JTO
02 Dec 2025

JTO - December 2025

 

Volume 13 Issue 4

From the Executive Editor

“Tell me and I forget. Teach me and I remember. Involve me and I learn.” – some of the features in this issue drive home the message from that Benjamin Franklin quote. Evidence that trainee led procedures like hip and knee replacements are safe and lead to good patient outcomes that are similar to consultant led procedures should provide sufficient reassurance to involve trainees as lead surgeons with appropriate supervision (Sam Jain et al.). Knowledge based and simulated practical training has its role, as reported by Natalie Green and colleagues, by reviewing trainee feedback before and after training in the use of Jamshidi bone biopsy technique. Our trainee article featuring the IMPACT study, highlights the current issues with training in our specialty. The quality and structure of training, variation in implementation of competency-based curriculum across deaneries, and the current dependency on fellowships are the main areas of concern and should be considered in the ongoing curriculum reform. Deepa Bose has a good overall perspective as chair of the T&O SAC and provides an update on T&O specialty training covering the current challenges and ‘sparks of hope’ for the future.

Artificial intelligence is the flavour of the month, where the BOA AI Conference held on 1st – 2nd December brought together expertise and interested delegates to focus on AI in orthopaedics and musculoskeletal science. The ‘Hackathon’ has become a popular and exciting part of the annual conference, and the report from Roy Ormiston and the 2024 hackathon winning team, highlights how interdisciplinary collaboration, particularly bringing together expertise from T&O and data science can lead to developing new models of care.

Did you know that clinical negligence claims cost the NHS £3.6 billion in 2024-25 of which orthopaedics alone was £178 million? Julianna Jones provides an overview of what is required of a clinician and the role of a Trust’s legal team in supporting surgeons. Our international features include a report by Lucy Harriss on her elective in paediatric orthopaedics at Beit-CURE hospital in Malawi. It is heartening to read how such an elective placement in F1 year of training can help cement one’s interest in the specialty (and subspecialty!). Mike Wilson reports on his travelling fellowship experience at the CURE hospital in Zimbabwe. His key learning points and the case made for global health partnerships are worth noting.

I thank Professor Xavier Griffin for leading the subspecialty section on trauma, which has brought together an interesting mix of articles covering important and topical matters in trauma.

I would also like to say a special thanks to Dr Kristin Abraham, pharmacist by training, and part of the extended clinical team at the Queen Elizabeth Hospital in Gateshead for the cover artwork.

And finally, I wish you all a happy festive season – may it be merry and bright!

Amar Rangan, President elect

 

Subspecialty Section

Appendices

IMPACT [Insights to Maximise Progression of Trainees Aspiring to be a Consultant in T&O] Study: Training today, prepared for tomorrow

Appendix 1

 

Appendix 1 - The IMPACT Questionnaire

 

IMPACT Survey - Insights to Maximise Progression of trainees during Annual review of Competency in T&O programmes

1. Did you receive a non-standard ARCP outcome at any of your ARCPs in the last 12 months *

Mark only one.

  • No. I received Outcome 1 / Outcome 6 / Outcome 8. Skip to question 9
  • Yes. Outcome 2. Skip to question 2
  • Yes. Outcome 3. Skip to question 2
  • Yes. Outcome 4. Skip to question 2
  • Yes. Outcome 5. Skip to question 2
  • Other

ARCP outcomes

2. If you received a non-standard ARCP outcome, what was the reason? (Select all that apply) *

Tick all that apply.

  • Inadequate Logbook Numbers
  • Inadequate WBAs (e.g PBAs, CEXs, CBDs, MCRs)
  • Research
  • Audits
  • Admin (e.g. MCR, Meeting, Certificates etc.)
  • Covid-Related Previous Outcome 10
  • Not Applicable. I did not receive a non-standard ARCP outcome.
  • Other:

3. If Logbook numbers was the reason for non-standard ARCP outcome, please select below all that apply

Tick all that apply.

  • Inadequate total logbook numbers for current level of training
  • Inadequate first surgeon logbook numbers for current level of training
  • Inadequate indicative procedures for the current level of training
  • Not applicable.
  • Other

4. If inadequate logbook numbers was an issue, did you receive support from your deanery/TPD to help make up numbers?

Tick all that apply.

  • Yes - Favourable Placements
  • Yes - Extra operating lists
  • Yes - Access to Private Sector
  • No
  • Not Applicable
  • Other:

5.If inadequate indicative numbers were the reason, then please select below which subgroup operations.

Mark only one.

  • Major joint arthroplasty
  • Osteotomy
  • Nerve decompression
  • Arthroscopy
  • Compression Hip Screw for Intertrochanteric Fracture Neck of Femur
  • Hemiarthroplasty for Intracapsular Fracture Neck of Femur
  • Application of Limb External Fixator
  • Tendon Repair for trauma
  • Intramedullary nailing including elastic nailing for fracture or arthrodesis
  • Plate fixation for fracture or arthrodesis
  • Tension band wire for fracture or arthrodesis
  • K wire fixation for fracture or arthrodesis
  • Children’s displaced supracondylar fracture
  • Not Applicable

6. If inadequate indicative numbers were the reason for the non-standard ARCP outcome, did you achieve adequate WBAs appropriate for your level in those operations?

Mark only one.

  • Yes
  • No
  • Not applicable.

7. If research or audit were the reason for the non-standard ARCP outcome, please choose the best option below.

Mark only one.

  • Inadequate published papers/recruitment/presentations
  • Inadequate audits / QIPs
  • Inadequate evidence of journal club, reflections and evidence based practice
  • Not Applicable
  • Other

8. This question is aimed at trainees with non-standard ARCP outcomes at the critical waypoints (ST6/ST8) to be signed off for FRCS / CCT. Did you have an opportunity at your previous ARCP to discuss what was needed to achieve progression at your critical waypoint?

Mark only one.

  • Yes
  • No
  • Not Applicable

Fellowship

9. Do you feel you will be ready to be a day one consultant in your chosen subspecialty at the end of CCT?

Mark only one.

  • Yes
  • No
  • Not Sure

10. Are you planning to do / are doing a post-CCT fellowship? *

Mark only one.

  • Yes
  • No
  • Not Sure

11. What is the likely total duration of all post-CCT fellowship training that you plan/will be doing prior to becoming a consultant?

Mark only one.

  • 6 months or less
  • 7-12 months
  • 13-18 months
  • 19-24 months
  • More than 24 months
  • I don't plan to do a Fellowship

12. What are your main reasons for doing a post-CCT fellowship? (please select below all that apply)

Tick all that apply.

  • I don't feel my training will fully prepare me to be a consultant in my chosen subspecialty
  • Employers/Market forces require me to do a fellowship
  • I want to gain a different life experience
  • I want to learn a set of skills that are not available in my deanery
  • Family or personal reasons
  • Strategic job aspiration in the region of fellowship
  • I am not planning on doing a fellowship (please type in details about your reasons using the "Other" option below)
  • Other

13. What are your main concerns in relation to post-CCT fellowships? (please select below all that apply)

Tick all that apply.

  • Financial impact
  • Travel / Commute related challenges
  • Being away from family / partner
  • Challenges in relation to caring responsibilities
  • Applying and interviewing for multiple different fellowship jobs and competition
  • Administrative Burden of Licensing, Regulatory, Immigration, Credentialing etc.
  • I have no concerns
  • Other

14. Please write below any other comments or suggestions in relation to training, progression, fellowship, and the path to be ready as a day one consultant in your chosen subspecialty?

Tell BOTA about yourself.
This anonymised information will help us understand the composition and spread of our trainee community which helps us when we analyse your challenges and aspirations.

15. What is your training grade? *

Mark only one.

  • Foundation Doctor
  • Core Surgical Trainee
  • ST1 (Scotland run through)
  • ST2 (Scotland run through)
  • ST3
  • ST4
  • ST5
  • ST6
  • ST7
  • ST8
  • Pre-CCT (TIG) Fellow
  • Post-CCT Fellow
  • Other:

16. Which Gender do you identify as? *

Mark only one.

  • Cisgender man (gender identity matches the sex you were assigned at birth)
  • Cisgender woman (gender identity matches the sex you were assigned at birth)
  • Transgender man
  • Transgender woman
  • Non-binary
  • Intersex
  • Gender-queer/gender-fluid
  • Agender
  • Prefer to self describe (please specify in the Other text box)
  • Prefer not to say
  • Other

17. Please choose one option that best describes your ethnic group or background *

Mark only one.

  • White - British/English/Northern Irish/Scottish/Welsh
  • White - Irish
  • White - Gypsy or Irish Traveller
  • Arab
  • Asian/Asian British - Bangladeshi
  • Asian/Asian British - Chinese
  • Asian/Asian British - Indian
  • Asian/Asian British - Pakistani
  • Black/ African/Caribbean/Black British - African
  • Black/ African/Caribbean/Black British - Caribbean
  • Mixed/Multiple - White and Asian
  • Mixed/Multiple - White and Black African
  • Mixed/Multiple - White and Black Caribbean
  • Prefer not to say
  • Other

18. How old are you? *

Mark only one.

  • 18-20
  • 21-25
  • 26-30
  • 31-35
  • 36-40
  • 41-45
  • 46-50
  • 51-55
  • 56-60
  • 61-65
  • Prefer to not say
  • Other:

19. What is your training region? *

Mark only one.

  • Armed Forces
  • Birmingham
  • East Anglia
  • East Midlands
  • East Scotland
  • Kent, Surrey, Sussex
  • North West (Mersey and Manchester)
  • London (North East - Percival Potts)
  • London (North East - Royal London)
  • London (North East - Stanmore)
  • London (North East - UCH)
  • London (North West)
  • London (South East)London (South West)
  • Mersey
  • North Scotland
  • North Yorkshire
  • Northern
  • Northern Ireland
  • Oswestry
  • Oxford
  • Peninsula
  • Severn
  • South East Scotland
  • South Yorkshire
  • Trent
  • Wales
  • Warwick
  • Wessex
  • West Scotland
  • Prefer to not say
  • Other:

20. Which is the most probable subspecialty that you are aspiring to become a consultant in? *

Mark only one.

  • Academic Career
  • Arthroplasty - Hip / Knee
  • Foot and Ankle
  • Hands
  • Oncosurgery
  • Paediatrics
  • Shoulder / Elbow
  • Spinal Surgery
  • Sports Surgery
  • Trauma / Major Trauma / Limb Reconstruction
  • Prefer to not say
  • Not sure
  • Other

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A poorer path, less trodden – patients with ‘ambulatory trauma’ in the United Kingdom

  1. Baldock, T.E., Walshaw, T., Walker, R., Wei, N., Scott, S., Trompeter, A.J. and Eardley, W.G.P.E. (2023) ‘The ORthopaedic Trauma Hospital Outcomes - Patient Operative Delays (ORTHOPOD) study’, Bone Jt Open, 4(6), pp. 463–471. Available at: https://pmc.ncbi.nlm.nih.gov/articles/PMC10289117/ (Accessed: 20 September 2025).
  2. Wei, N., Baldock, T.E., Elamin-Ahmed, H., Walshaw, T., Walker, R., Trompeter, A. and Eardley, W.P.G. (2023) ‘ORthopaedic trauma hospital outcomes - Patient operative delays (ORTHOPOD) Study: The management of day-case orthopaedic trauma in the United Kingdom’, Injury, 54(6), pp. 1588–1594. Available
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  4. Elamin Ahmed, H., Baldock, T., Wei, N., Scott, S. and Eardley, W.G.P. (2023) ‘Lack of regional pathways impact on surgical delay: Analysis of the Orthopaedic Trauma Hospital Outcomes–Patient Operative Delays (ORTHOPOD) study’, Injury, 54(12), p. 111007. Available at: https://www.sciencedirect.com/science/article/pii/S002013832300713X (Accessed: 20 September 2025).
  5. Farrow, L., Jenkins, P.J. and Dunstan, E. (2022) ‘Predicted waiting times for orthopaedic surgery’, Bone Joint Res, 11(12), pp. 890–892. Available at: https://pmc.ncbi.nlm.nih.gov/articles/PMC9792871 / (Accessed: 20 September 2025).
  6. Hampton, M. (2021) ‘The orthopaedic waiting list crisis: two sides of the story’, J Bone Joint Surg Br, 103(8), pp. 1153–1154. Available at: https://pmc.ncbi.nlm.nih.gov/articles/PMC8325974 / (Accessed: 20 September 2025).
  7. Sibanda, V., Anazor, F.C. and Bhadresha, A. (2023) ‘The impact of the post- COVID 19 pandemic elective waiting list delays on patient reported symptoms and intention to proceed with planned upper limb surgeries-A prospective cohort study’, Musculoskeletal Care, 21(2), pp. 453–461. Available at: https://pubmed.ncbi.nlm.nih.gov/36695277 / (Accessed: 20 September 2025).
  8. Athar, M.S., Fazal, M.A., Ashwood, N., Arealis, G., Buchanan, D. and Okoth, F.H. (2019) ‘Daycase trauma list: a safe and cost-effective service delivery’, Ann R Coll Surg Engl, 101(7), pp. 519–521. Available at: https://pmc.ncbi.nlm.nih.gov/articles/PMC6667966 / (Accessed: 20 September 2025).
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  10. Zogg, C.K., et al. (2022) ‘Learning From England’s Best Practice Tariff: Process Measure Pay-for-Performance Can Improve Hip Fracture Outcomes’, Annals of Surgery, 275(3), pp. 465-472. Available at: https://pmc.ncbi.nlm.nih.gov/articles/PMC9233527 / (Accessed: 20 September 2025).
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