Training in Orthopaedics: The Show Must Go On

20 Apr 2020

By Morgan Bailey, Sabina Barbur, Daniel Cadoux-Hudson, Rishi Das and Daniel Marsland
Hampshire Hospitals Foundation Trust

Published 20 April 2020

Introduction

After a hard winter that saw numerous elective cancellations due to bed pressures in many orthopaedic units, we have been hit with a much bigger crisis in the form of COVID-19. It was immediately obvious that this was going to have a significant impact on the training of orthopaedic registrars both with regards to our day to day clinical activities and the extra-curricular events we attend to develop ourselves as surgeons. For some, the impact has been even greater, such as those who have fallen victim to postponement of exams and ST3 National Selection.

The impact of COVID-19 upon training will be felt not only nationally but across the globe1. Our unit has traditionally had a reputation for delivering regular high quality teaching in addition to the scheduled clinical commitments of theatre lists and clinics. After an initial period of adjustment to the change in clinical activities and the evolving rota patterns, consultants and registrars alike collaborated to help develop an educational program that could be delivered in the context of social distancing and irregular work patterns. We would like to share our ideas and experience to encourage other units to do something similar. We feel this has a two-fold benefit of maintaining orthopaedic focus and raising morale in a time when many of us may feel lost without regular access to power tools.

Journal Club

Prior to the changes to working patterns that were introduced in the Department in response to the COVID-19 pandemic, Trauma and Orthopaedic Journal Clubs were undertaken once a month. In light of the significant disruption, and the need to respect the Government’s Social Distancing policy during the pandemic, the journal clubs were postponed. 

Following the initial period of upheaval we have reintroduced the regular journal club teaching using video conferencing facilities. The Trust has access to Microsoft TEAMS which is a secure messaging application that also has the facility to run video conferencing and file sharing.  This was chosen as the preferred method of delivering these education sessions as it allows for dissemination of material and can keep an ongoing record of meetings and conversations. 

The journal clubs have been set up fortnightly in the evenings, and have been based on the pre existing timetable in order to allocate supervising consultants equitably. Each consultant allocates papers relevant to their specialty. These papers are a combination of seminal work behind current orthopaedic practices and recent publications to enable consultants and registrars alike to stay up to date with current research outcomes.

After the effects of the pandemic have passed we hope to return to the face to face model that existed previously, however the hope is that the lessons learned from delivering quality teaching remotely can be applied in the future. This will be a useful tool in the world of limited working hours and shift patterns that are commonplace in the modern medical workplace.

Registrar Lead FRCS Basic Sciences Tutorials

Another regular feature of our departmental activity included a registrar lead lunchtime tutorial. Held once a week and supervised by a magnanimous former FRCS examiner, this was a session not to be missed. Topics were allocated to both pre exam & post exam trainees and the opportunity to present a section of basic sciences to peers has the benefit of deepening understanding in an informal learning environment.

The tutorials were well attended, even managing to assemble junior FY1/2s, who were keen to broaden their knowledge and perhaps spark an interest in a career in orthopaedics.

In times of social distancing and altered working practices we were all anxious for the tutorials to continue their success. The first two sessions on Zoom covered the scintillating topics of lubrication & wear and the structure of cartilage. Those who could not attend 'live' still had the opportunity to access recordings of the sessions for future enjoyment. This serves a second purpose of being able to develop a bank of revision resources, and when it comes to basic sciences, most of us need all the help we can get!

Consultant delivered tutorials

Keeping orthopaedic consultant morale high during a crisis could prove difficult after closure of theatre and redeployment of skills. In place of elective operating, the orthopaedic consultants now work shifts in the Emergency Department delivering a front of house Minor Injuries Unit and also in in Critical Care as part of a ‘proning team’.  We therefore needed to engage them in the education process from day one to ensure that we all still felt part of a unit and team.  They volunteered to run 60-minute subspeciality tutorials with discussion time each week which gave them free rein of the subject choice as long as it was pitched at the level of the FRCS. This provided the opportunity to stay in touch with both the registrars who had swapped clinics for ward cover but also fellow consultants within their specialty. The timetable was coordinated by a registrar to prevent overlap of topics. 

A Microsoft Teams group was set up for all registrars and other trainees who wished to be involved to access on a weekly basis at a set time making it a regular session on our timetables. By keeping it virtual this allowed all of us to access it whether at work or off site. These sessions have been recorded to create an online database of subspecialty lectures for the department but also will be used to support the Wessex deanery registrar teaching program in the event that reduced group contact continues into the next academic year. We all feel this has created both a learning platform but also a level of camaraderie, communication and teamwork between us.

Conclusion

Different orthopaedic departments will find their working patterns and department dynamic suit different types of training. It takes collaboration on the part of both the trainees and the consultant bodies to develop a system that works for their own department. The net result is likely to be an overwhelmingly positive one. At the end of the day, most of us are in this specialty because of our passion for the subject matter, so anything we can do to keep this passion alive must be worthwhile.

Whether you are sat home self isolating, taking on new roles in the Minor Injuries Unit, or rediscovering your cannulation skills because your juniors have all been redeployed to the medical teams, remember we are still orthopaedic surgeons, and the show must go on.

References

1. Kogan M, Klein SE, Hannon CP, Nolte MT. Orthopaedic Education During the COVID-19 Pandemic. J Am Acad Orthop Surg. 2020 Apr 8. [Epub ahead of print].

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