Training & Fellowships

Orthopaedic Surgery

Overview

For more information on Orthopaedic Surgery, please click here.

Programme(s)

Paediatric Orthopaedic Surgery Fellowship Training

Teaching and Training

This fellowship has been designed for Fellows from around the region ie ASEAN/ASIA where there might not be a formal programme for the training of Paediatric Orthopaedic Surgeons. Each will have a designated supervisor who is of at least Specialist level. The supervisor will be the one mentoring the Fellow as well as providing the required progress reports to the SMC. This programme follows that set out by the Royal College of Surgeons of Edinburgh, which leads to the FRCS Orthopaedic exit exam. We have been recognised as a training centre for Higher Surgical Training in Orthopaedic Surgery by the Royal College of Surgeons of Edinburgh since 2005.

By the end of the programme, the trainee should be able to confidently recognize and manage some the more common paediatric Orthopaedics. It is hoped that the best practices acquired during the fellowship will be shared with the colleagues of the aforesaid Fellows in the own Department/Units in their countries.

Outpatient clinics

The Fellow will run outpatient clinics under the supervision of a specialist physically present in the clinic. The supervising specialist, however, will make all major clinical decisions. On average, there will be two clinic sessions with one being trauma related and the other mostly non trauma elective type cases.

The Fellow will be guided in clinic based procedures such as serial casting and manipulations in clubfeet, percutaneous tenotomy etc.

Fellows will be exposed to Combined and Specialty clinics to recognize the complexities of managing these conditions:

Cerebral Palsy (CP) combined clinics
Brachial Plexus Combined clinics
Congenital Paediatric Hand Clinics
Musculoskeletal Oncology Tumour boards
Spine clinics in KKH and School Health Service
Spastics Clinics at the Spastics Association

Operating Theatre

The Fellow will be supervised in the operating theatre on a regular roster. He/She may be allowed to perform some the more common operations when deemed to be ready to do so by their supervisors.

Teaching

The Fellow will be guided in giving talks on topics relevant to the current management of the more common conditions on Paediatric Orthopaedics. (See more information under Course Content)

There will be a combined teaching with the Paediatric Orthopaedic Division at the National University Hospital on a weekly basis. These sessions are held in the viva style of the FRCS (Orth) examination. These sessions also expose the Fellows to the more complicated cases with management dilemmas.

Journals readings are carried out regularly. The Fellow is taught how to critique these journals and to be able to recognize the scientific worth of published works.

There will be opportunities to present and attend regular combined meetings such as Singapore Orthopaedic Associations (SOA) where topics are discussed in a more in depth manner amongst a panel of experts.

Calls

All Fellows will be fully supervised for at least three months during night calls. They will be reassessed at the end of this period before they are allowed to do calls on their own. During the period of supervision, the supervisor will supervise all procedures until the Fellow is deemed to be able to do it on their own. There will also be opportunities for fracture management at the emergency level.

Resources

The department is fully equipped with most equipment/material required for making presentations and doing literatures searches.

Fellows will be given guides specific to the practice of paediatric Orthopaedics in the Department.

The Medical Officer Guide Book
The Registrar's Starter Kit in Paediatric Orthopaedics
The Guide on Pathway and Protocols.

They will be given full access to the Hospital online full text Journals such Journal of Paediatric Orthopaedics (JPO) and Journal of Joint and Bone Surgery (JBJS)

Research

All Fellows will be given at least one project to complete and present at an appropriate conference during the period of the programme. They will be guided till the project is in a publishable form for peer refereed high impact international journals. There will be opportunities for the Fellow to attend conferences held within the country. There are several Research funding bodies which the Fellow can apply to. They will be assisted by their supervisors in acquiring these funding.

Objective

Based on our training programme of the Joint Committee for Specialist Training (JCST) ASTs, the Fellow is expected to be independent in at least the following procedures:

The management of all grades of supra condylar fractures (being the most common fracture seen)
The management of lateral condyle fractures of the distal humerus
The management of ankle fractures
The management of forearm fractures
Superficial abscesses and lacerations

In addition, the fellow should be familiar with the management of the conditions (See list below) which is in the syllabus for the FRCS Orthopaedics which is the benchmark used for a qualified specialist.

In other words, besides being confident in treating common conditions in Paediatric Orthopaedics with well-accepted best practices, a Fellow passing out of this programme should do well in the paediatric segment of the FRCS (Orth) examination.

Conditions that the Fellow should be familiar with at the end of the programme:

Normal development
Normal variants and self limiting conditions
Screening procedures, e.g. for DDH, scoliosis
Congenital malformation of spine and limbs, e.g. failure of formation; syndactyly, skeletal dysplasia
Injuries in children; acute, chronic, multiple and, non-accidental. Management* of fractures including growth plate and joint injuries
The handicapped child in society with particular reference to the management of neuromuscular conditions (e.g. cerebral palsy, spina bifida and arthrogryposis), Osteogenesis Imperfecta, muscle dystrophy
Principles and techniques of correction of limb deformity, including leg equalization
Bone and joint infections
Metabolic bone disease
Benign and malignant tumours
Spinal disorders, such as back pain in children, sponylolisthesis, scoliosis
Hip disorders, such as irriable hip, DDH, Perthes disease, SUFE
Knee disorders, such as anterior knwee pain, patellar instability and osteochondrities dissecans
Foot and ankle disorders such as CTEV, pes cavus, tarsal coalitions, osteochondritieds
Upper limb disorders, such as Erbs palsy, ganglia, trigger thumb

Course Contents

The department covers as many topics as possible during their stint with us. Teachings include non-trauma and trauma topics.

Non-trauma

Torticollis
Limb Length Discrepancy
Approach to limb length discrepancy
Approach to limping in a child
Common upper limb problems in children
Lower limb sports injuries in the child
Patella dislocation - a systematic overview
The lower extremity in Cerebral palsy
Adolescent Idiopathic Scoliosis
Back pain in children
CTEV
ERB's Palsy
Syndactyly
Spondylolysis/Spondylolisthesis
Perthes Disease
Muscular dystrophies
Bone and Joint Infections
Osteomyelitis in children - what's new in the literature
Flatfoot
The Cavus Foot - evaluation & management
DDH - birth to 12 months
DDH: birth to 18 months
DDH: The older child
An approach to tumours in childhood
Benign bone tumours in childhood - approach and management
A systematic approach in analysing bone lesions on plain x-ray
Fibrosarcoma
Osteomyelitis in childhood
Orthopaedic issues in Myelomeningocoele
Osteogenesis imperfecta
Slipped Capital Femoral Epiphysis
ACL injuries in the skeletally immature
Approach to skeletal displasia

Trauma

Angles in Paediatrics Orthopaedics
Physeal Surgery and the Bone Growth Foundation
Physeal injuries and fracture remodelling in children
Hand injuries in the young child
Forearm Fractures
Monteggia fracture – dislocations
Forearm shaft fractures
Fractures around the elbow
Distal radius fractures in children
Fractures of the distal femur
Radius and ulna shaft fractures in children
Femur shaft fractures
Femoral shaft fractures in children and adolescents - one entity or many?
Fractures around the knee
Fractures of the foot (inc calcaneum and talus)
Fractures around the ankle in children
Injuries Around the Proximal Humerus
Hip fractures in children
Tibia fractures
`Transitional fractures' around the ankle - anatomy and management
Fractures of the proximal femur
Commonly Missed Fractures
Approach to the multiply injured child
Radiation protection during fluoroscopy
Early complications of fractures and their management
Tractions
Compartment Syndrome
General Considerations in Paediatric Fractures
Non Accidental Injuries
Various Traction practical
Understanding fracture healing

Method

NA.

For Whom

Fully qualified General Orthopaedics Surgeons from the region (ASEAN/ASIA) who want an attachment in Paediatric Orthopedics to familiarize themselves with Paediatric Orthopaedics. (Six months).

Orthopaedics surgeons from the region (ASEAN/ASIA) undergoing their Advanced Surgical Training with an intent of sub specializing in Paediatric Orthopaedics in their own countries (One year).

Pre-requisite

Qualifications that allow for conditional registration spelt out by the Singapore Medical Council (SMC).

Doctors who cannot be conditionally registered, can only have observer status (see below).

Clinical Observer
In situations when the Fellow is unable to fulfill the SMC requirement for a conditional registration, as may be the case with some Fellows from around the region, they will be given an observer status.

They will be allowed to partake actively in teaching and research as for Clinical Fellows (see above)

When it comes to patient care, they will be allowed to observe and ask questions without actively taking part in the management of the patient. The limits of their involvement have been defined by the SMC as following:

Allowed to observe in clinic
Allowed to enter the operating theatre to observe from a safe distance away from the operating table. However he or she is not allowed to assist in the handling of equipment in the operating theatre.
Not allowed to manage patients primarily.
Not allowed to prescribe treatment.
Not allowed to perform procedures, such as hands-on training.
Not allowed to write in patient clinical records.
Not allowed to write prescriptions.

Not allowed to communicate instructions to patients on issues of management or function as a primary physician.
Observer Fellow is given a roster to attend department teachings, join in the ward round, attach to Consultant’s clinic and observe in operating theatre.