JTO - March 2017
Volume 5 Issue 1
From the Editor
The concentrated and rapid acquisition of skills and knowledge at the start of a career is not a new concept. Commencing higher surgical training remains a daunting prospect for most trainees. The article on “Boot Camps” [cover image] explores how they get new registrars up and running, able to cope with the sudden increase in responsibility and support their incorporation into the orthopaedic community within the training programme. The BOA and BOTA are supporting their rollout across the UK (page 30).
People learn in different ways and new technology makes the learning environment richer and more accessible. The BOA podcast project that was championed by the late Andy Sprowson has come to fruition with regular updates on fascinating and controversial topics (page 6).
Commissioning of elective orthopaedic services is a subject that is reaching white heat. As finances get ever tighter, the criteria for referral for surgery begin to look more like overt rationing. Balanced and transparent evidence-based commissioning would protect patients who risk unnecessary suffering, progressive immobility and dependency and worse outcomes. Ian Winson argues that enlightened shared decision-making should support both patients and surgeons in his Presidential piece on page 2.
The fall in the number of Medical Students and Foundation Doctors exposed to our specialty is having a negative impact on patient care and limiting career options for those who may never consider a future in surgery. The development of “physician associates” in the extended surgical team is now gaining momentum and suitable graduates will be able to enter a specific post-graduate degree course. We will need to play a part in curriculum development and regulation, but also embrace them and see them as a positive influence on training for the whole team (page 18).
Another hot topic is audit data. Some excellent advice is given on what to do if your practice is singled out at being at variance. The robust systems in place around the NJR data and the limitation of publication to unit level outcomes should support confidence in the newer registries that will cover other sub-specialties (page 22).
Finally, I would like to give thanks to our Guest Editor, Duncan Tennent, who has commissioned some excellent articles on various aspects of shoulder surgery that should appeal to both the specialist and generalist.
Phil Turner - BOA Vice President Elect
Reference Lists
How I ... Manage First Time Traumatic Anterior Shoulder Dislocation
References
1. K. KrØner, T. Lind and J. Jensen. “The epidemiology of shoulder dislocations,” Arch Orthop Trauma Surg., vol.108, pp. 288–90, 1989.
2. M. A. Zacchilli and B.D. Owens. “Epidemiology of shoulder dislocations presenting to emergency departments in the United States.,” J Bone Joint Surg (Am)., vol. 92, pp. 542–549, 2010.
3. P. Brownson, O. Donaldson, M. Fox, J. L. Rees, A. Rangan, A. Jaggi, G. Tytherleigh-Strong, J. McBernie, M. Thomas and R. Kulkarni. “BESS/BOA Patient Care Pathways: Traumatic anterior shoulder instability.,” Shoulder & Elbow., vol. 7, pp. 132-138, 2015.
4. C. M. Robinson, J. Howes, H. Murdoch, E. Will and C. Graham. “Functional outcome and risk of recurrent instability after primary traumatic anterior shoulder dislocation in young patients.,” J Bone Joint Surg (Am)., vol. 88, pp. 2326–36, 2006.
5. N. Mall, A. Lee, J. Chahal, S. Sheman, A. Romeo, N. Verma and B. Cole. “An evidence-based examination of the epidemiology and outcomes of traumatic rotator cuff tears.,” Arthroscopy, vol. 29, pp. 366–76, 2013.
6. W.A. Wallace and M. Hellier. “Improving radiographs of the injured shoulder.,” Radiography, vol. 49, pp. 229–33, 1983.
7. W.H. Paterson, T.W. Throckmorton, M. Koester, F.M. Azar and J. E. Kuhn. “Position and duration of immobilization after primary anterior shoulder dislocation: a systematic review and meta-analysis of the literature.,” J Bone Joint Surg (Am), vol. 92, pp. 2924-33, 2010.
8. S. Liavaag, J. I. Brox, A. H. Pripp, M. Enger, L. A. Soldal and S. Svenningsen. “Immobilization in external rotation after primary shoulder dislocation did not reduce the risk of recurrence: a randomised controlled trial.,” J Bone Joint Surg (Am), vol. 93, pp. 897-904, 2011.
9. M. M. Gombera and J. K. Sekiya. “Rotator cuff tear and glenohumeral instability: a systematic review.,” Clin Orthop Relat Res, vol 472, pp. 2448-56, 2014.
10. T. R. Lenters, A. K. Franta, F. M. Wolf, S. S. Leopold and F. A. Matsen. “Arthroscopic compared with open repairs for recurrent anterior shoulder instability. A systematic review and meta-analysis of the literature.,” J Bone Joint Surg (Am), vol. 89, pp. 244-54, 2007.
11. S. S. Burkhart, J. F. De Beer, J. R. Barth, T. Cresswell, C. Roberts and D. P. Richards. “Results of modified Latarjet reconstruction in patients with anteroinferior instability and significant bone loss.,” Arthroscopy, vol. 23, pp. 103341, 2007.
12. D. G. Kline and D. H. Kim. “Axillary nerve repair in 99 patients with 101 stretch injuries.,” J Neurosurg., vol. 99, pp. 630-6, 2003.
13. C. M. Robinson, N. Shur, T. Sharpe, A. Ray and I.R. Murray. “Injuries associated with traumatic anterior glenohumeral dislocations.,” J Bone Joint Surg (Am)., vol. 94, pp. 18-26.
ST3 'Boot Camp' Training in Trauma and Orthopaedic Surgery
References
1. Briggs T. A National Review of Adult Elective Orthopaedic Services in England. 2015 Mar 1;Available from: https://www.boa.ac.uk/wp-content/uploads/2015/03/GIRFT-National-Report-Mar15..pdf
2. Fitzgerald JEF, Caesar BC. The European Working Time Directive: a practical review for surgical trainees. Int J Surg. 2012;10(8):399–403.
3. Simpson C, Cottam H, Fitzgerald JE, et al. The European working time directive has a negative impact on surgical training in the UK. Surgeon. 2011 Feb;9(1):56–57.
4. Khan Y, Palmer J, Briggs T. ST3 Recruitment in Trauma and Orthopaedics: what are the characteristics of successful candidates? BMJ Careers [Internet]. 2014 Feb 12;Available from: http://careers.bmj.com/careers/advice/view-article.html?id=20016442
5. El-Harasis MA, Shalhoub J, Maruthappu M, et al. The Shape of Training review: broadening the non-clinical curriculum is essential for good patient care. Postgrad Med J. 2014 Dec;90(1070):673–674.
6. Cook DA, Hatala R, Brydges R, et al. Technology-enhanced simulation for health professions education: a systematic review and meta-analysis. JAMA. 2011 Sep 7;306(9):978–988.
7. Heskin L, Mansour E, Lane B, et al. The impact of a surgical boot camp on early acquisition of technical and nontechnical skills by novice surgical trainees. Am. J. Surg. 2015 Sep;210(3):570–577.
8. Selden NR, Anderson VC, McCartney S, et al. Society of Neurological Surgeons boot camp courses: knowledge retention and relevance of hands-on learning after 6 months of postgraduate year 1 training. J. Neurosurg. 2013 Sep;119(3):796–802.
9. Blackmore C, Austin J, Lopushinsky SR, et al. Effects of Postgraduate Medical Education “Boot Camps” on Clinical Skills, Knowledge, and Confidence: A Meta-Analysis. J Grad Med Educ. 2014 Dec;6(4):643–652.
10. Tortolani PJ, Moatz BW, Parks BG, et al. Cadaver training module for teaching thoracic pedicle screw placement to residents. Orthopedics. 2013 Sep;36(9):e1128–33.
11. McCarthy AD, Moody L, Waterworth AR, et al. Passive haptics in a knee arthroscopy simulator: is it valid for core skills training? Clinical Orthopaedics and Related Research. 2006 Jan;442:13–20.
12. Aïm F, Lonjon G, Hannouche D, et al. Effectiveness of Virtual Reality Training in Orthopaedic Surgery. Arthroscopy. 2016 Jan;32(1):224–232.
13. Howells NR, Gill HS, Carr AJ, et al. Transferring simulated arthroscopic skills to the operating theatre: a randomised blinded study. J Bone Joint Surg (Br). 2008 Apr;90(4):494–499.
14. Kneebone RL, Nestel D, Vincent C, et al. Complexity, risk and simulation in learning procedural skills. Med Educ. 2007 Aug;41(8):808–814.
15. Mazzocco K, Petitti DB, Fong KT, et al. Surgical team behaviors and patient outcomes. Am. J. Surg. 2009 May;197(5):678–685.
16. Yule S, Flin R, Paterson-Brown S, et al. Development of a rating system for surgeons' non-technical skills. Med Educ. 2006 Nov;40(11):1098–1104.
17. Jones M, Howells N, Mitchell S, et al. Human-factors training for surgical trainees. Clin Teach. 2014 Jun;11(3):165–169.