ORTHOPEDIC & TRAUMA SURGERY - DUBAI RESIDENCY TRAINING PROGRAM - DEPARTMENT OF MEDICAL EDUCATION
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DEPARTMENT OF MEDICAL EDUCATION
ACADEMIC AFFAIRS CENTRE
ORTHOPEDIC & TRAUMA SURGERY
A Guide to the Six Year Specialty Training Program
DUBAI RESIDENCY TRAINING PROGRAM
Last Updated :: November 2016
Contents Introduction ..........................................................................................................................................1 Program Administrators .........................................................................................................................2 Competencies .......................................................................................................................................3 Program Structure & Rotations ...............................................................................................................6 Education Modules ................................................................................................................................6 Clinical Research ..................................................................................................................................7 Resident Job Descriptions ......................................................................................................................9 Assessments & Supervision .................................................................................................................. 10 Syllabus .............................................................................................................................................. 11 Operative Procedures .......................................................................................................................... 16 Recommended Readings & References ................................................................................................20
Introduction
This document outlines the Orthopedic & Trauma Training Program under the Dubai Residency Training Program at Dubai Health
Authority (DHA), Dubai - UAE
Details included descriptions of Residents’ Entry requirements, knowledge & skills content, rotations, assessment methods, accreditation
and certification for training in Orthopedic & Trauma and elaborated appendices.
It is expected that trainees will acquire the training and experience essential for independent practice in Orthopedic & Trauma.
The Program
The Program is in accordance with the German regulations for Specialist Training of the Berlin Chamber of Physicians
(Weiterbildungsordnung Orthopädie und Unfallchirurgie der Ärztekammer Berlin).
After satisfactory completion of the six year program, graduates will be German Board certified in the specialty of Orthopedic & Trauma
Surgery.
Residents, by way of enrolling and training under the program, attain membership to the Berlin Chamber of Physicians. The Medical
Association of Berlin (ÄKB) authorizes them to take the Board Examination (Facharzt), subject to observance of program regulations
and specific training criteria being met during the Residents’ training in Dubai.
The Berlin Chamber of Physicians however will not guarantee the Residents’ success in the Examination, which is deemed a personal
obligation of the candidate.
After having successfully achieved the Facharzt Certification, trainees are required to resume work at DHA in the capacity of Specialist
(SSR) in Orthopedics and Trauma Surgery.
The mission of the program is to develop and train Orthopedic & Trauma Surgeons who are competent to practice in the field of
Orthopedic & Trauma independently. The main goal is to prepare the Residents for a career in Orthopedic & Trauma and post Residency
Fellowship Training.
General Objectives
The training program (Facharzt) will provide a broad educational experience in recognition and treatment of surgical musculoskeletal
disorders including trauma. Upon completion of training, the graduate is expected to be a competent Specialist in Orthopedic &
Trauma, capable of independent practice.
During training, the resident will acquire thorough knowledge of the theoretical basis of Orthopedic & Trauma, including its foundations
in the basic medical sciences and exposure to research activities. The graduate will be able to access and apply relevant knowledge
and skills to clinical practice and provide effective consultation services with respect to patient care, education and medico-legal issues.
The resident in Orthopedic & Trauma must acquire:
- Knowledge and expertise in clinical and operative management of diseases of the musculoskeletal system, trauma, emergency &
critical care and ambulatory patient care.
- Mastery of surgical skills of Orthopedic & Trauma, soft tissue surgery and a basic training in general surgery
- Effective clinical judgment & decision making in dealing with Orthopedic & Trauma surgical problems based on sound surgical
principles.
- The knowledge, skills and attitudes relating to gender, culture and ethnicity pertinent to Orthopedic and Trauma Surgery and
incorporate these in research activities.
Specific Objectives
The resident in Orthopedic & Trauma is required to attain sufficient training and knowledge of:
- Basic science related to Orthopedic & Trauma including relevant clinical applied anatomy.
- The pathophysiology, differential diagnosis and management of orthopedic diseases, including trauma.
- Appropriate skills in diagnostic procedures
- Clinical examinations, laboratory investigation, performance of ultrasound, Focused Assessment with Sonography for Trauma
(FAST), musculoskeletal Ultrasound, Understanding of X-ray, CT and MRI
- Indications for appropriate operative and conservative treatment as well as the use of pharmacological agents and contrast media
in surgical practice
- Clinical and operative competence in both emergency and elective settings
- Intensive care, management of shock and resuscitation
- Local and regional anesthesia.
- Enteral and Parenteral nutrition
- Specific Requirements for Day Case Surgery.
- Quality control measures for surgical procedures.
- Palliative care and quality of life issues.
- Medical ethics, health economics, medico-legal matters, risk management, medical statistics, information technology and health
service management
- Clinical audits & Research methods.
- Teaching and training others in Trauma and Orthopedic Surgery
- Making oral presentations at professional meetings effectively
DRTP :: Orthopedic & Trauma Surgery Program Manual 2016 Page 1 | 20Program Administrators
Our Program Administrators in partnership with an expert team of supervisors & faculty steer the Orthopedic & Trauma Surgery
Program towards the zenith of quality Residency training education offered in Dubai.
Under their expert care, your training journey is guaranteed to be an enlightening experience.
Dr. Bilal El Yafawi
PROGRAM DIRECTOR
Consultant - Rashid Hospital
Dr. Khalid Abdulla Mohammed Alawadi Dr. Malallah Hassan Ali
PROGRAM CO-DIRECTOR PROGRAM CO-DIRECTOR
Consultant - Rashid Hospital Consultant - RH
DRTP :: Orthopedic & Trauma Surgery Program Manual 2016 Page 2 | 20Competencies
MEDICAL EXPERT / CLINICAL DECISION-MAKER
Ortho Trauma Specialists will possess a defined body of knowledge and procedural skills, which are used to collect and interpret data,
including X-ray images, CT, MRI & ultrasound, make appropriate clinical decisions and carry out diagnostic and therapeutic procedures
within the boundaries of their discipline and expertise. Their care is characterized by up-to-date (and whenever possible evidence-
based), ethical, cost-effective clinical practice, effectively communicating with patients, other health care providers & the community.
The role of medical expert/clinical decision maker is central to the function of the specialist clinician.
The Resident is required to attain sufficient knowledge, diagnostic expertise, judgment and skills in Orthopedic & Trauma surgical
techniques including polytrauma management and minimal access surgery to manage patients with regard to:
- Degenerative disease - Orthopedic trauma with neurovascular compromise
- Trauma/Critical illness including Emergency/ Intensive care - Interventional imaging technologies
- Surgical infections and inflammatory diseases - Diagnostic laboratory procedures & their interpretation
- Skin and soft tissue injuries - Multidisciplinary care
- Principles of thoracic surgery - Pathology of injuries
- Biomechanics
General Requirements
- Demonstrate diagnostic and therapeutic skills for ethical and effective patient care
- Access and apply relevant information and therapeutic options to clinical practice
- Demonstrate effective consultation services with respect to patient care, education and legal options.
- Recognize personal limits of expertise
Specific Requirements
Knowledge - Basic Science and Anatomy
Demonstrate knowledge of the following: - Pertinent biomechanical principles of the musculoskeletal
- The anatomy growth and development of the axial and system, including joint reconstruction
appendicular skeleton, embryology, histology, physiology and - Pathology and treatment of soft tissue and bone neoplasia
biochemistry of bone, cartilage, tendon, ligament, muscle, nerve related to the musculoskeletal system, Pharmacology including
and skin principles of metabolism, action and toxicity of drugs
- Fracture / Wound healing, thermal and chemical injuries commonly used in orthopedics, as well as variations associated
- Metabolic bone disease, congenital abnormalities, inflammatory with age, gender and ethnicity; be familiar with drug
conditions and arthritis, infections related to the musculoskeletal interactions and recognize and manage adverse drug reactions.
system
Knowledge - Technical
Demonstrate knowledge of surgical options that allow appropriate - Use of surgical equipment: understand its use, recognize its limits
operative selection, including: and apply to tissues safely, taking measures to protect both self
- Trauma: care of fractures, joint and soft tissue injuries as well as & other associates from blood and airborne debris
polytrauma management and care - Use of imaging equipment: understand usage, recognize risks of
- Competence in all surgical & technical procedures commonly and appreciate safety measures require to protect patients, self
performed in orthopedics and other personnel from ionizing radiation
Knowledge - Clinical
Recommend appropriate method in performing: - Preoperative planning: understand the concept order of
- Medical history: relevant, concise, accurate and appropriate to appropriate preoperative investigations to assist in planning;
patient’s problem(s) execution of preoperative plan during surgery
- Physical Exam: relevant, sufficiently elaborate & appropriate - Post-operative care: provide appropriate care to include effective
- Diagnostic tests: medically appropriate investigative tools in a pain management (with multidisciplinary assistance, if
cost-effective, ethical and useful manner necessary), both in the hospital and office environment;
- Medical imaging tests: appropriate imaging investigations; recognize & manage postoperative complications effectively
interpretation of basic X-ray, ultrasound, computer-assisted - Emergency management - recognition and first therapeutic
tomography (CT), MRI and radionuclide studies response: Able to identify and respond appropriately to urgent
- Clinical diagnosis and decision-making: analysis, synthesis and medical and surgical problems. Efficiently provide appropriate
integration of all relevant data to formulate a rational and primary emergency therapy
effective diagnostic and therapeutic strategy for problems - Emergency management - decision to operate: Intervene based
encountered in patients of all ages on rational interpretation of clinical and ancillary investigation.
- Documentation/presentation: well-documented and organized Intervention is timely, with appropriate pre-operative assessment
assessments and recommendations in written and/or coherent - Evidence-based practice: aware of the role of evidence in clinical
and concise verbal form in response to a request from another decision making. Able to access, retrieve and apply relevant
health provider information. Makes clinical judgments based on sound evidence.
- Intra-operative decision making: arrive at correct, timely
operative decisions for routine and complex procedures
COMMUNICATOR
In order to provide humane, high-quality care, Orthopedic & Trauma Residents establish effective relationships with patients, other
physicians and health professionals. Communication skills are essential for the functioning of a specialist, and are necessary for obtaining
and revealing information to patients and their families. Furthermore, these abilities are critical in eliciting patients' beliefs, concerns,
and expectations about their injury or disease and for assessing key factors impacting on patients' health.
Copyright © 2009 The Royal College of Physicians and Surgeons of Canada. http://rcpsc.medical.org/canmeds. Reproduced with permission
DRTP :: Orthopedic & Trauma Surgery Program Manual 2016 Page 3 | 20General requirements include the ability to: - Establish therapeutic relationships with patients/families - Obtain relevant history from patients/families/communities, listen effectively - Discuss appropriate information with patients/families and the health care team - Know how to react to situations of adverse effects, critical situations & errors e.g. basics of risk management & patient safety malpractice Specific Requirements - Recognize that being a good communicator is an essential - Deliver information to patient & family in a humane manner and function of a surgeon & understand that effective communication in such a way that it is understandable, encourages discussion can foster patient satisfaction and compliance as well as and promotes the patient's participation in decision-making to a influence the manifestations and outcome of patients’ illness, degree that is compatible with current surgical practice trauma & surgical intervention. - As a prelude to surgical intervention use above skills to obtain - Establish relationship with the patient that is characterized by informed consent; consider alternative means of acquiring understanding, trust, respect, empathy & confidentiality consent if the patient is incompetent to provide consent on the - Recognize the emotional stress for patients & families faced with grounds of age or mental status or other disqualifying factors orthopedic conditions and their associated surgical management, - Understand & demonstrate the importance of cooperation and a stress especially accentuated in the treatment of children communication among healthcare professionals involved in the - Gather information not only about the injury but also about the care of individual patients such that their roles are defined and patient's beliefs, concerns and expectations about the injury / consistent message is delivered to patients & their families trauma, while considering the influence of factors such as the - Demonstrate skills in working with others who present patient's age, gender, ethnic, cultural and socioeconomic significant communication challenges as a result of an ethno- background, and spiritual values on that injury / trauma and any cultural background which is different from the clinician’s own proposed surgical intervention. or those who exhibit anger or confusion - Write well-organized letters, providing clear directions to the - Maintain clear, accurate and appropriate written records referring physician and other physician and allied personnel, - Write well organized, legible orders & progress notes where indicated. - Complete concise hospital discharge summaries promptly COLLABORATOR Orthopedic & Trauma Residents work in partnership with others who are appropriately involved in the care of individuals or specific groups of patients. It is therefore essential for Orthopedic & Trauma Residents to be able to collaborate effectively with patients and a multidisciplinary team of expert healthcare professionals for provision of optimal patient care, education, and research. General Requirements - Consult effectively with other physicians and health care professionals. - Contribute effectively to other interdisciplinary team activities. Specific Requirements - Develop an ability to work effectively and harmoniously with - Participate in an interdisciplinary team meeting, demonstrating other health care workers. the ability to accept, consider and respect the opinions of other - Function competently in initial management of conditions that in team members, while contributing personal specialty-specific major centers fall within the realm of other surgical specialties expertise. - Develop a care plan for a patient, who has been assessed, - Understand how health care governance influences patient including investigation, treatment and continuing care, in care, research and educational activities at a local, provincial, collaboration with interdisciplinary teams. regional, and national level. - Identify and describe the role, expertise and limitations of all - Effectively communicate with the members of an members of an interdisciplinary team required to optimally interdisciplinary team in the resolution of conflict, provision of achieve a goal related to patient care, a research problem, an feedback, and where appropriate, be able to assume a educational task, or an administrative responsibility. leadership role. MANAGER Orthopedic & Trauma Residents function as managers when they make everyday practice decisions involving resources, co-workers, tasks, policies and their personal lives. They do this in the settings of individual patient care, practice organizations and in the broader context of the health care system. Thus, Orthopedic & Trauma Residents require abilities to prioritize and effectively execute tasks through teamwork with colleagues and make systematic and rational decisions when allocating finite health care resources. As managers, they take on positions of leadership within the context of professional organizations and the health care system. General Requirements - Utilize resources effectively to balance patient care, learning needs, and outside activities. - Allocate finite health care resources well. - Work effectively and efficiently in health care organizations. - Utilize information technology to optimize patient care, life-long learning and other activities. Specific Requirements - Understand how to function effectively in health care organizations, ranging from individual clinical practice to local, regional and national surgical associations. - Understand the structure, resourcing, and operation of the Emirates healthcare system and function effectively within it, as well as being capable of playing an active role in its evolution. - Acquire the ability to access and apply a broad base of information to the care of ambulatory patients, and those in hospitals and other health care settings. - Make clinical decisions and judgments based on sound evidence for the benefit of individual patients & the population served. - Understand population-based approaches to health care & its implication on medical practice & prioritization to access for services. Copyright © 2009 The Royal College of Physicians and Surgeons of Canada. http://rcpsc.medical.org/canmeds. Reproduced with permission DRTP :: Orthopedic & Trauma Surgery Program Manual 2016 Page 4 | 20
HEALTH ADVOCATE Orthopedic & Trauma Residents recognize the importance of advocacy activities in responding to the challenges represented by the social, environmental, and biological factors that determine the health of patients. They recognize advocacy as an essential and fundamental component of health promotion that occurs at the level of the individual patient, the practice population, and the broader community. Health advocacy is appropriately expressed both by the individual and collective responses of specialist physicians in influencing public health and policy. General Requirements - Identify the important determinants of health, affecting patients. - Contribute effectively to improved health of patients and community. - Recognize and respond to issues where advocacy is appropriate. Specific Requirements - Demonstrate an understanding of determinants of health by identifying those that are the most important (i.e., poverty, unemployment, early childhood education, social support systems), being familiar with the underlying research evidence, and applying this understanding to common problems and conditions in general surgery - Demonstrate an understanding of determination of the patient's status with respect to one or more of the determinants of health and adapting management accordingly; and assessing the patient's ability to access various services in the health and social system; - Demonstrate an understanding of the need to work collaboratively with specialty societies and other associations in identifying current ‘at risk’ groups and application of available knowledge regarding prevention to ‘at risk’ groups. SCHOLAR Orthopedic & Trauma Specialists engage in a life-long pursuit of mastery of their professional expertise. They recognize the need to be continually learning and model this for others. Through their scholarly activities, they contribute to the appraisal, collection, understanding of health care knowledge, and facilitate the education of their students, patients & others. General Requirements - Develop, implement and monitor a personal continuing education strategy. - Critically appraise sources of medical information. - Facilitate learning of patients, interns, students and other healthcare professionals. - Contribute to development of new knowledge. Specific Requirements The Resident in Orthopedic & Trauma will develop an analytical mind and a critical attitude to scientific literature, as well as an ability to adapt to innovations and development which will occur during a career in Orthopedic & Trauma. Clinical: - Identify clinical problems in Orthopedic & Trauma - Develop a system to store & retrieve relevant literature - Recognize & identify gaps in knowledge and expertise - Consult health professionals in a collegial manner - Formulate a management plan - Propose treatment for the clinical problem - Conduct appropriate literature search based on clinical question - Evaluate the outcome - Assimilate and appraise the literature - Identify practice areas for research Research: - Pose a research question (clinical, basic or population health) - Defend and disseminate the results of the research - Develop a proposal to solve the research question - Identify areas for further research that flow from the results. Be - Conduct appropriate literature search based on research question familiar with the principles of evidence based medicine and - Identify, consult and collaborate with appropriate content experts prove this by analyzing four different recent publications in to conduct the research trauma and orthopedics (clinical intervention studies) in a short - Propose a methodological approach to solve the question written appraisal - Carry out the research outlined in the proposal Education: Demonstrate an understanding and the ability to apply the principles of adult learning, with respect to others & self with an understanding of preferred learning methods in dealing with students, residents, and colleagues. PROFESSIONAL Orthopedic & Trauma Residents have a unique societal role as professionals with a distinct body of knowledge, skills, and attitudes dedicated to improving the health and wellbeing of others. Orthopedic & Trauma Surgeons are committed to the highest standards of excellence in clinical care and ethical conduct and continually aspire to master their discipline. General Requirements - Deliver the highest quality care with integrity, honesty and compassion. - Exhibit appropriate personal and interpersonal professional behavior. - Practice medicine ethically, consistent with the obligations of a clinician. Specific Requirements - Acquire the training and experience to maintain competence as - Have the ability to explore and resolve interpersonal difficulties a specialist or sub specialist in professional relationships - Assume responsibility for the overall care of the surgical patient - Have a knowledge and understanding of the professional, legal - Have comprehensive knowledge of the principles of biomedical and ethical codes to which clinicians are bound ethics and medical jurisprudence - Have the ability to recognize, analyze and know how to deal - Maintain ethical relationship with colleagues, patients & families with unprofessional behavior in clinical practice, taking into - Recognize one's own limitations of professional competence account local and national regulations - Demonstrate ways of attempting to resolve conflicts & role strain DRTP :: Orthopedic & Trauma Surgery Program Manual 2016 Page 5 | 20
Program Structure & Rotations
The total duration of training will be 6 years.
The resident will start with 3 months in the Orthopedic & Trauma Department, intended to serve as a means of Orientation to the
Department and Program as such.
2 years in the Common Trunk shall involve:
General Surgery 6 months
Neurosurgery 6 months
Emergency 6 months
Intensive Care & Anesthesia 6 months
4 years in Trauma & Orthopedics, this includes:
- Initial 3 months Orientation
- One Year in Berlin - Germany
Contents of the curriculum that is not available Dubai shall be covered in Germany, during the mandatory professional activity at the
end of the Residency Program.
Residents are required to travel to Berlin for a minimum of 6 months at the end of their specialist training and become registered
members of the Berlin Chamber of Physicians during this time.
This is however subject to:
- Obtaining an official working permit from the German authorities
- Acquiring sufficient knowledge of the German language ‘Level C’ - Goethe-Institut
A Typical Weekly Schedule in the Orthopedic & Trauma Department:
Sunday Ward Round/ Outpatient Clinic
Monday Operating Theatre
Tuesday Academic Day
Wednesday Operating Theatre
Thursday Ward Round/ Outpatient Clinic
Education Modules
Module 1 :: Core Lecture Series
Weekly lectures, lasting 1hour: formal lectures, case discussions. There will be a consultant in attendance to moderate the session
and lead the discussion. Attendance of the daily meetings to discuss all the admitted cases
Schedule for the Academic Day (Tuesday of Every Week)
Time* Activity* Time* Activity*
07.30 Morning meeting 11.30 Case discussion
08.00 Department CME program 12.30 Clinical examination on patients (bedside)
09.00 1st presentation about main subject 13.30 Questions and discussion
10.00 Coffee break 14.00 Afternoon meeting
10.30 2nd presentation about main subject *Schedule subject to annual review & revision
- Main subject 1st presentation prepared and presented by one of the Education Committees.
- Main subject 2nd presentation prepared and presented by one of the education comity.
- Case discussion to be prepared by one of the candidates under supervision of one of the education committee.
- Clinical examination session can be replaced by X-ray meeting (pre-op and post-op X-ray diagnosis and discussion) done by
one of the Education Committee members.
Module 2 :: Operation Log Book and Surgical Skills
A log Book must be maintained. At the end of each year, it will be the responsibility of the Program Director or the Department Head
to ensure that the trainee in his department completes his respective list
Module 3 :: Research and Publications
In each year of training, at least one case report should be completed and presented at a scientific meeting which may be subsequently
published. In addition, one basic science research project can be undertaken. Also the Resident should collect 20 major cases in
which he was in direct contact during management
Module 4 :: Training Courses and Conferences
These are courses that are essential for training. Some courses must be funded in part or whole by the trainee’s employing institution,
also attending scientific conferences and CME activities in the hospital
Course Year 1 Year 2 Year 3 Year 4 Year 5 Year 6
Basic Life Support / BLS
Advanced Trauma life Support / ATLS
AO Basic Course
Ultrasound Course
AO Advanced Course
AO Spine Principle
Knee-Shoulder Arthroscopy — Basic
Endo-prosthetic Principle Course
AO Master Course
DRTP :: Orthopedic & Trauma Surgery Program Manual 2016 Page 6 | 20Clinical Research
Residents are required to present a research through final year thesis and for this purpose, workshops are held as follows:
- Research methodology (3 days)
- Literature review & Refworks (1 day)
- SPSS (Basic Statistics)
The goal of these workshops is to understand and able to apply the following:
- Using electronic databases such as Medline & Internet to conduct literature searches and to locate information
- Critically appraise/evaluate relevant literature, reviews and new techniques/technologies
- Use word processors, databases, spreadsheets and statistical packages to produce statistical analysis & research papers
- Conduct a literature review
- Develop an hypothesis to be tested
- Choose an appropriate research methodology and design a research study
- Write a grant application to fund a research project.
- Apply for ethics committee approval for a clinical or laboratory based study
- Collect, collate and interpret data
- Apply basic statistical analysis to clinical data
- Develop an outline structure for a research paper
- Write a literature review for a research paper
- Apply the developed outline to write a research paper
- Searching the literature and data-bases purposefully
- Appraising critically relevant articles and reports
- Interpreting findings and consider their applications to other contexts
- Know how to select and draw on clinical evidence to inform practice
- Be able to define the following terms
Clinical significance Laboratory variability
Statistically significant / insignificant Observer variability
Variability Data types: categorical, continuous, qualitative,
Biological variability quantitative, discrete
- Understand the following methods of and terms associated with data collection:
Epidemiological studies Observational studies
Randomized controlled & crossover clinical trials Discrete and continuous variables
Randomized controlled laboratory study Sample size determination
- Recognize and understand the following concepts of problems associated with data:
Bias: confounding - measurement - sampling Understand the significance & limitations of measures of
Randomization central tendency:
Stratification o Mean, median, mode
o Variance
Blindness (masking)
o Co-variance
Relevance of sample size to the ultimate o Standard deviation
Outcome of the statistical analysis o Confidence interval
- Understand and apply the following statistical terms:
Probability & probability distribution models Meta-analysis
Regression and correlation analysis Absolute risk
Risk — sensitivity analysis, particularly: o Absolute risk difference
Exposure odds ratio o Absolute risk reduction
o Attributable risk
Number needed to treat
o Etiologic fraction
Significance testing o Relative Risk
- Getting Research skills:
Choosing a topic for research
Having a detailed literature review for this purpose
Designing a research as per standard methodology
Choosing a mentor on the related field
Finalize the research proposal and get both scientific and ethical approval
The research proposal will consist of at least of Title page, Specific Aims
Introduction/Background and Significance
Objectives and Hypothesis
Research Design and Methodology
References / Bibliography
Conduct the research through data gathering, survey, or any standard tool
Analyze the data
Present the data on a thesis as per DRTP thesis guidelines.
DRTP :: Orthopedic & Trauma Surgery Program Manual 2016 Page 7 | 20Each thesis must be arranged in the following order:
- Title Page (Sample A). Do not place a page number on this page.
- Dedication. Do not place a page number on this page.
- Acknowledgements and/or Preface. Do not place a page number on this page.
- Abstract (Sample B). Do not place a page number on this page.
- Table of Contents. Do not place a page number on this page.
- List of Tables, Figures, Illustrations/Maps/Slides, List of Supplemental Files such as multimedia files.
- List of abbreviations
- Text of the Thesis. All pages from the first page of text through the bibliography or Vita, if included, are numbered consecutively
in Arabic numerals, beginning with Arabic numeral “1” on the first page of the thesis text.
- Introduction
- Material and Methods
- Results
- Discussion
- Limitations
- Conclusion
- Appendix or Appendices. Continue text numbering with Arabic numerals.
- References. Vancouver or Harvard standard style.
- Publications (please insert the full text of your published paper if you have any)
- Curriculum Vita. Continue text numbering with Arabic numerals.
Thesis Formatting and Layout Requirements:
Page Size Page size should be standard A4 size (8.50 x 11.00).
Margins 1 inch on all sides, including page numbers.
Page Nos. Should be at least 1" from the below margins edges of the page, as appears in this document.
Spacing Preliminary pages and text must be double-spaced or 1.5-spaced. Under certain conditions, quotations may be
single spaced. Table of Contents and lists with lengthy entries may be single spaced with a double space between
entries.
References may be single spaced, with a double space between entries.
Page Alignment Each new chapter/ major section (i.e. Chapter 1 - 2, Appendix, Bibliography, Vita) must begin on a new page.
Pagination All text page in the thesis is numbered.
All text page numbers in the thesis must be centered under the text in the same location on each page and located
at least one inch from the bottom of the page.
Word Your final thesis must be correct in spelling and punctuation and presented in a consistent, structured format. A
Processing single, legible font must be used throughout the thesis, the only exceptions being in tables, figures, graphs,
appendices, foot notes, and supplemental files. The font size should be 12-pt. Accuracy and consistency is
required in format of the thesis.
Tables & Pages carrying illustrative material must be given page numbers appropriate to their place in the document.
Illustrations Illustrative material may not be inserted after the document has been numbered and given numbers such as “10a.”
All tables, figures, illustrations, and other types of examples included and referenced in the text of the thesis
should be numbered for identification. There should be no duplication of these numbers; i.e., no two tables
should be assigned the same number. Figures may be numbered in one of two ways: consecutively throughout
the document (Table 1, Table 2, Table 3, etc.), or double-numbered so that illustrations’ numbers reflect their
locations in the document (Fig. 9.3 is the third figure in Chapter 9, or Fig. A2 is the second figure in Appendix A.)
Captions & To be placed on the same page with the figure, graph, table or illustration they describe. In order to fit both figure
legends and caption on the same page, captions may be single-spaced, margins may be decreased to one inch, and figures
may be reduced in size to fit. If the figures are reduced from their original size, then the page number must be
added after the reduction so as not to alter its size. If there is no other way to manage the amount of material to
be shown, the caption and figures should be side-by-side in continuous view. This method should only be used
in the rare instance where all of the pertinent material will not fit on the same page. Figures, captions, and page
numbers must be easily readable when the electronic document is viewed at 100 percent.
Copies Residents upload a single pdf file of their thesis to Research website (e.g. thesis submission site). The electronic
Required pdf file serves as the DHA archival copy of the thesis. As an extra measure of security, students are strongly
encouraged to keep a copy of their approved thesis and to provide an additional copy to their thesis supervisor
or department/program library, if applicable. By keeping an electronic backup on hand, students can easily
provide scholars with a copy of the thesis during the time between submission and publication, if necessary. A
paper copy of the thesis is required by the AAC
Footnote Each thesis must include a reference, or bibliography section,. This section may be called “Bibliography” or
Citations, “References”. The bibliography is the last required section of the thesis and the last section heading listed on the
References & Table of Contents unless an optional Vita page is included. When a Vita page is included, the bibliography
Bibliography immediately precedes the Vita at the end of the thesis. The bibliography must indicate materials actually used,
such as articles, chapters of books, websites, etc
DRTP :: Orthopedic & Trauma Surgery Program Manual 2016 Page 8 | 20Resident Job Descriptions
In Emergency room In Wards In Out Patient Department In Operating Room Educational Activities
- The first on call; - Clerk all admissions (history, general & orthopedic clinical examination); - Attend the general - Participate in basic operative - Presentation of cases in rounds.
conducts primary suggest basic investigations & plan of management. orthopedic and fracture planning of fracture fixation - Participation in grand rounds and journal
assessment and - Perform daily rounds. Write detailed daily progress notes clinic with other senior staff - Participate in minor surgical clubs
management of - Arrange discharge, home medication & follow up appointments of inpatients. - Complete various hospital procedures and perform some - Attend all educational activities of the
patients in ER - Assist and learn to perform various bedside procedures; including traction, cast forms. under supervision residency program, local education
- Suggest admission of application, joint aspiration, etc - Assist and learns outpatient - Participate in moderate surgical courses and basic courses of internal
YEAR 3
patients - Follow and obtain various results of investigations and reports abnormal results procedures in the clinic and procedures as an assistant. fixation.
- Perform closed to seniors. plaster room. - Attend major and subspecialty
reduction of fractures - Follow up referral of patients to other specialties surgical procedure.
and cast application - Observe seniors explaining to patients, methods of management & their illness - Write operative notes and
under supervision. and discusses this process with seniors. postoperative orders.
- Assist in various - Observe the approaches taken by the seniors when talking to patients about - Usage of various operative
emergency procedures prognosis of their illness instruments and implants
performed in ER. - Check completeness of medical reports of patients
- Participate in pre and post-operative assessment of the patient.
- The first/ second on - Perform or Supervising clerking of all admissions, requests basic and special - Assess patients in the general- Prepare operation lists & active - Supervise junior in daily case
call; conducting investigations and draws plan of management orthopedics & fracture clinic engagement in operative presentation in the rounds
primary assessment - Perform daily rounds - Comment on daily progress notes, write discharge notes with supervision planning of various fractures and - Present cases in grand rounds and
and management of with supervision and checks proper home medication and doses and proper - Attend sub-specialized ortho reconstructive operations prepares topics for journal clubs
patients in ER follow up appointments of inpatients clinics with consultants - Perform minor surgical procedures - Participate and presents cases in
- Decide on and admits - Perform various bedside procedures under supervision if necessary; including - Request investigations - Perform moderate surgical pathology/radiology meetings
YEAR 4
patients with traction, cast application, joint aspiration etc. - Perform basis outpatient procedures as first assistant - Participate in morbidity & mortality mtngs
consultation of seniors - Check results of various investigations. procedures in the clinic and - Assist consultants/senior - Presents topics in the orthopedic club
- Perform closed - Suggest referral of patients to other specialties plaster room (removal of the performing major & sub-specialty - Attend all educational activities and
reduction of fractures - Assist in explaining to patients the methods of management and their illness cast, change of cast, joint surgical procedure (2nd Assistant) lectures of continuous education.
and cast application and discusses this process with senior staff aspiration) - Write operative notes and post- - Attend local education courses & basic &
- Perform various - Observe the approaches taken by the seniors when talking to patients about - Suggest booking patients operative orders under supervision advanced courses of internal fixation
emergency procedures prognosis of their illness for elective admission under - Master the usage of various - Plan clinical research projects; Helping
performed in ER - Write preliminary medical reports of patients supervision & Completing operative instruments & implants; in data collection and data search of
- Ensure full preoperative assessment and preparation under supervision of admission forms their advantages & disadvantages ongoing research
seniors, Perform post-operative follow up of patients - Prepare A/V materials for presentations
- The second on call; - Comprehensive clinical assessments of all admissions, supervising junior trainees- Run a general orthopedic - Ensure completion of operation - Head daily rounds
Supervising junior approving basic investigations & requesting advanced investigations and fracture clinic alone with lists, operative planning of - Supervise case presentation in grand
trainee on primary - Execution & modification management plan after consulting with senior staff supervision of seniors various fractures and rounds and topics for journal clubs
management of - Daily rounds on all patients - Attend sub-specialized reconstructive operations - Prepare and present cases in
patients in ER - Supervise & ensure complete & up-to-date clinical progress notes are written orthopedic clinics with - Assist junior trainee performing pathology/radiology meetings
- Check and approve - Resolve problems related to discharge of patients, their home medications & consultants minor surgical procedures - Help in preparation of morbidity and
decision of admission follow up appointments - Interpret results of various - Perform moderate surgical mortality meetings
and management of - Supervise various bedside procedures; and Ensuring the quality of execution investigations and takes procedures as independently - Present cases in the orthopedic club
YEAR 5
patients and follow up of such procedures decisions related to patient - Perform major and sub-specialty - Attend educational activities & prepares
- Supervise and perform - Take actions based on results of investigations after consulting with seniors management surgical procedure (1st/ 2nd Assst) the schedule for lectures of continuous
closed reduction of when required - Supervise performance of - Write operative notes and education & teaching of the residency
fractures - Suggest and execute referral of patients to other specialties basic outpatient procedures postoperative orders program & Supervising juniors
- Supervise & perform - Ensure understanding of patients, their management plan, Surgeries, in the clinic and plaster independently and Supervising - Attend education courses
various procedures medications & various procedures room, ensuring quality juniors doing so - Organize the on call Rota
performed in ER - Answer patients with regards to prognosis under the supervision of or after control - Learn special techniques and - Allocate duties and tasks to juniors and
discussion with consultants - Arrange booking patients for usage of special implants for Supervising their execution
- Approve preliminary & write detailed medical reports elective admission after complicated cases. - Prepare various A/V presentations
- Perform preoperative assessment of inpatients & discusses assessment with consulting with the seniors - Participate in ongoing research and
seniors. Ensure proper post-operative follow up of patients preparation of papers and data collection
Copyright © 2008 Jordanian Royal Medical Services - http://www.jrms.gov.jo/Portals/1/logbook/Logbook%20Orthopedics.pdf
DRTP :: Orthopedic & Trauma Surgery Program Manual 2016 Page 9 | 20Assessments & Supervision
Examinations
With an aim to streamline the Annual Promotion of Residents, a yearly internal assessment examination to evaluate his/her eligibility
for progress will be held.
There will be Formal assessments in Written and/or Oral form at the end of the common trunk to decide the Resident’s promotion from
Phase 1 (Year 1-2) to Phase 2 (Year 3-4-5-6).
Log Books
Resident in Phase 2 shall be assessed on the logbook as well.
It is mandatory that all activities that the Resident undertakes during the Program are recorded in a logbook of procedures and
interventions (operative and conservative treatment).
Each entry is to be signed by the Resident as well as by the responsible Supervisor. At the completion of the rotation all documents, the
logbook and assessment records will be forwarded to the Program Director.
The trainee’s log book, and copies of reports which record the Resident’s operative and diagnostic experience (Refer Annexure), shall
indicate the degree of supervision
(A) Assisting senior surgeon
(S1) Performing a procedure under direct supervision - Consultant” scrubbed” for the major part of the operation (includes
performing a significant part of the operation under supervision)
(S2) Performing a procedure under supervision - Consultant present in the theatre but not “scrubbed”
(P) Performing a procedure without direct supervision
(T) Supervising a more junior trainee.
The log book is a means of analysis to assess both the experience & training level/position of the Resident.
Minimum requirements for numbers of procedures:
A minimum number of cases to be operated upon or examined by the Resident, in addition methods of assessment of competencies,
both clinical and operative, should be developed.
Specialty Examination In Orthopedic & Trauma
Participants of the program will be trained according to the curriculum of the German Society of Orthopedics and Trauma (DGOU) in
Dubai thus reaching the level of skills necessary for a specialist in Orthopedics and Trauma. Contents of the curriculum that participants
cannot obtain in Dubai will be acquired in a hospital during the mandatory professional activity at the end of the program in Germany.
Subject to following conditions, Residents may be admitted to the Facharztprüfung Exam at the Berlin Chamber of Physicians.
- Necessary legal requirements being met
- Residents’ Registration to the Berlin Chamber of Physicians
DGOU is responsible for the placement of the participants of the Dubai Residency Training Program in suitable hospitals and will
ensure the professional mentoring of the trainees during their stay in Germany. Thus the requirements are met to apply for presenting
themselves for the board exam at Berlin Chamber of Physicians.
ÄKB allows registered members of the Berlin Chamber of Physicians that also were participants of the Dubai Residency Training
Program to take the board exam (Facharztprüfung), if the requirements with regard to requested contents and times of the regulations
on specialized training are met. Passing of the exam lies within the personal responsibilities of the candidate and cannot be guaranteed
by the Berlin Chamber of Physicians.
After having successfully taken the exam at Berlin Chamber of Physicians, the specialists will return to Dubai and work for DHA as
Specialists (SSR) in the Orthopedics and Trauma Department.
Supervision
- Clinical responsibilities must be assigned to the residents in a carefully supervised and progressive manner, so that the resident
assumes increasing responsibility in accordance with their level of education, ability and experience
- Teaching staff supervision must include timely and appropriate feedback to the residents
- The Resident’s clinical involvement must be in fulfillment of the program’s written educational curriculum
- Teaching staff must demonstrate concern for each Resident’s well-being and professional development.
- Teaching staff who supervise the residents have overall responsibility for patient care and are the authority for final decision
- Teaching staff schedules must be structured to ensure continuous supervision of residents and availability of consultation
- All decisions regarding diagnostic tests and therapeutics, initiated by the residents will be reviewed with the responsible Consultants
during patient care rounds
- Patients will be seen by the team of residents, interns and medical student and their care will be reviewed with the Consultant at
appropriate intervals
- The residents are required to promptly notify the patient’s Consultant physician in the event of any controversy regarding patient
care or any serious change in the patient’s condition
- In clinics and consultation services, the Consultant or supervising physician must review overall patient care rendered by residents
- In the operating theatres, the Consultant or supervising physicians are responsible for the supervision of all operative cases.
Consultants or supervising physicians must be present in the operating room with residents during critical parts of the procedure.
For less critical parts of the procedure, the Consultant or supervising physician must be immediately available for direct consultation.
DRTP :: Orthopedic & Trauma Surgery Program Manual 2016 Page 10 | 20Syllabus
General Orthopedic
Trainees are expected to possess in depth knowledge and exposure to following areas and key aspects of Orthopedic & Trauma, eventually, applying this knowledge when interpreting clinical
symptoms, signs and investigations in the practice of orthopedics and identifying available therapeutic options and preventative measures
Basic Science Tissues: Operative Topics: Thromboembolism & Pain:
Knowledge of basic science, when interpreting clinical Normal histological structure & Different aspects of design of operating theatre & Different aspects & principles of:
investigations & the practice of orthopedic surgery. function of musculoskeletal tissue: their application, determining the possible - Thromboembolism & prophylaxis
- Cellular & molecular biology discomfort, distress and risks to which the patient - Pain and pain relief
Anatomy: - Bone may be exposed pre/intra/post operatively, - Complex regional pain syndromes e.g.
Anatomy of the musculoskeletal system and neuro- - Cartilage - articular, & meniscal particularly: Reflex Sympathetic Dystrophy and
anatomy with special emphasis on applied anatomy - Muscle and tendon - Pre- Operative assessment Causalgia
relevant to clinical methods of assessment and - Synovium - Tourniquets
management in orthopedic practice, particularly: - Ligament - Operative theatres (Design, Circulation & Infections
- Anatomy & embryology of musculoskeletal system - Nerve Ventilation) Classification of different infectious diseases
- Anatomy of nervous and vascular systems - Intervertebral Disc - Anesthesia - principles and practice of local and of bone and joints, soft tissue and their
- Clinical & functional anatomy with pathological and regional anesthesia and principles of general pathogenesis and identifying common
operative relevance anesthesia causative organisms
- Surgical approaches to the limbs & axial skeleton - Postoperative assessment and care
Physiology, Biochemistry & Genetics: Biomechanics & Bioengineering: General Diseases Research & Audit in Orthopedic practice:
- Bone homeostasis, metabolism & hormonal regulation - Biomechanics of musculoskeletal Describing and Categorizing the pathology of bone & - Design & conduction of clinical trials
- Physiology of cartilage tissues joints, incl. Metabolic bone diseases, osteoarthritis, - Data analysis and statistics
- Bone grafts, bone banking & tissue transplantation - Biomechanics of fracture fixation osteoporosis, rheumatoid arthritis & other - Epidemiology
- Shock- types, physiology, recognition & treatment - Tribology of natural and artificial arthropathies (inflammatory, crystal, etc), - Evidence based medicine
- Metabolic & immunological response to trauma joints haemophilia, inherited musculoskeletal disorders, - Audit
- Blood loss in trauma/surgery, fluid balance & blood - Design of implants and factors neuromuscular disorders (inherited and acquired),
transfusion associated with implant failure osteonecrosis, osteochond-ritides & heterotopic
- Application/ relevance of modern genetics to (wear, loosening) ossification.
orthopedic disease and treatment - Kinematics and gait analysis
- Biomaterials
Investigations: Prosthetics & Orthotics: Infection - Prevention & Control Orthopedic Oncology
- The range of investigations available and the - Design of standard prostheses The standard guidelines and protocols for infection Identify & describe the presentation,
circumstances in which they are used. - Prescription and fitting standard control and prevention in the orthopedic setting, radiological features, pathological features,
- Selection appropriate investigations and recognize prostheses including: treatment and outcome of orthopedic benign
when further action is required. - Orthotic bracing for control of - Standard precautions and malignant bone and soft tissue tumors.
- Limitations of the investigation and the implications of disease, deformity and instability - Aseptic techniques Principles of management of patients with
a positive or negative test result. - Antiseptics and disinfectants metastatic bone disease in terms of
- The possible discomfort and distress and risks to which - Sterilization investigation, prophylactic and definitive
the patient may be exposed during the test - Antimicrobial policy fixation of pathological fractures and
- The cost & localize the resources involved, particularly - Surgery in high risk patients with blood-borne oncological management
blood tests. viruses (HBV-HCV-HIV) & its ethical implications
- Musculoskeletal imaging: x-ray, contrast studies on healthcare providers.
(myelography, arthrography), CT, MRI, ultrasound,
radioisotope studies & the effects of radiation, bone
densitometry & electrophysiological investigations
DRTP :: Orthopedic & Trauma Surgery Program Manual 2016 Page 11 | 20Basic Science Pathology: Clinical Assessment: Treatment:
The basic science (anatomy, biomechanics - Systemic response of body to major injury. - Clinical assessment of patients with severe injury, - Categorizing different treatment options for musculoskeletal injury, both
& pathology) applied to diagnosis and - Response of infants, children & elderly to including spinal cord injury, soft tissue injury, burns & non-operative and operative.
surgical treatment of common bone, joint injury. head injury. - Explaining the principles necessary to plan the overall care of severely
and soft tissue injuries. - Science of fluid replacement therapy in the - Assessment of all types of fractures and dislocations, injured
acutely injured. their complications, early and late. - Outlining & justifying the treatment of all types of common fracture &
- Classification systems for fractures & - Life & limb threatening injuries and priorities of dislocation incl. the bone and soft tissue treatment of open fractures &
Anotomy: dislocations. treatment. treatment of pathological fractures
- Anatomical structures particularly at risk - Bone & soft tissue healing, including skin, - Investigations: Principles, application and side effects - Management and treatment of patients with common injuries that are
TRAUMA GENERAL
from common injuries/ surgical approaches muscle, tendon & neurological structures. of commonly used investigations, including normally treated by a subspecialist (e.g. spinal injury, arterial injury or intra
- Physical anatomy & its application to - Pathogenesis of compartment syndrome. radiographs, CT and MRI scans, radio-isotope imaging, cranial hemorrhage) and outline the principles of the specialist treatment.
injury. - Mechanisms underlying Acute Respiratory ultrasound scans and electrophysiological - Principles of reconstructive surgery for the injured, treatment of non-union
Distress Syndrome and similar life investigations. & mal-union of fractures, bone defects, chronic post-traumatic
threatening conditions. osteomyelitis, principles of soft tissue reconstruction & delayed treatment of
Biomechanics: - Response of the body & local musculo- nerve injury
- Fracture pattern and fracture treatment skeletal tissues to infection. - Principles of amputation in the injured & rehabilitation of such patients.
both operative and non-operative. - Pathology of non-union of fractures.
- Open reduction and internal fixation of
fractures and external skeletal fixation.
- Biomechanics of implants &fracture
fixation systems, incl. their material
properties.
Basic Science Clinical Assessment: Investigations: Treatment:
PEDIATRIC ORTHO SURGERY
- Growth of bones, physeal anatomy & its - Competently interpret orthopedic clinical - Indications for plain x-ray, CT, MRI & interpret images. - Fractures (including non-accidental injury) and growth plate injuries and
application to fracture types & pathological examination of a child & to relate effectively - Indications for the use of ultrasound, arthrogram and recognize the sequelae.
processes & infection in particular. with the family. nuclear imaging. - Bone and joint infection
- Anatomy of bones and joints in the - Normal variants that would be considered - Limitations of certain investigations in Pediatric practice - Common Pediatric Orthopedic conditions; irritable hip, anterior knee pain,
growing child and its application to growth deformities by family and pediatricians - Screening methods for congenital abnormalities & Talipes, slipped epiphysis & Perthes' disease.
and deformity. - Identification of proper management in methods for assessment of physical disability. - All trainees should be able to list the treatment options for birth injuries,
- Neurological processes involved in the pediatric orthopedic practice & when to Developmental dysplasia of the hip, Scoliosis, Simple foot deformities (e.g.
deformity e.g. spina bifida, cerebral palsy, refer suitably for specialists’ treatment. hallux valgus, metatarsus varus), Simple congenital hand abnormalities
muscular dystrophy and poliomyelitis. (e.g. trigger thumb), Osteogenesis imperfect, Skeletal dysplasias, Tarsal
coalitions, Torticollis, and leg length discrepancy.
Copyright © 2008 Jordanian Royal Medical Services - http://www.jrms.gov.jo/Portals/1/logbook/Logbook%20Orthopedics.pdf
DRTP :: Orthopedic & Trauma Surgery Program Manual 2016 Page 12 | 20You can also read
