General hand surgery talk2

The Birmingham Hand Centre

Hand Surgery for the

uninterested

Recent advances, practice, training and

accreditation


University Hospitals Birmingham NHS Foundation Trust

Mr Vaikunthan Rajaratnam

MBBS(Mal),AM(Mal),FRCS(Ed),FRCS(Glasg),FICS(USA),

MBA(USA),Dip Hand Surgery(Eur),

PG CertMedEd(Dundee),FHEA(UK)

Consultant Hand Surgeon Birmingham Hand Centre

University Hospital Birmingham NHS Foundation Trust

Royal Orthopaedic Hospital United Kingdom

www.handsurgerymanual.com



Birmingham Hand Centre

•UHB NHS FT

•QEHB

•ROH NHS FT



•Bones joints distal to radius

•Soft tissues

•Nerves & brachial plexus

•Vessel distal to the wrist

Defining Hand Surgery

Berretini anastomosis

Neuroanatomy [2009] 8: 15–19



•Sub speciality of orthopaedic and plastic

• Independent speciality – Norway, Sweden

and Singapore

•Orthopaedic, plastic surgery, vascular surgery

and microsurgery

Speciality



Fellowship 1 year

Core Specialty 6 years

CT 2 years

FY 2 years

Medical School 5 years

Training Ladder



Hand Sub Speciality 2 years

Hand Surgery 4 years

CT 2 years

FY 2 years


Proposed UK Training Ladder



Hand Sub Speciality Fellowship 1 year

Hand Surgery R3 - 6

Core Residency R1 & 2

Pre Reg HO (Intern)


Future Training Ladder



•Musculoskeletal disorders most common work

related ailment in Great Britain

•30% of WRMSD is Upper Limb

•4.7 million working days were lost in 2003/04

•estimated 18.3 days off in 1 year

• 2005/06 - 374 000 people in Great Britain

suffered from an WRMSULD

The Need



• Trauma

•Fractures

•Finger tips

•Burns

•Tendon/nerve/skin loss

•Elective

•Compressive Neuropathy

•Tumours

•Arthritis

•Deformities

•Congenital

Current Practice



•Moving from trauma to more elective

•Nerve entrapments

•WRMSD rather than industrial accidents

•Sports injuries

• Infections

•Assault/self inflicted

•DIY

Hand Surgery Practice



•Congenital

•Brachial Plexus and Peripheral Nerve

•Wrist

•Spastic Hand

•Microsurgical reconstruction

Sub Speciality





•Patience

•Fine motor coordination

• Inquiring mind

• Innovative

•Community orientated

•Self critical

•Strive for mastery

Qualities



Some examples





Hand Fractures




































28 , Male, R Hand dominant

















































Stake Holders

•Regulators

•Educators – University,

Professional bodies

•Patients/Community

•Funders of health



Needs analysis

•Challenges of

developing and rural

community

•Fit for purpose

•Delivering the service



Training vs Education



Political

•Regulation

•University vs

Professional bodies

•Credentialing

•Accreditation



Economy

•Time

•Service Commitments

•Teacher supply

•Funding



Social

•Adult learning styles

• Self paced

• On demand

• Experiential

• Work based

•Teaching styles



Technology

•Curriculum 2.0

•On line resources

•On line skill acquisition

•On line assessment

•Digital Video

•Tele medicine

•On line mentoring



Opportunity in developing community

•Patients

•Training Time

•Teachers

•Technology

•University backed

•Green field

•Demand for education

• Infrastructure



The Ideal Surgeon

•Wide Knowledge Based

•Holistic & Ethical

•Right Thinking

•Highly Skilled

• Innovative

•Surgical wisdom

•Teacher



What to teach?

•Surgical thinking

•Curriculum

•Surgical practice

• Integrating and applying

propositional knowledge

•Careful perception

•Opportunistic LEARNING

•DISCIPLINE

•Assessments –

summative and formative



Accreditation

•Quality

•Patient Safety

•Education

•Advancement

•Research

•Orthopaedics

•Plastics

•A&E

•General Surgeons

• Inclusive not exclusive



•www.handsurgerymanual.com

•http://handsurgery.moodlehub.com/

•http://www.bssh.ac.uk/

•http://www.sshs.org.sg

•http://www.fessh.com/

•http://www.ifssh.info/

Thank you

http://www.handsurgerymanual.com/

http://handsurgery.moodlehub.com/

http://www.bssh.ac.uk/

http://www.sshs.org.sg/

http://www.fessh.com/

http://www.ifssh.info/

Health & Medicine

General hand surgery talk2