the warwick programme
the warwick
programme
specialty training in trauma & orthopaedics
clinical excellence | educational innovation | academic distinction
programme director
Professor Damian Griffin
deputy programme directors
Mr Giles Pattison (education)
Mr Matt Costa (research)
web
www.warwick.ac.uk/go/orthotraining
email
OrthoTrainingProg@warwick.ac.uk
address
Warwick Orthopaedics
Clinical Sciences Research Institute
Warwick Medical School
Clifford Bridge Road
Coventry CV2 2DX
Version 3.2 [11/09]
orthopaedics
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the warwick programme
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introduction
The Warwick Programme is one of the West Midlands Deanery Higher
Surgical Training schemes. It is an eight-year run-through specialist
training programme in Trauma and Orthopaedic Surgery.
This new programme was created following
a reorganisation of orthopaedic training in the
West Midlands. It was stimulated by the building
of a brand new University teaching hospital
in Coventry, and the increasing recognition of
Warwick Medical School as a centre of excellence
for orthopaedic training and the development of
orthopaedic research in the United Kingdom. The
programme is closely supervised with 32 trainees.
It has some of the best clinical facilities and the
most rapidly developing academic Orthopaedic
Department in the country, as well as a wide
variety of consultant orthopaedic surgeons who
are nationally and internationally recognised for
expertise and innovation in their sub-specialities.
The Warwick Programme is a geographically
compact rotation, with a full range of specialist
training opportunities, and a group of enthusiastic
trainers and trainees from ST1 to ST8.
Trainees receive excellent clinical training in the
generality of orthopaedic surgery with a clear focus
on the SAC curriculum and the MRCS and FRCS(Tr
and Orth) examinations. They are also trained in
sub-specialities of their interest, spend time on at
least one overseas Fellowship (several of which
are closely linked with the programme) and usually
complete a higher degree in orthopaedic research
or teaching whilst doing their Orthopaedic training.
The Programme is directed by Professor Damian
Griffin, Chair of Trauma and Orthopaedic Surgery
at the University of Warwick. He is supported
by a Mr Matt Costa, Senior Lecturer, and by Mr
Giles Pattison, a consultant with a special interest
in medical education, as well as a large group
of orthopaedic surgeons, all enthusiastic about
Specialty Trainee teaching. As a new programme,
we have had the opportunity to design many
aspects from scratch, and have chosen to focus
on clinical excellence, educational innovation and
academic distinction. Each of these are described in
more detail on the following pages.
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clinical excellence
The Warwick programme provides excellent clinical training in both trauma
and elective orthopaedics. This section describes the clinical training in outline,
and then the opportunities in each of the Programme hospitals in detail.
outline of clinical training
During ST1/2 or CT1/2, trainees rotate between
posts in a range of surgical specialties and intensive
care. The focus is on learning to manage injured
and acutely ill patients, and to acquire basic surgical
skills including the ability to perform surgical
treatment of common fractures.
During ST3 to ST8 trainees rotate yearly, spending
three years in the University Hospital and a year in
each of three District General Hospitals, selected
from Alexandra Hospital in Redditch, Heartlands
Hospital and Solihull Hospital in east Birmingham,
South Warwickshire Hospital in Warwick, and
Worcestershire Royal Hospital in Worcester.
• In year 3, trainees work at the University
Hospital where the emphasis is on using sound
elective and trauma skills.
• In Years 4 and 5, trainees are allocated to two
of the excellent District General Hospitals on the
Programme. During these years the trainee will
further develop his or her trauma and elective
skills. By the end of Year 5, trainees will have
been exposed to the full breadth of trauma and
orthopaedic surgery.
• For Years 6 and 7, trainees rotate back to the
University Hospital for more advanced speciality training and for exam preparation. Current
arrangements for the FRCS (Tr & Orth) are such
that most trainees will sit the first part of the
exam in July at the end of their fourth year and
the second part in November early in the fifth
year.
• Year 8 is spent completing sub-speciality training, usually in District General Hospitals.
• Most trainees on the Warwick Programme will
complete an overseas Fellowship in a sub-speciality of their choice. Planning for this begins
in Year 4, and includes opportunities to take up
one of a number of posts linked to the Warwick
Programme. These include a wide range of
elective sub-specialities and trauma, and are
scattered across the world in cities such as
Melbourne, Dallas, Seattle, Vancouver, Toronto,
Paris, Rome, Cape Town, and Auckland. Fellowships can be in Year 8, or (especially to fit in
with southern hemisphere timetables) from the
middle of Year 7 to the middle of Year 8.
year 1
year 2
year 3
year 4
year 5
year 6
year 7
year 8
aug-jul
aug-jul
aug-jul
aug-jul
aug-jul
aug-jul
aug-jul
aug-jul
ROTATION
ROTATION
University
Hospital
DGH
DGH
3 x 4 month
attachments
4 x 3 month
attachments
Emphasis on acutely ill
patients and trauma surgery
MRCS Exam
3 x 4 month
attachments:
trauma and two
elective firms.
Emphasis on
basic skills
2 x 6 month
attachments
University Hospital
DGH
2 x 6 month 6 x 4 month attachments, two in trauma Final training
attachments including complex trauma surgery and in subspeciality
four in tertiary referral subspecialities.
of choice
Preparation for final exam
Accumulate experience in a
range of subspecialities
Fellowship
FRCS(Tr&Orth)
Exam Parts 1 & 2
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the warwick programme
University Hospital
The University Hospitals of Coventry and
Warwickshire NHS Trust includes a brand new
University teaching hospital in Coventry and an
elective orthopaedic centre in Rugby.
The University Hospital opened in July 2006. It is
has 1,250 beds and 28 operating theatres. Facilities
are to the most modern standard, including for
example, 3 CT scanners, a conventional MRI, open
MRI and a 3T high-resolution MRI, and a PET-CT.
All the surgical specialities are housed under one
roof and configured as a regional Level 1 trauma
unit. There is a very large emergency department
with a CT scanner adjoining the trauma room.
The emergency department is served by the
Warwickshire and Northamptonshire Air Ambulance
which lands on a purpose built helipad immediately
outside. There is a separate adjoining children’s
emergency department. There are two orthopaedic
wards on the fifth floor that include a study centre
for orthopaedic trainees.
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The clinical training at the University Hospital
and Rugby St Cross is arranged as four-month
attachments. One attachment in a typical year is
spent doing exclusively trauma surgery as part
of a trauma team, and most of the on-call work
falls within this period. Maximum exposure to
trauma surgery and close consultant supervision
have increased both the quality of training and the
number of cases that each trainee experiences. The
four-month elective attachments are each to a firm
of two consultants with similar specialised practice
to allow focused learning. There is only occasional
weekend on-call work during elective attachments
and this allows the trainee to concentrate on
developing elective skills.
consultants and special interests
Mr M. Costa Trauma
Miss I. Dunn, Mr A. Gaffey,
Mr G. Pattison Paediatric Orthopaedics
Mr M. Margetts General and Paediatrics
Miss A. Edwards Upper Limb and Paediatrics
Mr S. Drew, Mr S. Turner Shoulder
The Trust provides tertiary services to Coventry and
Warwickshire and beyond. Regional and supraregional services include: the Midlands Pelvic and
Acetabular fracture service; a departmental special
interest in sports surgery, especially cartilage repair;
a regional paediatric service; and a national hip
arthroscopy service.
Mr P. Wade Hand
Mr W. Merriam, Mr N. Shergill, Mr. R. Sneath Spine
Professor D. Griffin Pelvic and acetabular fractures,
young hip surgery, hip arthroscopy
Mr M. Blakemore Pelvic and acetabular fractures,
lower limb
Mr S. Krikler Trauma and hip arthroplasty
Mr U. Prakash, Mr P. Foguet Hip and knee arthroplasty
Rugby St Cross Hospital has 5 theatres and 140
beds and is located in Rugby, 15 miles to the east
of the University Hospital. It provides a separate
elective orthopaedic facility, unaffected by the
emergency admissions to the main University
Hospital.
All inpatient trauma surgery is managed at
University Hospital. Elective surgery is split between
University Hospital and Rugby St Cross, with
University Hospital concentrating on more complex
surgery, such as revision joint replacement and
major spine surgery and on childrens’ orthopaedics.
Mr T. Spalding, Mr M. Taylor,
Mr P. Thompson Knee surgery and sports injuries
[New appointment] Foot and ankle
[New appointment] Hip and knee arthroplasty
Heart of England NHS Trust
This Trust includes two hospitals with orthopaedic
facilities: Birmingham Heartlands and Solihull.
The Heartlands site is purely a trauma unit with
three wards. Injured patients are admitted to this
unit via the Accident and Emergency Departments
of both hospitals. A comprehensive trauma service
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the warwick programme
is provided, including management of multiplyinjured patients. There is a dedicated trauma
theatre with planned trauma lists seven days a
week. No in-patient elective orthopaedic surgery is
undertaken on this site.
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consultants and special interests
Mr M. Arafa Hand and upper Limb Surgery
Mr K. Bell Knee Surgery
Mr R. Knebel Lower Limb Arthroplasty
Mr K. Mathur Knee and Shoulder Surgery
Ms A. Moon Hand Surgery
The Solihull site is dedicated to elective
orthopaedics. There are two operating theatres
with clean air enclosures. A full spectrum of
orthopaedic surgery is performed with an emphasis
on joint replacement surgery.
There are outpatient and fracture clinics on both
sites.
consultants and special interests
Mr T. Lawrence Primary and Revision Hip Arthroplasty
Mr M. Pereira Foot & Ankle Surgery
Mr A. Reading Hip Surgery
Mr D. Selvey Shoulder and Elbow Surgery
Worcestershire Royal Hospital
Part of the Worcester Acute Hospitals NHS Trust,
this is a newly opened district general hospital in
Worcester. It has superb postgraduate and teaching
facilities. He provides a comprehensive trauma and
elective orthopaedic service with a wide variety of
subspecialist interests among consultants.
& Knee Surgery
Mr H. Rahman Lower Limb Arthroplasty
consultants and special interests
Mr S. Brooks Primary and Revision Knee Arthroplasty,
D. O’Dwyer Hip arthroplasty
Sports Injuries of the Knee
Mr A. Sambatakakis Primary Revision Knee
Arthroplasty, Sports Injuries of the Knee
Mr J. Ramos Foot and Ankle Surgery, Primary Knee
Arthroplasty & Knee Arthroscopy
Mr S. Bryan Shoulder Surgery, General Upper Limb
D. Robinson Shoulder
M. Trevitt Foot and ankle
E. Rouholamin Knee
N. Aslam Hip and knee
M. Grainger Spine
P. Ratcliffe Hands
Surgery
Mr M. Shrivastava Shoulder Surgery, Lower Limb
Arthroplasty
Mr S. Hughes Pathological Fractures, Lower Limb
Arthroplasty
Mr V. Goswami Sports Injury of the Shoulder and Knee,
Lower Limb Arthroplasty
Alexandra Hospital, Redditch
Part of the Worcester Acute Hospitals NHS Trust,
this is a busy district general hospital in Redditch.
There are eight orthopaedic consultants working
full time and responsible for elective and trauma
admissions. Each consultant, in addition to their
direct involvement in the management of trauma
cases, has a special interest including surgery of the
rheumatoid upper and lower limbs, hand surgery,
major joint arthroplasties and back pain surgery.
Warwick Hospital
There are seven consultant orthopaedic and trauma
surgeons in this hospital. All aspects of general
orthopaedics and trauma are covered but there
is considerable experience in joint replacement
surgery, revision surgery, arthroscopic surgery, foot
surgery and upper limb surgery. There is excellent
supervision of training both on routine and elective
lists and with trauma lists each week.
consultants and special interests
Mr S. Young Hip Surgery
Mr P. Binfield, Mr S Farooqui Foot Surgery
Mr I. Nwachukwu,
Mr M. Stanislas Upper Limb Surgery
Mr T. Robertson, Mr K. Shah Hip and Knee Surgery
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educational innovation
The Warwick Programme is at the forefront of modern
teaching methods in orthopaedics.
We have produced and are continuing to develop
an innovative educational programme. Surgical
education has undergone great changes in the
last few years. As a new Specialist Training
scheme, the Warwick Programme is particularly
well placed to take account of new educational
practices required for the modern environment.
The West Midlands have been both pre-pilot and
pilot for the F1, F2 and ST1/2 programmes and
we were well-placed for the advent of modern
run-through training. Those entering the Specialty
Training Programme will be less experienced than
the traditional registrar. Every training opportunity
needs to be utilised. Our training programme
is fundamentally based on the trainee/trainer
relationship and our trainers understand the need
for formalising the relationship. Presently all trainee
and trainers are engaged in the Orthopaedic
Competency Assessment Project (OCAP) and the
Inter-collegiate Surgical Project (ICSP).
As well as encouraging and nurturing high quality
trainer/trainee partnerships, we have innovative
Core Curriculum Programmes weekly (on
Wednesdays). The Basic Core programme prepares
trainees for MRCS, whilst ensuring achievement
of trauma and orthopaedic learning objectives.
The Advanced Core programme delivers the entire
orthopaedic curriculum over a two year period. In
each year there are two semesters, consisting of 12
sessions. Each session consists of 10 hours of study
time spread over two weeks. Six and a half hours
of this take the form of reading and exercises.
There is a self-assessment pre-test to allow trainees
to assess that they have acquired this knowledge
to an appropriate level. The remaining three and
a half hours are delivered in a teaching afternoon
which takes place on alternate Wednesdays in the
Clinical Sciences Building at the University Hospital.
Each teaching afternoon begins with an hour of
clinical examination training. This is small group
teaching on patients with appropriate physical
signs. The second hour is a small group session
supervised by consultant faculty. Specialist
trainees confirm their understanding of the prereading material by discussion. Specific learning
objectives are explored, based on the faculty’s
previous knowledge of those areas which trainees
usually find difficult. The third hour seeks to bring
together all of the activities up to that point ie
knowledge acquisition, clinical examination training
and discussion of difficult areas. This small group
work is based around clinical problems and will
allow the trainees to integrate the previously
acquired knowledge and skills to a high level. The
last half hour of the afternoon is dedicated to an
assessment test and a summary session.
Some core curriculum sessions are skill-based and
include practical workshops. The basic science
sessions have a different structure but are, again,
based on sound educational principles.
The Warwick Programme’s educational activity is
new and innovative: it has proven second to none.
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the warwick programme
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academic distinction
We believe that training in research methodology and medical
education are important parts of the professional development of
an orthopaedic surgeon, and that these will be significant factors in
consultant appointments in the future, especially in larger hospitals.
Warwick Orthopaedics, the trauma and
orthopaedic research group in Warwick Medical
School, provides the major opportunity for research
by Specialist Trainees on the Programme.
The research focus of this group is Evidence-Based
Trauma and Orthopaedic Surgery. We design and
perform research that addresses the questions
of which surgical treatments work, and which
are most cost effective. Warwick Orthopaedics is
becoming a nationally and internationally important
source of robust information on the clinical and
cost effectiveness of treatments in trauma and
orthopaedic surgery.
The group is led by Professor Damian Griffin. Mr
Matthew Costa is the Clinical Senior Lecturer. There
are six Honorary Senior Lecturers, three Postdoctoral Research Fellows, six Clinical Research
Fellows, a team of Research Nurses and Research
Physiotherapists, and administrative staff.
primary clinical effectiveness studies
We design, lead and perform studies to provide
primary evidence of the effectiveness and cost
effectiveness of treatments. We intend to be at
the centre of national networks to perform multicentre, publicly-funded observational studies
and trials to measure and compare the clinical
effectiveness of operations and other interventions.
We have extensive international collaborations
to achieve greater breadth and generalisability.
Cost effectiveness and best design of health care
systems are included in studies in collaboration
with Professors of Health Economics and Social
Science at Warwick Medical School.
secondary studies
We perform systematic reviews of evidence of
effectiveness and cost effectiveness from the
existing primary literature, and synthesis of this
evidence with that from new primary studies.
methodology
All of the trainees on the Warwick Programme
are encouraged to participate fully in the research
agenda of the department. Every trainee has the
opportunity to spend four months in a full-time
academic post as part of their rotation. All can be
trained in research methods and critical appraisal as
part of the MSc in Evidence-Based Musculoskeletal
Care at Warwick University and will play an active
role in one any of the following four linked research
themes:
We perform theoretical and empirical research
to develop novel approaches to primary and
secondary research in musculoskeletal medicine
and surgery, with special emphasis on solving
the problems of performing high quality clinical
outcome research in orthopaedic surgery.
research into practice
We develop methods to summarise and
disseminate evidence of effectiveness in a clinically
applicable form, and to influence clinicians to use it
in everyday practice.
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the warwick programme
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integrated academic training
teaching
In response to the Walport Report , the Warwick
Programme was awarded annual Clinical Academic
Fellows posts and two-yearly Clinical Lecturers
posts by the Department of Health. These were
the first Academic Specialist Training posts in
orthopaedics in the country. These trainees receive
a formal academic training in parallel with clinical
training to CCT. The Programme enables ACFs
to obtain funding for a PhD, do that PhD while
retaining their run-through training number, and
then complete training to CCT. Clinical Lecturers
are supported in raising grants for post-doctoral
research, in order to be competitive for Senior
Lecturers posts when they are ready to be
appointed as consultants. We anticipate that most
of the Professors of the future will be trained in this
way.
Warwick Orthopaedics has extensive teaching
commitments at all levels, from medical students,
to junior doctors, to professional development for
consultants. This provides tremendous opportunities
for Specialist Trainees to practice techniques of
medical education, under supervision, and backed
up by University courses in education up to and
including a Masters Degree in Medical Education.
1
Each trainee will also be expected to play a full
part in the extensive teaching commitments of the
Department. This includes teaching and examining
Medical Students, Foundation Doctors and Allied
Health Professionals.
Four Academic Clinical Fellows are already in post,
two of whom have begun PhDs. Two more will
be appointed in the January 2010 appointment
round - one to develop an academic expertise
in clinical research and the second to complete a
PhD in medical education relevant to Trauma and
Orthopaedic Surgery. These posts are primarily
intended for entry at ST1 for run-through training,
with the most important criterion for appointment
being demonstration of academic potential to
successfully complete a PhD. Rotations for these
posts are designed flexibly, with a quarter of the
trainees’ time committed to preparing a successful
PhD grant application. A postdoctoral, mid-specialty
training clinical lecturer was appointed in 2009 and
another will be appointed in 2011.
Warwick Orthopaedics runs a wide range of
internal and external courses which are open to the
Specialist Trainees. Professor Griffin is the Surgical
Training Director of the West Midlands Surgical
Training Centre2, an 8-station, purpose-designed,
cadaveric training facility within the University
Hospital, Coventry. In conjunction with other forms
of simulation, it is being extensively used in open
and arthroscopic training with the vision that ‘no
surgeon should do an operation for the first time on
a living patient’. At the other end of the spectrum,
we run an international sports surgery symposium
every six months on a two-year rotation through
Sports Hip Surgery, Sports Knee Surgery, Sports
Shoulder Surgery, and Sports Foot and Ankle
Surgery.The University Hospital Department also
runs nationally advertised ATLS, CCrISP and Basic
Surgical Skills courses and encourages trainees to
become instructors.
1 http://www.mmc.nhs.uk/download/Medically-and-DentallyQualified-academic-staff-recommendations-Report.pdf
2 http://www.warwick.ac.uk/fac/med/research/csri/
orthopaedics/about_us/vac/academclinfellow/stc.pdf
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