spine 13. Fracture neck of femur, Intertrochanteric fracture and Subtrochanteric fracture 14. Soft tissue lesions 15. Injuries – tendons and nerves 16. Synovial fluid analysis 17. Gait – Normal and abnormal 18. Neurological assessment : Peripheral nerve injuries 19. Osteoarthritis-PBL 20. Joint pain 21. Bone tumors: benign and malignant 22. Metabolic bone diseases


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COURSE OUTLINE OF ACTIVE LEARNING

1 Basic core knowledge of clinical medicine.

i. Introduction to clinical orthopaedics

ii. Basic history taking

iii. Physical examination 2 Proper history taking and documentation :

i. Pearls in history taking ii. Documentation

3 Physical examination including general and systematic examination and document the same.

i. Thorough physical examination

ii. Systems examination

4 Present the case succinctly to the facilitator and colleagues. i. Effective case presentation ii. Appraisal

5 Explain provisional diagnosis, differential diagnoses, and provide a plan of investigations and management.

i. Art of arriving at differential diagnosis ii. Diagnosis algorithm

6 Recognize and identify common clinical problems. i. Common acute orthopaedic emergencies ii. Common orthopaedic procedures

7 Observe and perform common procedures done in the orthopaedic wards. i. Introduction to orthopaedic procedures ii. How to perform common procedures

8 Interpret basic investigation results performed on medical patients. i. Abnormal tests results ii. Erroneous interpretation

Recognize anatomical structures in common radiographs and interpret common abnormalities.

9 Describe basic knowledge in the principles of post-operative care

i. Basic Principal of bone healing 10.

Describe basic knowledge of patient management and therapeutics. Introduction to clinical therapeutics orthopaedic interventions


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ASSESSMENT SYSTEM

Orthopaedics - End of Posting Examination The assessment consists of Part I and Part II:

Part I

(i) Continuous Assessment - 40% (ii) Theory Paper Examination - 60%

(i) And (ii) Form The Total Theory Mark 100%

Part II- Clinical Examination : (i) Long Case – One- 100% (ii) Short Cases- Two- 100% (50% For Each Case)

a. Components of Continuous Assessment include:

i. Professionalism 5% ii. Word work 5% iii. Punctuality 5% iv. Case presentation 5% v. Seminar presentation 5% vi. Case write up- 2 cases 10% vii. Log book 5%

b. Theory paper examination consists of:

i. OBA (one best answer)/ MCQ- 30 minutes- 20% (30 questions) ii. Patient management problem- 60 minutes- 40% ( 3 problems out of 4)

c. The clinical examination includes:

i. One long case- = 90 minutes ii. Two short cases- (1×15) = 30 minutes


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Kuliyyah of Medicine and Health sciences LONG CASE MARK SHEET

Student’s Name: ____________________________ Student’s Number: ______________ Patient’s Name: ____________________________ Diagnosis: _____________________ Assessment Components

Inadequate Satisfactory Outstanding Comments

Manner, attitude, Communication

History taking Physical Examination

Discussion; Differential Diagnosis

Investigations; Management

Presentation skills

Overall Performance (please circle the appropriate) Clear failure Redeemable Failure Bare Pass Clear Pass (44% or less) (45 – 49%) (50 - 54%) (55 – 59%) Good Pass Distinction (60 – 74%) (75% - 100%) Examiner’s recommended mark Agreed final Mark: Overall Comments: _______________________________________________________________ Name of the Examiner: ________________________________________________________ Signature of the Examiner: _____________________ Date of Examination: _____________


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Kuliyyah of Medicine and Health sciences SHORT CASE MARK SHEET

Student’s Name: ____________________________ Student’s Number: ______________ Patient’s Name: ____________________________ Diagnosis: _____________________ Assessment Components

Inadequate Satisfactory Outstanding Comments

Manner, attitude, Communication

Clinical Skills;Technique

Accuracy of Findings

Interpretation of Clinical Findings Differential iagnosis

Investigations; Management

Presentation skills

Overall Performance (please circle the appropriate) Clear failure Redeemable Failure Bare Pass Clear Pass (44% or less) (45 – 49%) (50 - 54%) (55 – 59%) Good Pass Distinction (60 – 74%) (75% - 100%) Examiner’s recommended mark Agreed final Mark: Overall Comments: ________________________________________________________________ Name of the Examiner: ________________________________________________________ Signature of the Examiner: _____________________ Date of Examination: _____________


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REFERENCES

Learning Website https://www.kuinorthopaedics.moodlecloud.com

Main reference: Textbook 1. Apley’s system of Orthopedics and Fractures: Graham Apley & Louis Solomon-9th Edition 2. Tractions and Orthopaedic appliances: John D.M Stewart and Jeffrey P. Hallett Clinical manuals 1. Clinical Orthopaedic Examination: Ronald McRae 2. Physical Examination in Orthopedics: Lee Joon Kiong 3. Netter’s Evidence Based Clinical Examination in Orthopaedics Additional reference:

• Clinical Oriented Anatomy: Keith L Moore and Arthur F Dalley

Other additional information: Campbell’s operative surgey

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POSTING: ORTHOPAEDICS & TRAUMA I - UniSHAMS