programme guidelines for trainees

DOCTOR OF ORTHOPAEDICS and TRAUMATOLOGY

(DOKTOR PAKAR ORTOPEDIK dan TRAUMATOLOGI)

Dr. Ortho & Trauma (UKM)

PROGRAMME GUIDELINES FOR TRAINEES

DEPARTMENT OF ORTHOPAEDICS and TRAUMATOLOGY

FACULTY OF MEDICINE

UNIVERSITI KEBANGSAAN MALAYSIA

2018/19

CONTENTS

1. Doctor of Orthopaedics and Traumatology 1.1 Introduction ..............................................................................3 1.2 Course Objectives ....................................................................4 1.3 Course Structure and Format ...................................................4 - 5 1.4 Entry Requirements ..................................................................6 1.5 Rules, Regulations and Monitoring ...........................................7 - 13

1.5.1 Log Book ...........................................................................7 - 8 1.5.2 Case Book .........................................................................8 - 9 1.5.3 Dissertation .......................................................................10 1.5.4 Fees and Annual Leave ....................................................11 1.5.5 Postponement, Deferment, Exemption and Termination ...11 - 12 1.5.6 Short Courses ....................................................................12 1.5.7 Awards ...............................................................................12 -13

1.6 Guidelines to Examinations .........................................................13

2. Part I Examination .................................................................................14 - 28

2.1 Syllabus for Part I .......................................................................14 - 26 2.2 Examination Structure and Format .............................................26 - 27 2.3 Recommended Texts and References .......................................27 - 28

3. Part II Examination .................................................................................28 - 32 3.1 Syllabus for Part II .......................................................................28 - 30 3.2 Examination Structure and Format .............................................31 - 32 3.3 Recommended Texts and References ........................................32

4. Attachments .............................................................................................33 - 43 4.1 Attachment I: Trainee Assessment Form ......................................33 - 41 4.2 Attachment II: Cover Page of Log Book of Operations .................42 4.3 Attachment III: Inside Page of Log Book of Operations ................43 4.4 Attachment IV: Mahmood Merican Award .....................................44 4.5 Attachment V: Candidate Portfolio..................................................45 - 62

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1. DOCTOR OF ORTHOPAEDICS and TRAUMATOLOGY

1.1 INTRODUCTION

The Faculty of Medicine, Universiti Kebangsaan Malaysia (UKM) was the first in Malaysia to initiate the postgraduate programme in surgery: this began with Orthopaedic Surgery and General Surgery in June 1981. These were credited to the efforts of the late Prof QM Iqbal (Orthopaedic Surgery) and the late Prof Sir Harry Annanamuntodo (Dept of Surgery).

The postgraduate programme in Orthopaedic Surgery started with the intake of 3 orthopaedic trainee lecturers, all of whom graduated in 1986. The programme was in the form of a closed system, structured in-service training where trainees were taught and trained within the Department of Orthopaedics and Traumatology, UKM and the General Hospital, Kuala Lumpur (1981 – 1997) and later Hospital UKM (from 1998).

After discussions with the Ministry of Health (MOH) Malaysia, who became the major stakeholders, the Open System was started in June 1996 with an intake of 21 trainees (16 from MOH and the rest from Universities). The Open System involves trainees from MOH, where they were taught and trained in the initial 2 years in MOH hospitals accredited by the University (later by the Conjoint Board of Orthopaedics); the 3rd year in General Hospital, Kuala Lumpur (now known as Hospital Kuala Lumpur) and the 4th (final) year in the Department of Orthopaedics and Traumatology, UKM.

Demand for the need of orthopaedic surgeons from the MOH, Malaysia culminated in the largest intake in June 1997 of 23 trainees. In June 1995, the first female trainee from MOH entered the training programme and completed her training in May 1999.

The orthopaedic postgraduate programme then expanded further with the first intake of international trainees in June 2003 (1 from Sudan and another from Indonesia). As of June 2014, there were international trainees from 8 different countries. All international trainees are trained under the Closed System.

The year 2003 also witnessed the coming together of the orthopaedic departments of the 3 major universities in Malaysia [UKM, UM and USM (Universiti Sains Malaysia)] to form the Conjoint Board of Orthopaedics under the umbrella of the National Conjoint Board for postgraduate studies together with the Academy of Medicine and the MOH. The Part II examinations are now held conjointly involving the International Islamic University of Malaysia (IIUM) in 2007 and UNIMAS in 2014.

The Department of Orthopaedics and Traumatology, UKM has as of May 2014, produced 285 graduates, of whom 27 are women, in Orthopaedic Surgery in Malaysia. These orthopaedic surgeons, many of whom are now teachers and trainers in their own right as well as being sub-specialists in various fields of orthopaedic surgery, are now serving the country in the Ministry of Health, the Universities, the Ministry of Defence and private hospitals. Our international trainees are also working in their own countries as well as in Australia, England, Canada and United Arab Emirates.

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1.2 COURSE OBJECTIVES

At the end of the course, the trainee is expected to have acquired sufficient

knowledge and surgical skills to perform as a safe and competent orthopaedic

surgeon at the level of a first year orthopaedic surgeon in a general hospital.

1.3 COURSE STRUCTURE and FORMAT

This is a 4-year in-service training programme covering a staged progression of

learning processes of acquiring knowledge and surgical skills. Teaching as well

as examinations are conducted in English. Trainees shall not be allowed to

remain in the programme for more than 7 years.

In-service training means that the trainee performs all duties required as a

medical officer in a surgical discipline which include carrying out ward

responsibilities, running outpatient clinics, performing operations or assisting in

operating theatre (OT) sessions and carrying out on-call duties.

Year 1 Trainees are expected to learn and acquire adequate basic sciences knowledge (anatomy, physiology, pathology, microbiology and immunology, basic biomechanic and biomaterial) and principles of orthopaedic surgery to enable appropriate application of knowledge for decision-making in solving clinical problems including executing accurate general surgical procedures as well as procedures related to orthopaedics and traumatology.

Year 2 Trainees are expected to use proactive learning concept to acquire specific surgical skills and skills in decision-making in a specialty training.

Year 3 Trainees are expected to be involved in proactive guidance to consolidate their skills in decision-making to a level equivalent to that of a surgical registrar and serve to assist and perform certain surgical procedures under supervision.

Year 4 Trainees are expected to assume the function of a senior registrar with competency to lead a team to handle common problems including management of critically ill patients. Trainees are allowed to perform operative procedures under the supervision of a consultant.

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Course Programme

Year Course Content

1 Basic Sciences Basic Sciences General Orthopaedics Basic Trauma Rotation within specialties 12 weeks Rotation within specialties 12 weeks

2 General Orthopaedics Basic Trauma Basic Trauma Rotation within specialties 12 weeks

Rotation within specialties 12 weeks Elective (optional) : 3 – 6 months (in either 2nd or 3rd Year)

3 Rotation in Specialty Postings 3 months each

Advance Trauma Paediatric Orthopaedics Arthroplasty Rehabilitation Hand and Microsurgery Spine Orthopaedic Oncology Sports and Arthroscopy

Elective (optional) : 3 – 6 months (in either 2nd or 3rd Year)

4 Rotation in Specialty Postings 3 months each

Paediatric Orthopaedics Arthroplasty Rehabilitation Hand and Microsurgery Spine Advance Trauma Sports and Arthroscopy Orthopaedic Oncology

NOTE: From June 2014, all trainees including PGY4 will undergo a 3-monthly

rotation. There will be an end of posting assessment for all PGY3 and PGY4

trainees at the end of each rotation. The assessment will consist of a theory

and/or viva examination and a clinical assessment [short cases].

PGY3 trainees who fail 3 or more postings will not be promoted to Y4. PGY4 trainees who fail 2 postings will not be eligible to sit for the Part 2 examination and will be extended by another 6 months. PGY4 trainees are also required to teach medical students on clinical examination techniques. On completion of the course and passing the required examinations, the trainee

shall be conferred the degree of Doctor of Orthopaedics and Traumatology This is the highest professional and academic qualification awarded by

UKM in Orthopaedics and Traumatology. On obtaining the degree, the trainee is eligible for registration as a

specialist in Orthopaedics and Traumatology, after a period of 6 months

supervision under an orthopaedic surgeon. 5

1.4 ENTRY REQUIREMENTS

1.4.1 MALAYSIAN APPLICANTS

1. Graduates of medical schools in Malaysia with a credit in Bahasa Malaysia

at the Sijil Pelajaran Malaysia (SPM) level. 2. Malaysians who graduate from foreign universities (Commonwealth

countries) with MBBS, MBChB, MD or its equivalent from a recognized university by Malaysian Medical Council(MMC) with a credit in Bahasa Malaysia and English at the SPM level.

3. Registered with the Malaysian Medical Council. 4. Applicants must have at least 2 years clinical experience after

graduation from medical school.

1.4.2 INTERNATIONAL APPLICANTS

1. First medical degree is recognized by the Malaysian Medical Council (MMC).

2. Registration is required with the MMC.

3. Must have at least 3 years clinical experience after 1st

medical degree (1 year internship / housemanship and 2 years medical officer).

4. Must have a Medical Examination Report from a Malaysian medical practitioner.

5. Must have medical insurance. 6. Must be fluent in speaking and writing in English; must posses TOEFL

score of at least 750 or IELTS band 7. 7. Priority shall be given to trainees who posses scholarship / sponsorship. 8. Trainees without scholarship / sponsorship must submit a bank statement

of accounts and must possess at least USD 20,000.00. 9. A period of clinical attachment of 3 months followed by an interview to

determine eligibility is required before being accepted into the programme.

10. It is also mandatory for all foreign trainees to take the Malay language course organised by the university, which runs over period of 14 weeks. The course is conducted after office hours, and no one is exempted, including those from Indonesia, Brunei and Singapore.

METHOD OF APPLICATION

For Malaysian applicants, this shall be on application forms obtained from the

Unit Pusat Universiti (UPU) of the Ministry of Education following advertisement

in the Malaysian newspapers.

For international applicants, the application is through the university’s Centre for

Graduate Studies [Pusat Pengajian Siswazah (PSS)], available on the Internet at

www.ukm.my/pps

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1.5 RULES, REGULATIONS and MONITORING

Commencing June 2014:

1. Upon entering the postgraduate programme, supervisors from the Orthopedic Department where the trainee is posted shall be allotted to trainees.

2. Trainees exempted from Part I [those who have passed the BSE Orth from November 2014 or those with membership of the Royal College of Surgeons (MRCS) degree or its equivalent] and those who have passed the Part I shall discuss with their supervisors regarding the nature and process of the research project for the dissertation.

3. Trainees shall meet with their supervisors regularly to discuss and report on their progress with regard to continuous assessment, research project for dissertation and case write-ups.

4. Supervisors shall submit their reports to the Trainee Coordinator/Head,

Department of Orthopaedics and Traumatology, UKM before the end of each

semester (i.e. before 31 May and 30 Nov) on the progress of the trainees as

stated in (3) above (c.f. ATTACHMENT I: Trainee Assessment Form).

5. For trainees who come to HUKM in the 3rd year, internal supervisors shall be appointed to them to ensure continuity of supervision.

6. Dissertations and case write-ups should be accepted as satisfactory by supervisors before being submitted in bound form (hard cover) 5 months before the Final (Part II) Examinations:

6.1 End of December for trainees sitting the May examination

6.2 End of June for trainees sitting the November examination.

NOTE:

Trainees who fail to submit their assessment forms or whose assessment

reports are poor may not be allowed to proceed to the next semester / year.

Trainees who fail to comply with article (6) above shall not be allowed to sit for

the CBO (Conjoint Board of Orthopaedics) Final (Part II) examinations.

As of June 2009, promotion to 2nd Year is only after passing Part I exams. The

trainee must complete the course within a minimum of 4 years and a maximum

of 7 years.

1.5.1 LOG BOOK

LOG BOOK of OPERATIONS:

1. The log book is important as one of the means of assessing the trainee’s progress in surgical exposure / experience.

2. Trainees are to required to enter surgical operations that they have assisted / performed under supervision / performed on their own into the log book.

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3. As a standardisation procedure, the format of entry is as in the log book provided; no other format is to be used (cf ATTACHMENT II and ATTACHMENT III).

4. Trainees are advised to group their log books under various categories e.g. Trauma, General Orthopaedics, Spine, Paediatric Elective Orthopaedics, Arthroplasty, LLRS (Limb Lengthening and Reconstructive Surgery), Orthopaedic Oncology, Hand and Microsurgery and Sports Orthopaedics.

5. It is advised that these entries are made at the end of each surgical operation i.e. entry into the book is to be done sequentially and not in retrospect.

6. The book must be available for inspection on request by the supervisor. 7. It is advised that a digital copy is also made and kept by the trainee as a

back-up. 8. The hard copy of the log book must be safely-kept and maintained by the

trainee to be shown to his/her supervisor on a regular basis and also for perusal by the Department of Orthopaedics UKM towards the end of the final year.

9. Any deficiencies therein must be rectified to the satisfaction of the supervisor and the Department before allowing the trainee to proceed for the CBO Part II examination.

10. The logbook shall be shown to the external examiner before the CBO Part II examination and may be used in the viva examination as a platform to question the trainee.

1.5.2 CASE BOOK

1. The case book must be approved by the supervisor and the department

before it can be formally accepted as a complete work enabling the

trainee to be eligible to sit for the CBO Part II examination.

2. Trainees are required to write 10 case write-ups which are to be

submitted to the Department in bound form 5 months before the CBO Part

II examinations (i.e. end of December and end of June).

3. Four copies are required (one each for the Department, the Faculty, the

University and the trainee).

4. Case write-ups should be 3 on Trauma and one each on Paediatric

Orthopaedics, Spine, Arthroplasty, Hand and Microsurgery, Sports

Orthopaedics, Oncology and Rehabilitation.

5. Case write-ups should be on interesting, unique, unusual or rare cases

and should be good enough to be to be submitted to a journal for

publication.

6. Since the trainee is training to be an orthopaedic surgeon, the case write-

up should involve an operative procedure.

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7. The general outline of the case write-up should be as follows:

i. Patient identification data

ii. Concise history and physical findings

iii. Diagnosis and differential diagnoses, if any

iv. Relevant investigations

v. An account of the operation performed

vi. Postoperative management and follow-up

vii. Discussion

viii. Conclusion or Summary

ix. References

8. The case book shall to be shown to the external examiner for comments before

the CBO Part II examination and may be used in the viva examination as a

platform to question the trainee.

9. The guideline / schedule of writing the case write-ups are as follows:

MINIMUM NO. of CASE WRITE-UPS

CATEGORY to be COMPLETED (cumulative)

During 1st Year 2

During 2nd Year 2

During 3rd Year 3

During 4th Year 3

TOTAL 10

No. of published Case Write-Ups Total no. of Case Write-Ups to

be submitted

1 9

2 8

3 7

4 or more 6

* Please take note that the total number of Case Write-Ups to be submitted (as above) is inclusive of

the published Case Write-Ups

New Policy Commencing 1.6.2009:

1. Failure to submit the required no. of case write-ups at the end of each study year

may lead to a 6-month extension in the course.

NOTE: Failure to comply results in failure to progress to the subsequent year of study or non-

permission to sit for the final examinations.

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1.5.3 DISSERTATION / THESIS

1. The dissertation / thesis must be approved by the supervisor and the

Department before it can be formally accepted as a complete work enabling

the trainee to be eligible to sit for the CBO Part II examination.

2. The dissertation / thesis shall be shown to the external examiner for

comments before the CBO Part II examination and may be used in the viva

examination as a platform to question the trainee.

3. The general outline of the dissertation / thesis should be as follows:

i. Written in comprehensible language either in Malay or

English. ii. Preceded with a title and a synopsis. iii. Should be on 210 x 280mm paper, double-spaced type

written with 40mm margin on all sides. iv. The covers should be of hard cloth-covered cardboard.

4. The dissertation/thesis should be in the form of a manuscript ready to be

submitted for publication and must have relevant histograms, tables, charts, figures, photographs or schematic representation and should broadly follow the format below:

i. Abstract not exceeding 300 words ii. Introduction iii. Materials and methods iv. Results v. Discussion vi. Conclusion vii. Acknowledgement viii. References.

5. The trainee is required to present his dissertation at the department

upon completion and a soft copy of the dissertation has to be submitted

to the dept.

6. The trainee is required to submit the abstract of the dissertation / thesis to

the Malaysian Orthopaedic Association (MOA) for presentation in the MOA

Annual Scientific Meeting. The trainee is encouraged to vie for the Mahmood

Merican Award for best oral presentation.

7. The trainee is also required to submit the manuscript of the dissertation

to a local or international journal for publication.

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1.5.4 FEES and ANNUAL LEAVE

1.5.4.1 FEES

Course fees as Semester I (June) 2018/19:

NOTE: Fees may vary with time.

1.5.4.2 ANNUAL LEAVE

1. Trainees’ application for leave is subject to approval by the department. Leave is allowed up to a maximum of 2 weeks per semester (including maternity / sick leave).

2. Only under special circumstances will leave exceeding this period is considered and will be determined on a case-by-case basis by the department.

1.5.5 POSTPONEMENT, DEFERMENT/SUSPENSION and TERMINATION

1. Postponement of registration into the programme (6 months or 1 year) is

allowed but with valid reasons and with prior notification to the

University/Department at least 1 month before the date of registration.

2. A trainee who is already in the course may apply for suspension/deferment of

1 or 2 semesters but with valid reasons and with prior notification to the

University/Department at least 1 month before the date of the examination.

3. Both the above situations must be approved by the Head of Department and

then by the Secretariat of Postgraduate Studies (SPS) in the Faculty.

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1.5.5.A Termination of Candidature

The trainee may decide voluntarily to terminate his tenure in the course.

Otherwise, termination is as follows:

[UKM Act (Graduate Studies) 15/11/2000]

i. Infringement of Act and Regulations as stipulated by UKM. ii. Violation of civil law and order. iii. Problems with attitude and behaviour. iv. Poor progress or deterioration in study. v. Mental or physical disability. vi. Indulgence in subversive activities. vii. Contacting examiners to procure examination results.

1.5.6 SHORT COURSES and SKILLS WORKSHOPS

Trainees, at the discretion of the Department, are encouraged to attend short

courses and skills workshops during their 4 years in the programme. These are

held not only UKM Medical Centre (UKMMC) but also in other Universities and

MOH hospitals in the country. Examples of such courses are

i. Intensive courses (for Part I as well as for Part II)

ii. SPSS course

iii. Research Week Course

iv. Basic AO Course

v. Survival Skills Course

vi. Foot and Ankle Course

vii. Hand and Microsurgery Course

viii. Basic Arthroplasty Course

ix. Paediatric Orthopaedic Course etc. NOTE: Course fees (for MOH trainees) - JPA provides RM500.00 subsidy annually.

1.5.7 AWARDS

1.5.7.1 Dr Mohd Noor Manukaran Book Prize

For each semester year, a deserving final year trainee shall be awarded the

above prize in the form of RM500.00 cash. This deserving trainee will be

chosen from amongst all the final year UKM trainees who sat for both the

November and subsequent May CBO Part II examinations. The nominee

shall be the one with the highest score in examination marks and with a

satisfactory record of academic, social and community activities as well as

being of good character and a team player. This prize may not be awarded

if there is no eligible nominee for a particular semester year. This award to

the trainee shall be announced during the University Convocation.

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1.5.7.2 Professor N Subramanian Award

For each semester year, the Malaysian Orthopaedic Association shall award

a deserving final year trainee with the above prize in the form of a gold

medallion. This deserving trainee will be chosen from amongst all the final

year trainees from the universities who sat for both the November and

subsequent May CBO Part II examinations.

1.6 GUIDELINES TO EXAMINATIONS

1.6.1 PART I

1. The Part I examinations are held every 6 months (May and November). 2. The CBO Part 1 examination will commence in November 2014. 3. Trainees who have obtained the BSE Orthopaedics from November 2014 or

MRCS are exempted from the Orthopaedics Specialty Committee (OSC) Part I examination.

4. Trainees must register for the examination, pay all required fees and meet all criteria for sitting for the examination as stipulated by the department and the University (cf Continuous Assessments, Log Book records and Case write-ups).

5. Trainees who run foul of the above conditions may be barred from sitting for the examination; this forfeiture is counted as one (1) attempt.

6. Trainees may sit for the examination for a maximum of 4 attempts. 7. If still unsuccessful after 4 attempts, the trainee may apply to sit for a 5th

attempt; however, sitting for the examination a 5th time is not automatic and depends on the support of the department which primarily bases its decision on whether the trainee has shown progressive improvement in the previous examination results. Failure in the examination after the 5th attempt eliminates the trainee from the course.

8. The trainee may only proceed to the 2nd year of the course when he/she has passed the Part I examination and has completed the 1st year of the course.

1.6.2 PART II

1. The Part II examination is a conjoint examination between UKM, UM, USM, IIUM, UNIMAS,UPM,MOA and AM under the auspices of the Conjoint Board of Orthopaedics.

2. It is held every 6 months (May and November). 3. Trainees must have passed the Part I examination or its equivalent and must

have gone through the 4-year in-service training before being eligible to sit for the Part II examination.

4. Trainees must register for the examination, pay all required fees and meet all criteria for sitting for the examination as stipulated by the department and the University (cf Continuous Assessments, Log Book, Case Book and Dissertation).

5. Trainees who run foul of the above conditions may be barred from sitting for the examination; this forfeiture is counted as one (1) attempt.

6. There is no limit in the number of attempts in the part 2 examination within the 7-year training period.

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2. PART I EXAMINATION

Commencing November 2014:

2.1 SYLLABUS FOR CBO PART I

2.1.1 APPLIED ANATOMY

i. Upper Limb

i. Bones, joints, muscles, vessels, lymphatic drainage and nerves

ii. Hand, forearm, arm, shoulder, pectoral girdle, breast, axillary and scapular region

iii. The anatomy of extensile exposures of the bones and joints of the upper limb

iv. The anatomy related to surgical management of breast carcinoma

v. The anatomy of brachial plexus injuries and its clinical signs

vi. The anatomy of the rotator cuff injuries

vii. The anatomy of entrapment neuropathies

ii. Lower Limb

i. Bones, joints, muscles, vessels, lymphatic drainage and nerves

ii. Foot, lower leg, thigh, gluteal region

iii. The anatomy of surgical approaches to the hip joint, knee joint and ankle joint

iv. The anatomy of vascular anastomosis of the lower limb for trauma and atherosclerosis

v. The anatomy of the lower limb as it relates to external fixation

vi. The anatomy of the knee injuries

iii. Head and Neck

i. Scalp, skull, cerebrum, cerebellum, mid brain, brain stem

ii. Face, eyes, ears, nose

iii. Mouth, pharynx, larynx

iv. Neck

v. Bones, joints, muscles, vessels, nerves and cranial nerves. vi. Anatomy related to skull fractures and complications

vii. Anatomy of cerebral circulation

viii. Anatomy of facial palsies

ix. Anatomy of ocular palsies

x. Anatomy of facial fractures and complications

xi. Anatomy of the larynx as it related to deglutition, respiration, and intubations

xii. Anatomy of thyroidectomy and complications

xiii. Anatomy of the movement of the neck

xiv. Anatomy as it relates to cervical spine injuries

xv. Anatomy of lymphatic drainage of head and neck malignancies 14

iv. Thorax

i. Chest wall, ribs, diaphragm

ii. Airways and lungs

iii. Heart and great vessels

iv. Mediastinum

v. Anatomy of thoracic surgical approaches

vi. Anatomy of congenital malformations

vii. The circulatory anatomy of the heart and lungs related to

bypass surgery

v. Abdomen

i. Abdominal wall and peritoneum

ii. Liver, spleen, intestines, pancreas, kidneys and ureters

iii. Aorta and vessels

iv. Anatomy of inguinal ligament and hernia repair v. Anatomy of common surgical procedures: cholecystectomy,

gastrectomy, appendicectomy, colectomy, bowel resection, nephrectomy.

vi. Anatomy of congenital malformations

vii. Abdominal vascular anatomy

vi. Pelvis

i. Bones, joints, muscle

nerves, vessels

ii. Urinary and reproductive organs

iii. Congenital malformations

iv. Anatomy of urolithiasis and

surgical treatment

vii. Spine

i. Vertebral column

ii. Spinal cord and nerves

iii. Anatomy of traumatic paraplegia

viii. Tissues and Structures

i. Skin, mucous membrane, subcutaneous tissue, deep fascia

ii. Muscles, tendons, ligaments, joints, cartilage

iii. Peripheral nerves, vessels and lymphatic

iv. Anatomy of common pedicle and free flaps

v. Anatomy of surgical skin incisions

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ix. Surface Anatomy

i. Basic Embryology of limbs and spine Notochord, mesoderm,

endoderm, limb formation, totipontential, pluripotential ii. Comparative Anatomy of the Child - Epiphyseal plates,

proportions, growth, osteology of the child

x. Anatomy of Regional Anaesthesia

i. Ankle block, digital block, wrist block, flexor tendon block,

axillary block, femoral n. block

2.1.2 PHYSIOLOGY

Greater emphasis is placed on understanding of pathophysiology and treatment of common surgical problems related to organs failure or dysfunction.

i. Cellular Physiology

i. Cellular function and signalling

ii. The genome and its expression

iii. Basic actions of cellular poisons

iv. Cell division

ii. Body Fluid and Electrolytes Physiology

i. Distribution and control of body fluid

ii. Osmotic pressure

iii. Oncotic pressure

iv. Fluid and electrolyte management in the postoperative period

v. Fluid resuscitation of the traumatised patient vi. Fluid resuscitation in the diabetic patient vii. Sodium homeostasis

viii. Potassium homeostasis

iii. Acid Base Balance

i. Buffer systems

ii. Respiratory regulation iii. Renal regulation iv. Interpretation of arterial blood gases

v. Changes with pathology: Vomiting, renal failure, hepatic failure, respiratory failure

vi. Changes during surgery and trauma

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iv. Respiratory System

i. Normal respiratory mechanism

ii. Lung volumes

iii. Functional residual capacity

iv. Compliances

v. Changes in gaseous composition

vi. Gaseous exchanges

vii. Oxygen delivery and transport viii. Carbon dioxide transport ix. Central/peripheral control of respiration

x. Cyanosis

xi. Hypoxia and hypoxemia

xii. Changes during anaesthesia

xiii. Surgery to the chest wall xiv. Pneumathorax

xv. Flail chest xvi. Respiratory failure

xvii. Adult respiratory distress syndrome (ARDS) xviii. Post operative hypoxemia

v. Cardiovascular System

i. Mechanism of circulation: Cardiac circle and output

ii. Determinants of myocardial performance

iii. Central venous pressure and Pulmonary artery wedge pressure

iv. Venous return

v. Valsava manoeuvre

vi. Control of blood pressure

vii. Shock

viii. Coronary blood flow

ix. Cerebral blood flow

x. Hepatic blood flow

xi. Renal blood flow

xii. Pulmonary circulation

xiii. Autoregulation

xiv. Myocardial action potentials

xv. Myocardial muscle properties

xvi. Myocardial failure

vi. Renal System

i. Renal functions

ii. Counter current multiplier system

iii. Glomerular filtration rate

iv. Creatinine and Renal clearance

v. Excretion of bicarbonate 17

vi. Excretion of urea vii. Endocrines functions of kidney viii. Chronic renal failure

vii. Blood and Hematologic System

i. Composition of blood and role of its components

ii. Coagulation pathway

iii. Bleeding

iv. Anaemia

v. Compatibility testing of blood

vi. The immune system

vii. Abnormal conditions of blood-haemophilia, sickle cell, Caisson disease

viii. Alimentary System

i. Swallowing

ii. Digestion

iii. Gastric secretion

iv. Bile

v. Control of digestion

vi. Small bowel function

vii. Large bowel function

viii. Functions of liver

ix. Carbohydrate metabolism

x. Fat metabolism

xi. Protein metabolism

xii. Iron metabolism

xiii. Vitamins

xiv. Malabsorption syndrome

xv. Post gastrectomy syndrome

ix. Nervous System

i. Resting membrane potential ii. Propagation of action potential iii. Blood brain barrier iv. Effect of anaesthesia agents

v. Pain and its management vi. Nerve repair vii. Autonomic nervous system

viii. Glasgow coma scale

ix. Brain stem death

x. Changes with intracranial pressure

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x. Muscle and Neuromuscular Junctions

i. Skeletal and smooth muscle

ii. Physiology of neuromuscular transmission

iii. Muscle contraction

iv. Muscle spindles

xi. Endocrine System

i. Hormones

ii. Insulin and regulation of blood glucose level

iii. Thyroid hormones and its regulation

iv. Calcium metabolism v. Adrenal gland

vi. Hypothalamic- pituitary- adrenal axis

xii. Miscellaneous Topics

i. Metabolism response to trauma

ii. Nutrition of surgical patients

iii. Heat Exhaustion

2.1.3 PATHOLOGY The Normal Cell

i. Cellular Injury and Tissue Response to Injury

i. Acute and chronic inflammation ii. Healing and repair

ii. Fluid and Hemodynamic Derangements

i. Haemorrhage, haemostasis, and thromboembolism

ii. Oedema, hyperaemia and congestion

iii. Shock

iv. Infarction Embolism

iii. Immune System

i. The immune system

ii. Hypersensitivity reactions

iii. Transplant rejections

iv. Autoimmune diseases

v. Immunodeficiency disorders

vi. Amyloidosis

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iv. Infections

i. Infectious agents

ii. Host barriers to infectious agents

iii. Pathogenesis of infectious diseases

iv. Diagnosis of infectious diseases

v. Neoplasia

i. Nomenclature

ii. Carcinogenesis and Molecular Basis of Cancer

iii. Characteristics of benign and malignant tumours iv. Biology of tumour growth

v. Clinical features and laboratory diagnosis of cancer

vi. Genetic and Pediatric Disorders

i. Mutations

ii. Mendelian disorders

iii. Cytogenetic disorders

iv. Congenital anomalies

v. Paediatric disorders

vi. Diagnosis of genetic disorders

vii. Environmental Diseases

i. Environmental Pollution ii. Tobacco iii. Chemical agents iv. Physical agents v. Ionizing radiation vi. Nutritional disorders

The following topics are common conditions encountered in clinical practice and

students are encouraged to read them for further understanding of pathological

disorders.

viii. Respiratory System

i. Obstructive and restrictive lung diseases

ii. Pulmonary infections

iii. Tumours

iv. Disorders of the upper respiratory tract

20

ix. Cardiovascular System

i. Ischaemic heart disease

ii. Heart failure

iii. Valvular heart diseases

iv. Congenital heart diseases

x. Vascular Disorders

i. Normal vessels and response to injury

ii. Atherosclerosis

iii. Hypertensive

iv. Aneurysms and dissection

v. Vasculitis

vi. Venous diseases

xi. Gastrointestinal Disorders

i. Disorders of the oesophagus

ii. Gastritis, ulcers and tumours iii. Tumours of the small and large intestines

iv. Disease of the appendix

xii. Liver and Biliary Tract

i. Jaundice and hepatitis

ii. Cirrhosis and liver failure

iii. Gallbladder diseases

xiii. Pancreas

i. Exocrine pancreatitis

ii. Endocrine pancreas

xiv. Renal System

i. Manifestations of renal diseases

ii. Glomerular disorders

iii. Diseases of the tubules and the interstitium

iv. Acute and chronic renal failure

v. Hypertensive renal disease

vi. Urinary outflow obstruction

xv. Musculoskeletal System

i. Fractures

ii. Bone infections

iii. Bone tumours

iv. Metabolic bone disorders

v. Diseases of the joints

vi. Soft tissue tumours

vii. Myopathies

21

xvi. Haematopoietic System

i. Red cell disorders

ii. White cell disorders

iii. Bleeding disorders

xvii. Endocrine System

i. Pituitary

ii. Thyroid

iii. Parathyroid

iv. Pancreas

v. Adrenal

xviii. The Breast

i. Tumours of the breast

ii. The male breast

iii. Fibrocystic changes

xix. The Male Genitalia

i. Scrotum, testis and epidydimia

ii. Prostatic disorders

iii. Sexually transmitted diseases

xx. Diseases of Ageing

2.1.4 PRINCIPLES OF SURGERY Students are expected to understand basic processes and their applications in surgery.

i. Perioperative Management

i. Metabolic and Nutritional Support ii. Fluid & electrolyte management iii. Nutrition in the surgical patient iv. General surgical complications v. Respiratory failure vi. Acute renal failure vii. Systemic inflammatory response syndrome (SIRS) viii. Multiple organ dysfunction syndrome (MODS)

22

ii. Surgical Techniques and Technology

i. Surgical Wounds

ii. Classification of surgical wounds

iii. Principles of wound management iv. Pathophysiology of wound healing

v. Principles of safe surgery

vi. Incisions and wound closure

vii. Diathermy, laser, principles of cryosurgery

viii. Sutures and ligature materials

ix. Basic surgical instruments

x. Tourniquets in the Operating Theatre

xi. Indications for tourniquet use

xii. Tourniquet application

xiii. Effects and complications of tourniquets

iii. Good Clinical Practice and Legal Issues

i. Evidence Based Surgical Practice

ii. Decision making in surgery

iii. Statistics

iv. Principles of research and clinical trials

v. Management Aspects of Surgical Practice

vi. Clinical audit

vii. Clinical governance

viii. Medico-legal aspects of surgery

iv. Clinical Microbiology

i. Surgical Microbiology

ii. Sources of surgical infection

iii. Principles of asepsis and antisepsis

iv. Modern Antibiotic Usage

v. Commonly used antibiotics

vi. Preoperative prophylaxis

vii. Antibiotic resistance

viii. Surgery in Hepatitis and HIV Carriers

ix. Blood-borne viruses

x. Universal precautions

xi. Surgical precautions

xii. Immunization

23

v. Emergency Medicine and Trauma

i. Pathophysiology of Trauma

ii. Shock and cardiovascular physiology iii. Metabolic response to injury iv. Adult respiratory distress syndrome (ARDS) v. Traumatic Oedema and Compartment Syndrome

vi. Diagnosis and treatment of Environmental Emergencies

vii. Hypothermia

viii. Heat exhaustion

ix. Management of a radiation incident

vi. Principles of Oncology

i. Epidemiology of Common Cancers ii. Common cancers iii. Screening Programmes iv. Clinico-Pathological Staging of Cancer v. Principles of Cancer Treatment vi. The role of surgery – block dissections vii. Radiotherapy viii. Chemotherapy ix. Hormone therapy x. Immunotherapy xi. Palliative Care xii. The palliative care team xiii. Pain and other symptoms

2.1.5 BIOMATERIALS & BIOMECHANICS

2.1.5.1 BIOMATERIALS

Definition: Characteristics: Biocompatibility, Bioinert

i. Types of Material

i. Metal ii. Stainless Steel iii. Cobalt Chrome Alloys iv. Titanium v. Non-metal vi. Polymers such as polyethylene, hydroxylapatite vii. Ceramics such as alumina viii. Composites

24

ii. Mechanism Of Material Failure

i. Corrosion

ii. Fatigue

iii. Wear

iii. Material Properties

i. Load and Forces

ii. Stress and Strain

iii. Stress and Strain Curves (Yield point, Ultimate strength, Breaking point, Plastic deformation and Young’s Modulus)

iv. Strength

v. Elasticity

vi. Plasticity

vii. Ductility

viii. Toughness

ix. Brittleness

x. Viscoelastic

2.1.5.2 BIOMECHANICS

i. Kinetic And Kinematic

i. Newton’s Law: First, Second And Third ii. Forces And Moment (Torque) iii. Work And Energy iv. Friction v. Biomechanics Of Musculoskeletal Tissues vi. Bone vii. Mechanical Properties viii. Mechanism Of Fractures ix. Strain Theory On Fracture Healing x. Ligament And Tendons xi. Mechanical Properties xii. Mechanical Properties Of Synthetic Replacements xiii. Natural And Artificla Joints xiv. Hip Biomechanics xv. Knee Biomechanics xvi. Spine Biomechanics xvii. Biomechanics Of Fracture Fixation xviii. Tissue Response To Implants xix. Properties Of Screws, Plates, Nail xx. Plates Vs Nail (In Terms Of Rigidity And Function) xxi. Concept Of Load Sharing And Sparing xxii. Factors Of Internal Fixation Failure xxiii. External Fixation xxiv. Factors Enhancing Stability xxv. Hip Biomechanics

25

xxvi. An understanding of the lever arms, muscles and body weight

forces that produce the joint reaction force in both normal and

abnormal hips

xxvii. An understanding of the application of these principles to

replacement arthroplasty

xxviii. Knowledge of the biocompatibility and mechanical properties of

materials in common use in total hip arthroplasty

xxix. Knee Biomechanics

xxx. The mechanics of the patello-femoral mechanism

xxxi. Axis of Knee Joints

xxxii. The medial and lateral weight-bearing joints and their inter-

relationship

xxxiii. The cruciate and collateral ligaments and other ligamentous and

muscular supports

xxxiv. Menisci and articular cartilage

xxxv. Spine Biomechanics

xxxvi. Basic knowledge of the biomechanics of the cervical and

lumbosacral spines

xxxvii. An understanding of the biomechanics of spinal instability as

applied to trauma, tumour, infection and spondylolysis/listhesis

xxxviii. A knowledge of the basic mechanics of spinal instrumentation

2.2 EXAMINATION STRUCTURE and FORMAT

CBO Part I

2.2.1 SECTION A – SAQ

1. This section consists of 100 Single Answer Question (SAQs) 2. Timing for each SAQ: 1.8 minutes per question. The total of time for this paper

is 100 x 1.8 minutes = 180 minutes (3 hours) 3. The distribution of the questions is as stated in the table below

NO CORE SUBJECTS (MCQ) NO OF

QUESTIONS

1 Surgical Anatomy 30

2 Surgical Physiology 30

3 Surgical Microbiology/ Pathology 20

4 Surgical Principles 15

5 Surgical Pharmacology/ Biomechanics/ Biomaterials 5

26

4. The total marks for Section A examination is 100 marks. The

passing mark for this section is 50 marks or 50% 5. Only those trainees who passed Section A will be allowed to proceed to

Section B.

2.2.2 SECTION B - OSCE AND VIVA VOCES

2.2.2.1 OSCE

1. OSCE examination consists of 10 OSCE stations. 2. The OSCE examination will include the following assessment of the

basic daily clinical surgical skills: i. Basic surgical skills e.g. suturing, dressing, aseptic technique

etc. ii. Three dimensional spatial orientation iii. Instrument identification iv. Communication skills

3. The total marks for OSCE examination is 100 marks. The passing mark for this section will be 70 marks or 70%.

2.2.2.2 VIVA Examination

1. This section consists of 3 viva voces i.e. Table 1 - Anatomy, Table 2

Physiology and Table 3 – Pathology, Principle of Surgery,

Biomechanics and Biomaterials 2. The total marks for all the three viva voces is 300 marks (100 marks

each). 3. The overall passing marks for the three viva voces are 150 marks

or 50%.

Special Rules: 40 or less in any section is unredeemable fail

41-49 in one section is a redeemable fail 41-49

in 2 sections is an unredeemable fail

The successful trainee will need to pass all three components

(i.e. SAQ, OSCE and Viva Voce) in order to pass the examination.

2.3 RECOMMENDED TEXTS and REFERENCES

1. Chummy S Sinnatamby. Last's Anatomy: Regional and Applied. 11th

Edition. Churchill Livingstone Elselvier. 2. Susan Standring. Gray's anatomy: the anatomical basis of clinical

practice. 39th Edition. Churchill Livingstone Elselvier. 3. Frank H Netter. Netter's Concise Atlas of Orthopaedic Anatomy. Sounders. 4. Richard S Snell. Clinical Anatomy

27

5. Barret KE, Barman SM, Boitano S, Brooks HL, Ganong’s Review of

Medical Physiology 23rd Edition. McGraw-Hill, 2009. 6. Guyton AC, Hall JE. Textbook of Medical Physiology 12th Edition. Saunders. 2011 7. Vinay Kumar, Abul K Abbas, Nelson Fauto, Mitchell. Robbins Basic Pathology. 8. Vinay Kumar, Abul K Abbas, Nelson Fauto, Jon Aster. 2010. Robbins &

Cotran Pathology Basic of Disease. 8th Edition. 9. Andrew Kingsnorth, Aljafri Majid. 2001. Principles of Surgical Practice.

Greenwich Medical Media Limited. 10. RM Kirk. Basic Surgical Techniques. 6th Edition. CL Elsevier. 11. Robert Steele, Alfred Cuschieri. Essential Surgical Practice: Higher Surgical

Training in General Practice. 4th Edition. Hodder Arnold Publication. 12. F. Brunicardi, Dana Andersen. 2010. Schwartz’s Principles of Surgery. 9th Edition.

13. Mark D Miller. Review of Orthopaedics. Saunders Elsevier. 14. Orthoteers Orthopaedic Resource (http:www.orthoteers.org) 15. Mark D Miller, Jennifer Hart, John MacKnight. Essential Orthopaedics.

Saunders Elsevier. 16. David J Warwick, Louis Solomon, Selvadurai Nayagam. Apley’s

system of orthopaedic and fractures. 8th Edition

3. PART II EXAMINATION

3.1 SYLLABUS FOR PART II 3.1.1 ORTHOPAEDICS AND TRAUMATOLOGY

Students are expected to gain clinical experiences in surgery of a wide variety

of orthopaedics and trauma cases commonly encountered in Malaysia. For

monitoring purposes, these experiences are recorded in the logbook

i. General Principles

i. Principles of fractures and dislocation

ii. Principles of open fractures treatment

iii. Multilply injured patients

iv. Principles of internal and external fixations

v. Healing of musculoskeletal tissues under different osteosynthesis

techniques

vi. Pathological fractures and stress fractures

vii. Complications of fracture and dislocation

ii. Upper Extremity

i. Fractures and dislocations of the shoulder joint ii. Injuries of the sternoclavicular joint iii. Injuries of the acromioclavicular joint

28

iv. Fractures of the clavicle

v. Fractures of the scapula

vi. Fractures of the humerus

vii. Fractures and dislocations of the elbow

viii. Fractures of the radius and ulna

ix. Fractures and dislocations of the wrist

x. Fractures and dislocations of the hand

iii. Spine

i. Fractures and dislocations of the cervical spine

ii. Fracture and dislocations of the thoracic spine

iii. Fractures and dislocations of the thoraco-lumbar spine

iv. Fractures of the sacrum

iv. Lower Extremity

i. Fractures of the pelvic ring and acetabulum

ii. Fractures and dislocations of the hip

iii. Fractures of the femur (proximal, diaphysis and distal)

iv. Peri- and intra-articular fractures of the knee

v. Knee dislocations

vi. Fractures and dislocations of the patella

vii. Fractures of the tibia and fibula

viii. Fractures and dislocations of the ankle

ix. Fractures and dislocations of the foot y.

v. Paediatric Orthopaedics

i. Embryology

ii. Chromosomal and teratologic disorders

iii. Birth injuries

iv. Cerebral palsy

v. Neuromuscular disorders

vi. Skeletal dysplasia

vii. Metabolic bone diseases

viii. Haemopoietic diseases

ix. Paediatric spine diseases and trauma

x. Hip diseases and trauma

xi. Knee disorders and trauma

xii. Foot deformities and trauma

xiii. Hand deformities and trauma

xiv. Other deformities and trauma of the upper limbs

vi. General Orthopaedics

i. Orthopaedic infections

29

ii. Osteoarthritis

iii. Osteonecrosis

iv. Osteoporosis and other metabolic bone diseases

v. Biomechanics related to bone, joint, tendon and ligament

vii. Adult Reconstruction Surgery/Arthroplasty

i. Shoulder

ii. Elbow

iii. Wrist and hand

iv. Hip

v. Knee

vi. Ankle

vii. Foot

viii. Principles of Illizarov /Taylor-Spatial external fixators in LLRS

viii. Sports Medicine and Arthroscopic Surgery

i. Shoulder and elbow

ii. Wrist and hand

iii. Hip

iv. Knee

v. Foot and ankle ix. Foot and Ankle

x. Hand and Reconstructive Microsurgery

xi. Spinal Surgery

xii. Musculoskeletal Oncology

xiii. Orthopaedic Rehabilitation

xiv. Imaging techniques in orthopaedics

i. General ii. Bone Scans and PET scans

iii. CT Scans including 3D Reconstruction images

iv. MRI v. Ultrasound

vi. Interventional radiology

vii. Nuclear medicine

30

3.2 EXAMINATION STRUCTURE and FORMAT

The CBO Part II examination consists of 3 Sections:

1. Section I – Theory 2. Section II – Clinicals 3. Section III – Viva and OSCE.

Trainees MUST PASS ALL THREE (3) Sections to pass the examination.

SECTION SECTION SECTION I II III

(THEORY) (VIVA and OSCE) (CLINICALS)

1. PAPER I 1. VIVA I 1. LONG CASES [from May - 3 long essays + 1 short - Principles of Orthopaedic 2015]

notes Surgery - 2 patients per trainee - 2 hrs - 30 min - examiners sit in

- 100 marks [50%] - 50 marks attendance throughout

2. PAPER II 2. VIVA II - 15 min clerking &

physical - 3 long essays + 1 short - Operative Orthopaedics examination

notes - 30 min - 15 min discussion

- 2 hrs - 50 marks (30 min per case)

- 100 marks [50%] 3. OSCE (VIVA III) * - 100 marks

3. MCQs 2. SHORT CASES

- 20 questions

- 60 questions (single-answer - 2 hrs - 3 patients per trainee type) - 200 marks - 10 min each patient

- 2 hrs (TOTAL 30 min) - 100 marks - 100 marks total

TOTAL 200 marks TOTAL 300 marks TOTAL 200 marks

PASS MARK 100/200 PASS MARK 150/300 ** PASS MARK 100/200

* O S C E (Objective Structured Clinical Examination) is in the form of a Powerpoint

Slide Presentation consisting of questions under the following categories:

i. Radiology ii. Pathology iii. Implants and Biomechanics iv. Orthotics, Prosthetics and Rehabilitation v. Clinical

** Special requirement for the Clinical Component:

In both the Long Case and Short Cases, the trainee must obtain a minimum of 40% i.e. if a trainee obtains less than 40% in either the Long or Short cases, he fails the entire examination (unredeemable fail).

31

VIVA VOCE

Viva I: Principles of Orthopaedic Surgery Viva II: Operative Orthopaedics

NOTE: Only those trainees who pass the Theory Section are allowed to

proceed with the Clinicals and Viva voce examination. From May 2015, there will be a change in the format of the long case

examination. Each trainee will be tested on 2 long cases of 30 mins each

i.e. 15 mins for clerking and examination and 15 mins for discussion

3.3 RECOMMENDED TEXTS and REFERENCES (Please refer to the most current issue of the references listed)

1. Operative Hand Surgery Volumes I and II. Edited by Green DP. 5th Ed,

Churchill Livingston, London, 2007. 2. Campbell’s Operative Orthopaedics Volumes I, II, III, IV, V, VI. Edited by

Canale ST, Beaty JH. 11th Ed, Mosby-Elsevier, Philadelphia, 2008. 3. AO Principles of Fractures Management Vol. I and Vol. II. Reudi TP, Murphy

WM. Stuggard, New York, Thieme, 2007. 4. AO Manual of Fracture Management: Hand and Wrist. Edited by Jupiter

JB, Ring DC. 1st Ed. Thieme, Sluggard-New York, 2005. 5. Rockwood and Green’s Fractures in Adults. Edited by Bushels RW, Heckman JD

and Court-Brown C. 6th

Ed. Lippincott, Williams and Wilkins, Philadelphia, 2006. 6. Rockwood and Green’s Fractures in Children. Edited by Rockwood CD and

Wilkins. 6th Ed. Lippincott, William and Wilkins, Philadelphia, 2006. 7. Skeletal Trauma : Basic Sciences, Management and Reconstruction

Volumes I and II. Edited by Browner B, Jupiter J, Levine A, Trafton P. 4th Ed, Saunders-Elsevier, Philadelphia, 2009.

8. Skeletal Trauma : In Children. Edited by Green NE, Kwiatkowski MF.

4th Ed, Saunders-Elsevier, Philadelphia, 2009. 9. Orthopaedics Surgical Approaches. Edited by Miller MD, Chakra AB, Hurwitz S,

Mishawka WM, Sheen FH. 1st Ed. Lippincott, Saunders-Elsevier, Philadelphia, 2008.

10. Tachdjian’s Paediatric Orthopaedic Volumes I, II and III. Edited by Herring J.

4th Ed, Saunders, Philadelphia 2008.

32

ATTACHMENT I

TRAINEE ASSESSMENT FORM

DEPARTMENT OF ORTHOPAEDIC AND TRAUMATOLOGY FAKULTI PERUBATAN


TRAINEE ASSESSMENT FORM TRAINEE : TRAINEE YEAR : 1 2 3 4 SPECIALTY / CONSULTANT : HOSPITAL : ATTACHMENT ATTACHMENT START DATE : END DATE :

1. This is an official confidential document when completed. The original is the

property of the Department of Orthopaedic and Traumatology (DOT). Before

the end of each semester (i.e. before 31 May and 30 Nov), the trainee shall

submit this form to the consultant for completion.

2. On completion of the form signed by both the trainer and trainee, the consultant

in charge will send the completed from to the DOT, Fakulti Perubatan, UKM.

3. Trainees shall not start their new posting without the completion and

submission of this form to DOT.

TRAINER SIGNATURE: DATE :

AND NAME IN BLOCK CAPITALS

TRAINEE SIGNATURE : DATE :

Trainees who disagree with the contents of this report may appeal to the Head, Department of Orthopaedic and

Traumatology, Fakulti Perubatan, Universiti Kebangsaan Malaysia, Cheras, Kuala Lumpur

33

1 2 3 4 5

POOR DEFICIENT SATISFACTORY GOOD EXCELLENT

CLINICAL SKILL

KNOWLEDGE

TRAINEE ACTIVITIES

ATTITUDE

SOCIAL INTERACTION

TRAINER’S COMMENTS : Please summarise the trainee’s character and overall performance drawing

attention to any outstanding features or alternatively ways in which

the trainee failed to meet your expectations during this rotation. Do

you foresee any specific difficulties / gaps in training the trainee

will have in completing his / her training? 34

ATTACHMENT I


DEPARTMENT OF ORTHOPAEDIC AND TRAUMATOLOGY FAKULTI PERUBATAN


TRAINEE ASSESSMENT FORM TRAINEE : TRAINEE YEAR : 3 4 POSTING: CONSULTANT : ATTACHMENT ATTACHMENT START DATE : END DATE :

1. This is an official confidential document when completed. The original is the

property of the Department of Orthopaedic and Traumatology (DOT) at the end

of the rotation, the trainee must submit this form to the consultant for completion.

2. On completion of the form signed by both the trainer and trainee, the consultant

in charge will send the completed from to the DOT, Fakulti Perubatan, UKM.

3. Trainees shall not start their new posting without the completion and

submission of this form to DOT.

TRAINEE SIGNATURE : DATE :

Trainees who disagree with the contents of this report may appeal to the Head, Department of Orthopaedic and

Traumatology, Fakulti Perubatan, Universiti Kebangsaan Malaysia, Cheras, Kuala Lumpur

35

TRAINER SIGNATURE: DATE:

AND NAME IN BLOCK CAPITALS

OVERALL ASSESSMENT (please refer to guide on next page) :

CLINICAL SKILL

KNOWLEDGE

TRAINEE ACTIVITIES

ATTITUDE

SOCIAL INTERACTION

1 2 3 4 5

POOR DEFICIENT SATISFACTORY GOOD EXCELLENT

END ROTATION ASSESSMENT :

COMPONENT GRADE

THEORY

CLINICAL

A B C D E

100 80 60 35 20

EXCELLENT GOOD PASS FAIL POOR FAIL

OVERALL PASS / FAIL

TRAINER’S COMMENTS : Please summarise the trainee’s character and overall performance drawing

attention to any outstanding features or alternatively ways in which the trainee failed to meet your expectations

during this rotation. Do you foresee any specific difficulties / gaps in training the trainee will have in completing his

/ her training?

36

ATTACHMENT I


UKM ORTHOPAEDIC DEPARTMENT

TRAINEE PEER-REVIEW FORM

The aim of this peer review form is to assess the professional behavior and attitude of

the trainees in Year 1,2 and 3 by the Year 4 trainees. Attendance at teaching sessions,

working with team members and time management will be assessed as follows:

A. Name of trainee/year of training :

B. Period of review (date) :

C. Subspecialty team :

Poor Fair Good Very Good Excellent

Attendance

Teamwork

Punctuality

Name of PGY4 Reviewer Name of Head of Unit

Signature Signature

Date Date

Heads of units will give feedback to their trainees in areas of concern

37

GUIDE

A. CLINICAL SKILLS 1 2 3 4 5 Poor Deficient Satisfactory Good Excellent

History taking Incomplete, Poorly recorded Complete, systematic Precise, detail, can spot rarity

Physical exam Lacks basic skills. Elicit correct signs. Recognizes most significant Thorough, accurate. Know and elicits specialist findings signs.

Investigations Inappropriate, random, Appropriate. Able to interpret results Appropriate to D diagnosis. Excellent at Inability to interpret tests. interpretation

Diagnosis Fails to interpret and synthesis symptoms, Competent clinician. Orderly approach to D Outstanding diagnostician. Excellent clinical signs and investigations diagnosis memory

Judgement Unreliable. Fails to take appropriate action. Reliable. Competent. Asks for advice Outstanding clinician who is aware of his/her Under or over reacts to emergencies appropriately limits

Operative skill Clumsy, rough with tissues. Poor surgical Competent. Good technique. Master technician.

technique.

After care Uninterested. Conscientious. Excellent on wards. Notices problems early. Fails to notice complications and act Aware of complications. Reliable in outpatients Outstanding in follow up outpatients. appropriately

B. KNOWLEDGE 1 2 3 4 5

Poor Deficient Satisfactory Good Excellent Basic Science Uninterested, does not read. Fails to apply Adequate knowledge and relates this Outstanding knowledge and understanding of the

basic science knowledge to clinical problems satisfactorily to patients care basic science. Widely read.

Clinical Poorly read. Lacks knowledge to constructs a Satisfactory knowledge. May fail to spot rarity Outstanding knowledge. Can be relied on to spot D diagnosis. Fails to learn from experience but learns from experience the rarity. Widely read.

C. TRAINEE ACTIVITIES 1 2 3 4 5 Poor Deficient Satisfactory Good Excellent

Teaching Uninterested in teaching. Contributes minimal Competent and conscientious in teaching Excellent enthusiastic teacher. Can inspire in educating junior trainees. others

Lecturing style Avoids if possible. Poor style, poorly delivered, Reasonably delivered. Competent but lacking Excellently delivered. Dynamic logical and clear. boring spark Can hold an audience

Case presentation Poor in history, signs, diagnosis and discussion Competent. History and signs. Good deduction Excellent presentation and discussion Presentations No interest. Does it badly. Fails to get across a Keen in presentations Well illustrated and well Fully researched. Original ideas. Answers

message delivered questions lucidly

Publications No interest. Devoid of ideas. Poor English Keen, tries hard but lacking originality. An excellent CV. Many original ideas which are Reasonable English translated into published articles.

Research ability and Has Neither inclination or ideas. Unable to Keen but needs considerable direction. Flair for original research with ability to carry it audit carry out directed projects. Not interested in Reasonable: statistic and research methods. our independently. Utilizes effective research

audit. methods.

D. ATTITUDE

Overall Grade 1 2 3 4 5 Poor Deficient Satisfactory Good Excellent

Reliability Unreliable. Forgets to do things to the possible Dependable. Needs no reminders. Highly conscientious. Anticipates problems detriment of patients. Conscientious in patient care

Self Motivation No inclination to organize work. Needs to be Organize without supervision. Looks for Constantly proactive, always prepared to accept pushed constantly opportunities to learn additional opportunities to advance.

Leadership Very limited. Switches people off. Colleagues Competent but lacks inspiration. Gives clear Outstanding team leader with exceptional ability and other staff confused by his/her instructions. to motivate others.

instruction.

Administration Cannot be bothered. Always behind with Conscientious. Can be confidently left to deal Excellent at routine administration. He has a good letters and summaries. In a permanent with letters, summaries, waiting lists etc. grasp of hospital management and politics. muddle.

E. SOCIAL INTERACTION

Overall Grade 1 2 3 4 5 Poor Deficient Satisfactory Good Excellent

a. Colleagues Fails to get on with seniors, contemporaries or Good rapport. Willing to help in a crisis. Ever willing to help personally Able to defuse juniors. Undermine them. Refuse to help. Trusted, easy to work with team’s problems. Excellent colleagues

b. Patients Increases patients’ anxieties. Rude. Not Caring. Ally patients’ fears. Listens and Inspires confidence. Excellent rapport and wanted by patients. Poor listener and explains well. Trusted by patient communicator. Patients delighted to be looked communicator after by him / her

c. Other staff Treats them with disdain. Generates as Round and professional Approachable. Treats Inspires enthusiasm. Exceptional communication opposed to solving problems. Rude others with respect and is respected in return skills.

38

ATTACHMENT I THESIS PROGRESS REPORT

JABATAN ORTOPEDIK & TRAUMATOLOGI, FAKULTI PERUBATAN UNIVERSITI KEBANGSAAN MALAYSIA

39

Y

E

A

R

2

Comments by supervisor Signature

0-6 months

Title

Literature review

6-9 months Proposal preparation

and presentation

9-12 months Submission to ethical

committee

End of year Ethical committee ap-

proval


40

Y

E

A

R

3


0-6 months

Data collection

6-12 months

Data collection

Manuscript preparation

End of year

Data collection

completion


41

Y

E

A

R

4


0-3 months

Statistical analysis

3-6 months Manuscript preparation

End of year

Submission of

manuscript on 31st Dec

ATTACHMENT II

UNIVERSITI KEBANGSAAN MALAYSIA DOCTOR OF ORTHOPAEDICS and TRAUMATOLOGY (Dr. Ortho & Trauma), UKM

UNIVERSITI MALAYA MASTER OF ORTHOPAEDIC SURGERY, UM UNIVERSITI SAINS MALAYSIA MASTERS OF MEDICINE (ORTHOPAEDICS), USM INTERNATIONAL ISLAMIC UNIVERSITY OF MALAYSIA MASTERS OF SURGERY(ORTHOPAEDICS), IIUM UNIVERSITI PUTRA MALAYSIA MASTER OF SURGERY (ORTHOPAEDICS), UPM

CONJOINT BOARD ORTHOPAEDICS

LOG BOOK NAME : INSTITUTION : STUDENT NO. :

42

ATTACHMENT III

HIP

ARTHROPLASTY (HEMI)

Patient’s Name RN Date Remarks Observe Assisting Perform Outcome

ARTHROPLASTY (TOTAL)


MICELLANEOUS


ARTHROPLASTY (RESURFACING)


ARTHROPLASTY (REVISION)


ARTHROTOMY


EXTERNAL FIXATION


ARTHROCENTESIS


ARTHRODESIS


43

ATTACHMENT IV

MAHMOOD MERICAN AWARD

This is an annual award for the best original scientific or clinical paper submitted

by young trainees in orthopaedic surgery in Malaysia, and submitted for

presentation at the Annual Scientific meeting of the Malaysian Orthopaedic

Association (MOA). This award was initiated in 1997 to encourage a high

standard of research and scientific presentations among the young trainees. The prize A cash prize of RM1,000.00 donated by Dato' Dr Mahmood Merican. Regulations 1. The competition is open to all registered trainees currently working in

Malaysian hospitals. 2. The work may take the form of clinical trials, surveys, retrospective studies,

laboratory experiments or any other form of unpublished original work. 3. The bulk of the work which is submitted must be performed by the author

himself/herself even though he/she may have done the work in conjunction with other doctors or agencies either locally or overseas. However, the work must be carried out in Malaysia.

4. The author himself/herself should present the paper at the Annual Scientific Meeting of

the Malaysian Orthopaedic Association if the paper is short-listed for the award.

Procedure 1. An abstract of the paper must be submitted to the Malaysian

Orthopaedic Association. 2. The closing date for submission will be announced 3 months before the MOA

Annual general meeting and annual scientific meeting.

44

Photo.

ATTACHMENT V

Doctor of Orthopaedics and

Traumatology

(Dr. Orth. & Trauma)

Universiti Kebangsaan Malaysia

Profile of Candidate:

Name :

Matric Number :

Address :

Contact Number :

E-mail :

45

YEAR 1

Place of Attachment :

Hospital :

Supervisor :

E-mail :

Contact No. :

46

Progress of Candidate:

Year 1 (session ____/____)

Rotation:

Date: Supervisor/Signature:

1. ______________ _________________

2. ______________ _________________

3. ______________ _________________

4. ______________ _________________

Part 1 Examination

Signature:

Date : Result: Pass/Fail Supervisor: Candidate:__________

Date: Result: Pass/Fail Supervisor: Candidate:__________



47

Case Write Up

Case No: 1

Title :

Date Submitted: Assessor: Supervisor:

Candidate:

Date resubmitted: Assessor: Supervisor:

Candidate:

1.

2.

Date Accepted: Assessor: Supervisor:

Candidate:

Case No: 2

Title :


Candidate:


Candidate:

1.

2.


Candidate:

48

End of year Assesment/Interview:

Date of Assesment:

Report/Comment:

Outcome:

1. Remain in Year 1

Reason:

Signature: ___________________

Head, Candidate:

Dept of Orthopaedic and Traumatology

2. Promoted to Year 2

Signature: ___________________

Head, Candidate:


49

YEAR 2


Hospital :

Supervisor :

E-mail :

Contact No. :

50



Rotation:


1. ______________ _________________

2. ______________ _________________

3. ______________ _________________

4. ______________ _________________

Elective:

Place: ______________ __________________

Dissertation:

Name of Supervisor/Co-supervisor:

Topic:

1. Literature Review

Date:

Outcome/Plan:

Signature:

Supervisor: Candidate:

2. Proposal

Date:

Outcome/Plan:

Signature:


51

3. Ethics Committe Submission

Date:

Outcome/Plan:

Signature:


4. Date Approved by EC: (please attached letter of approval) _________________

5. Progress of Work

Date:

Outcome/Plan:

Signature:

Supervisor Candidate:

____________________________________________________________

Date:

Outcome/Plan:

Signature:


____________________________________________________________

Date:

Outcome/Plan:

Signature:


_____________________________________________________________

Date:

Outcome/Plan:

Signature:


52

Case Write Up

Case No: 3

Title :


Candidate:


Candidate:

1.

2.


Candidate:

1.

Case No: 4

Title :


Candidate:


Candidate:

1.

2.


Candidate:

1.

53

YEAR 3


Hospital :

Supervisor :

E-mail :

Contact No. :

54

Early of year 3 Assesment/Interview:

Date of Assesment:

Report/Comment:

Outcome:

1. Extension for 6 months

Reason:

Signature: ___________________

Head, Candidate:


2. No extension.

Signature: ___________________

Head, Candidate:


55



Rotation:


1. ______________ _________________

2. ______________ _________________

3. ______________ _________________

4. ______________ _________________

Elective:

Place: ______________ __________________

Dissertation:


Topic:

5. Progress of Work

Date:

Outcome/Plan:

Signature:


____________________________________________________________

Date:

Outcome/Plan:

Signature:


____________________________________________________________

Date:

Outcome/Plan:

Signature:


______________________________________________________________

56

Case Write Up

Case No: 5

Title :


Candidate:


Candidate:

1.

2.


Candidate:

1.

Case No: 6

Title :


Candidate:


Candidate:

1.

2.


Candidate:

1.

Case No: 7

Title :


Candidate:


Candidate:

1.

2.


Candidate:

1.

57

End of year 3 Assesment/Interview:

Date of Assesment:

Report/Comment:

Outcome:

3. Remain in Year 3( Extension 6 months)

Reason:

Signature: ___________________

Head, Candidate:


4. Promoted to Year 4

Signature: ___________________

Head, Candidate:


58

YEAR 4


Hospital :

Supervisor :

E-mail :

Contact No. :

59



Rotation:


1. ______________ _________________

2. ______________ _________________

3. ______________ _________________

4. ______________ _________________

5. _______________ _________________

6. _______________ _________________

Dissertation:


Topic:

7. Progress of Work

Date:

Outcome/Plan:

Signature:


____________________________________________________________

Date:

Outcome/Plan:

Signature:


Date

Outcome/Plan:

Signature:


____________________________________________________________

60

Date:

Outcome/Plan:

Signature:


Case Write Up

Case No: 8

Title :


Candidate:


Candidate:

1.

2.


Candidate:

1.

Case No: 9

Title :


Candidate:


Candidate:

1.

2.


Candidate:

1.

Case No: 10

Title :


Candidate:


Candidate:

1.

2.


Candidate:

1.

61

Assesment/Interview for eligibility to sit for Part 2:

Date of Assesment:

Report/Comment:

Outcome:

1. Remain in Year 4(extension for 6 months)

Reason:

Signature: ___________________

Head, Candidate:


2. Allow to sit for Part 2 Examination:

Signature: ___________________

Head, Candidate:


62

More Information : UKM Medical Centre Tel: +603-91455087 Fax: +603-91456640 Email: [email protected] Web: www.ppukm.ukm.my Centre for Academic Management Universiti Kebangsaan Malaysia 43600 UKM Bangi, Selangor Darul Ehsan, Malaysia Tel : +603-8911 8389 / 8468 Fax: +603-8911 8470 www.facebook.com/Pusat Pengurusan Akademik UKM Website: www.ukm.my/akademik / www.facebook.com/Pusat Pengurusan Akademik UKM Email: akad[at]ukm[dot]edu[dot]my

http://www.ppukm.ukm.my/

http://www.ukm.my/akademik%20/

programme guidelines for trainees

Documents