Ashok K. Banskota MD, FACS
Training of Orthopaedists
 Under Ministry of Education & Sports
 Tribhuvan University (TU)
 Kathmandu University (KU)
• Under Ministry of Health & Population
– BP Koirala Institute of Health Sciences
(BPKIHS)
– National Academy of Medical Sciences (NAMS)
Trends in Post Graduate Program
Development
 IOM, (TU)MBBS  Higher Studies
1979  1982 (PG)  1998 (Ortho)
 KU
1994  1999 (Ortho)
1994  1998 (Ortho)
 NAMS (PG Institute)  2003 (Ortho)
 BPKIHS
Course Duration
ALL
Pre Requirement
1yr House officer, Post MBBS
NMC Registration
IOM (TU
BPKIHS
KU
NAMS
4 yrs
3 yrs
3 yrs*
3 yrs**
Global Objectives
 Meet increasing specialist manpower need
 Produce a skilled orthopaedic specialist of at least
minimum international standards
 Provide a training experience with an adequate
knowledge base of the applied basic sciences, trauma
care principles and management of common
orthopaedic disorders.
Candidate Selection Criteria
Slated Criteria
 All
 Entrance Examination for pre
qualifiers
 Interview
Special Circumstances
 Accommodating diploma
Holders (NAMS)
 Scholarships (Foreigner)
 Manpower needs of
training institutions (KU)
 BPKIHS (meeting National
manpower needs)
Costs of Training
•
•
•
•
IOM
KU
BPKIHS
NAMS
 University Expenses
 Student – monthly
stipend
 Training institution
logistic expenses
 Expenses for Special
courses / meetings
Challenges in Orthopaedic Care – Nepal
 Specialist needs enormous
 90 orthopaedists / 26 million
 No uniformity in standards of practice – trainees from
different backgrounds
 Practice opportunities limited – enormous input
required throughout the country
Kathmandu University – Ortho
Residency (1999)
 MS – B & B Hospital + Hospital and




Rehabilitation Center for Disabled
Children (HRDC)
Initiated to meet growing needs
compliment of case load /
institutional base / preceptors
Controversies – (now resolved)
1999-2006 : 11 graduates
10 Lakhs
Pre-Residency
University
Program
1 year
3 years
E
X
A
M
Registrar
1 year
IOM – TU PG Ortho (1998)




TUTH – Venue
Foreign nationals / Paying
4 years course
Intake initially 2/year now
4/year
 Criteria: Entrance Exam
 Passed out : 15
 Cost 10 Lakhs
BPKIHS – Ortho 1998
 Medical University – 3 year Program
 Central Government of India collaboration
 Apex institute for manpower training
 Intake initially 2/year now 4/year
(foreign nationals)
 Total passed out : 16
 Cost : 10 – 14 Lakhs
NAMS – Ortho (2003)
 Bir Hospital (PG Institute) Valley Group of Hospitals
 Accommodation of Diploma Holders in Government
Positions
 Capitation students (local + Foreign) also taken
 Intake 6 (regular – 3, diploma -1, sponsor-1, foreign -1)
 Passed out 12
 Cost : 8 Lakhs
Orthopaedic Graduates from 1998 to 2007
20
15
15
11
16
12
10
5
0
KU
NAMS
IOM
BPKIHS
PG Orthopaedic Training – Nepal Scenario







Government & Non Government Participation
Course Objectives similar
Duration of training variable
Training experience ununiform except for truama
Evaluation systems
not tested nor reviewed
Student / Teacher ratio 1:1
Teachers: making use of available manpower often
lacking experience.
Training Process – Documentation
Core logbook
 To maintain records of the acquisition of skills
 To indicate the levels of competence expected &
achieved
Thesis
Training Program – Common Patterns




IOM
BPKIHS
KU
NAMS




Group discussions
Case Presentations
Journal Clubs
Practical Learning
 ER
 OPD
 OT
 Clinical Research
 Hours / Duties / Time off
 No Hours 80-90 hrs/week
Training Program – Special Aspects
 KU – Additional Pediatric & Rehabilitation Exposure
 BPKIHS
 Community orthopaedics
 Link with AIIMS & other leading Indian Institutions
Evaluations
 Formative Evaluation
 Applied Basic Sciences
 Clinical Presentations
 Annual Examinations
 Dissertation (Thesis)
 Final Examination
 Written : I, II & III
 Practical
 Examiners
Examinations
 Paper setting as per guidelines of university
 Chairman – appointed
 Written papers
 Practical
 OSCE
 Short and long cases
 Table viva
Examinations – Shortcomings
 Uniformity lacking – Specially in implementation
 Pre-tests of examinations ?
 Validity to need and training ?
 Bias – competitive / institutional
Roles of Non-Orthopaedists
 Initial evaluation/primary care/emergency care
 Transport
 Definitive care
Health Assistant (HA)
 Course Duration : 2 ½ years to 3 years
 11 centers and 40 intake in each center
 Course content:





Basic Science
Basic Medicine
Basic Surgery
Basic epidemiology
Maternal Child Health




Immunization
First Aid Surgery
Preventive Health
Referral
 Job Posting : Health Post
 Job Responsibility
Community Medical Assistant
(CMA)
 Course Duration : 15 months
 Course content:





Basic Science
Basic Medicine
First Aid Surgery
Basic epidemiology
Maternal Child Health




Immunization
First Aid
Preventive Health
Referral
 Job Posting : Sub Health Post
 Job Responsibility
Community Based Rehabilitation (CBR)
Worker -(HRDC)
 Stationed in the field
 HRDC need based
 Primary selection and intensive 3 months long training
with annual 6 weeks refreshers.
 Goals – preventive, facilitative, screening, referral, Rx
Physiotherapy and Rehabilitation
(PRT)Trainee- (HRDC)
 Pre requirement – High School
 Training
 Didactic/Practical
 Community Need based
 Follow up care / rehabilitation needs of patients
emphasized
Other Non-Orthopaedist Workers
 Compounder/Dresser
 Plaster cast technician
 Ambulance Driver/attendant
 Traditional practitioners, including bone-setters,
barbers
Conclusions: Orthopaedists
1.
2.
3.
4.
5.
6.
Curriculum needs to have a practical focus, instead of trying to be
“complete”.
Uniformity in training experience should be a continuous target.
Cost effective non-operative treatment methods need to be promoted.
Technically, market driven orthopaedic practices, may give wrong
message to trainee.
Case material for training can be pooled from all the available
institutions to strengthen a broad exposure
Areas that need strengthening
1.
Evaluations Process
2.
Research and Publications
3.
Availability of special courses in weaker areas.
Conclusions: Non-Orthopaedists
Important but largely neglected manpower
2. Very simple and basic training can be cost effective.
3. Serious complications/fatalities would be prevented.
4. Curriculum design and urgent implementation is the
need of the day
1.