Virtual learning for SHOs – a further area to develop?

07 May 2020

By Philip Beak
Core Surgical Trainee Year 2, Kingston Hospital NHS Foundation Trust, London, UK
Corresponding author e-mail:

Published 07 May 2020

We are presently witness to many outstanding examples of orthopaedic teams establishing new and effective methods of delivering quality teaching in this unprecedented context. As an SHO, that broadly-covering term, I have sadly not experienced a significant element of this targeted to those at the most junior specialty level.

Online expansion

Within this journal there has been numerous examples of specialty registrars happily extolling the virtues of newly established virtual learning environments1–3. This is allowing for registrars to continue to develop important knowledge along with the curriculum in their march towards ‘the exam’, particularly in a period where their practical skills may become rusty.

I see an opportunity to advance this teaching further than is presently occurring. Speaking with my regional SHO colleagues it is clear that quality and quantity of orthopaedic teaching is at best variable and at worst minimal. A topical ST3 question of recent times has become ‘why are SHOs unhappy?’. A well-prepared answer (that none of us have unfortunately been given the chance to express this year due to face-to-face interview cancellation) would likely include both greater teaching and an improved sense of value.

As such, now, more than any time prior, may be the time to drive for some dedicated SHO-level orthopaedic virtual/online teaching. Such sessions could take the form of that demonstrated at recently4. Short virtual lectures can be an effective teaching delivery method due to their ease of accessibility at a suitable time and distribution potential to SHOs across teaching hospitals and district generals alike.

Who, when, what to teach?

Responsibility for such teaching could be assumed by a national body or by a collaboration of different trusts in order to contribute to a single valuable resource. Administration of such a resource would require input from consultants but should bring benefit to orthopaedic departments across the country. Investing in the knowledge of the first line of orthopaedic response can surely benefits both patients and departments.

To take a step further, SHO rotas could have allocated time in their week/month/schedule for viewing of virtual teaching resources. Educational supervisors could feel reassured that their SHOs are receiving relevant regular training whilst rota co-ordinators/clinical leads would know that doctors could undertake teaching without significant travel implications. Perhaps, these sessions could even be followed by a subsequent consolidation discussion with a consultant/senior trainee to record in their portfolio.

For the moment, I would advise SHOs still involved within an orthopaedic service to view the aforementioned orthohub talk on non-operative management strategies. The Royal College of Surgeons has made some of their course resources, including those for CCrISP, online during this period which may be particularly useful for those of us redeployed to the medical arena5. Further useful orthopaedic virtual learning can be achieved via interactive modules available via the AO Trauma STaRT website6.

In future, teaching resources targeted for SHO level could base themselves upon the T&O curriculum for core surgery, which has input from the BOA7. At the most junior specialty level an introduction to basic management concepts and understanding of commonly presenting conditions are what is required. Once normality is resumed, SHOs will return to regular rotation and thus concise, appropriate, online content that can be repeatedly consumed is the ideal medium.

Final thought

Therefore, as our teaching horizons are expanded during this difficult time, I hope that this evolution can spread to benefit those at the most junior specialty level - SHOs. A national repository of quality, level-appropriate virtual lectures seems an achievable target given what we have seen be produced for registrars in the space of a few weeks across a number of deaneries. Benefit for patients, doctors and departments will surely follow and perhaps the question: ‘why are SHOs so happy?’ may be seen in the next round of interviews.


  1. Ibrahim M, Poole A. Virtual arthroplasty training during the COVID-19 era: Is this the way forward? The Transient Journal of Trauma, Orthopaedics and the Coronavirus. April 2020. Available at:
  2. Bailey M, Barbur S, Cadoux-Hudson D, Das R, Marsland D. Training in Orthopaedics: The Show Must Go On. The Transient Journal of Trauma, Orthopaedics and the Coronavirus. April 2020. Available at:
  3. Al-Obaedi O, Subramanian P. ‘Distant Learning’: A Glimpse into the Future and Beyond? The Transient Journal of Trauma, Orthopaedics and the Coronavirus. April 2020. Available at:
  4. Orthohub (2020). COVID-19 x Charnley - the conservative management of orthopaedic injuries. Available at:
  5. Royal College of Surgeons (2020). RCS Online Learning. Availabe at:
  6. AO Trauma (2020). AO STaRT - Platform. Available at:
  7. Intercollegiate Surgical Curriculum Programme (2017). Specialist Training in Trauma and Orthopaedics Curriculum August 2015. Available at:
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