General hand surgery talk2

1. Hand Surgery for the uninterested Recent advances, practice, training and accreditation The Birmingham Hand Centre

2. Mr Vaikunthan Rajaratnam MBBS(Mal),AM(Mal),FRCS(Ed),FRCS(Glasg),FICS(USA), MBA(USA),Dip Hand Surgery(Eur), PG CertMedEd(Dundee),FHEA(UK) Consultant Hand Surgeon Birmingham Hand Centre University Hospital Birmingham NHS Foundation Trust Royal Orthopaedic Hospital United Kingdom www.handsurgerymanual.com The Birmingham Hand Centre University Hospitals Birmingham NHS Foundation Trust

3. Birmingham Hand Centre • UHB NHS FT • QEHB • ROH NHS FT The Birmingham Hand Centre University Hospitals Birmingham NHS Foundation Trust

4. Defining Hand Surgery • Bones joints distal to radius • Soft tissues • Nerves & brachial plexus • Vessel distal to the wrist Berretini anastomosis Neuroanatomy [2009] 8: 15–19 The Birmingham Hand Centre University Hospitals Birmingham NHS Foundation Trust

5. Speciality • Sub speciality of orthopaedic and plastic • Independent speciality – Norway, Sweden and Singapore • Orthopaedic, plastic surgery, vascular surgery and microsurgery The Birmingham Hand Centre University Hospitals Birmingham NHS Foundation Trust

6. Training Ladder Fellowship 1 year Core Specialty 6 years CT 2 years FY 2 years Medical School 5 years The Birmingham Hand Centre University Hospitals Birmingham NHS Foundation Trust

7. Proposed UK Training Ladder Hand Sub Speciality 2 years Hand Surgery 4 years CT 2 years FY 2 years Medical School 5 years The Birmingham Hand Centre University Hospitals Birmingham NHS Foundation Trust

8. Future Training Ladder Hand Sub Speciality Fellowship 1 year Hand Surgery R3 - 6 Core Residency R1 & 2 Pre Reg HO (Intern) Medical School 5 years The Birmingham Hand Centre University Hospitals Birmingham NHS Foundation Trust

9. The Need • Musculoskeletal disorders most common work related ailment in Great Britain • 30% of WRMSD is Upper Limb • 4.7 million working days were lost in 2003/04 • estimated 18.3 days off in 1 year • 2005/06 - 374 000 people in Great Britain suffered from an WRMSULD The Birmingham Hand Centre University Hospitals Birmingham NHS Foundation Trust

10. Current Practice • Trauma • Fractures • Finger tips • Burns • Tendon/nerve/skin loss • Elective • Compressive Neuropathy • Tumours • Arthritis • Deformities • Congenital The Birmingham Hand Centre University Hospitals Birmingham NHS Foundation Trust

11. Hand Surgery Practice • Moving from trauma to more elective • Nerve entrapments • WRMSD rather than industrial accidents • Sports injuries • Infections • Assault/self inflicted • DIY The Birmingham Hand Centre University Hospitals Birmingham NHS Foundation Trust

12. Sub Speciality • Congenital • Brachial Plexus and Peripheral Nerve • Wrist • Spastic Hand • Microsurgical reconstruction The Birmingham Hand Centre University Hospitals Birmingham NHS Foundation Trust

13. The Birmingham Hand Centre University Hospitals Birmingham NHS Foundation Trust

14. Qualities • Patience • Fine motor coordination • Inquiring mind • Innovative • Community orientated • Self critical • Strive for mastery The Birmingham Hand Centre University Hospitals Birmingham NHS Foundation Trust

15. Some examples The Birmingham Hand Centre University Hospitals Birmingham NHS Foundation Trust

17. Hand Fractures The Birmingham Hand Centre University Hospitals Birmingham NHS Foundation Trust

35. 28 , Male, R Hand dominant The Birmingham Hand Centre

59. Stake Holders • Regulators • Educators – University, Professional bodies • Patients/Community • Funders of health The Birmingham Hand Centre University Hospitals Birmingham NHS Foundation Trust

60. Needs analysis • Challenges of developing and rural community • Fit for purpose • Delivering the service The Birmingham Hand Centre University Hospitals Birmingham NHS Foundation Trust

61. Training vs Education The Birmingham Hand Centre University Hospitals Birmingham NHS Foundation Trust

62. Political • Regulation • University vs Professional bodies • Credentialing • Accreditation The Birmingham Hand Centre University Hospitals Birmingham NHS Foundation Trust

63. Economy • Time • Service Commitments • Teacher supply • Funding The Birmingham Hand Centre University Hospitals Birmingham NHS Foundation Trust

64. Social • Adult learning styles • Self paced • On demand • Experiential • Work based • Teaching styles The Birmingham Hand Centre University Hospitals Birmingham NHS Foundation Trust

65. Technology • Curriculum 2.0 • On line resources • On line skill acquisition • On line assessment • Digital Video • Tele medicine • On line mentoring The Birmingham Hand Centre University Hospitals Birmingham NHS Foundation Trust

66. Opportunity in developing community • Patients • Training Time • Teachers • Technology • University backed • Green field • Demand for education • Infrastructure The Birmingham Hand Centre University Hospitals Birmingham NHS Foundation Trust

67. The Ideal Surgeon • Wide Knowledge Based • Holistic & Ethical • Right Thinking • Highly Skilled • Innovative • Surgical wisdom • Teacher The Birmingham Hand Centre University Hospitals Birmingham NHS Foundation Trust

68. What to teach? • Surgical thinking • Curriculum • Surgical practice • Integrating and applying propositional knowledge • Careful perception • Opportunistic LEARNING • DISCIPLINE • Assessments – summative and formative The Birmingham Hand Centre University Hospitals Birmingham NHS Foundation Trust

69. Accreditation • Orthopaedics • Quality • Plastics • Patient Safety • A&E • Education • General Surgeons • Advancement • Research • Inclusive not exclusive The Birmingham Hand Centre University Hospitals Birmingham NHS Foundation Trust

70. Thank you • www.handsurgerymanual.com • http://handsurgery.moodlehub.com/ • http://www.bssh.ac.uk/ • http://www.sshs.org.sg • http://www.fessh.com/ • http://www.ifssh.info/ The Birmingham Hand Centre University Hospitals Birmingham NHS Foundation Trust

General hand surgery talk2

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General hand surgery talk2