NATIONAL ORTHOPAEDIC HOSPITAL, ENUGU.
RESIDENTS’ TRAINING MANUAL.
TABLE OF CONTENTS
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SECTION ONE
BACKGROUND
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VISION AND MISSION -
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THE POST GRADUATE MEDICAL COLLEGES
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EXPECTATIONS/ OBLIGATIONS OF THE TRAINER
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EXPECTATIONS/OBLIGATIONS OF THE RESIDENTS
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SECTION TWO
THE PROGRAMME-
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ADMISSION INTO THE PROGRAMME
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PROGRESSION
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SPONSORSHIPS TO EXAMINATIONS AND COURSES -
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ELIGIBILITY -
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WITHDRAWAL FROM PROGRAMME -
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RESEARCH GRANT
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OVER-SEA CLINICAL ATTACHMENT -
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DISCIPLINE
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1.
BACKGROUND
The National Orthopaedic Hospital, Enugu, is a 250 bedded hospital which offers
services and training in Orthopaedics & Trauma Surgery, Burns & Plastic Surgery and
Anaesthesia. The training is accreditated by both the National Postgraduate College of
Nigeria and the West African College of Surgeons. Services and training are offered in
the sub-specialties of General Orthopaedics as well as Trauma, Arthroplasty,
Arthoscopy, Spine surgery, Paediatric Orthopaedics, General Plastic surgery, Burns,
Craniofacial surgery, Hand Surgery, Microvascular surgery, Aesthetic surgery, Plastic
Surgical oncology and Paediatric Plastic Surgery. Recently, the hospital decided to start
training in Anaesthesia.
The institution provides training for an average of 50 residents with a yearly intake of
10 – 12 residents. At the end of the training programme residents are expected to have
acquired proficiency in their chosen specialty to be appointed consultants.
They are expected to have acquired definite competencies in the four areas of
professional practice namely, clinical problem solving, research, education and Health
services management.
MISSION AND VISION STATEMENT OF NATIONAL ORTHOPAEDIC HOSPITAL,
ENUGU.
OUR MISSION:
To provide the highest quality of services, training, and Research in Orthopaedics.
Accidents and Emergency care, Burns & Plastic Surgery and Rehabilitation.
OUR VISION
To be a state-of-the art hospital with highly trained and motivated manpower where,
Orthopaedic, Accident & Emergency Care, Burns, Plastic and Reconstructive surgery,
Medical diagnostics, Rehabilitation and Efficient management are offered to all levels
comparable to similar hospitals in any part of the world and to improve the quality of
life of Nigerians.
THE POSTGRADUATE MEDICAL COLLEGES.
There are two postgraduate Medical Colleges involved in the training and certification of
our residents.
1. THE NATIONAL POSTGRADUATE MEDICAL COLLEGE OF NIGERIA.
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Address: Km 26, Lagos – Badagary Expressway
PMB 2003, Ijanikan, Lagos, Nigeria.
Email: enquiry@npmcn.edu.ng
Website: www.npcn.edu.ng
Time of Examinations: May and November.
2. WEST AFRICAN COLLEGE OF SURGEONS
Address: 8, Taylor Drive, off Edmund Crescent, Medical compound
PMB 2023, Yaba, Lagos, Nigeria.
Email: registrar@wac-physicians.org
admin@wac-physicians.org
Website: www.wac-physicians.org
Time of Examinations: April and October
EXPECTATIONS FROM/OBLIGATIONS OF TRAINERS/HOSPITAL.
1. Trainers are committed to creating an environment conducive to the educational
needs of all residents.
2. Trainers are committed to provide clear rotation charts/plans for all residents
from admission to completion of or withdrawal from programme.
3. Trainers should provide timely discussion of unit based rotation specific goals, be
available to ensure the actualization of such goals and ensure constructive and
fair assessment of the residents based on the parameters in the Residents
Evaluation & Assessment Form (REAAF).
4. The trainer is expected to actively engage in regular teaching and discussions
with the residents
5. He/She is expected to be present at surgical sessions and to develop a
systematic module for skill transfer to the residents.
6. The trainer is expected to help the resident learn the tenets of biomedical
research.
7. The hospital is to encourage unit sub-specialization to enhance optimal learning
during rotations.
8. In all cases where residents are required to go to other centers for specific
rotations, as may be required by either of the two colleges, the hospital will
provide adequate and timely support to such residents.
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EXPECTATIONS FROM/OBLIGATIONS OF THE RESIDENTS
1. The resident is expected to be well motivated and dedicated in applying himself
to mastery of the requirements of the programme.
2. The resident is expected to demonstrate a collegial and professional attitude at
all times towards graduated learning and responsiblity process. This is expected
to conform to the ethics of the profession and code of conduct of the hospital.
3. The resident is expected to demonstrate compassionate exemplary clinical care
in the context of a multidisciplinary team environment.
4.
Residents are expected to seek appropriate back up from trainers or seniors in
the face of clinical uncertainty beyond their level of training or competence. At
no time shall a resident embark on any procedure beyond his level of training or
competence.
5.
Residents Availability: The resident is obliged to be available, for services and
training, at all times in compliance with requirements of the programme.
6.
The resident is expected to request for and participate in regular unit based
academic discussions and teaching programmes.
7.
The resident is expected to request for and participate in regular tutored
operative sessions geared towards skill transfer and acquisition
8.
The resident is expected to acquire teaching, communication, research and
management skills.
9.
The resident is obliged to fill and sign off his log book at the end of each theatre
session.
10.
The resident is obliged to promptly present himself for assessment at the end of
each posting.
11.
The resident is expected to assess his trainer(s) at the end of each posting by
appropriate use of the feedback system as provided in the REAAF.
NB: Residents are in training to become life-long learners to the practice and art of
their respective disciplines.
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PROGRAMME – Culled from the Harmonized Curriculum.
LEARNING OBJECTIVES
GENERAL EDUCATIONAL OBJECTIVES
By the end of his over-all training in the Residency programme, each resident in
Surgery
should be able to:
1. Obtain, at first consultation, as complete a
data base (History, Physical
Examination) and Laboratory data) as is compatible with
the urgency and
complexity of the patient’s problems.
2. Recognise within the database, problems that:
(a) require further investigation or
(b) require therapeutic or supportive intervention.
3. Investigate clinical problems using relevant tests and other
in order to clearly define the patient’s problems.
4.
appropriate tools
Interprete clinical findings and the results of diagnostic investigations, and
by a clear process of deductive reasoning reach appropriate decision on
clinical management and therapeutic intervention.
5.
Perform all common operative procedures required for the restoration
and/or maintenance of health for the individual patient.
6.
Explain and defend the rationale of, and the technique and procedure
employed in standard surgical operations.
7.
8.
Effect adequate post-operative care and full rehabilitation of his patient.
Demonstrate a clear, knowledge of the pathology, pathophysiology, clinical
features, management options and result of therapy of common surgical
diseases.
9.
Provide effective supervision for his junior professional colleagues in their
performance of simple surgical procedures.
10. Teach surgical concepts and operating skills to Junior colleagues.
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11. Explain concepts of surgical diagnosis and treatment not only to his patients,
but also to other members of the health team, so as to facilitate
successful
surgical care.
12. Demonstrate problem-solving ability by designing and implementing a simple
research project relevant to the needs of his local environment.
13. Demonstrate general management competence in the appropriate use of
resources (man, materials and money) to achieve effective surgical care.
14. Provide effective and purposeful leadership of the surgical team.
15. Ability to set up, organise and manage
facility.
surgical services in any health care
COURSE DURATION
The duration of the courses shall be as follows:
Part I Fellowship: 24-36 months.
Part II Fellowship: 24 - 36 months depending on the sub-specialty.
COURSE STRUCTURE
PRIMARY
The Primary Fellowship examination seeks to establish the Candidate’s trainability in
Surgery by certifying that he is able to demonstrate adequate knowledge of basic
medical sciences as applied to surgery in
(a) Human Anatomy (including cell biology, histology, embryology and osteology)
(b) Human Physiology (including biochemistry and pharmacology)
(c) Human Pathology (including haematology, chemical pathology, immunology and
microbiology) as applied to surgery.
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THE PRIMARY EXAMINATION
The Primary examination now features:
Two sections of a single Paper :A 3 hour MCQ objective paper
consisting of 150
stem Questions made up of:
-75 in Anatomy (including Embryology, histology and genetics).
- 75 in Pathophysiology of surgical conditions (including Microbiology
and Pharmacology)
FORMAT FOR TRAINING
Training consists of two successive phases each lasting a minimum of twenty-four
months viz:
(a)
Junior Residency,
(b)
Senior Residency.
JUNIOR RESIDENCY TRAINING- EDUCATIONAL OBJECTIVES
Resident should be able to
1.
Successfully conduct the pre and post operative management of surgical
diseases common in this environment.
2.
Carry out all simple elective surgical procedures including skin incision and
closure, herniorrhaphies, etc as well as perform the incision, exposure and wound
closure for major operative procedures.
3.
Perform common emergency surgical procedures, e.g. closed reduction and
immobilization of fractures, laparotomy, appendicectomy, tube drainage of the pleural
space, catheterization for the relief of urinary obstruction, burrhole for evacuation of
extradural haematoma etc.
4.
Manage
(a)
(b)
(c)
the critically ill patient
simple head injured patient
the multiple-injured patient
FORMAT OF TRAINING – Junior Residency
A.
1.
Core Postings
Accident and Emergency (Casualty)
Duration
6 months
2.
General Surgery
6 months
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3.
Urology
3 months
4.
Orthopaedics and Trauma
3 months
TOTAL
=
18months
FORMAT OF TRAINING – Junior Residency
B.
Elective Postings
Durations
1.
Anaesthesia
3 months
2.
Burns and Plastic Surgery 3 months
3.
Cardiothoracic Surgery
3 months
4.
Neurosurgery
3 months (now mandatory for the faculty of
Orthopaedics)
5.
Paediatric surgery
3 months
In order to enhance the overall competence in surgical practice, even when a resident,
has not rotated through a particular Elective posting, there should be opportunities for
learning through the departmental didactic sessions covering ALL disciplines.
SENIOR RESIDENCY ENTRY REQUIREMENT
A candidate is eligible to be admitted to a Senior Residency Training in Surgery only on
successful completion of the Junior Residency Training and passing the Part I
Examination or exempted from Part I by the Faculty Board after passing any of its
recognized equivalents.
GENERAL EDUCATIONAL OBJECTIVES
During this phase of training, residents are expected to perform at a higher proficiency
level than they did during their junior residency, to assume a greater degree of
responsibility for decision making in patient care as well as cover a much wider scope of
surgical techniques and procedures.
By the end of the senior residency programme, each successful resident is expected to
be able to perform effectively as a consultant surgeon.
SENIOR RESIDENCY
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The senior residency training in Surgery lasts a period of twenty-four to thirty six
months.
During his senior residency each resident is expected to execute a research project on a
topic of his choice in any aspect of clinical surgery, under the supervision of at least
two Consultants (at least one supervisor should be a Fellow of the College in Surgery).
GOAL OF THE DISSERTATION PROJECT
The goal of the dissertation exercise is to enable the resident to acquire skills for
research and problem solving. It is not mandatory that, he breaks a completely new
ground; the essence is for the resident to make contribution to knowledge.
To handle the Materials and Method of the study to obtain results relevant to the
stated goals;
To analyze the results using appropriate statistical tools, and draw logical
conclusions ;
To discuss his findings in relation to existing body of knowledge on the subject.
OBJECTIVES OF THE DISSERTATION PROJECT
To select and define clearly the research problem
To delineate the scope of the study bearing in mind the resources available
To define the objectives of the study in precise, clear terms leaving no doubt as to
feasibility.
To review critically (not merely cite references from) available literature on the subject.
Course Structure for the Part II Training Programme
The sub-specialties in surgery are the following:
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GENERAL SURGERY
ORTHOPAEDICS
PAEDIATRIC SURGERY
UROLOGY
BURNS, PLASTIC AND RECONSTRUCTIVE SURGERY
CARDIOTHORACIC SURGERY
NEUROSURGERY
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1.
GENERAL SURGERY
Following successful completion of the part I examination, the candidate wanting to
train in GENERAL SURGERY should seek admission into an accredited hospital for
training in this specialty.
The training is for a period of 24-36 months and training is in various aspects of
general surgery.
Each candidate should keep a daily and up to date record of operative procedures
he/she participates in during this period of training, using the prescribed logbook
for general surgery published by the faculty.
During this period, the candidate is encouraged to attend the integrated revision
course in surgery regularly organized by the college.
CORE POSTINGS
These shall be the core postings;
a. Surgical Oncology [including Breast diseases, Surgical endocrinology and Skin /
soft tissue lesions] - 6 months
b. Gastroenterology [including upper GIT, Colo-proctology, Laparoscopic and
Endoscopic Surgery]
- 12months
c. Hepatopancreaticobiliary surgery [may be combined with Gastroenterology but
ideally should have a separate unit] 6 months
ELECTIVE POSTING: The remaining 12 months
should be undertaken in 4 of the following areas:
Burns & Plastic Surgery
3 months
b. Paediatric Surgery
3 months
c. Orthopaedics/Trauma
3 months
d. Neuro Surgery
3 months
e. Urology
3 months
f. Cardio thoracic/Vascular Surgery 3 months
2.
ORTHOPAEDICS
Following successful completion of the part I examination, the candidate wanting to
train in ORTHOPAEDICS should seek admission into an accredited hospital for
training in this specialty.
The training is for a period of 24-36 months and training is in various aspects of
Orthopaedic surgery and 6 months of elective postings.
The Core postings are:
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Trauma
Arthroplasty
Arthroscopy
Paediatric Orthopaedics
Spine
The elective postings are:
Orthopaedic oncology
Burns and Plastic surgery
3.
BURNS, PLASTIC AND RECONSTRUCTIVE SURGERY
Following successful completion of the part I
examination, the candidate wanting to train in
Burns, Plastic and Reconstructive Surgery
should seek admission into an accredited
hospital for training in this specialty.
The training is for a period of 36 months and
training is in various aspects of Burns, Plastic
and Reconstructive Surgery
The rotations are as follows:
General Plastic surgery
Trauma surgery
Burns surgery
Paediatric plastic surgery
Oncological surgery
Hand surgery
Reconstructive and aesthetic plastic surgery
Reconstructive genitalia surgery
Microsurgery
4.
ANAESTHESIA
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EVALUATION
PART 1 FMCS
Formative Assessment is done by the Training institutions.
Summative assessment is done by the Colleges.
PART II FMCS
Formative Assessment (Training institutions)
Summative (the College)
ADMISSION INTO THE PROGRAMME
Admission into the Residency Training Programme in the hospital is open to all medical
practitioners with basic medical degrees registrable with the relevant National body for
the regulation of Medical and Dental practice.
A pass in the surgery or anaesthesia specialty primary fellowship examination is
mandatory for admission.
There are two modes of admission into the programme:
(a) Regular Residency
(b) Supernumerary
(A)
Regular residency requires MBBS, full registration with Medical and Dental
council, NYSC discharge certificate, a current practicing license and success at the
selection interview.
(B)
Supernumerary residents require MBBS, registration with Medical and Dental
Council , NYSC discharge certificate, current practicing licence and a sponsor. The
admission is subject to availability of vacancy and payment of stipulated bench fee.
PROCEDURE FOR ADMISSION
1.
Admission shall be in October each year for regular residents.
2.
All new residents will be expected to pass through an orientation programme
within the first three months of admission.
3.
All residents shall have copies of the hospital training manual and be aware of
the requirements of the programme.
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4.
All new residents shall be included in the flow chart within the first rotation.
5.
All residents shall be assessed on completion of each rotation. The assessment
form must be submitted to the RET secretariat not later than two weeks from the
completion of each posting.
PROGRESSION
1. A Resident shall be admitted as Junior Resident II.
2. A Junior Resident II shall be promoted to Junior Resident I after 12 (twelve)
months of satisfactory posting.
3. A Junior Resident I shall be promoted to Senior Resident II on passing the Part I
fellowship examination.
4. A Senior Resident II shall be promoted to Senior Resident I after 12 (twelve)
months satisfactory posting.
SPONSORSHIP TO EXAMINATIONS & COURSES
Only regular residents are entitled to sponsorships.
EXAMINATION
1. Sponsorship for part I examinations shall be for a maximum of 3 (three)
examinations irrespective of college.
2. Senior Residents shall be sponsored to a maximum of 3 (three) part II
examinations of the college passed first at Part I or as determined by the
resident provided success in the second Part I examination is within the same
examination season as the first.
COURSES
Residents shall be sponsored to attend the following courses.
1.
2 (two) update courses for Part I and one (1) update course for Part II.
2.
1 (one) research methodology course or Manuscript writing course.
3.
1 (one) management course.
NB: Sponsorship opportunities for part I examinations automatically terminates
following success in any of the colleges within an examination season.
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ELIGIBILITY
To be certified fit to sit for examinations and to enjoy sponsorship to courses, a resident
must score at least 70% in attendance to RET organized academic programmes and
have a satisfactory REAAF assessment.
1.
Application for sponsorship should be done at least one month from the intended
examination or course
2.
A resident is qualified for sponsorship to examination and/or course if he/she
meets the requirements of the colleges and the hospital as outlined in this
manual.
3.
A resident is eligible to sit for an examination on satisfactory completion of
stipulated postings.
WITHDRAWAL FROM THE PROGRAMME
4.
A Resident shall automatically withdraw from the programme if he fails to pass
the Part I Fellowship examination 18 months after the date of the first Part 1
examination you become eligible to sit.
5.
If he fails to pass the Part II Fellowship examination 18 months after the date of
the first Part II examination you become eligible to sit.
6. Six months after successful completion of the Part II examination or
7. If there is an established case of gross misconduct against the resident or
8. The resident may voluntarily withdraw from the programme in accordance with civil
service rules.
RESEARCH GRANT
A research grant of one hundred thousand naira only shall be awarded to post part I
residents on presentation of an approved dissertation proposal. This grant will is subject
to periodic review.
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OVERSEAS CLINICAL ATTACHMENT
Post part I residents may be sponsored to overseas clinical attachment based on
hospital needs and National Policy.
DISCIPLINARY MEASURES
Residents are expected to comport themselves and comply with the laid down rules of
the hospital and civil service.
Residents should avail themselves of a copy of the public service rules.
Stipulated disciplinary actions in the public service rules shall apply to erring residents.
It is proposed that the Education Advisory Committee for Surgeons be re-christened
Residency Training Committee.
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