kurikulum - Kolegium IOA

KURIKULUM
PENDIDIKAN DOKTER SPESIALIS
ORTHOPAEDI DAN TRAUMATOLOGI
KOLEGIUM ORTHOPAEDI DAN TRAUMATOLOGI INDONESIA
PERHIMPUNAN DOKTER SPESIALIS ORTHOPAEDI DAN TRAUMATOLOGI INDONESIA
JAKARTA, JUNI 2012
TIM PENYUSUN DAN EDITOR
Penanggung Jawab
:
Prof. dr. Errol U Hutagalung, SpB, SpOT(K)
- (Ketua Kolegium Orthopaedi dan Traumatologi
Indonesia )
Prof Dr. dr. Moh. Hidayat, SpB, SpOT(K)
- (Wakil Ketua)
Ketua Komisi Kurikulum:
Sekretaris Komisi
:
Anggota
:
Prof. Dr. dr. Putu Astawa, MKes. SpB, SpOT (K)
Dr. dr. Nucki N Hidajat, MKes, SpOT(K)
Prof. Dr. dr. Moh Hidajat, SpB, SpOT(K)
- Staf Pengajar PPDS Orthopaedi dan Traumatologi
FKUB
dr. Ifran Saleh, SpOT(K)
- KPS PPDS Orthopaedi dan Traumatologi FKUI
Dr. dr. Ismail, SPOT ( K )
- SPS PPDS Orthopaedi dan Traumatologi FKUI
Dr. dr. Ferdiansyah, SpOT(K)
- Ka Dept. Orthopaedi & Traumatologi FK UNAIR
/RSU Dr.Soetomo
-
Dr. dr. Dwikora Novembri Utomo, SpOT(K)
- KPS PPDS Orthopaed dan Traumatologi FUNAIR
-
dr. Mouli Edward, SpOT(K)
- KPS PPDS Orthopaed dan Traumatologi FKUNAIR
Dr. dr. Hermawan Nagar Rasyid, SpOT(K), MT(BME),
PhD
- KPS PPDS Orthopaedi dan Traumatologi FK UNPAD
dr. Yoyos Dias Ismiarto, SpOT(K)
- SPS PPDS Orthopaedi dan Traumatologi FK UNPAD
Prof. Dr. dr. H.R. Agung Saifullah, SpB,SpOT(K)
- KPS PPDS Orthopaedi dan Traumatolohi FK UNHAS
dr. M. Ruksal Saleh, SpOT(K), PhD
- SPS PPDS Orthopaedi danTraumatologi FK UNHAS
dr. Ismail Mariyanto, SpOT(K)
- KPS PPDS Orthopaedi dan Traumatologi FK UNS
i
dr. Mujaddid Idulhaq, M.Kes, SpOT
- SPS PPDS Orthopaedi dan Traumatologi FK UNS
Dr. dr. Rahadyan Magetsari, SpOT(K)
- KPS PPDS Orthopaedi dan Traumatologi FKUGM
Dr. dr. Puntodewo, M.Kes, SpOT(K)
- SPS PPDS Orthopaedi dan Traumatologi FKUGM
Prof. Dr. dr. I Ketut Siki Kawiyana, SpB, SpOT(K)
- KPS PPDS Orthopaedi dan Traumatologi FK UNUD
dr. I Ketut Suyasa, SpB, SpOT (K)
- SPS PPDS Orthopaedi dan Traumatologi FK UNUD
Dr. dr. Edi Mustamsir, SpOT (K)
- KPS/Ka. SMF Orthopaedi dan Traumatologi FKUB
dr. Istan Irmansyah, SpOT (K)
- SPS PPDS Orthopaedi dan Traumatologi FKUB
Editor
:
Prof. Dr. dr. Putu Astawa, MKes, SpOT(K)
- Staf Pengajar PPDS Orthopaedi dan Traumatologi FK
UNUD
Dr. dr. Nucki N Hidajat, MKes, SpOT(K)
- Kepala Dept. Orthopaedi dan Traumatologi FK UNPAD
/RS Dr. Hasan Sadikin
iii
KATA PENGANTAR
Syukur Alhamdulillah kita panjatkan ke hadirat Allah SWT,
bahwa telah bisa diterbitkan buku kurikulum Progam Pendidikan Dokter
Spesialis (PPDS) Orthopaedi dan Traumatologi oleh Kolegium Orthopadi
dan Traumatologi edisi tahun 2012 ini, Buku ini merupakan revisi dan
perubahan format serta penambahan di beberapa bagian dari edisi 2007,
hal ini dilakukan atas dasar bahwa ilmu Orthopaedi dan Traumatologi
merupakan cabang ilmu kesehatan yang terus bergerak secara dinamis
sesuai dengan kebutuhan masyarakat maupun perkembangan ilmu
teknologi kedokteran sendiri.
Penambahan yang paling signifikan adalah dalam aspek
kompetensi afektif
rujukan
adalah
serta bidang sport injury, yang menjadi sumber
Kurikulum
pendidikan
dari
British
Orthopaedic
Assossiation (BOA) yang disesuaikan dengan kondisi situasional local dan
tingkatan kompetensi dari KKI (Konsil Kedokteran Indonesia).
Kami sangatlah menyadari buku kurikulum ini jauh dari
kesempurnaan sehingga merupakan keniscayaan adanya asupan dan
kritikan yang dapat membuat buku ini menjadi lebih baik.
Wassalam.
Editor.
.
v
KATA SAMBUTAN
Ketua Kolegium Orthopaedi dan Traumatologi Indonesia
Dokter Spesialis Orthopaedi dan Traumatologi adalah dokter
yang telah mencapai kemampuan tertentu dan secara professional
mengkhususkan diri dalam pelayanan bidang Orthopaedi dan trauma
muskuloskeletal dan mempunyai kemampuan menyerap, mengembangkan
serta mentransformasikan keilmuannya.
Penerbitan Buku Kurikulum Pendidikan Dokter Spesialis
Orthopaedi dan Traumatologi edisi tahun 2012 merupakan hasil
penyempurnaan cetakan sebelumnya, Pada edisi ini dimasukan berbagai
informasi baru yang merupakan hasil pengembangan dan pendalaman
serta penyelarasan dari berbagai sumber.
Buku kurikulum ini disusun oleh Kolegium dan menjadi paduan
bagi seluruh pimpinan, pendidik, tenaga kependidikan, dan paserta didik
program dokter spesialis Orthopaedi dan Traumatologi di Indonesia, untuk
dapat dilaksanakan secara konsisten. Disamping itu, untuk melengkapi
buku ini diterbitkan pula buku Standar Penyelenggaraan Pendidikan
Profesi Dokter spesialis Orthopaedi dan Traumatologi.
Kami mengucapkan terima kasih dan penghargaan setinggi-tingginya
kepada Editor, Tim komisi Kurikulum kolegium Orthopaedi dan
Traumatologi, dan anggota Kolegium lainya yang telah bekerja keras
untuk
menuangkan
informasi yang
relevan
dan
terkini serta
melakukan kajian-kajian secara berkesinambungan dalam penyusunan
buku ini.
vii
Saran dan kritik untuk penyempurnaan buku kurikulum ini dapat
ditujukan kepada Tim kurikulum kolegium Orthopaedi dan Traumatologi
Indonesia.
Semoga Allah Subhanahu Wata’ala memberikan bimbingan,
petunuk, dan kekuatan kepada kita. Aamiin.
Jakarta, Juni 2012
Ketua Kolegium Orthopaedi & Traumatologi Indonesia
(Periode Nopember 2010 – Nopember 2012)
Prof. dr. Errol Untung Hutagalung, SpB, SpOT(K)
viii
SURAT KEPUTUSAN PENGGUNAAN BUKU
SURAT KEPUTUSAN
Nomor : 013/Koleg-IOT/XII/2012
Kolegium Orthopaedi dan Traumatologi Indonesia
Tentang
PELAKSANAAN PEMAKAIAN BUKU
KURIKULUM
PENDIDIKAN DOKTER SPESIALIS ORTHOPAEDI DAN TRAUMATOLOGI
KOLEGIUM ORTHOPAEDI DAN TRAUMATOLOGI
Menimbang
: 1.
2.
Mengingat
: 1.
2.
Memutuskan
: 1.
2.
3.
Bahwa untuk menjalankan kegiatan Pendidikan Dokter Spesialis
Orthopaedi dan Traumatologi diperlukan Buku Kurikulum Pendidikan
Dokter Spesialis Orthopaedi dan Traumatologi.
AD / ART BAB 1. Pasal 13.2 Tentang Tugas Kolegium Orthopaedi dan
Traumatologi Indonesia yaitu ayat 13.2.12 : Menyusun katalog
pendidikan profesi dokter spesialis dan spesialis konsultan Orthopaedi
dan Traumatologi Indonesia.
SK Kolegium Orthopaedi dan Traumatologi Indonesia mengenai
Koordinator Pelaksana Komisi Kurikulum Kolegium Orthopaedi dan
Traumatologi Indonesia tanggal 23 Desember 2009 yaitu menugaskan
Komisi Kurikulum untuk merevisi Kurikulum dan Standarisasi Seleksi
Nasional Peserta Didik, yang diharapkan revisi Kurikulum sudah dapat
digunakan pada Januari 2011.
Untuk menjalankan kegiatan Pendidikan Dokter Spesialis Orthopaedi
dan Traumatologi diperlukan Buku Kurikulum Pendidikan Dokter
Spesialis Orthopaedi dan Traumatologi.
Bahwa hasil revisi Buku Kurikulum Pendidikan Dokter Spesialis
Orthopaedi dan Traumatologi dapat mulai digunakan sebagai buku
pegangan Program Studi Orthopaedi dan Traumatologi Indonesia.
Surat keputusan ini berlaku sejak tanggal ditetapkan.
Bila kemudian hari ada kekeliruan, SK ini dapat diperbaiki sebagaimana
mestinya.
ix
CARA PENGGUNAAN BUKU
Buku ini terdiri atas 4 Bab.
Bab I, Pendahuluan mengambarkan filosofi yang mendasari
disusunnya Kurikulum dan beberapa pengertian tentang istilah yang
dipergunakan didalamnya.
Pada Bab II, Menjelaskan tentang isi atau kontain yang terbagi
dalam bidang Kognitif, Psikomotor, dan Afektif.
Bidang kognitif dikelompokkan berdasarkan kombinasi antara region
anatomis (Spine, Hip, Knee, Ankle Foot, Shoulder Elbow, Hand),
Diseases (Oncology, Paediatrik, Sport Injuri, dan Trauma), dan Ilmuilmu Dasar (Basic science, General Orthopaedi).
Bidang Psikomotor dikelompokkan dalam Trauma Hard Tissue dan
Soft Tissue (General, Upper limb, Pelvic girdle, Lower limb, spine),
dan Non trauma dengan pembagian sesuai dengan regionya.
Bidang Afektif di bagi kedalam 6 kelompok, yaitu Perilaku
Profesional, Komunikator yang baik, mengajar dan melatih, Keeping
Up to date, Menjadi manajer yang baik, Promoting Good Health,
Etika.
Bab III, Menjelaskan secara sistematika tahapan pencapaian
Kompetensi, dan ruang lingkup yang harus di bahas maupun
dikerjakan. Tingkat Kompetensi yan dipakai dalam buku ini adalah
sesuai dengan standar dari KKI, yang matrikulasi semua ini
dijabarkan di dalam lampiran 1, 2 dan 3.
Bab IV, Dalam bab ini dijelaskan secara sistematis cara
melaksanakan Kurikulum dari ketiga aspek Pendidikan, Prasyarat,
serta Ketentuan-ketentuan yang harus dipenuhi, serta bagaimana cara
memonitor dan evaluasinya.
xi
DAFTAR ISI
Tim Penyusun dan Editor…………………………………………….
Kata Pengantar ......................................................................................
Kata Sambutan Ketua Kolegium ……………………………………..
Surat Keputusan Penggunaan Buku Kurikulum......................................
Cara penggunaan buku ...........................................................................
Daftar isi ................................................................................................
BAB I
1.1
i
iii
iv
Vi
Vii
viii
1
1.2
PENDAHULUAN............................................................
Pengertian Kurikulum Ilmu Orthopaedi dan Traumatologi
Indonesia ………………………………...
Model Kurikulum……………………………………….
BAB II
2.1
2.2
2.3
ISI KURIKULUM............................................................
Bidang Kognitif (Applied Clinical Knowledge Syllabu)....
Bidang Psikomotor (Applied Clin Procedures Syllabus.
Bidang Afektif (Professional & Management and Good
3
6
25
Clinical
Practice)…………………………………………….
34
2
2
3.1.
3.2
TINGKAT KOMPETENSI DAN LINGKUP
BAHASAN……………………………………………...
Tingkat Kompetensi…………………………………….
Tahapan Pencapaian Kompetensi………………...……..
BAB IV
4.1
4.2
4.3
4.4
4.5
4.6
PELAKSANAAN KURIKULUM...................................
Cara Pelaksanaan ……………………………………….
Modul tambahan Kursus ……………………………….
Karya Ilmiah Wajib……………………………………..
Pelaksanaan Stase……………………………………….
Monitor dan Evaluasi …………………………………...
Buku Acuan Wajib ……………………………………..
47
47
47
48
48
50
52
DAFTAR PUSTAKA............................................................................
53
LAMPIRAN...........................................................................................
Lampiran 1 Tingkat Kompetensi Kognitif Peserta didik berdasarkan
Topik dan Thapan Pendidikan……………
Lampiran 2 Tingkat Kompetensi Psikomotor Peserta Didik
berdasarkan Topik dan Tahapan………………….........
Lampiran 3 Tingkat Kompetensi Afektif Berdsarkan Topik dan
Tahapan Pendidikan …………………………………
Lampiran 4 Modul-modul ……………………………………….....
54
BAB III
41
41
43
54
75
84
91
xiii
BAB I
PENDAHULUAN
Pencapaian kesehatan yang optimal sebagai hak asasi
manusia masyarakat perlu mendapat perhatian. Pelayanan yang baik
dan bermutu merupakan dambaan masyarakat Indonesia. Untuk
mendapatkan itu perlu dihasilkan pelayan kesehatan yang baik
termasuk perawat, dokter umum dan juga dokter sepesialis. Dokter
sebagai salah satu komponen utama pemberi pelayanan kesehatan
masyarakat
mempunyai peran yang sangat penting sehingga
Pendidikan Kedokteran akan menjadi penting.
Untuk memberikan perlindungan kepada pasien dan
mempertahankan mutu
pelayanan kesehatan pemerintah dengan
Undang-undang RI No. 20 tahun 2003 tentang Sistem Pendidikan
Nasional
dan
Undang-Undang RI No. 29 tahun 2004 tentang
Praktik Kedokteran menekankan Standar Pendidikan Kedokteran
dam memberi kepastian hukum kepada masyarakat dan Dokter.
Asosiasi Institusi Pendidikan Kedokteran berkoordinasi
dengan Organisasi Profesi, Kolegium, Asosiasi Rumah Sakit
Pendidikan, Departemen Pendidikan Nasional dan Departemen
Kesehatan
Kolegium
kedokteran
dalam
menyusun
standar
Pendidikan Profesi Dokter berkoordinasi dengan Organisasi Profesi,
Asosiasi Institusi Pendidikan, Departemen Pendidikan Nasional dan
Departemen Kesehatan
1
1.1. Pengertian Kurikulum Ilmu Orthopaedi dan Traumatologi
Indonesia
Kurikulum merupakan seperangkat rencana dan pengaturan
pendidikan yang meliputi tujuan pendidikan, isi, bahan pelajaran,
cara pencapaian dan penilaian, yang digunakan sebagai pedoman
penyelenggaraan Pendidikan Ilmu Orthopaedi dan Traumatologi
1.2. Model Kurikulum
Model Kurikulum berbasis Kompetensi dilakukan dengan
pendekatan terintegrasi baik horizontal maupun vertikal, serta
berorientasi pada masalah kesehatan individu, keluarga dan
masyarakat dalam konteks pelayanan kesehatan paripurna
2
.
BAB II
ISI KURIKULUM
Isi Kurikulum meliputi prinsip-prinsip metode ilmiah,
biomedik, ilmu kedokteran klinik dalam hal ini Ilmu Orthopaedi
dan Traumatologi, Ilmu humaniora yang disesuaikan dengan
Standar Kompetensi
yang ditetapkan. Prinsip-prinsip metode
ilmiah meliputi metodologi penelitian, filsafat ilmu, berpikir kritis,
biostatistik dan evidence-based medicine.
Ilmu biomedik meliputi anatomi, biokimia, histologi,
biologi sel dan molekuler, fisiologi, mikrobiologi, imunologi,
parasitologi, patologi, dan farmakologi. Ilmu biomedik dijadikan
dasar ilmu kedokteran klinik dalam hal ini Ilmu Orthopaedi dan
Traumatologi sehingga anak didik mempunyai pengetahuan yang
cukup untuk memahami konsep dan praktik kedokteran klinik.
Ilmu-ilmu humaniora meliputi ilmu perilaku, psikologi
kedokteran, sosiologi kedokteran dan profesionalisme. Menurut Dr.
Victor Neufeldt, satu kunci konsep kurikulum baru adalah “…that
it is not only the sum total of residents’ experience, planned or
unplanned. A broader view is needed, and the curriculum should be
seen as an activity where residents and faculty learn and work
together…”
3
Kurikulum berdasarkan Kompetensi terdiri atas dua
komponen utama yaitu Core Kurikulum dan Non Core Kurikulum
(miss program of special study, local content.) Core Kurikulum
sangat penting yang harus dikuasai oleh semua residen dan terdiri
dari :
1. Bidang Kognitif (Applied Clinical Knowledge Syllabus)
2. Psikomotor (Applied clinical Procedure Syllabus)
3. Afektif (Professional and Management and Good Clinical
Practice)
Core Curriculum dapat disederhanakan menjadi General
Core Curriculum kemudian komponen Kurikulum sehingga
memudahkan Peserta Didik untuk mengikuti proses belajar
mengajar.
4
Curriculum communication
resident
Management
of change
Resident
& faculty support
systems
How to learn
What to learn
(Methods –
(content)
strategies)
Assessment
Education competency
Fostering conducive environment Curriculum renewal
Gambar 1.1. Skema Tujuan Komprehensif Kurikulum
5
2.1. Bidang Kognitif (Applied Clinical Knowledge Syllabus)
1.
BASIC SCIENCE
No.
1A
General Core
Curriculum
Anatomy:
1B.
Tissues:
1C
Physiology,
Biochemistry &
Genetics:
1D.
Biomechanics &
Bioengineering:
2.
Komponen Curriculum
 Clinical and functional anatomy with pathological and
operative relevance
 Anatomy (and embryology) of nervous and vascular
systems
 Surgical approaches to the limbs and axial skeleton
 Anatomy (and embryology) of musculo-skeletal
system
 Bone - Structure & Function
 Cartilage - articular, meniscal - Structure & Function
 Muscle and tendon - Structure & Function
 Synovium - Structure & Function
 Ligament - Structure & Function
 Nerve - Structure & Function
 Intervertebral disc - Structure & Function
 Structure and function of connective tissues
 Application/relevance of modern genetics to
orthopaedic disease and treatment
 Shock - types, physiology, recognition and treatment
 Metabolism and hormonal regulation
 Metabolic and immunological response to trauma
 Blood loss in trauma/surgery, fluid balance and blood
transfusion
 Bone grafts, bone banking and tissue transplantation
 Biomechanics of musculoskeletal tissues
 Biomechanics of fracture fixation
 Tribology of natural and artificial joints
 Design of implants and factors associated with
implant failure(wear, loosening)
 Kinematics and gait analysis
BONE, JOINT DISEASE & GENERAL ORTHOPAEDIC
2A
6
General:




Osteoarthritis
Osteoporosis
Metabolic bone disease
Rheumatoid arthritis and other
(inflammatory, crystal, etc)
 Haemophilia
 Inherited musculoskeletal disorders
arthropathies
No.
2A
General Core
Curriculum
General: (Cont.)
2B
Investigations:
2C
Operative Topics:
2D
Miscellanous:
2E
Prosthetics &
Orthotics:
2E
Research & Audit:
2F
Medical Ethics:
No.
General Core
Komponen Curriculum






Neuromuscular disorders - inherited and acquired
Osteonecrosis
Osteochondritides
Heterotopic ossification
Blood tests
Musculoskeletal imaging: x-ray, contrast studies (
myelography, arthrography), CT, MR, ultrasound,
radioisotope studies
 Effects of radiation
 Bone densitometry
 Electrophysiological investigations
 Tourniquets
 Principles of Sterilization
 Design of theatres & Skin preparation
 Anaesthesia - principles and practice of local and
regional anaesthesia and principles of general
anaesthesia
 Principle treatment of musculoskeletal tumor
 Principle surgery of musculoskeletal tumor
 Infection, Thromboembolism & Pain:
 Infection of bone, joint, soft tissue, including
tuberculosis , and their prophylaxis
 Thromboembolism and prophylaxis
 Behavioural dysfunction and somatization
 AIDS and surgery in high-risk patients
 Management of Pain and pain relief
 Complex regional pain syndromes e.g. Reflex
Sympathetic
 Dystrophy and Causalgia
 Principles of design
 Prescription and fitting of standard prostheses
 Principles of orthotic bracing for control of disease,
deformity and instability
 Design and conduct of clinical trials
 Data analysis and statistics - principles and
applications
 Principles of Epidemiology
 Audit
 Duties of care
 Informed consent
 Medical negligence
Komponen Curriculum
7
Curriculum
3. HAND & MICRORECONSRUCTION
3A.
Anatomy of:
3B.
Pathology:
3C.
Clinical
Assessment:
8
 The wrist/MCP/PIP/DIP joints and CMC joint of the
thumb
 The flexor and extensor mechanism of the fingers
including interaction between extrinsic and intrinsic
mechanism
 The posture of the thumb in pinch, power and key grip
 The nerve supply to the hand
 The closed compartments of forearm and hand
 An understanding of the special circum-stances
associated with swelling and the effects of rising
pressure in a closed compartment secondary to infection
and injury
 An understanding of the special circum-stances in which
oedema causes fibrosis and permanent stiffness
 Tendon injury and healing
 Nerve injury and healing
 An appreciation of the imbalances and deformities
associated with inflammatory arthritis
 A classification system for congenital hand disorders
 Langers lines
 Hand tumours (e.g. ganglion/enchondroma)
 Dupuytren's disease
 History of examination of hand and wrist in the
assessment of tendons, distal radioulnar and
radiocarpal joints
 Ability to elicit median, ulnar and radial nerve
function and disorders
 Recognition of patterns of presentation of common
compressive neuropathies and brachial neuralgia
 Assessment of intrinsic and extrinsic motors in digits
and recognition of common deformities and
deficiencies
 Awareness of presentation of work-related hand
disorders
 Ability to examine and assess common rheumatoid
hand deformities, e.g.: inferior radioulnar subluxation
and carpal translo-cation; MCP subluxation and ulnar
drift; digital Boutonniere and swan neck; thumb
Boutonniere deformity and CMC disease
 Ability to recognise and assess focal hand swellings
No.
3D.
General Core
Curriculum
Investigations:
3E.
Treatment:
Komponen Curriculum
 Interpretation of plain and stress x-rays of wrist.
 A knowledge of other views
 Awareness
of
role
of
MRI/bone
scan/
arthrography/arthroscopy
 Place and interpretation of nerve conduction studies
 Knowledge of a strategy of management for the
osteoarthritic rheumatoid hand.
 Understanding of the place of soft tissue
reconstruction, joint fusion, interposition and
excision arthroplasty in the treatment of the arthritic
hand and wrist.
 Knowledge of the management of stenosing
tenovaginitis
 Knowledge of the principles of treatment for
common flexor and extensor tendon injuries and of
the common surgical approaches to the digital flexor
and extensor compartments
 Fractures of metacarpals and phalanges
 Familiarity with the surgical treatment of
Dupuytren’s disease
 Awareness of the principles of tendon transfer for
the reconstruction of mediun, ulnar and radial nerve
palsy and familiarity with simple transfers, e.g.
indicis to EPL
 Knowledge
of
splinting
techniques
and
rehabilitation principles
 Ability to plan management for finger tip injuries
and undertake
 closed management
 Knowledge of surgical approach to digits with
particular regard to the restoration of function and
prevention of stiffness
 Knowledge of the levels for digital amputation
 Injuries of ulnar collateral ligament of thumb
 Dislocations of carpus and carpal instability
 Knowledge of closed and operative options of
treatment for fractures of distal radius and common
carpal injuries including scaphoid non union.
 Familiarity with the surgical treatment of common
compressive neuropathy
 Ability to manage common hand infections
9
No.
General Core
Curriculum
Komponen Curriculum
4. KNEE
4A.
Anatomy:
4B.
Biomechanics:
4C.
Pathology:
 Knowledge of regional anatomy of the knee, including:
 Surface anatomy
 Neural and vascular structures and their relations with
particular reference to standard anterior and posterior
surgical approaches
 Knowledge of regional anatomy of the knee, including:
 Surface anatomy
 Neural and vascular structures and their relations with
particular reference to standard anterior and posterior
surgical approaches
 Bones and joints
 Functional anatomy of ligaments and supporting
muscles
 Innervation of the knee including controlling
musculature
 The extent and function of the synovium and bursae of
the knee
 The structure and function of the menisci, and articular
cartilage
 The mechanics of the patello-femoral mechanism
 The medial and lateral weight-bearing joints and their
inter-relationship
 The cruciate and collateral ligaments and other
ligamentous and muscular supports
 Menisci and articular cartilage
 The mechanism of ligamentous, bony and combined
trauma to the knee and healing potential
 A complete knowledge of arthritides, including
degenerate wear, ageing changes and traumatic
damage
 Pathology of inflammatory disease and infection
affecting the knee
 The response of synovium to debris
 Benign and malignant conditions in the knee and surrounding
structures including recognised classification where
appropriate
4D.
10
Clinical
Assessment:
 A sound knowledge and understanding of:
 History and examination of the knee to include relevant
surrounding structures
 The standard clinical signs of the knee and relevant
adjacent structures and competent skill in describing
these
No.
4D.
4E.
4F.
General Core
Curriculum
Clinical
Assessment:
(Cont.)
Investigations:
Treatment:
Komponen Curriculum
 A critical understanding of rating and outcome
measures in common use













Indications for and interpretations of:
Radiographs – standard and specialised
Blood investigation
Aspiration
Special investigations including CT, MRI and
radioisotope scanning
Arthroscopy
Biomechanical testing
A sound knowledge of conservative and surgical
management, including the indications for referral to a
specialist of:
Paediatric disorders, including deformity, dislocations,
epiphyseal disorders, osteochondritis and discoid
meniscus
Adolescent disorders including patello femoral and
meniscal dysfunction, osteochondritis dissecans
Young adult disorders including patello femoral and
meniscal injuries, instability and ligament deficiency,
synovial disorders, benign and malignant tumours
Degenerative and inflammatory arthritis, including a
balanced understanding of conservative and surgical
options,including
osteotomy,
arthrodesis
and
arthroplasty
Traumatic disorders including skin and soft tissue
injuries, fractures and dislocations of patella, tibia and
femoral components, ligament ruptures and internal
derangement of the knee. Conservative and surgical
indications and detailed .Methods of treatment.
Outcomes of conservative and operative management
 Infections, particularly infections and inflammations
of the bursae, intra-articular sepsis, prevention and
management of sepsis in implant surgery
 A sound working knowledge of the range of
arthroplasties for primary and revision surgery for
patello femoral, unicompartmental and total
replacement of the knee with particular reference to
secure bone anchorage, alignment, ligament stability
and optimising range of movement; a good knowledge
of post-operative complications, their Sprophylaxis and
management
11
No.
4F.
General Core
Curriculum
Treatment
(cont):
Komponen Curriculum
 A knowledge of the indications and techniques of
revision surgery particularly for aseptic and septic
loosening
 A knowledge of simple arthroscopic surgery including
meniscectomy, trimming and shaving
 An appreciation of complex arthroscopic procedures
 An appreciation of medical and surgical techniques
available to repair and replace articular cartilage
5. ANKLE & FOOT




















5A.
Anatomy:
5B.
Biomechanics:
5C.
Pathology:
5D.
1)
Ability to recognise and assess the following diseases of the ankle and foot:
Neurological
 Charcot joint
disorders:
 Morton's neuroma
 Nerve entrapment
 Neurological foot deformity
Trauma:
 Evaluation of skin and soft tissue injury
 Compartment syndrome
 Recognition of all fractures and dislocations
 Ankle and hindfoot disorder:
2)
12
Bones and articulations
Ligamentous structures – ankle/hindfoot/ midfoot
Plantar fascia and MTP anatomy
Surface markings of neural and vascular structures
Tendon anatomy
Muscle compartments of the foot
Function of the lower limb and foot in gait
Ankle and subtalar joint
Plantar fascia mechanisms
Tendon function
Orthoses and footwear
Arthritides
Degenerative joint disease
Rheumatoid foot disease
Neuropathy
Neuropathic joint and skin changes
Tumours
E.g. osteoid osteoma and plantar fibroma
Clinical Assessment:
History and clinical examination of the foot and ankle
in order to assess pain, joint function, deformity, nerve,
muscle and tendon function
No.
2)
General Core
Curriculum
Trauma: (Cont.)
3)
Forefoot
disorders:
4)
Tumours:
5E.
Investigations:
Radiograph:
CT, MRI and
Scintigraphy:
5F.
EMG:
Treatment
Non-operative:
Operative:
Komponen Curriculum

















Hindfoot pain
Ankle instability
Heel pain
Degenerative disease of the ankle
Rheumatoid arthritis
Osteochondritis dissecans of talus
Hallux valgus
Hallux rigidus
Lesser toe deformities
Metatarsalgia
Inflammatory arthritis
Ability to recognise and assess local foot swellings
Diabetic foot:
Complex foot deformity
Flatfoot deformity - mobile and rigid
Cavus deformity
Residual congenital foot deformity
 Standard foot and ankle views
 Knowledge of role of these ancillary investigations in certain specific conditions e.g. infection,
tumour, tibialis posterior rupture, osteonecrosis
 Relevance to foot and ankle disorders
 Knowledge of rational basis for the use of
footwear modifications, orthoses and total contact
casting
 Detailed knowledge of closed and operative methods
for management of fractures and dislocations of ankle,
hindfoot and forefoot, including knowledge of common
reconstructive surgical procedures for foot deformity
including hallux valgus, lesser toe deformity, acquired
flat-foot, to include arthrodesis, osteotomy and softtissue reconstruction
 Knowledge of common amputations through foot
and ankle
 Knowledge of common reconstructive surgical
procedures for degenerative and inflammatory
disorders of ankle and foot including arthrodesis,
arthroplasty, excision arthroplasty procedures to
first ray both proximal and distally for
management of hallux valgus and rigidus
13
No.
General Core
Curriculum
6. HIP JOINT
6A.
Anatomy:
6B.
Basic knowledge
of the regional
anatomy of the
hip including:
Komponen Curriculum







6C.
Biomechanics:

Development of the hip joint
Relationship of bony elements
Blood supply of the femoral head
Anatomical course of all major regional vessels and
nerves
The capsule, labrum and related ligaments
An understanding of the action, anatomy and
innervation of the regional musculature
Detailed knowledge of the applied anatomy of
common surgical approaches to the hip (medial,
anterior, lateral and posterior)
An understanding of the lever arms, muscles and body
weight forces that produce the joint reaction force in
both normal and abnormal hips
 An understanding of the application of these principles to
the rationale of both pelvic and femoral osteotomies, and
replacement arthroplasty
6D.
Pathology:
6E.
Clinical
Assessment:
14
 Knowledge of the tribological properties of materials
used for articulating surfaces
 Knowledge of the biocompatibility and mechanical
properties of materials in common use in total hip
arthroplasty
 Basic knowledge of the pathology of pyogenic and
non-pyogenic arthritis, slipped upper femoral epiphysis
[SUFE], Perthes' disease and hip dysplasia
 Mechanism and pattern of common fractures and
fracture dislocations around the hip (intracapsular,
extracapsular, acetabular and periacetabular, femoral
head, etc)
 Knowledge of the pathology of osteoarthritis,
rheumatoid arthritis and the seronegative arthritides at
the hip and of osteonecrosis of the femoral head
 Familiarity
with
current
theories
of
the
aetiopathogenesis of osteoarthritis
 An understanding of the microbiological rationale for
the prevention of sepsis in total hip arthroplasty
 A sound knowledge of clinical assessment of the hip,
lumbosacral spine and knee. Particular reference
should be paid to the gait, the Trendelenberg sign, limb
length, loss of movement and deformity at the joint
No.
6E.
General Core
Curriculum
Komponen Curriculum
The trainee needs to be well informed of current opinion regarding
aetiopathogenesis, clinical presentation and appropriate investigation of:
 Proximal femoral fractures (intracapsular, extracapsular)
and simple fracture dislocations of the hip
 Osteoarthritis and the inflammatory arthropathies





Perthes' disease
Slipped upper femoral epiphysis
Septic arthritis
Osteonecrosis
Soft tissue conditions around the hip (snapping hip,
gluteus medius tendonitis, etc)
A working knowledge of the clinical presentations and investigations of:





6F.
Investigation:
The sequelae of CDH and hip dysplasia
The sequelae of SUFE
Juvenile chronic arthritis
Non pyogenic arthritis
The painful total hip replacement
 A working knowledge of the interpretation of plain
radiographs,
dynamic
arthrography,
CT,
bone
scintigraphy and MRI of the hip region
 A working classification of proximal femoral and
periacetabular fractures. Also, mechanisms and classification
of failure of joint replacement and of periprosthetic fractures
6G.
Treatment:
 Non-operative
 An understanding of the principles of traction, bracing and
spica immobilisation
 An understanding of the non operative aspects of the
management of hip pathology
 Operative
 A thorough knowledge of soft tissue surgery, osteotomy,
arthrodesis and arthroplasty (excision and replacement). A
sound knowledge of anterior, anterolateral, lateral and
posterior approaches to the hip and of the complications
associated with each
 A sound knowledge of: internal fixation of proximal femoral
fractures, hemiarthroplasty for intracapsular fractures,
primary total hip replacement for OA and inflammatory
arthropathies in the elderly, simple proximal femoral
osteotomies. Familiarity with potential complications (i.e.
thromboembolism, sepsis, dislocation, etc) and be aware of
current opinion on the prevention and management of these
complications
 A knowledge of the indications for, and principles of,
complex proximal femoral osteotomies, hip arthroscopy,
reconstruction of the hip in young adults (JCA and hip
dysplasia, etc), complex hip revision surgery
15
No.
6G.
General Core
Curriculum
Treatment (Cont.)
7. THE SPINE
7A.
Anatomy:
7B.
Biomechanics:
Komponen Curriculum
 An appreciation of complex acetabular and pelvic
fractures, complex periacetabular osteotomies
 An understanding of the place of modern technologies
such as, joint resurfacing procedures minimally
invasive hip replacements and computer assisted
implantation in the management of hip pathology and
the attendant risks and complications
 Development of the spine, spinal cord and nerve
roots
 Surgical anatomy of the cervical, dorsal and
lumbosacral spine
 Anterior and posterior surgical approaches to the
spine at each level
 Basic knowledge of the biomechanics of the
cervical and lumbosacral spines
 An understanding of the biomechanics of spinal
instability as applied to trauma, tumour, infection and
spondylolysis/listhesis
7C.
Pathology:
7D.
Clinical
Assessment:
 Biomechanics of spinal deformity
 A knowledge of the basic mechanics of spinal
instrumentation
 Pathophysiology of the ageing spine and
degenerative disc disease
 Acute and chronic infections of the spine
 Pathology of spinal deformity
 Pathology of the acutely prolapsed cervical and
lumbar disc
 Recognition of patterns of spinal injury and
associated cord and nerve root damage
 Tumours of the spine
 A thorough knowledge of general and orthopaedic
history-taking and examination
 A knowledge of the assessment of spinal deformity
 An understanding of the assessment of thoracic pain
 A sound knowledge of clinical assessment of the spine
for low back pain, sciatica, spinal claudication, neck
pain, radiating arm pain, spinal injury and incipient
myelopathy
 A knowledge of the assessment of spinal tumour
 A basic knowledge of the assessment of a patient
after failed spinal surgery
16
No.
7E.
7F.
General Core
Curriculum
Investigation:
Treatment:
Non-operative
Operative
8. TRAUMA
8A.
Anatomy:
8B.
Biomechanics:
Komponen Curriculum
 A thorough knowledge of the basic investigations
required in spinal surgery, specifically: blood tests,
plain radiographs, bone scintigraphy, discography,
electrophysiological
studies
[including
cord
monitoring], CT scanning, MRI scanning
 A thorough knowledge of how each of these
investigations contributes to the diagnosis and
management of each of the major areas of spinal
disease
 A knowledge of the non-surgical methods available for
the treatment of low back pain, sciatica, claudication,
neck pain, spinal deformity, instability, tumour,
infection and fracture to include:
 Analgesics and NSAIDs, physiotherapeutic regimes,
pain clinic techniques, bracing, use of radiotherapy and
chemotherapy, non-operative management of spinal
injuries
 A sound knowledge of the indications for and
operative surgical management of the acute prolapsed
lumbar intervertebral disc, spinal stenosis, lumbar
spinal instability due to spondylolysis/listheses
 A knowledge of the indications for, and operative
surgical management of the acutely
 prolapsed cervical disc, cervical stenosis, spinal injury
and the surgery of spinal infection
 A basic knowledge of the surgery of spinal deformity
and tumours of the spine
 Applied to diagnosis and surgical treatment of
common bone, joint and soft tissue injuries
 Knowledge of those anatomical structures particularly
at risk from common injuries or in surgical approaches
 Physeal anatomy and its application to injury
 Application to open reduction and internal fixation of
fractures and external skeletal fixation
 Applied to fracture formation and fracture treatment
both operative and non-operative
 Biomechanics of implants and fracture fixation
systems, including their material properties
 Epidemiology and Research Methods:
 Research and audit methods including the design of
clinical trials
17
No.
8C.
General Core
Curriculum
Pathophysiology
& Pathology:
Komponen Curriculum
 Applied to fracture and soft tissue healing, including
skin, muscle, tendon and neurological structures
 Classification systems for fractures and dislocations
 Pathology of non-union of fractures
 Response of the body, and local musculoskeletal
tissues to infection
 Systemic response of body to major injury
 Mechanisms underlying Acute Respiratory Distress
Syndrome and similar life threatening conditions
 Science of fluid replacement therapy in the acutely injured
including application to the treatment of burns
8D.
Clinical
Assessment:
8E.
Investigations:
8F.
Management:
18
 Science of treatment of compartment syndrome
 Response of infants, children and the elderly to injury
 Initial clinical assessment of the patient with severe
injury, including spinal cord injury, soft tissue injury,
burns and head injury
 Assessment of all types of fracture and dislocation,
their complications, early and late
 Identification of life threatening/ limb threatening
injuries. Understanding priorities of treatment
 Knowledge of the principles, application and side effects
of commonly used investigations, including radiographs,
CT and MRI scans, radio-isotope imaging, ultrasound
scans and electrophysiological investigations
 Knowledge of different treatment options for
musculoskeletal injury, both non-operative and operative.
Ability to analyse the pros and cons for each method
 Ability to manage the overall care of the severely injured
 Ability to undertake the complete treatment of all types of
common fracture and dislocation including the bone and
soft tissue treatment of open fractures and the treatment of
pathological fractures
 Where common injuries are normally treated by a sub
specialist (e.g. spinal injury, arterial injury or intra cranial
haemorrhage) there should be ability to manage the initial
treatment of the patient and know the principles of the
specialist treatment
 Principles of reconstructive surgery for the injured,
including treatment of non-union and malunion of
fractures, bone defects, chronic post-traumatic
osteomyelitis and delayed treatment of nerve injury;
principles of soft tissue reconstruction
 The principles of amputation in the injured and the
rehabilitation of such patients
No.
General Core
Komponen Curriculum
Curriculum
9. PAEDIATRIC ORTHOPAEDIC
9A
Basic Science:
 Detailed knowledge of the growth of bones, physeal
anatomy and its application to fracture types and
pathological processes and infection in particular
 Knowledge of the anatomy of bones and joints in the
growing child and its application to growth and
deformity
 Knowledge of the neurological processes involved in the
production of deformity e.g. spina bifida, cerebral palsy
and muscular dystrophy
9B
Clinical
Assessment:
9C
Investigations:
9D
Treatment:
 Core knowledge should be at least that of a general
orthopaedic textbook
 'Expert' knowledge, i.e. the level of the speciality
journal is required for those wishing to pursue a career
in children's orthopaedics
 The trainee must be able to clinically examine a child
competently and to relate effectively with the family
 The trainee must be able to make proper management
decisions in paediatric practice and to refer
appropriately for treatment
 Knowledge of the indications for plain x-ray,
arthrogram, CT, MRI and the ability to interpret the
images
 Knowledge of the indications for the use of ultrasound
and nuclear imaging
 Awareness of the limitations of certain investigations
in paediatric practice
 A sound knowledge of normal variants, e.g. knock
knees, bow legs and flat feet
 A detailed knowledge of the treatment for:
o Fractures (including non-accidental injury) and
growth plate injuries and recognise the sequelae
o Bone and joint infection
o Common childhood orthopaedic conditions, e.g.
irritable hip, anterior knee pain
 A working knowledge of the treatment for:
o Slipped epiphysis
o Perthes' disease
o Developmental dysplasia of the hip
o Talipes
o Scoliosis
o Simple foot deformities (e.g. hallux valgus,
metatarsus varus)
19
No.
9D
General Core
Curriculum
Treatment (Cont.):
9E
A knowledge of:
Komponen Curriculum
o Simple congenital hand abnormalities (e.g. trigger
thumb)
o Osteogenesis imperfecta
o Skeletal dysplasias
o Tarsal coalitions
o Torticollis
o Leg length discrepancy
 Screening services for congenital abnormalities
 Assessment of physical disability
10. SHOULDER & ELBOW
10A.
Anatomy:
Basic knowledge of the regional anatomy of the shoulder including:
10B.
Biomechanics:
10C.
Pathology:
 Detailed
anatomy
of
the
sternoclavicular,
acromioclavicular, glenohumeral and elbow joints to
include the connecting bones, muscles and tendons acting
across them, neurovascular supply, bursae and
relationships to local structures
 Surgical approaches: deltopectoral and posterior
approaches to glenohumeral joint; superior (McKenzie)
approach to rotator cuff; and surgical approaches to the
acromioclavicular and sternoclavicular joints
 Structure and function of the above joints; a clear
understanding of the static and dynamic stabilisers of the
glenohumeral and elbow joints
 Biomechanics of the shoulder and elbow to the level of the
currently published specialist journals
 Knowledge of the various types of shoulder and elbow
prostheses including the factors influencing design, wear
and loosening to the level of the currently published
specialist journals
 Sound knowledge of all commonly encountered benign
and malignant conditions affecting the shoulder girdle,
elbow and surrounding soft tissues








20
A basic understanding of the pathology of:
Impingement and rotator cuff disorders
Instability of the shoulder and the elbow
Inflammatory and degenerative conditions affecting the
articular cartilage and synovium
Infection
Adhesive capsulitis of the shoulder
The pathology of the stiff elbow
Disorders such as ulnar neuritis and tennis or golfer’s
elbow
No.
10D.
10E.
General Core
Curriculum
Clinical
Assessment:
Investigation:
Komponen Curriculum
 Detailed history and examination of the painful, stiff or
unstable shoulder or elbow
 Knowledge of clinical tests used specifically to assess
instability of the shoulder and elbow, rotator cuff
disorders, the stiff shoulder or elbow and the use of
local anaesthetic in assessment. Examples are the
apprehension
tests
for
shoulder
instability,
impingement signs and tests, Gerber’s lift off test,
Napoleon's sign, elbow instability tests, ulnar nerve
assessment
 Knowledge of conditions causing referred symptoms to
the shoulder and elbow (e.g. cervical spine diseases,
entrapment neuropathies and thoracic outlet disorders)
 Knowledge to the level of a basic specialist shoulder
textbook of common conditions affecting the shoulder
including instability, impingement, rotator cuff tears,
adhesive capsulitis, osteoarthritis, rheumatoid disease,
avascular necrosis, biceps tendon disorders, fractures
of the proximal humerus and clavicle, and disorders of
the acromioclavicular and sternoclavicular joints and
scapula
 Knowledge to the level of a basic specialist elbow
textbook of common conditions affecting the elbow
including instability, osteoarthritis, rheumatoid
arthritis, causes of stiffness, soft tissue problems such
as medial and lateral epicondylitis, neuropathies and
fractures around the elbow
 Knowledge of plain radiographs as used to assess
shoulder and elbow disorders. This should include a
knowledge of those special views (e.g. Modified axial,
Stryker notch, Supraspinatus Neer outlet and cubital
tunnel views) required to assess adequately the
conditions which commonly affect the shoulder and
elbow. The ability to recognise correctly normal and
abnormal abnormalities on plain radiographs
 Knowledge of the value of ultrasound, arthrography, CT
and MRI as used to assess the shoulder and elbow. An
ability to identify straightforward abnormalities on CT and
MRI (e.g. full thickness and partial thickness rotator cuff
tears on MRI and the pathological anatomy of fractures
around the shoulder and elbow using CT)
 Knowledge of the use and abuse of arthroscopy of the
shoulder and elbow including a knowledge of normal and
abnormal arthroscopic findings
21
No.
10F.
1)
2)
2)
General Core
Curriculum
Treatment:
Non-operative
Operative
Operative (cont.)
Komponen Curriculum
 An ability to supervise the non-operative management
of fractures, dislocations and soft tissue injuries around
the shoulder and elbow
 An in-depth knowledge of the management of
straightforward fractures and dislocations of the shoulder
girdle and elbow. Knowledge of the treatment options for
more complex fractures with an understanding that these
might more appropriately be referred to someone with a
special interest; examples of these might include four part
fractures of the proximal humerus and complex
intraarticular fractures of the distal humerus. An ability to
recognise upper limb injuries involving injuries to the
brachial plexus and refer on as appropriate
 A knowledge of injection techniques for both the shoulder
and the elbow
 Knowledge of both the non-operative and operative
treatment of common disorders such as recurrent anterior
traumatic instability of the shoulder, rotator cuff
impingement and small rotator cuff tears, adhesive
capsulitis, acromioclavicular joint pain
 A knowledge of the management of soft tissue elbow
disorders such as lateral and medial epicondylitis and
ulnar neuropathy
 Knowledge of the indications, options and complications for
prosthetic replacement of the shoulder and elbow. A detailed
knowledge of the surgical techniques is not required
 Knowledge of the indications and benefits of arthroscopy of
the shoulder and elbow. An ability to perform an arthroscopic
assessment of the shoulder is expected but a knowledge of the
techniques of arthroscopic surgery procedures is not required
 Understanding the principles of management of tumours
around the shoulder and elbow
11. ORTHOPEDIC ONCOLOGY
11A
22
Basic
 Knowledge of the presentation, radiological features,
pathological features, treatment and outcome for common
benign and malignant bone tumours
 Knowledge of the presenting features, management and
outcome of soft tissue swellings, including sarcomas
benign and malignant
 Understanding of the principles of management of patients
with metastatic bone disease in terms of investigation,
prophylactic and definitive fixation of pathological
fractures and oncological management
No.
General Core
Curriculum
11B
11C
Staging
11D
Treatment
11E
Specific Tumours
Bone
Metastases
Soft Tissues Tumor
12. SPORT INJURY
Arthroscopy
12A
12B
Komponen Curriculum















Classification benign/malignant
Tissue of origin
Investigations
Enneking Classification
Biopsy techniques
Basic Histopathologal Interpreatation
Principles surgical treatment
Incisional Excision
Marginal Excision
Wide Excision
Radical Excision
Radiotherapy
Chemotherapy-principles of action
Treatment of pathological fracturres
Palliative treatment












Primary
Osteoid Osteoma
Osteoblastoma
Osteosarcoma
Ewing sarcoma
Giant cell sarcoma
Chondrosarcoma
MFH
Fibrosarcoma
Multiple myeloma
General Features
General features
 Principles of Arthroscopy
 Common indication of arthroscopy
 Standard and additional portals for knee, shoulder
arthroscopy
 Complication of arthroscopy
 Pathoanatomy of ACL/PCL injuries and their
management
 Pathoanatomy of MCL/LCL injueris and their
management
 Pathoanatomy of meniscal injuries and management
 Patella-femoral disorder and various causes of anterior
knee pain
 Causes and management of PF maltracking/ Instability
23
No.
General Core
Curriculum
12B
Cont.:
12C
Shoulder
12D
Ankle
24
Komponen Curriculum
 Types and synovials plicae and treatment
 Management of knee dislocation and multiple
ligaments injury
 Pathoanatomy of recurrent shoulder dislocation
and management
 Types of shoulder impingement syndrome and ita
management
 Rotator cuff arthropathy
 Types of AC joint dislocation
 Acute and chronic ankle ligaments injury
 Impingement syndrome and meniscoid lesion
 Tendon archilles rupture
2.2.
NO.
Bidang Psikomotor (Applied Clinical Procedures Syllabus)
TOPIC
1.
TRAUMA
1A
Trauma
General
1B
Axial Sceleton
1)
Cervical Spine
2)
Thoraco-lumbal
Spine
3)
Pelvis
PROCEDURE
 Free flap
 Full thickness skin graft
 Muscle flap
 Nerve repair
 Pedicle flap
 Removal external fixator or frame
 Removal foreign body from skin / subcutaneous
tissue
 Removal K wires or skeletal traction
 Split skin graft
 Transpositional flap
 Wound closure, delayed primary or secondary
 Wound Debridement
 Internal Fixation of Long Bone
 Internal fixation of complex fracture
 External fixation
 Periarticuler fracture
 Tendon repair
 Vascular repair
 Casting and splinting














Anterior fixation fracture / dislocation cervical spine
Application halo / tong traction cervical spine
MUA fracture / dislocation cervical spine
Posterior fixation fracture / dislocation cervical spine
Posterior decompression / fixation thoracic spine
Lumbar Spine
Anterior decompression / fixation lumbar spine
Posterior decompression / fixation lumbar spine
Simple acetabular fracture ORIF
Complex acetabular fracture ORIF
Pelvic fracture:
Pelvic fracture external fixator application
Simple pelvic fracture ORIF
Complex pelvic fracture ORIF
25
NO.
TOPIC
1C
Upper Limb
1)
2)
Brachial Plexus
Clavicle
3)
Shoulder Joint
4)
Humerus
5)
Elbow Joint
6)
26
Forearm
PROCEDURE



























Exploration / repair / grafting brachial plexus
ORIF clavicle fracture
ORIF non-union clavicle fracture
Anterior dislocation shoulder
Anterior dislocation shoulder closed reduction
Anterior dislocation shoulder open reduction +/- fixation
Acromioclavicular joint dislocation acute ORIF
Fracture proximal humerus ORIF
Glenoid fracture ORIF
Posterior dislocation shoulder closed reduction
Fracture diaphysis humerus non-op:
Non-union ORIF +/- bone grafting
Fracture diaphysis humerus IM nailing
Fracture diaphysis humerus MUA +/- POP
Fracture diaphysis humerus ORIF plating
Dislocated elbow +/- fracture:
Dislocated elbow +/- fracture closed reduction
Dislocated elbow +/- fracture open reduction +/- fixation
Intraarticular distal humerus fracture ORIF
Lateral condyle fracture ORIF
Medial condyle / epicondyle fracture MUA / K wire / ORIF
Olecranon fracture ORIF
Dislocated elbow +/- fracture:
Radial head / neck fracture MUA +/- K wire
Radial head / neck fracture ORIF
Radial head replacement for fracture
Supracondylar fracture:














Supracondylar fracture MUA +/- K wires
Supracondylar fracture ORIF
Fasciotomy for compartment syndrome
Fracture distal radius:
Fracture distal radius – closed non-op
Fracture distal radius external fixation
Fracture distal radius MUA & percutaneous wires
Fracture distal radius MUA & POP
Fracture distal radius ORIF
Fracture shaft radius / ulna:
Fracture shaft radius / ulna IM nailing
Fracture shaft radius / ulna MUA & percutaneous wires
Fracture shaft radius / ulna MUA & POP
Fracture shaft radius / ulna ORIF
NO.
TOPIC
7)
Wrist
8)
Hand:
9)
Tendon repair:
PROCEDURE
 Carpal fracture / dislocation:
 Carpal fracture / dislocation MUA & percutaneous
wires
 Carpal fracture / dislocation MUA & POP
 Carpal fracture / dislocation ORIF
 Scaphoid fracture non-op
 Scaphoid fracture ORIF
 Scaphoid fracture MUA & percutaneous wires
 Scaphoid fracture non-union ORIF +/- graft
 Carpal fracture / dislocation:
 5th metacarpal fracture / dislocation non-op
 5th metacarpal fracture / dislocation MUA &
percutaneous wires
 5th metacarpal fracture / dislocation MUA & POP
 5th metacarpal fracture / dislocation ORIF
 Finger tip reconstruction
 Infection:
 Infection hand drainage (not tendon sheath)
 Infection tendon sheath drainage
 IPJ fracture / dislocation:
 IPJ fracture / dislocation MUA & percutaneous wires
 IPJ fracture / dislocation MUA +/- POP
 IPJ fracture / dislocation ORIF
 Ligament repair hand
 Metacarpal fracture (not 1st or 5th) non-op
 Metacarpal fracture (not 1st or 5th) MUA &
Percutaneous wires
 Metacarpal fracture (not 1st or 5th) MUA +/- POP
 Metacarpal fracture (not 1st or 5th) ORIF
 Phalangeal fracture non-op
 Phalangeal fracture MUA & percutaneous wires
 Phalangeal fracture MUA +/- POP
 Phalangeal fracture ORIF
 Tendon repair extensor
 Tendon repair flexor
 MCPJ fracture / dislocation:
 MCPJ fracture / dislocation MUA & Percutaneous
wires
 MCPJ fracture / dislocation MUA +/- POP
 MCPJ fracture / dislocation ORIF
27
NO.
TOPIC
1D
Lower Limb
1)
1a)
Hip joint
Dislocated hip:
1b)
Extracapsular
fracture:
2)
Femur
Diaphyseal
fracture closed:
2a)
2b)
Subtrochanteric
fracture:
2c)
Supracondylar
fracture (not
intraarticular):
3)
Knee Joint
PROCEDURE
 Dislocated hip closed reduction
 Acute dislocated hip open reduction +/- fixation
 Neglected dislocated hip open reduction +/fixation
 Extracapsular fracture CHS / DHS
 Extracapsular fracture intramedullary fixation
 Extracapsular fracture other fixation
 Intracapsular fracture:
 Intracapsular fracture hemiarthroplasty
 Intracapsular fracture internal fixation
 Intracapsular fracture intracapsular fracture THR
 Diaphyseal fracture traction or spica in child
 Diaphyseal fracture intramedullary nailing
 Diaphyseal fracture plate/screw fixation
 Fasciotomy for compartment syndrome
 Subtrochanteric fracture intramedullary fixation
 Subtrochanteric fracture plate/screw fixation
 Supracondylar fracture (not intraarticular) DCS /
blade plate etc
 Supracondylar
fracture
(not
intraarticular)
intramedullary fixation
 Acute haemarthrosis arthroscopy
 Acute ligament repair
 Intraarticular fracture distal femur ORIF
 Patella dislocation closed reduction +/- open repair
 Patella fracture ORIF
 Patella tendon repair
 Quadriceps tendon repair
 Simple tibial plateau fracture
 Complex tibial plateau fracture
 Tibial plateau fracture arthroscopically assisted fixation
 Tibial plateau fracture ORIF with plates & screws
 Tibial plateau fracture treatment with circular frame
28
NO.
4)
TOPIC
Tibia & Fibula
Tibial
union:
5)
non-
 Diaphyseal tibial fracture external fixation
(including frame)
 Diaphyseal tibial fracture intramedullary nailing
 Diaphyseal tibial fracture MUA & POP
 Tibial shaft plating
 Fasciotomy for compartment syndrome
 Tibial non-union circular frame management
 Tibial non-union intramedullary nailing +/- bone
grafting
Ankle
Ankle fracture /
dislocation:
Pilon fracture:
6)
PROCEDURE
 Ankle fracture / dislocation MUA & POP
 Ankle fracture / dislocation ORIF
 Simple pilon fracture ORIF
 Complex pilon fracture ORIF
 Pilon fracture with circular frame
 Tendoachilles repair
Foot
 Amputation toe / ray for trauma
 Simple calcaneal fracture ORIF
 Complex calcaneal fracture ORIF
 Metatarsal fracture ORIF
 Phalangeal fracture MUA +/- K wire +/- ORIF
 Talar, subtalar or midtarsal fracture / disloc:
 Talar, subtalar or midtarsal fracture / dislocation MUA
+/-POP +/- K wires
 Talar, subtalar or midtarsal fracture / dislocation ORIF
 Achilles Tendon Repair
2. ELECTIVE (NON TRAUMA)
2A
Non Specific Site
 Aspiration / injection joint
 Benign tumour excision (not exostoses)
 Biopsy bone - needle
 Biopsy bone - open
 Bursa excision
 Cyst bone curettage +/- bone graft
 Epiphysiodesis
 Malignant tumour excision
29
NO.
TOPIC
2B
Axial Sceleton
1)
Cervical Spine
1)
Cervical Spine
(cont)
2)
Thoracic Spine
PROCEDURE
 Anterior decompression +/- fixation / fusion (C2-C7)
 Atlantoaxial fixation +/- fusion
 Biopsy cervical spine
 Excision cervical / 1st rib
 Nerve root / facet joint injection cervical spine
 Occipito-cervical fusion +/- fixation
 Posterior decompression +/- fixation / fusion (C20C7)
 Anterior decompression +/- fixation / fusion
 Biopsy thoracic spine
 Posterior decompression +/- fixation / fusion
 Scoliosis correction - anterior release +/- instrumentation
 Scoliosis correction - posterior fusion +/- instrumentation
3)
Lumbar Spine
4)
Pelvis
5)
Brachial Plexus
2C
Upper Limb
Shoulder
1)
30
 Caudal epidural injection
 Decompression lumbar spine with fusion +/- fixation
 Decompression lumbar spine without fusion (not
disectomy alone)
 Discectomy open / micro
 Nerve root / facet joint injection lumbar spine
 Salter Innominate Osteotomy
 Reconstruction Acetabulum
 Excision Sacrum
 Exploration / repair / grafting brachial plexus
 Neurolysis
 Acromioclavicular joint excison - arthroscopic / open
/ lateral clavicle
 Acromioclavicular joint reconstruction (e.g. Weaver
Dunn)
 Acromioplasty open
 Anterior repair for instability arthroscopic
 Anterior repair for instability open including capsular
shift
 Arthroscopic subacromial decompression
 Arthroscopy diagnostic
 Rotator cuff repair (open or arthroscopic) +/acromioplasty
 Total shoulder replacement
NO.
TOPIC
2)
Elbow
3)
Wrist
4)
Hand
2D
Lower Limb
Hip Joint
1)
Slipped upper
femoral
epiphysis:
PROCEDURE
 Arthrolysis elbow (open/arthroscopic)
 Arthroscopy elbow diagnostic
 Arthoscopy elbow therapeutic
 Arthrotomy elbow
 Excision radial head +/- synovectomy
 Radial head replacement
 Tennis / golfer elbow release
 Total elbow replacement
 Ulnar nerve decompression / transposition
 Arthrodesis wrist (includes partial arthrodesis)
 Arthroscopy wrist
 Carpal tunnel decompression
 De Quervain's decompression
 Excision distal ulna
 Ganglion excision at wrist
 Ulna shortening
 Ulnar nerve decompression at wrist
 Dupuytrens contracture operation
 Excision synovial cyst
 Fusion of MCPJ or IPJ
 MCPJ replacement
 Soft tissue reconstruction hand
 Tendon transfer hand
 Trapezium excision or replacement
 Trigger finger release
 Trigger thumb release












Arthrodesis hip
Arthrogram hip
Arthroscopy hip – diagnostic
Arthroscopy hip – therapeutic
Arthrotomy hip
Excision arthroplasty hip (e.g. Girdlestone)
Open reduction for DDH
Osteotomy hip – pelvic for DDH
Osteotomy hip – proximal femoral for DDH
Osteotomy pelvis – not for DDH
Slipped upper femoral epiphysis open reduction
Slipped upper femoral epiphysis pinning
31
NO.
TOPIC
Total Hip
Replacement:
2)
Femur
3)
Knee Joint
4)
Tibia & Fibula
5)
Ankle Joint:
32
PROCEDURE
 THR cemented
 THR hybrid
 THR surface replacement
 THR uncemented
 Revision THR acetabular component
 Revision Total Hip Replacement
 Revision THR both components
 Revision THR femoral component
 Amputation above knee
 Femoral lengthening
 Osteotomy corrective (not for DDH)
 Open ACL reconstruction
 Injection & aspiration Joint
 Arthroscopy ACL reconstruction
 Arthroscopic lateral release
 Arthroscopic partial meniscectomy
 Arthroscopic removal loose bodies knee
 Arthroscopic synovectomy
 Arthroscopic knee diagnostic
 Osteotomy distal femoral
 Osteotomy proximal tibial
 Patella realignment
 Patella resurfacing alone
 Revision TKR
 TKR
 Unicompartmental knee replacement
 Amputation below knee
 Tibial lengthening
 Harvesting Fibular Graft
 Arthrodesis ankle
 Arthroplasty ankle
 Arthroscopy ankle diagnostic
 Arthroscopy ankle therapeutic
 Arthrotomy ankle
 Decompression tendons at ankle
 Tendoachilles lengthening
NO.
6)
TOPIC
Foot
PROCEDURE
 Amputation toe / ray
 Calcaneal osteotomy
 CTEV correction
 Fifth toe soft tissue correction
 First metatarsal osteotomy
 First MTPJ arthrodesis
 First MTPJ excision arthroplasty
 First MTPJ soft tissue correction
 Hindfoot arthrodesis
 Ingrowing toenail operation
 Lesser metatarsal osteotomy
 Lesser toe arthrodesis
 Lesser toe excision part/all phalanx
 Lesser toe tenotomy
 Tendon decompression or repair
 Tendon transfer foot
 Wedge tarsectomy
33
2.3. Bidang Afektif (Professional & Management and Good
Clinical Practice)
1. Professional Behaviour
The Objective
1
2
3
4
5
6
7
8
9
10
11
12
To achieve an excellent level of care for the individual patient
a. to elicit a relevant focused history
b. to perform focused, relevant and accurate clinical examination
c. to formulate a diagnostic and therapeutic plan for a patient based upon
the clinic findings
d. to prioritise the diagnostic and therapeutic plan
e. to communicate a diagnostic and therapeutic plan appropriately
To produce timely, complete and legible clinical records to include case-note
records, handover notes, and operation notes.
To prescribe, review and monitor appropriate therapeutic interventions
relevant to clinical practice including non – medication based therapeutic and
preventative indications.
To prioritise and organise clinical and clerical duties in order to optimise
patient care.
To make appropriate clinical and clerical decisions in order to optimise the
effectiveness of the clinical team resource.
To prioritise the patient’s agenda ncompassing their beliefs, concerns
expectations and needs
To prioritise and maximise patient safety.
To understand that patient safety depends on;
a. The effective and efficient organization of care
b. Health care staff working well together
c. Safe systems, individual competency and safe practice
To understand the risks of treatments and to discuss these honestly and
openly with patients
To systematic ways of assessing and minimizing risk
To ensure that all staff are aware of risks and work together to minimise risk
To manage and control infection in patients, Including;
a. Controlling the risk of cross-infection
b. Appropriately managing infection in individual patients
c. Working appropriately within the wider community to manage the risk
posed by communicable diseases
Examples and Descriptors
Patient assessment
a. Introducing self clearly to patients and indicates own place in team
b. Checks that patients comfortable and willing to be seen
c. Informs patients about elements of examination and any procedures that the
patient will undergo
34
Examples and Descriptors(Cont.)
Clinical reasoning
a. In a straightforward clinical case develops a provisional diagnosis and a differential
diagnosis on the basis of the clinical evidence, institutes an appropriate investigative
and therapeutic plan, seeks appropriate support from others and takes account of the
patients Wishes
Record keeping
a. Is able to format notes in a logical way and writes legibly
b. Able to write timely, comprehensive, informative letters to patients and to GPs
Time management
a. Works systematically through tasks and attempts to prioritise
b. Discusses the relative importance of tasks with more senior colleagues.
c. Understands importance of communicating progress with other team members
Patient safety
a. Participates in clinical governance processes
b. Respects and follows local protocols and guidelines
c. Takes direction from the team members on patient safety
d. Discusses risks of treatments with patients and is able to help patients make decisions
about their treatment
e. Ensures the safe use of equipment
f. Acts promptly when patient condition deteriorates
g. Always escalates concerns promptly
Infection control
a. Performs simple clinical procedures whilst maintaining full aseptic precautions
b. Follows local infection control protocols
c. Explains infection control protocols to students and to patients and their relatives
b. Aware of the risks of nosocomial infections.
2. Being A Good Communicator
The objective
1
Communication with patients
a. To establish a doctor/patient relationship characterised by understanding,
trust, respect, empathy and confidentiality
b. To communicate effectively by listening to patients, asking for and
respecting their views about their health and responding to their concerns and
preferences
c. To cooperate effectively with healthcare professionals involved in patient
care
d. To provide appropriate and timely information to patients and their families
2
Breaking bad news
a. To deliver bad news according to the needs of individual patients
35
3
Communication with Colleagues
a. To recognise and accept the responsibilities and role of the doctor in
relation to other healthcare professionals.
b. To communicate succinctly and effectively with other professionals as
appropriate
c. To present a clinical case in a clear, succinct and systematic manner
Examples and Descriptors
a. Conducts a simple consultation with due empathy and sensitivity and writes
accurate records thereof
b. Recognises when bad news must be imparted.
c. Able to break bad news in planned settings following preparatory discussion
with seniors
d. Accepts his/her role in the healthcare team and communicates appropriately
with all relevant members thereof
3. Teaching and Training
The objective
1
2
3
4
To teach to a variety of different audiences in a variety of different ways
To assess the quality of the teaching
To train a variety of different trainees in a variety of different ways
To plan and deliver a training programme with appropriate assessments
Examples and Descriptors
a.
b.
c.
d.
Prepares appropriate materials to support teaching episodes
Seeks and interprets simple feedback following teaching
Supervises a medical student, nurse or colleague through a simple procedure
Plans, develops and delivers small group teaching to medical students, nurses
or colleagues
4. Keeping Up to Date
The Objective
36
1
2
To understand the results of research as they relate to medical practice
To participate in medical research
3
4
5
6
To use current best evidence in making decisions about the care of patients
To construct evidence based guidelines and protocols
To complete an audit of clinical practice
At actively seek opportunities for personal development
7
To participate in continuous professional development activities
Examples and Descriptors
a. Defines ethical research and demonstrates awareness of GMC
guidelines
b. Differentiates audit and research and understands the different types of
research approach e.g. qualitative and quantitative
c. Knows how to use literature databases
d. Demonstrates good presentation and writing skills
e. Participates in departmental or other local journal club
f. Critically reviews an article to identify the level of evidence
g. Attends departmental audit meetings
h. Contributes data to a local or national audit
i. Identifies a problem and develops standards for a local audit
j. Describes the audit cycle and take an audit through the first steps
k. Seeks feedback on performance from clinical supervisor / mentor /
patients / careers / service users
5. Good Manager
The Objective
1
2
Self awareness and self management
a. To recognise and articulate one’s own values and principles,
appreciating how these may
b. differ from those of others
c. To identify one’s own, limitations and the impact of their
behaviour
d. To identify their own emotions and prejudices and understand how
these can affect their judgment and behaviour
e. To obtain, value and act on feedback from a variety of sources
f. To manage the impact of emotions on behaviour and actions
g. To be reliable in fulfilling responsibilities and commitments to a
consistently high standard
h. To ensure that plans and actions are flexible, and take into account
the needs and requirements of others
i. To plan workload and activities to fulfill work requirements and
commitments with regard to their own personal health
Team working
a. To identify opportunities where working with others can bring added
benefits
b. To work well in a variety of different teams and team settings by
listening to others, sharing information, seeking the views of others,
empathising with others, communicating well, gaining trust, respecting
roles and expertise of others, encouraging others,managing differences
of opinion, adopting a team approach
37
3
4
5
Leadership
a. To develop the leadership skills necessary to lead teams effectively. These
include:
b. Identification of contexts for change
c. Application of knowledge and evidence toproduce an evidence based
challenge to systems and processes
d. Making decision by integrating values with evidence
e. Evaluating impact of change and taking corrective action where necessary
Principles of quality and safety improvement
a. To recognise the desirability of monitoring performance, learning from
mistakes and adopting no blame culture in order to ensure high standards
of care and optimise patient safety
b. To critically evaluate services
c. To identify where services can be improved
d. To support and facilitate innovative service
e. Improvement
Management and NHS culture
a. To organise a task where several competing priorities may be involved
b. To actively contribute to plans which achieve service goals
b. To manage resources effectively and safely
c. To manage people effectively and safely
d. To manage performance of themselves and others
e. To understand the structure of the NHS and the management of local
healthcare systems in order to be able to participate fully in managing
healthcare provision
Examples and Descriptors
1. Self awareness and self management
a. Obtains 360° feedback as part of an assessment
b. Participates in peer learning and explores leadership styles and preferences
c. Timely completion of written clinical notes
d. Through feedback discusses and reflects on how a personally emotional
situation affected
e. communication with another person
f. Learns from a session on time management
2. Team working
a. Works well within the multidisciplinary team and recognises when
assistance is required from the relevant team member
b. Invites and encourages feedback from patients
c. Demonstrates awareness of own contribution to patient safety within a team
and is able to outline the roles of other team members.
d. Keeps records up-to-date and legible and relevant to the safe progress of the
patient.
e. Hands over care in a precise, timely and effective manner
f. Supervises the process of finalising and submitting operating lists to the
theatre suite
38
3. Leadership
a. Complies with clinical governance requirements of organisation
b. Presents information to clinical and service managers (e.g. audit)
c. Contributes to discussions relating to relevant issues e.g. workload, cover
arrangements using clear and concise evidence and information
4. Quality and safety improvement
a. Understands that clinical governance is the over-arching framework that
unites a range of quality improvement activities
b. Participates in local governance processes
c. Maintains personal portfolio
d. Engages in clinical audit
e. Questions current systems and processes
5. Management and NHS Structures
a. Participates in audit to improve a clinical service
b. Works within corporate governance structures
c. Demonstrates ability to manage others by teaching and mentoring juniors,
medical students and others, delegating work effectively,
d. Highlights areas of potential waste
6. Promoting Good Health
The Objective
1
2
3
To demonstrate an understanding of the determinants of health and
public policy in relation to individual patients
To promote supporting people with long term conditions to self-care
To develop the ability to work with individuals and communities to
reduce levels of ill health and to remove inequalities in healthcare
provision
Examples and descriptors
1. Understands that “quality of life” is an important goal of care and that this may
have different meanings for each patient
2. Promotes patient self care and independence
3. Helps the patient to develop an active understanding of their condition and how
they can be involved in self management
4. Discusses with patients those factors which could influence their health
5. Understands that “quality of life” is an important goal of care and that this may
have different meanings for each patient
6. Promotes patient self care and independence
7. Helps the patient to develop an active understanding of their condition and how
they can be involved in self management
8. Discusses with patients those factors which could influence their health
39
7. Probity and Ethics
The Objective
1
To uphold personal, professional ethics and values, taking into account the
values of the organisation and the culture and beliefs of individuals
2 To communicate openly, honestly and inclusively
3 To act as a positive role model in all aspects of communication
4 To take appropriate action where ethics and values are compromised
5 To recognise and respond the causes of medical error
6 To respond appropriately to complaints
7 To know, understand and apply appropriately the principles, guidance and
laws regarding medical ethics and confidentiality as they apply to surgery
8 To understand the necessity of obtaining valid consent from the patient and
how to obtain
9 To understand the legal framework within which healthcare is provided
10 To recognise, analyse and know how to deal with unprofessional behaviours
in clinical practice, taking into account local and national regulations
11 To understand ethical obligations to patients and colleagues
12 To appreciate an obligation to be aware of personal good health
Examples and descriptors
a.
b.
c.
d.
e.
f.
g.
h.
i.
j.
Reports and rectifies an error if it occurs
Participates in significant event audits
Participates in ethics discussions and forums
Apologises to patient for any failure as soon as an error is recognised
Understands and describes the local complaints procedure
Recognises need for honesty in management of complaints
Learns from errors
Respect patients’ confidentiality and their autonomy
Understand the Data Protection Act and Freedom of Information Act
Consult appropriately, including the patient, before sharing patient
information
k. Participate in decisions about resuscitation status, withholding or
withdrawing treatment
l. Obtains consent for interventions that he/she is competent to undertake
m. Knows the limits of their own professional capabilities
40
BAB III
TINGKAT KOMPETENSI
DAN LINGKUP BAHASAN
3.1. Tingkat Kompetensi
Menurut Standar Pendidikan Dokter Indonesia,
Pendidikan
Dokter harus mempunyai 7 Standar Kompetensi Dokter yaitu:
1. Mempunyai keterampilan berkomunikasi secara efektif
2. Memiliki Keterampilan Klinik Dasar dan Lanjut
3. Mampu menerapkan Ilmu Kedokteran Dasar dalam praktek
Kedokteran
4. Mampu mengelola masalah kesehatan individu dan keluarga dalam
konteks pelayanan kesehatan paripurna.
5. Mampu memanfaatkan, mengelola Teknologi Informasi
6. Mawasdiri dan mampu mengembangkan diri dengan belajar sepanjang
hayat
7. Mampu mempertimbangkan moral dan etika dalam praktek
Kedokteran
Sebelum mencapai Kompetensi sebagai Spesialis Orthopedi &
Traumtologi (SpOT) secara lengkap, para Peserta Didik dalam proses
Pendidikan harus melalui Tahapan Kompetensi sesuai kategori sebagai
berikut,
1. Kompetensi tingkat Ilmu Dasar Bedah (IDB)
2. Kompetensi tingkat Orthopedi Dasar (OD)
3. Kompetensi tingkat Orthopaedi Lanjut 1 dan 2 (OL1 & OL2)
4. Kompetensi tingkat Chief Residen (CR)
3.1.1. Kompetensi Spesialis Orthopaedi dan Traumatologi Dasar,
mencakup:
1) Mampu memberikan penyuluhan, pelayanan dan perawatan pasca
tindakan terhadap penyakit yang tergolong harus dikuasai sampai
tingkat pemula.
41
2) Mampu mendiagnosis dan melakukan tindakan Orthopaedi dan
Traumatologi terhadap penyakit di bidang Orthopaedi dan
Traumatogi pada tingkat Kompetensi B2, C1
3) Mampu merencanakan dan melaksanakan kerjasana antar Disiplin
4) Siap mengantisipasi kemajuan dalam bidang Orthopaedi &
Traumatologi
3.1.2. Kompetensi Spesialis Orthopaedi dan Traumatologi Lanjut
1 dan 2 mencakup:
1) Mampu memberikan penyuluhan, pelayanan dan perawatan pasca
tindakan terhadap penyakit yang tergolong harus dikuasai sampai
tingkat magang dalam proses Pendidikan Dokter Spesialis
Orthopaedi dan Traumatologi (tingkat Kompetensi KKI :
A3,B3,C2)
2) Siap mengembangkan Kompetensi terhadap penyakit yang
penguasaan dalam proses Pendidikan Spesialis Orthopaedi dan
Traumatologi tergolong hanya sampai Tingkat Mandiri sesuai
dengan tahap Kurikulumnya.
3) Mampu mendiagnosis dan melakukan tindakan Orthopaedi dan
Traumatologi terhadap penyakit di bidang Orthopaedi dan
Traumatogi pada tingkat Kompetensi B3, C2
4) Mampu mengadakan penelitian dalam bidang Orthopaedi dan
Traumatologi
5) Mampu merencanakan dan melaksanakan kerjasama antar Disiplin
6) Dapat menjadi Pendidik/Fasilitator Ilmu Orhopaedi dan
Traumatologi di Program S1
3.1.3. Kompetensi Spesialis Orthopaedi dan Traumatologi Chief
Residen, mencakup:
1) Mampu memberikan penyuluhan, pelayanan dan perawatan pasca
tindakan terhadap penyakit yang tergolong harus dikuasai sampai
Tingkat Mandiri dalam proses Pendidikan Dokter Spesialis
Orthopaedi dan Traumatologi (tingkat Kompetensi KKI :
A3,B4,C3)
42
2) Siap mengembangkan Kompetensi terhadap penyakit yang
penguasaan dalam proses Pendidikan Spesialis Orthopaedi dan
Traumatologi tergolong hanya sampai Tingkat Mandiri sesuai
dengan tahap Kurikulumnya.
3) Mampu mendiagnosis dan melakukan tindakan Orthopaedi dan
Traumatologi terhadap penyakit di bidang Orthopaedi dan
Traumatogi pada tingkat Kompetensi B4, C3
4) Mampu mengadakan penelitian dalam bidang Orthopaedi dan
Traumatologi
5) Mampu merencanakan dan melaksanakan kerjasama antar Disiplin
6) Dapat menjadi Pendidik/Fasilitator Ilmu Orhopaedi dan
Traumatologi di Program S1
7) Siap mengantisipasi kemajuan dalam bidang Orthopaedi dan
Traumatologi, baik teknik operasi maupun diagnostik canggih
8) Siap meningkatkan profesionalisme dalam sikap dan perilaku
3.2. Tahapan Pencapaian Kompetensi
Tahapan Pendidikan Orthopaedi dan Traumatologi dilakukan dalam
beberapa tahap yaitu:
1.
2.
3.
4.
5.
Tahap Pra Ilmu Dasar Bedah
Tahap Ilmu Dasar Bedah
Tahap Orthopaedi Dasar
Tahap Orthopaedi Lanjut 1 dan 2
Tahap Chief Residen
Dari Core Kurikulum yang telah disebutkan diatas dijabarkan lagi
sesuai dengan tahapan Pendidikan sebagai berikut.
3.2.1. Tahap Pra Ilmu Dasar Bedah
Tahap Pra Bedah Dasar diselenggarakan bersama dengan
Peserta Didik dari Program Studi Bedah lainnya selama 3 sampai 6
bulan, dengan mengikuti beberapa modul sebagai berikut dibawah
ini dan isi modul secara lengkap dapat dilihat pada lampiran 4
43
Module
Module
Module
Module
1
2
3
4
:
:
:
:
Module 5
:
Module 6
:
Module 7
Module 8
Module 9
:
:
:
Basic Science
Common Surgical Conditions
Basic Surgical Skill
The Assesment
& Management Of The
Surgical Patient
Peri operative Care
The Assesment & Management Of patients
with Trauma (Including the Multiply Injured
Patient)
Surgical Care of The Paediatric Patient
Management of The Dying Patient
Organ & Tissue Transplantation
3.2.2. Tahap Ilmu Dasar Bedah
(semester I-II)
Tahap Ilmu Dasar Bedah dilakukan selama sembilan
bulan, merupakan kegiatan stase magang di beberapa divisi atau
subbagian yang berada di Departemen Bedah Umum, yaitu;
A. Bedah Plastik
B. Bedah Urologi
C. Bedah Thorax/Vaskuler
D. Bedah Digestif
E. Bedah Anak
F. Intensive Care Unit
3.2.3.Tahap Orthopaedi & Traumatologi Dasar
(semester III-IV)
Tahap Orthopaedi dan Traumatologi Dasar dilaksanakan
di Program Studi Orthopaedi dan Traumatologi pada semester ke-3
dan 4, dengan topik bahasan sebagai berikut;
1)
2)
3)
4)
5)
6)
44
Biologi selular dan molecular musculoskeletal
Pembentukan, Pertumbuhan dan Dasar Genetik Kelainan
Muskuloskeletal
Surgical Anatomy and Approach
Biomekanik Muskuloskeletal dan Biomaterial
Inflamasi, Degenerasi dan Neoplasma Muskuloskeletal
Imaging Orthopaedi
7) Dasar Traumatologi Muskuloskeletal
8) Komplikasi Trauma Muskuloskeletal
9) Dasar Osteosintesa
10) Orthopaedic research (Methodology and statistic).
Lingkup bahasan dan tingkat Kompetensi secara terperinci seperti
tercantum dalam lampiran 1 untuk Kognitif, lampiran 2 untuk
Psikomotor, dan lampiran 3 untuk Afektif.
3.2.4.Tahap Orthopaedi & Traumatologi Lanjut 1 dan 2
( semester V-VIII)
Lingkup bahasan dalam Kompetensi Kognitif pada tahap
Orthopaedi dan Traumatologi Lanjut 1 dan 2 adalah seperti yang
tercantum dalam lampiran 1, dengan level Kompetensi yang harus
dicapai sesuai tingkat sebagai berikut;
A1: Dapat mengetahui dan mengingat materi
A2: Dapat memahami dan mengerti materi
A3: Dapat menerapkan, menganalisa, mengevaluasi dan merumuskan
B1: Mampu mendiagnosis dan merujuk
B2: Mampu mendiagnosis dan memberi terapi sementara dan
merujuk
B3: Mampu mendiagnosis dan memberi terapi paripurna
B4: Mampu mendiagnosis, terapi dan rawat bersama
Lingkup bahasan dalam Kompetensi Psikomotor pada tahap
Orthopaedi dan Traumatologi Lanjut 1 dan 2 adalah seperti yang
tercantum dalam lampiran 2, dengan level Kompetensi yang harus
dicapai sesuai tingkat sebagai berikut;
C1 : Melihat dan asimilasi
C2 : Mengerjakan dengan bimbingan
C3 : Mengerjakan mandiri dengan pengawasan
45
Lingkup bahasan dalam Kompetensi Afektif pada tahap
Orthopaedi dan Traumatologi Lanjut 1 & 2 adalah seperti yang
tercantum dalam lampiran 3.
3.2.5. Tahap Chief Residen (Semester IX)
Lingkup bahasan dalam Kompetensi Kognitif pada tahap
Orthopaedi dan Traumatologi Chief Residen adalah seperti yang
tercantum dalam lampiran 1, dan Lingkup bahasan dalam
Kompetensi Psikomotor pada tahap Orthopaedi dan Traumatologi
Chief Residen adalah seperti yang tercantum dalam lampiran 2,
Kompetensi Afektif seperti tercantum pada lampiran 3.
3.2.6. Tahap Penyelesaian Akhir
Semua Peserta Didik melakukan rotasi Nasional,
mempresentasikan Thesis/Penelitian Akhir, dan melaksanakan
Ujian Institusi dan Ujian Nasional Board.
46
BAB IV
PELAKSANAAN KURIKULUM
4.1. Cara Pelaksanaan
Kurikulum dilaksanakan dengan pendekatan/strategi SPICES
(Student-centred, Problem-based, Integrated, Community-based, Elective/
Early clinical Exposure Systematic). Dengan cara belajar mengajar sbb.:
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
Lectures
Standard textbook reading
Journal reading
Journal review
Symphosia and seminar
COE (Continuing Orthopaedic Education)
Clinical ward work
Bed side teaching /PBL
Out patient department work
Out patient clinic
Operation theatre
Rehabilitation
Whorkshop/Courses
4.2. Modul tambahan Kursus
Untuk memenuhi Kompentensinya setiap Peserta Didik diperlukan
pelatihan dalam bentuk kursus yang telah diakui dan ditetapkan oleh
Kolegium di setiap Tahapan Pendidikan dan harus dibuktikan dengan
dilampirkanya sertifikat. Kursus tersebut adalah;
1. Kursus di Tahap Bedah Dasar
- Basic Surgical Skill (BSS) (optional)
2. Kursus di Tahap Orthopaedic Dasar
- Basic Orthopaedic Skill (BOS)
- Perioperative Course
3. Kursus di Tahap Orthopaedic Lanjut
- Basic Osteosynthesis Course (BOC)
47
4.3. Karya Ilmiah Wajib/Thesis (Penelitian Akhir)
Setiap Peserta Didik diwajibkan untuk menyusun Karya Ilmiah
yang dipublikasikan dalam forum Ilmiah tingkat Nasional, penyusunan
Karya Ilmiah tersebut harus diketahui oleh Ketua Program Studi dan
dibimbing oleh sekurang-kurangnya dua Staf Pendidik dengan level
penilai atau pendidik.
Tata cara penyusunan Karya Ilmiah harus mengikuti Buku
Pedoman Penulisan Karya Ilmiah yang diterbitkan oleh Kolegium. Karya
Ilmiah tersebut terbagi dalam dua bentuk yaitu,
1. Laporan Serial Kasus
2. Penelitian bidang Orthopaedi dan Traumatologi (Thesis/Penelitian
Akhir)
4.4. Pelaksanaan dalam Stase
Pada pelaksanaan pencapaian Kompetensi setiap Tahapnya dapat
dilakukan dalam bentuk stase di Departemen atau Divisi (Sub-Bagian)
sesuai dengan Time Table Proses Belajar Mengajar Terintegrasi sebagai
berikut;
Tahun 1
Semester 1
Pra Bedah Dasar
Kuliah Magister
(Combined Degree)
Tahun 2
48
Semester 3
Tahap Orthopaedi
Dasar
(Tutorial 10 topik)
Semester 2
Tahap Bedah Dasar
Stase magang di :
1. Plastik
2. Urologi
3. Digestive
4. Thorax
5. Bedah Anak
6. Anestesi/ICU
Semester 4
Tahap Orthopaedi dasar
(Stase divisi) :
1. Trauma 1
2. Hand 1
3. Onco 1
4. Spine 1
5. Pediatric
6. Hip knee / recons 1
Tahun 3
Tahun 4
Tahun 5
Semester 5
Tahap Orthopaedi dan
Traumatologi lanjut 1
Semester 6
Tahap Orthopaedi dan
Traumatologi lanjut 1
1. Trauma 2
2. Hand 2
3. Onco 2
4. Spine 2
5. Pediatric 2
6. Hip knee/recons 2
Semester 7
Tahap Orthopaedi dan
Traumatologi lanjut 2
1. Trauma 3
2. Hand 3
3. Onco 3
4. Spine 3
5. Pediatric 3
6. Hip knee / recons
Semester 8
Tahap Orthopaedi dan
Traumatologi lanjut 2
1. Trauma 4
2. Hand 4
3. Onco 4
4. Spine 4
5. Pediatric 4
6. Hip knee/recons 4
Semester 9
Chief Resident
1. Trauma 5
2. Hand 5
3. Onco 5
4. Spine 5
5. Pediatric 5
6. Hip knee/recons 5
Semester 10
Rotasi Nasional
1.
2.
3.
4.
5.
6.
Karya akhir
Trauma 6
Hand 6
Onco 6
Spine 6
Pediatric 6
Hip knee/recons 6
Ujian Institusi
Ujian Nasional Board
Catatan :
Kurikulum integrated learning baik horizontal maupun vertical
adalah proses pembelajaran dengan menyatukan Ilmu-ilmu Dasar
Orthopaedi dan Ilmu Orthopaedi Klinik yang kedalamannya sesuai
dengan tingkat semester. Masing masing pengampu Seksi/Divisi di PS
menyesuaikan dengan hubungan antara Pokok Bahasan,Tahapan
Pendidikan dan Tingkat Kompetensi Kognitif dan Afektif.
49
4.5. Monitor dan Evaluasi:
Monitor dan evaluasi pencapaian Kompetensi Kognitif,
Psikomotor dan Afektif Peserta Didik dilakukan secara berkala sesuai
dengan Tahap Pendidik dengan mengikuti prinsip umum assement,
yaitu valid, objektif, dan reliable. Assessment, meliputi penilaian
formative, berkelanjutan, dan summative (final) dilaksanakan dalam
bentuk teori dan juga dalam bentuk praktik/klinik.
Evaluasi Karya Ilmiah dan Thesis (Penelitian akhir) akan dinilai
secara terpisah.
4.5.1. Formative Assessment
Formative assessment dilakukan secara berkelanjutan
sesuai dengan tahapan tingkat Kompetensi. Penilaian dilakukan
berdasarkan feedback dari Senior Residen dan Konsulen.
Asessment dilakukan pada setiap akhir semester. Formative
assessment tidak menentukan apakah seorang kandidat
lulus/tidak lulus, tetapi dapat digunakan untuk memberikan
feedback terhadap kandidat yang bersangkutan, untuk lebih
maju.
4.5.2. Internal Assessment
Performa dari kandidat selama masa Pendidikan harus
dimonitor sepanjang Pendidikan dan dicatat dalam suatu
Logbook sebagai bukti untuk kemampuan dan pekerjaan yang
telah dilakukan sehari-hari. dengan komposisi sebagai berikut:
1.
2.
3.
4.
Personal Attributes
Clinical Work (Operative dan Non-Operative Logbook)
Academic Activities ( Logbook )
End of Term theory examination (MCQ, OSCE, Essay) baik
UTS maupun UAS
5. End of Term practical examination
Logbook (Clinical work) yang sudah disetujui oleh Ketua
50
Program Studi harus diserahkan sebelum Ujian Akhir, Logbook harus
berisi informasi :
 Nama dan Medical Record
 Diagnosis yang relevan
 Tanggal, prosedur tindakan, dan peranan sebagai asisten, operator
bimbingan, atau mandiri
Catatan :
 Passing level dipergunakan nilai 70 setiap kenaikan semester. Bila
tidak lulus dilakukan remedy 1 kali.
4.5.3. Penghentian Pendidikan
 Bila 2 kali berturut–turut tidak naik dalam jenjang yang sama
dilakukan ujian ke-3 untuk menentukan ybs bisa
lanjut/diberhentikan dari proses Pendidikan.
 Bila masa studi melebihi 1 ½ kali masa studi normal, juga akan
dilakukan penghentian masa studi.
 Penghentian Pendidikan dapat dilakukan bila ybs tersangkut
masalah atitude dan etika.
4.5.4. Summative
Evaluasi akhir pencapaian Kompetensi Peserta Didik
dilaksanakan dalam dua tahap, yaitu;
 Ujian Institusi diselenggarakan oleh Program Studi dengan
pengawasan dari Kolegium
 Ujian Board Nasional diselengarakan oleh Kolegium
Evaluasi akhir pencapaian (Summative) ini dilaksanakan dalam dua sesi,
Sesi I merupakan
Ujian Tulis, sesi II Ujian Long Case untuk
kasusTrauma dan Non Trauma (Elective), dan VIVA short case untuk
masing-masing Divisi yaitu, Hand, Spine, Paediatric Orthopaedic,
Oncology Orthopaedic, Adult Reconstruction.
Passing level dipergunakan nilai 70.
4.6. Buku dan Jurnal Acuan Wajib
51
Buku bacaan yang dijadikan bahan acuan dalam pendidikan program
ini adalah:
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
Louis Solomon, David Warwick, Sevadurai Nayagam. Apley’s System
of Orthopaedics & Fractures, 9th Ed. Hodder Arnold, UK, 2010.
W. C. Campbell, S. Terry Canale, James H. Beaty. Campbell’s
Operative Orthopaedics 11th Ed. Mosby/Elsevier, California, 2008.
Stanley Hoppenfeld, Piet deBoer, Richard Buckley. Surgical
Exposures in Orthopaedics: The Anatomic Approach, 4 th Ed.
Lippincott Williams & Wilkins, Philadelphia, 2009.
Ronald McRae. Clinical Orthopaedic Examination 5th Ed. Churchill
Livingstone, Michigan, 2004.
Hamilton Bailey, John Stuart Penton Lumley. Hamilton Bailey’s
Physical Signs: Demonstration of Physical Signs in Clinical Surgery,
18th Ed. Butterworth Heinemann, Boston, 1997.
Richard S. Snell. Clinical Anatomy by Regions 9th Ed. Lippincott
Willians & Wilkins, Philadelphia, 2011.
R. B. Duthie. Mercer’s Orthopaedic Surgery. Hodder General
Publishing Division, UK, 1996.
Anonymus. Pye’s Surgical Handicraft. Biblio Bazaar, Llc, 2010.
Stewart L. McCurdy. Manual of Orthopaedic Surgery: Atreatise on
Deformities and Diseases of Joints and Bones. Nabu Press, 2011.
Robert W. Bucholz, James D. Heckman, Paul Tornetta. Rockwood and
Green’s Fractures in Adults, 7th Ed. Lippincott Williams & Wilkins,
Philadelphia, 2009.
James H. Beaty, Charles A. Rockwood. Rockwood and Wilkins’
Fractures in Children, 7th Ed. Lippincott Williams & Wilkins,
Philadelphia, 2009.
Michael W. Chapman. Chapman’s Orthopaedic Surgery, 3rd Ed.
Lippincott Williams & Wilkins, Philadelphia, 2001.
Stuart L. Weinstein, Joseph A. Buckwalter. Turek’s Ortho-paedics:
Principles and Their Application. Lippincott Williams & Wilkins,
Philadelphia, 2005.
Ronald McRae, Max Esser. Practical Fracture Management, 4th Ed.
Churchill Livingstone, Michigan University, 2002.
15. John W. Insall, W. Norman Scott. Insall and Scott Surgery of The
52
Knee, 4th Ed. Churchill Livingstone/Elsevier, North-western
University, 2006.
16. Mark D. Miller, Brian J. Cole. Textbook of Arthroscopy, vol . 355.
Elsevier Health Serviced, USA, 2004.
17. John A. Herring, Mihran O. Tachdjian. Tachdjian’s Pediatric
Orthopaedics 4th Ed. Saunders/Elsevier, Minnesota, 2008.
Dalam pelaksanaan proses pendidikan peserta didik diwajibkan
untuk menyusun karya tulis ilmiah berupa laporan kasus atau penelitian
yang mana diperlukan tambahan bahan acuan untuk itu yang lebih up
todate, sehingga diperlukan jurnal dibidang ini.
Jurnal yang dijadikan bahan acuan dasar adalah:
1. Journal Bone and Joint Surgery, edisi Amerika dan British
2. Majalah Orthopaedi Indonesia
3. Cllinical Orthopaedic and Related Research
4. International Orthopedics
5. Journal of Orthopaedic Trauma
6. Orthopedics
7. Journal AAOS
8. Orthopaedic clinics of north America
9. Acta orthopaedica scandinavica
KEPUSTAKAAN
1.
2.
3.
4.
5.
6.
7.
8.
9.
Standar Pendidikan Dokter Indonesia
Standar Kompetensi Dokter Indonesia
Kolegium Orthopaedi & Traumatologi Indonesia, Kurikulum
Orthopaedi Dan Traumatologi Indonesia 2008
Buku Standar Pendidikan Profesi Dokter Spesialis Orthopaedi dan
Traumatologi Indonesia 2008
A Practical Guide For Medical Teacher
Specialist Training in Trauma and Orthopaedic ( British Orthopaedic
Association) 2009
Curriculum MS orthopaedics (India )
Guidesline for Competency Base Post graduates Training Programme
for diploma in orthopaedic (Amerika )
Guidelines to the Masters of Orthopaedic Surgery Programme
University of Malaya
53
LAMPIRAN 1
Tingkat Kompetensi Kognitif Peserta Didik
Berdasarkan Topik dan Tahapan Pendidikan
A1: Dapat mengetahui dan mengingat materi
A2: Dapat memahami dan mengerti materi
A3: Dapat menerapkan, menganalisa, mengevaluasi dan merumuskan
B1: Mampu mendiagnosis dan merujuk
B2: Mampu mendiagnosis dan memberi terapi sementara dan merujuk
B3: Mampu mendiagnosis dan memberi terapi paripurna
B4: Mampu mendiagnosis, terapi dan rawat bersama
Keterangan :
OD : Tahap Orthopaedi dan TraumatologiDasar
OL1: TahapOrthopaedi dan Traumatologi Lanjut 1
OL2: Tahap Orthopaedi dan Traumatologi Lanjut 2
CR : Tahap Chief Residen
54
Tingkat Kompetensi Kognitif Peserta Didik
Berdasarkan Topik dan Tahapan Pendidikan
TOPIC
OD
OTL1
OTL2
CR
A2B3
A2B2
A2B3
A3B4
A2B3
A2B2
A2B3
A3B4
A2B2
A2B2
A2B3
A3B4
A2B3
A2B2
A2B3
A3B4
1. BASIC SCIENCE
1.1. Anatomy:
Clinical and functional anatomy with pathological and operative relevance
Anatomy (and embryology) of nervous and
vascular systems
Surgical approaches to the limbs and axial
skeleton
Anatomy (and embryology) of musculo-skeletal
system
1.2. Tissues:
Bone - Structure & Function
Cartilage - articular, meniscal - Structure &
Function
Muscle and tendon - Structure & Function
Synovium - Structure & Function
Ligament - Structure & Function
Nerve - Structure & Function
Intervertebral disc - Structure & Function
A2B3
A2B2
A2B3
A3B4
A2B3
A2B2
A2B3
A3B4
A2B3
A2B3
A2B3
A2B3
A2B2
A2B2
A2B2
A2B2
A2B2
A2B2
A2B3
A2B3
A2B3
A2B3
A2B3
A3B4
A3B4
A3B4
A3B4
A2B3
A2B2
A2B2
A2B3
A2B3
A2B2
A2B2
A2B3
A2B3
A2B3
A2B2
A2B3
A3B4
A2B3
A2B2
A2B3
A3B4
A2B3
A2B2
A2B3
A3B4
A3B4
A2B2
A2B3
A3B4
A2B3
A2B2
A2B3
A3B4
A2B2
A2B3
A2B1
A2B2
A2B2
A2B2
A2B3
A2B3
A2B3
A2B3
A3B4
A2B3
A2B1
A2B2
A2B3
A3B4
A2B1
A2B1
A2B2
A2B3
A2B3
A2B3
1.3. Physiology, Biochemistry & Genetics:
Structure and function of connective tissues
Application/relevance of modern genetics to
orthopaedic disease and treatment
Shock - types, physiology, recognition and
treatment
Metabolism and hormonal regulation
Metabolic and immunological response to
trauma
Blood loss in trauma/surgery, fluid balance and
blood transfusion
Bone grafts, bone banking and tissue
transplantation
1.4. Biomechanics & Bioengineering:
Biomechanics of musculoskeletal tissues
Biomechanics of fracture fixation
Tribology of natural and artificial joints
Design of implants and factors associated with
implant failure (wear, loosening)
Kinematics and gait analysis
Biomaterials
55
TOPIC
OD
OTL1
OTL2
A2B2
A2B2
A2B3
A3B4
A2B1
A2B2
A2B3
A3B4
A2B2
A2B2
A2B3
A3B4
A2B2
A2B2
A2B2
A2B2
A2B2
A2B2
A2B3
A2B3
A2B3
A3B4
A3B4
A3B4
A2B2
A2B2
A2B3
A3B4
A2B1
A2B1
A2B1
A2B2
A2B2
A2B2
A2B2
A2B2
A2B2
A2B2
A2B2
A2B2
A2B3
A2B3
A2B3
A2B3
A2B3
A2B3
A3B4
A3B4
A2B3
A3B4
A2B3
A2B3
A2B3
A2B2
A2B2
A2B3
A3B4
A3B4
A2B2
A2B3
A3B4
A2B2
A2B2
A2B2
A2B2
A2B2
A2B3
A2B3
A2B3
A3B4
A2B3
A2B3
A2B3
A2B2
A2B2
A2B2
A2B3
A2B3
A3B4
A2B3
A2B2
A2B2
A2B3
A2B2
A2B2
A2B2
A2B3
A3B4
A2B2
A2B2
A2B2
A2B2
A2B3
A2B3
A2B3
A3B4
CR
2. BONE & JOINT DISEASE
2.1. Orthopaedic Oncology:
Knowledge of the presentation, radiological features,
pathological features, treatment and outcome for
common benign and malignant bone tumours
Knowledge of the presenting features, mana-gement
and outcome of soft tissue swellings, including
sarcomas benign and malignant
Understanding of the principles of management of
patients with metastatic bone disease in terms of
investigation, prophylactic and definitive fixation of
pathological fractures and onco-logical management
2.2. General:
Osteoarthritis
Osteoporosis
Metabolic bone disease
Rheumatoid arthritis and other arthro-pathies
(inflammatory, crystal, etc)
Haemophilia
Inherited musculoskeletal disorders
Neuromuscular disorders - inherited and acquired
Osteonecrosis
Osteochondritides
Heterotopic ossification
2.3. Investigations:
Blood tests
Musculoskeletal imaging: x-ray, contrast studies
(myelography,
arthrography),
CT,
MR,
ultrasound, radioisotope studies
Effects of radiation
Bone densitometry
Electrophysiological investigations
2.4. Operative Topics:
Tourniquets
Design of theatres
Anaesthesia - principles and practice of local and
regional anaesthesia and principles of general
anaesthesia
2.5. Principle treatment of musculoskeletal tumor
2.6. Infection, Thromboembolism & Pain:
Infection of bone, joint, soft tissue, including
tuberculosis, and their prophylaxis
Sterilisation
Thromboembolism and prophylaxis
56
TOPIC
OD
OTL1
OTL2
A2B2
A2B2
A2B2
A2B2
A2B3
A2B3
A2B3
A2B3
A2B3
A3B4
A2B3
A3B4
A2B2
A2B3
A2B3
A2B2
A2B2
A2B3
A2B3
A2B3
A2B3
A2B2
A2B3
A2B3
A2B2
A2B3
A2B3
A2B2
A2B3
A2B2
A2B2
A2B2
A2B3
A2B3
A2B2
A3B4
A2B2
A2B2
A2B2
A2B3
A2B3
A2B3
A3B4
A3B4
A3B4
A2B3
A2B2
A2B3
A3B4
A2B3
A2B2
A2B3
A3B4
A2B3
A2B2
A2B3
A3B4
A2B3
A2B2
A2B2
A2B2
A2B3
A2B3
A3B4
A3B4
A2B3
A2B2
A2B3
A3B4
A2B3
A2B2
A2B3
A3B4
A2B3
A3B4
A2B2
A2B2
A2B3
A2B3
A3B4
A3B4
A2B1
A2B2
A2B3
A3B4
Behavioural dysfunction and somatization
A2B2
AIDS and surgery in high-risk patients
A2B2
Pain and pain relief
A2B3
Skin preparation
A3B4
Complex regional pain syndromes e.g. Reflex
A2B2
Sympathetic Dystrophy and Causalgia
2.7. Prosthetics & Orthotics:
Principles of design
A2B1
Prescription and fitting of standard prostheses
A2B1
Principles of orthotic bracing for control of disease,
A2B1
deformity and instability
2.8. Research & Audit:
Design and conduct of clinical trials
A2B1
Data analysis and statistics - principles and
A2B1
applications
Principles of Epidemiology
A2B1
Audit
A2B3
2.9. Medical Ethics:
Duties of care
A2B3
Informed consent
A2B3
Medical negligence
A2B3
3. HAND & MICRORECONSRUCTION SURGERY
CR
3.1. BASIC SCIENCE
Anatomy of:
The wrist/MCP/PIP/DIP joints and CMC joint of the
thumb
The flexor and extensor mechanism of the fingers
including interaction between extrinsic and intrinsic
mechanism
The posture of the thumb in pinch, power and key
grip
The nerve supply to the hand
The closed compartments of forearm and hand
3.2. Pathology:
An understanding of the special circum-stances
associated with swelling and the effects of rising
pressure in a closed com-partment secondary to
infection and injury
An understanding of the special circum-stances in
which oedema causes fibrosis and permanent
stiffness
Tendon injury and healing
Nerve injury and healing
An appreciation of the imbalances and deformities
associated with inflammatory arthritis
57
TOPIC
OD
OTL1
OTL2
CR
n/a
A2B2
A2B3
A3B4
A2B3
A2B1
A2B1
A2B2
A2B2
A2B2
A2B3
A2B3
A2B3
A3B4
A3B4
A3B4
A2B3
A2B2
A2B3
A3B4
A2B3
A2B2
A2B3
A3B4
A3B4
A2B2
A2B3
A3B4
A2B2
A2B2
A2B3
A3B4
A2B2
A2B2
A2B3
A3B4
A2B1
A2B2
A2B3
A3B4
A2B2
A2B2
A2B2
A2B3
A2B3
A3B4
A2B2
A2B2
A2B3
A3B4
A2B1
A2B2
A2B3
A3B4
A2B1
A2B2
A2B3
A3B4
3.2. Pathology: (Cont.)
A classification system for congenital hand
disorders
Langers lines
Hand tumours (e.g. ganglion/enchondroma)
Dupuytren's disease
3.3. Clinical Assessment:
History of examination of hand and wrist in the
assessment of tendons, distal radioulnar and
radiocarpal joints
Ability to elicit median, ulnar and radial nerve
function and disorders
Recognition of patterns of presentation of common
compressive neuropathies and brachial neuralgia
Assessment of intrinsic and extrinsic motors in
digits and recognition of common deformities and
deficiencies
Awareness of presentation of work-related hand
disorders
Ability to examine and assess common rheu-matoid
hand deformities, e.g.: inferior radio-ulnar
subluxation and carpal translocation; MCP
subluxation and ulnar drift; digital Bou-tonniere and
swan neck; thumb Boutonniere deformity and CMC
disease
Ability to recognise and assess focal hand swellings
Investigations:
Interpretation of plain and stress x-rays of wrist. A
knowledge of other views
Awareness of role of MRI/bone scan/arthrography/arthroscopy
Place and interpretation of nerve conduction studies
3.4. Treatment:
Knowledge of a strategy of management for the osteo arthritic rheumatoid hand.
Understanding of the place of soft tissue
reconstruction, joint fusion, interposition and
excision arthroplasty in the treatment of the
arthritic hand and wrist.
Knowledge of the management of stenosing
tenovaginitis
Knowledge of the principles of treatment for
common flexor and extensor tendon injuries and
of the common surgical approaches to the digital
flexor and extensor compartments
58
A2B1
A2B2
A2B3
A3B4
A2B1
A2B2
A2B3
A3B4
A2B3
A2B2
A2B3
A3B4
TOPIC
OD
OTL1
OTL2
A2B3
A2B2
A2B3
A3B4
A2B1
A2B2
A2B3
A3B4
A2B1
A2B2
A2B3
A3B4
A2B3
A2B2
A2B3
A3B4
A2B3
A2B2
A2B3
A3B4
A2B3
A2B2
A2B3
A3B4
A2B3
A2B3
A2B1
A2B2
A2B2
A2B2
A2B3
A2B3
A2B3
A3B4
A3B4
A3B4
A3B4
A2B2
A2B3
A3B4
A2B3
A2B2
A2B3
A3B4
A2B3
A2B2
A2B3
A3B4
A2B3
A2B3
A2B2
A2B2
A2B3
A2B3
A3B4
A3B4
A2B3
A2B2
A2B3
A3B4
A2B3
A2B2
A2B3
A3B4
A2B3
A2B2
A2B3
A3B4
A2B3
A2B2
A2B3
A3B4
A2B3
A2B2
A2B3
A3B4
A2B3
A2B2
A2B3
A3B4
A2B1
A2B2
A2B3
A3B4
A2B2
A2B2
A2B3
A3B4
CR
3.4. Treatment (cont.):
Fractures of metacarpals and phalanges
Familiarity with the surgical treatment of
Dupuytren’s disease
Awareness of the principles of tendon transfer for
the reconstruction of mediun, ulnar and radial nerve
palsy and familiarity with simple transfers, e.g.
indicis to EPL
Knowledge of splinting techniques and rehabilitation principles
Ability to plan management for finger tip injuries
and undertake closed management
Knowledge of surgical approach to digits with
particular regard to the restoration of function and
prevention of stiffness
Knowledge of the levels for digital amputation
Injuries of ulnar collateral ligament of thumb
Dislocations of carpus and carpal instability
Knowledge of closed and operative options of
treatment for fractures of distal radius and common
carpal injuries including scaphoid non union.
Familiarity with the surgical treatment of common
compressive neuropathy
Ability to manage common hand infections
4. KNEE
4.1. BASIC SCIENCE
Anatomy:
Knowledge of regional anatomy of the knee, including:
Surface anatomy
Neural and vascular structures and their relations with
particular reference to standard anterior and posterior
surgical approaches
Bones and joints
Functional anatomy of ligaments and supporting
muscles
Innervation of the knee including controlling
musculature
The extent and function of the synovium and bursae of
the knee
The structure and function of the menisci, and articular
cartilage
4.2. Biomechanics:
The mechanics of the patello-femoral mechanism
The medial and lateral weight-bearing joints and their
inter-relationship
59
TOPIC
4.2. Biomechanics: (Cont.)
The cruciate and collateral ligaments and other
ligamentous and muscular supports
Menisci and articular cartilage
4.3. Pathology:
The mechanism of ligamentous, bony and
combined trauma to the knee and healing
potential
A complete knowledge of arthritides, including
degenerate wear, ageing changes and traumatic
damage
Pathology of inflammatory disease and infection
affecting the knee
The response of synovium to debris
Benign and malignant conditions in the knee and
surrounding structures including recognised
classification where appropriate
4.4. Clinical Assessment:
A sound knowledge and understanding of:
History and examination of the knee to include
relevant surrounding structures
The standard clinical signs of the knee and
relevant adjacent structures and competent skill in
describing these
A critical understanding of rating and outcome
measures in common use
4.5. Investigations:
Indications for and interpretations of:
Radiographs – standard and specialised
Blood investigation
Aspiration
Special investigations including CT, MRI and
radioisotope scanning
Arthroscopy
Biomechanical testing
OD
OTL1
OTL2
CR
A2B1
A2B2
A2B3
A3B4
A2B3
A2B2
A2B3
A3B4
A2B3
A2B2
A2B3
A3B4
A2B2
A2B2
A2B3
A3B4
A2B2
A2B2
A2B3
A3B4
A2B2
A2B2
A2B3
A3B4
A2B2
A2B2
A2B3
A3B4
A2B2
A2B3
A2B3
A2B2
A2B3
A3B4
A2B3
A2B2
A2B3
A3B4
A2B1
A2B2
A2B3
A3B4
A2B1
A2B1
A2B3
A2B2
A2B2
A2B2
A2B2
A2B3
A2B3
A2B3
A2B3
A3B4
A3B4
A3B4
A2B3
A2B2
A2B3
A3B4
A2B2
A2B1
A2B2
A2B2
A2B3
A2B3
A3B4
A3B4
4.6. Treatment:
A sound knowledge of conservative and surgical management, including the indications
for referral to a specialist of:
Paediatric
disorders,
including
deformity,
dislocations, epiphyseal disorders, osteochondritis
and discoid meniscus
Adolescent disorders including patello femoral and
meniscal dysfunction, osteochondritis dissecans
60
A2B2
A2B2
A2B3
A3B4
A2B2
A2B2
A2B3
A3B4
TOPIC
OD
OTL1
OTL2
A2B2
A2B2
A2B3
A3B4
A2B2
A2B2
A2B3
A3B4
A2B3
A2B2
A2B3
A3B4
A2B3
A2B2
A2B3
A3B4
A2B2
A2B2
A2B3
A3B4
n/a
A2B2
A2B3
A3B4
A2B2
A2B2
A2B3
A3B4
A2B1
A2B2
A2B3
A3B4
A2B1
A2B2
A2B3
A3B4
A2B3
A2B3
A2B3
A2B3
A2B3
A3B4
A2B2
A2B2
A2B2
A2B2
A2B2
A2B2
A2B3
A2B3
A2B3
A2B3
A2B3
A2B3
A3B4
A3B4
A3B4
A3B4
A3B4
A3B4
CR
4.6. Treatment: (Cont.)
Young adult disorders including patello femoral and
meniscal injuries, instability and ligament
deficiency, synovial disorders, benign and malignant
tumours
Degenerative and inflammatory arthritis, including a
balanced understanding of conservative and surgical
options, including osteotomy, arthrodesis and
arthroplasty
Traumatic disorders including skin and soft tissue
injuries, fractures and dislocations of patella, tibia
and femoral components, ligament ruptures and
internal derangement of the knee. Conservative and
surgical indications and detailed methods of
treatment. Outcomes of conservative and operative
management
Infections, particularly infections and inflammations
of the bursae, intra-articular sepsis, prevention and
management of sepsis in implant surgery
A sound working knowledge of the range of
arthroplasties for primary and revision surgery for
patello femoral, unicompartmental and total
replacement of the knee with particular reference to
secure bone anchorage, alignment, ligament stability
and optimising range of movement; a good
knowledge of post-operative complications, their
prophylaxis and management
A knowledge of the indications and techniques of
revision surgery particularly for aseptic and septic
loosening
A knowledge of simple arthroscopic surgery
including meniscectomy, trimming and shaving
An appreciation of complex arthroscopic procedures
An appreciation of medical and surgical techniques
available to repair and replace articular cartilage
5. ANKLE & FOOT SURGERY
5.1. BASIC SCIENCE
Anatomy:
Bones and articulations
Ligamentous structures-ankle/hindfoot/ midfoot
Plantar fascia and MTP anatomy
Surface markings of neural and vascular structures
Tendon anatomy
Muscle compartments of the foot
61
TOPIC
OD
OTL1
OTL2
A2B2
A2B2
A2B2
A2B2
A2B2
A2B3
A2B3
A2B3
A2B3
A2B3
A2B1
A2B2
A2B2
A2B2
A2B2
A2B2
A2B3
A2B3
A2B3
A2B3
A2B3
A2B1
A2B2
A2B3
A3B4
A2B3
A2B2
A2B3
A3B4
CR
5.2. Biomechanics:
Function of the lower limb and foot in gait
Ankle and subtalar joint
Plantar fascia mechanisms
Tendon function
Orthoses and footwear
A2B2
A2B2
A2B2
A2B2
A2B2
A3B4
A3B4
A3B4
A3B4
A3B4
5.3. Pathology:
Arthrities
Degenerative joint disease
Rheumatoid foot disease
Neuropathy
Neuropathic joint and skin changes
Tumours
E.g. osteoid osteoma and plantar fibroma
A2B2
A2B1
A3B4
A3B4
A3B4
5.4. Clinical Assessment:
History and clinical examination of the foot and
ankle in order to assess pain, joint function,
deformity, nerve, muscle and tendon function
Ability to recognise and assess the following diseases of the ankle and foot:
Neurological disorders:
Charcot joint
Morton's neuroma
Nerve entrapment
Neurological foot deformity
A2B1
A2B2
A2B2
A2B2
A2B2
A2B2
A2B2
A2B2
A2B3
A2B3
A2B3
A2B3
A3B4
A3B4
A3B4
A3B4
A3B4
A3B4
A2B3
A2B2
A2B2
A2B2
A2B3
A2B3
A2B3
A3B4
A3B4
A3B4
A2B1
A2B1
A2B1
A2B1
A2B1
A2B2
A2B2
A2B2
A2B2
A2B2
A2B2
A2B2
A2B3
A2B3
A2B3
A2B3
A2B3
A2B3
A3B4
A3B4
A3B4
A3B4
A3B4
A3B4
A2B1
A2B1
A2B1
A2B1
A2B2
A2B2
A2B2
A2B2
A2B2
A2B2
A2B3
A2B3
A2B3
A2B3
A2B3
A3B4
A3B4
A3B4
A3B4
A3B4
Trauma:
Evaluation of skin and soft tissue injury
Compartment syndrome
Recognition of all fractures and dislocations
Ankle and hindfoot disorder:
Hindfoot pain
Ankle instability
Heel pain
Degenerative disease of the ankle
Rheumatoid arthritis
Osteochondritis dissecans of talus
Forefoot disorders:
Hallux valgus
Hallux rigidus
Lesser toe deformities
Metatarsalgia
Inflammatory arthritis
62
TOPIC
Tumours:
Ability to recognise and assess local foot
swellings
Diabetic foot:
Complex foot deformity
Flatfoot deformity - mobile and rigid
Cavus deformity
Residual congenital foot deformity
Investigations:
Radiograph:
Standard foot and ankle views
CT, MRI and Scintigraphy:
Knowledge of role of these ancillary
investigations in certain specific conditions e.g.
infection, tumour, tibialis posterior rupture,
osteonecrosis
EMG:
Relevance to foot and ankle disorders
5.5. Treatment:
Non-operative:
Knowledge of rational basis for the use of
footwear modifications, orthoses and total contact
casting
Operative:
Detailed knowledge of closed and operative
methods for management of fractures and
dislocations of ankle, hindfoot and forefoot,
including knowledge of common reconstructive
surgical procedures for foot deformity including
hallux valgus, lesser toe deformity, acquired flatfoot, to include arthrodesis, osteotomy and softtissue reconstruction
Knowledge of common amputations through foot
and ankle
Knowledge of common reconstructive surgical
procedures for degenerative and inflammatory
disorders of ankle and foot including arthrodesis,
arthroplasty, excision arthroplasty procedures to
first ray both proximal and distally for
management of hallux valgus and rigidus
OD
OTL1
OTL2
CR
A2B1
A2B2
A2B3
A3B4
A2B2
A2B3
A2B3
A2B3
A2B3
A2B3
A3B4
A2B1
A2B1
A2B1
A2B2
A2B2
A2B2
A2B2
A2B2
A3B4
A2B2
A2B3
A3B4
A2B2
A2B2
A2B3
A3B4
A2B1
A2B2
A2B3
A3B4
A2B1
A2B2
A2B3
A3B4
A2B3
A2B2
A2B3
A3B4
A2B3
A2B2
A2B3
A3B4
A2B1
A2B2
A2B3
A3B4
A3B4
A3B4
A3B4
63
TOPIC
OD
OTL1
OTL2
A2B3
A2B2
A2B3
A3B4
A2B3
A2B3
A2B3
A2B2
A2B2
A2B2
A2B3
A2B3
A2B3
A3B4
A3B4
A3B4
A2B3
A2B2
A2B3
A3B4
A2B3
A2B2
A2B3
A3B4
A2B3
A2B2
A2B3
A3B4
A2B3
A2B2
A2B3
A3B4
A2B2
A2B2
A2B3
A3B4
A2B1
A2B2
A2B3
A3B4
A2B1
A2B2
A2B3
A3B4
A2B1
A2B2
A2B3
A3B4
A2B2
A2B2
A2B3
A3B4
A2B3
A2B2
A2B3
A3B4
A2B2
A2B2
A2B3
A3B4
A2B1
A2B2
A2B3
A3B4
A2B3
A2B2
A2B3
A3B4
CR
6. HIP
6.1. BASIC SCIENCE
Anatomy:
Basic knowledge of the regional anatomy of the hip
including:
Development of the hip joint
Relationship of bony elements
Blood supply of the femoral head
Anatomical course of all major regional vessels and
nerves
The capsule, labrum and related ligaments
An understanding of the action, anatomy and
innervation of the regional musculature
Detailed knowledge of the applied anatomy of
common surgical approaches to the hip (medial,
anterior, lateral and posterior)
6.2. Biomechanics:
An understanding of the lever arms, muscles and
body weight forces that produce the joint reaction
force in both normal and abnormal hips
An understanding of the application of these
principles to the rationale of both pelvic and femoral
osteotomies, and replacement arthroplasty
Knowledge of the tribological properties of
materials used for articulating surfaces
Knowledge of the biocompatibility and mechanical
properties of materials in common use in total hip
arthroplasty
6.3. Pathology:
Basic knowledge of the pathology of pyogenic and
non-pyogenic arthritis, slipped upper femoral
epiphysis [SUFE], Perthes' disease and hip dysplasia
Mechanism and pattern of common fractures and
fracture dislocations around the hip (intracapsular,
extracapsular, acetabular and periacetabular, femoral
head, etc)
Knowledge of the pathology of osteoarthritis,
rheumatoid arthritis and the seronegative arthritides
at the hip and of osteonecrosis of the femoral head
Familiarity with current theories of the
aetiopathogenesis of osteoarthritis
An understanding of the microbiological rationale
for the prevention of sepsis in total hip arthroplasty
64
TOPIC
6.4. Clinical Assessment:
A sound knowledge of clinical assessment of
the hip, lumbosacral spine and knee. Particular
reference should be paid to the gait, the
Trendelenberg sign, limb length, loss of
movement and deformity at the joint
The trainee needs to be well informed of current
opinion regarding aetiopathogenesis, clinical
presentation and appropriate investigation of:
Proximal femoral fractures (intracapsular,
extracapsular) and simple fracture dislocations of
the hip
Osteoarthritis and the inflammatory arthropathies
Perthes' disease
Slipped upper femoral epiphysis
Septic arthritis
Osteonecrosis
Soft tissue conditions around the hip (snapping
hip, gluteus medius tendonitis, etc)
OD
OTL1
OTL2
CR
A2B3
A2B2
A2B3
A3B4
A2B2
A2B2
A2B3
A3B4
A3B4
A2B2
A2B3
A3B4
A2B2
A2B2
A2B3
A3B4
A2B2
A2B2
A2B3
A2B3
A2B2
A2B2
A2B2
A2B2
A2B3
A2B3
A2B3
A2B3
A3B4
A3B4
A3B4
A3B4
A2B2
A2B2
A2B3
A3B4
A working knowledge of the clinical presentations and investigations of:
The sequelae of CDH and hip dysplasia
The sequelae of SUFE
Juvenile chronic arthritis
Non pyogenic arthritis
The painful total hip replacement
Investigation:
A working knowledge of the interpretation of
plain radiographs, dynamic arthrography, CT,
bone scintigraphy and MRI of the hip region
A working classification of proximal femoral
and periacetabular fractures. Also, mechanisms
and classification of failure of joint
replacement and of periprosthetic fractures
6.5. Treatment:
Non-operative
An understanding of the principles of traction,
bracing and spica immobilisation
An understanding of the non operative aspects
of the management of hip pathology
A2B1
A2B3
A2B1
A2B2
A2B1
A2B2
A2B2
A2B2
A2B2
A2B2
A2B3
A2B3
A2B3
A2B3
A2B3
A3B4
A3B4
A3B4
A3B4
A3B4
A2B2
A2B2
A2B3
A3B4
A2B3
A2B2
A2B3
A3B4
A2B3
A2B2
A2B3
A3B4
A2B3
A2B2
A2B3
A3B4
65
TOPIC
Operative
A thorough knowledge of soft tissue surgery,
osteotomy, arthrodesis and arthroplasty
(excision and replacement). A sound
knowledge of anterior, anterolateral, lateral
and posterior approaches to the hip and of the
complications associated with each
A sound knowledge of: internal fixation of
proximal femoral fractures, hemiarthroplasty
for intracapsular fractures, primary total hip
replacement for OA and inflammatory
arthropathies in the elderly, simple proximal
femoral osteotomies. Familiarity with potential complications (i.e. thromboembo-lism,
sepsis, dislocation, etc) and be aware of current
opinion on the prevention and management of
these complications
A knowledge of the indications for, and
principles of, complex proximal femoral
osteotomies, hip arthroscopy, reconstruction of
the hip in young adults (JCA and hip dysplasia,
etc), complex hip revision surgery
An appreciation of complex acetabular and pelvic
fractures, complex periacetabular osteotomies
An understanding of the place of modern
technologies such as, joint resurfacing procedures
minimally invasive hip replace-ments and
computer
assisted
implantation
in
the
management of hip pathology and the attendant
risks and complications
OD
OTL1
OTL2
CR
A2B3
A2B2
A2B3
A3B4
A2B3
A2B2
A2B3
A3B4
A2B1
A2B2
A2B3
A3B4
A2B3
A2B2
A2B3
A3B4
A2B2
A2B2
A2B3
A3B4
A2B3
A2B2
A2B3
A3B4
A2B3
A2B2
A2B3
A3B4
A2B3
A2B2
A2B3
A3B4
7. THE SPINE
7.1. BASIC SCIENCE
Anatomy:
Development of the spine, spinal cord and nerve
roots
Surgical anatomy of the cervical, dorsal and
lumbosacral spine
Anterior and posterior surgical approaches to the
spine at each level
66
TOPIC
OD
OTL1
OTL2
CR
A2B2
A2B2
A2B3
A3B4
A2B1
A2B2
A2B3
A3B4
A2B1
A2B2
A2B3
A3B4
A2B1
A2B2
A2B3
A3B4
A2B3
A2B2
A2B3
A3B4
A2B1
A2B1
A2B2
A2B2
A2B3
A2B3
A3B4
A3B4
A2B2
A2B2
A2B3
A3B4
A2B3
A2B2
A2B3
A3B4
A2B1
A2B2
A2B3
A3B4
A2B3
A2B2
A2B3
A3B4
A2B1
A2B1
A2B2
A2B2
A2B3
A2B3
A3B4
A3B4
A2B2
A2B2
A2B3
A3B4
A2B2
A2B2
A2B3
A3B4
A2B1
A2B2
A2B3
A3B4
A2B2
A2B2
A2B3
A3B4
A2B2
A2B2
A2B3
A3B4
Biomechanics:
Basic knowledge of the biomechanics of the
cervical and lumbosacral spines
An understanding of the biomechanics of spinal
instability as applied to trauma, tumour, infection
and spondylolysis/listhesis
7.2. Biomechanics
Biomechanics of spinal deformity
A knowledge of the basic mechanics of spinal
instrumentation
7.3. Pathology:
Pathophysiology of the ageing spine and
degenerative disc disease
Acute and chronic infections of the spine
Pathology of spinal deformity
Pathology of the acutely prolapsed cervical and
lumbar disc
Recognition of patterns of spinal injury and
associated cord and nerve root damage
Tumours of the spine
7.4. Clinical Assessment:
A thorough knowledge of general and orthopaedic
history-taking and examination
A knowledge of the assessment of spinal deformity
An understanding of the assessment of thoracic pain
A sound knowledge of clinical assessment of the
spine for low back pain, sciatica, spinal claudication,
neck pain, radiating arm pain, spinal injury and
incipient myelopathy
A knowledge of the assessment of spinal tumour
A basic knowledge of the assessment of a patient after
failed spinal surgery
Investigation:
A thorough knowledge of the basic investigations
required in spinal surgery, specifically: blood
tests, plain radiographs, bone scintigraphy,
discography,
electrophysiological
studies
[including cord monitoring], CT scanning, MRI
scanning
A thorough knowledge of how each of these
investigations contributes to the diagnosis and
management of each of the major areas of spinal
disease
67
TOPIC
OD
OTL1
OTL2
A2B2
A2B2
A2B3
A3B4
A2B1
A2B2
A2B3
A3B4
A sound knowledge of the indications for and
operative surgical management of the acute
prolapsed lumbar intervertebral disc, spinal stenosis,
lumbar
spinal
instability
due
to
spondylolysis/listheses
A2B2
A2B2
A2B3
A3B4
A knowledge of the indications for, and operative
surgical management of the acutely
prolapsed cervical disc, cervical stenosis, spinal
injury and the surgery of spinal infection
A basic knowledge of the surgery of spinal
deformity and tumours of the spine
A2B2
A2B2
A2B3
A3B4
A2B1
A2B2
A2B3
A3B4
A3B4
A2B2
A2B3
A3B4
A3B4
A2B2
A2B3
A3B4
A2B3
A2B2
A2B3
A3B4
A2B3
A2B2
A2B3
A3B4
A2B3
A2B2
A2B3
A3B4
A2B3
A2B2
A2B3
A3B4
A2B2
A2B2
A2B3
A2B3
CR
7.5. Treatment:
Non-operative
A knowledge of the non-surgical methods available for
the treatment of low back pain, sciatica, claudication,
neck pain, spinal deformity, instability, tumour,
infection and fracture to include:
Analgesics and NSAIDs, physiotherapeutic regimes,
pain clinic techniques, bracing, use of radiotherapy and
chemotherapy, non-operative management of spinal
injuries
Operative
TRAUMA
8.1. BASIC SCIENCE
Anatomy:
Applied to diagnosis and surgical treatment of
common bone, joint and soft tissue injuries
Knowledge of those anatomical structures
particularly at risk from common injuries or in
surgical approaches
Physeal anatomy and its application to injury
8.2. Biomechanics:
Application to open reduction and internal
fixation of fractures and external skeletal fixation
Applied to fracture formation and fracture
treatment both operative and non-operative
Biomechanics of implants and fracture fixation
systems, including their material properties
8.3. Epidemiology and Research Methods:
Research and audit methods including the design
of clinical trials
68
TOPIC
OD
OTL1
OTL2
CR
A2B2
A2B2
A2B3
A3B4
A3B4
A2B2
A2B3
A3B4
A2B3
A2B2
A2B3
A3B4
A3B4
A2B2
A2B3
A3B4
A3B4
A2B2
A2B3
A3B4
A3B4
A2B2
A2B3
A3B4
A3B4
A2B2
A2B3
A3B4
A3B4
A2B2
A2B3
A3B4
A3B4
A2B2
A2B3
A3B4
A3B4
A2B2
A2B3
A3B4
A3B4
A2B2
A2B3
A3B4
A3B4
A2B2
A2B3
A3B4
A3B4
A2B2
A2B3
A3B4
A2B3
A2B2
A2B3
A3B4
A2B3
A2B2
A2B3
A3B4
A2B3
A2B2
A2B3
A3B4
8.4. Pathology:
A knowledge of the non-surgical methods
available for the treatment of low back pain,
sciatica, claudication, neck pain, spinal
deformity, instability, tumour, infection and
fracture to include:
Applied to fracture and soft tissue healing,
including skin, muscle, tendon and neurological
structures
Classification systems for fractures and dislocations
Pathology of non-union of fractures
Response of the body, and local muscu-loskeletal
tissues to infection
Systemic response of body to major injury
Mechanisms underlying Acute Respiratory
Distress Syndrome and similar life threatening
conditions
Science of fluid replacement therapy in the
acutely injured including application to the
treatment of burns
Science of treatment of compartment syndrome
Response of infants, children and the elderly to injury
8.5. Clinical Assessment:
Initial clinical assessment of the patient with severe
injury, including spinal cord injury, soft tissue
injury, burns and head injury
Assessment of all types of fracture and dislocation,
their complications, early and late
Identification of life threatening/limb threatening
injuries. Understanding priorities of treatment
Investigations:
Knowledge of the principles, application and side
effects of commonly used investigations, including
radiographs, CT and MRI scans, radio-isotope
imaging, ultrasound scans and electrophysiological
investigations
Treatment:
Knowledge of different treatment options for
musculoskeletal injury, both non-operative and
operative. Ability to analyse the pros and cons for
each method
Ability to manage the overall care of the severely
injured
69
TOPIC
OD
OTL1
OTL2
CR
Treatment (Cont.):
Ability to undertake the complete treatment of all
types of common fracture and dislocation including
the bone and soft tissue treatment of open fractures
and the treatment of pathological fractures
A2B3
A2B2
A2B3
A3B4
Where common injuries are normally treated by a
sub specialist (e.g. spinal injury, arterial injury or
intra cranial haemorrhage) there should be ability
to manage the initial treatment of the patient and
know the principles of the specialist treatment
A2B3
A2B2
A2B3
A3B4
Principles of reconstructive surgery for the injured,
including treatment of non-union and malunion of
fractures, bone defects, chronic post-traumatic
osteomyelitis and delayed treatment of nerve injury;
principles of soft tissue reconstruction
A2B3
A2B2
A2B3
A3B4
The principles of amputation in the injured and
the rehabilitation of such patients
A2B3
A2B2
A2B3
A3B4
A2B2
A2B2
A2B3
A3B4
A2B2
A2B2
A2B3
A3B4
A2B2
A2B2
A2B3
A3B4
A2B2
A2B2
A2B3
A3B4
A2B2
A2B2
A2B3
A3B4
A2B2
A2B2
A2B3
A3B4
A2B2
A2B2
A2B3
A3B4
9. PAEDIATRIC ORTHOPAEDIC SURGERY
9.1. BASIC SCIENCE
Detailed knowledge of the growth of bones,
physeal anatomy and its application to fracture
types and pathological processes and infection in
particular
Knowledge of the anatomy of bones and joints in
the growing child and its application to growth
and deformity
Knowledge of the neurological processes
involved in the production of deformity e.g. spina
bifida, cerebral palsy and muscular dystrophy
9.2. Clinical Assessment:
Core knowledge should be at least that of a
general orthopaedic textbook
'Expert' knowledge, i.e. the level of the speciality
journal is required for those wishing to pursue a
career in children's orthopaedics
The trainee must be able to clinically examine a
child competently and to relate effectively with
the family
The trainee must be able to make proper
management decisions in paediatric practice and
to refer appropriately for treatment
70
TOPIC
Investigations:
Knowledge of the indications for plain xray, arthrogram, CT, MRI and the ability to
interpret the images
Knowledge of the indications for the use of
ultrasound and nuclear imaging
Awareness of the limitations of certain
investigations in paediatric practice
9.3. Treatment:
A sound knowledge of normal variants, e.g.
knock knees, bow legs and flat feet
A detailed knowledge of the treatment for:
Fractures (including non-accidental injury)
and growth plate injuries and recognise the
sequelae
Bone and joint infection
Common childhood orthopaedic conditions,
e.g. irritable hip, anterior knee pain
A working knowledge of the treatment for:
Slipped epiphysis
Perthes' disease
Developmental dysplasia of the hip
Talipes
Scoliosis
Simple foot deformities (e.g. hallux valgus,
metatarsus varus)
Simple congenital hand abnormalities (e.g.
trigger thumb)
Osteogenesis imperfecta
Skeletal dysplasias
Tarsal coalitions
Torticollis
Leg length discrepancy
A knowledge of:
Screening
services
for
congenital
abnormalities
Assessment of physical disability
OD
OTL1
OTL2
CR
A2B1
A2B2
A2B3
A3B4
A2B1
A2B2
A2B3
A3B4
A2B1
A2B2
A2B3
A3B4
A2B1
A2B2
A2B3
A3B4
A2B3
A2B2
A2B3
A3B4
A2B3
A2B2
A2B3
A3B4
A2B1
A2B2
A2B3
A3B4
A2B2
A2B1
A2B1
A2B1
A2B1
A2B2
A2B2
A2B2
A2B2
A2B2
A2B3
A2B3
A2B3
A2B3
A2B3
A3B4
A3B4
A3B4
A3B4
A3B4
A2B1
A2B2
A2B3
A3B4
A2B1
A2B2
A2B3
A3B4
A2B2
A2B1
A2B1
A2B1
A2B1
A2B2
A2B2
A2B2
A2B2
A2B2
A2B3
A2B3
A2B3
A2B3
A2B3
A3B4
A3B4
A3B4
A3B4
A3B4
A2B1
A2B2
A2B3
A3B4
A2B1
A2B2
A2B3
A3B4
71
TOPIC
OD
OTL1
OTL2
CR
10. SHOULDER & ELBOW
10.1. BASIC SCIENCE
Anatomy:
Basic knowledge of the regional anatomy of the shoulder including:
Detailed anatomy of the sternoclavicular,
acromioclavicular, glenohumeral and elbow
joints to include the connecting bones, muscles
and tendons acting across them, neurovascular
supply, bursae and relationships to local
structures
A2B3
A2B2
A2B3
A3B4
Basic knowledge of the regional anatomy of the shoulder including (cont.):
Surgical approaches: deltopectoral and posterior
approaches to glenohumeral joint; superior (McKenzie)
approach to rotator cuff; and surgical approaches to the
acromioclavicular and sternoclavicular joints
Structure and function of the above joints; a clear
understanding of the static and dynamic stabilisers of
the glenohumeral and elbow joints
A2B3
A2B2
A2B3
A3B4
A2B3
A2B2
A2B3
A3B4
A2B2
A2B2
A2B3
A3B4
A2B1
A2B2
A2B3
A3B4
A2B1
A2B2
A2B3
A3B4
A2B2
A2B2
A2B2
A2B2
A2B3
A2B3
A3B4
A3B4
A2B2
A2B2
A2B3
A3B4
A2B2
A2B2
A2B2
A2B2
A2B2
A2B2
A2B3
A2B3
A2B3
A3B4
A3B4
A3B4
A2B2
A2B2
A2B3
A3B4
10.2. Biomechanics:
Biomechanics of the shoulder and elbow to the
level of the currently published specialist journals
Knowledge of the various types of shoulder and
elbow prostheses including the factors
influencing design, wear and loosening to the
level of the currently published specialist journals
10.3. Pathology:
Sound knowledge of all commonly encountered
benign and malignant conditions affecting the
shoulder girdle, elbow and surrounding soft
tissues
A basic understanding of the pathology of:
Impingement and rotator cuff disorders
Instability of the shoulder and the elbow
Inflammatory and degenerative conditions
affecting the articular cartilage and synovium
Infection
Adhesive capsulitis of the shoulder
The pathology of the stiff elbow
Disorders such as ulnar neuritis and tennis or
golfer’s elbow
72
TOPIC
OD
OTL1
OTL2
A2B3
A2B2
A2B3
A3B4
A2B2
A2B2
A2B3
A3B4
A2B3
A2B2
A2B3
A3B4
A2B3
A2B2
A2B3
A3B4
A2B3
A2B2
A2B3
A3B4
A2B3
A2B2
A2B3
A3B4
A2B3
A2B2
A2B3
A3B4
A2B2
A2B2
A2B3
A3B4
CR
10.4.Clinical Assessment:
Detailed history and examination of the painful, stiff
or unstable shoulder or elbow
Knowledge of clinical tests used specifically to
assess instability of the shoulder and elbow, rotator
cuff disorders, the stiff shoulder or elbow and the
use of local anaesthetic in assessment. Examples are
the apprehension tests for shoulder instability,
impingement signs and tests, Gerber’s lift off test,
Napoleon's sign, elbow instability tests, ulnar nerve
assessment
Knowledge of conditions causing referred symptoms
to the shoulder and elbow (e.g. cervical spine
diseases, entrapment neuropathies and thoracic
outlet disorders)
Knowledge to the level of a basic specialist shoulder
textbook of common conditions affecting the
shoulder including instability, impingement, rotator
cuff tears, adhesive capsulitis, osteoarthritis,
rheumatoid disease, avascular necrosis, biceps
tendon disorders, fractures of the proximal humerus
and clavicle, and disorders of the acromioclavicular
and sternoclavicular joints and scapula
Knowledge to the level of a basic specialist elbow
textbook of common conditions affecting the elbow
including instability, osteoarthritis, rheumatoid
arthritis, causes of stiffness, soft tissue problems
such as medial and lateral epicondylitis,
neuropathies and fractures around the elbow
Investigation:
Knowledge of plain radiographs as used to assess
shoulder and elbow disorders. This should include a
knowledge of those special views (e.g. Modified axial,
Stryker notch, Supraspinatus Neer outlet and cubital
tunnel views) required to assess adequately the
conditions which commonly affect the shoulder and
elbow. The ability to recognise correctly normal and
abnormal abnormalities on plain radiographs
Knowledge of the value of ultrasound, arthrography,
CT and MRI as used to assess the shoulder and
elbow. An ability to identify straightforward
abnormalities on CT and MRI (e.g. full thickness
and partial thickness rotator cuff tears on MRI and
the pathological anatomy of fractures around the
shoulder and elbow using CT)
Knowledge of the use and abuse of arthroscopy of
the shoulder and elbow including a knowledge of
normal and abnormal arthroscopic findings
73
LAMPIRAN 2
TOPIC
OD
OTL1
OTL2
A2B3
A2B2
A2B3
A3B4
A2B3
A2B2
A2B3
A3B4
A2B2
A2B2
A2B3
A3B4
A2B2
A2B2
A2B3
A3B4
A2B2
A2B2
A2B3
A3B4
A2B2
A2B2
A2B3
A3B4
A2B1
A2B2
A2B3
A3B4
A2B1
A2B2
A2B3
A3B4
CR
10.5. Treatment:
Non-operative
An ability to supervise the non-operative management
of fractures, dislocations and soft tissue injuries around
the shoulder and elbow
An in-depth knowledge of the management of
straightforward fractures and dislocations of the
shoulder girdle and elbow. Knowledge of the treatment
options for more complex fractures with an
understanding that these might more appropriately be
referred to someone with a special interest; examples of
these might include four part fractures of the proximal
humerus and complex intraarticular fractures of the
distal humerus. An ability to recognise upper limb
injuries involving injuries to the brachial plexus and
refer on as appropriate
A knowledge of injection techniques for both the
shoulder and the elbow
Knowledge of both the non-operative and operative
treatment of common disorders such as recurrent
anterior traumatic instability of the shoulder, rotator
cuff impingement and small rotator cuff tears,
adhesive capsulitis, acromioclavicular joint pain
Operative
A knowledge of the management of soft tissue
elbow disorders such as lateral and medial
epicondylitis and ulnar neuropathy
Knowledge of the indications, options and
complications for prosthetic replacement of the
shoulder and elbow. A detailed knowledge of the
surgical techniques is not required
Knowledge of the indications and benefits of
arthroscopy of the shoulder and elbow. An ability
to perform an arthroscopic assessment of the
shoulder is expected but a knowledge of the
techniques of arthroscopic surgery procedures is
not required
Understanding the principles of management of
tumours around the shoulder and elbow
74
LAMPIRAN 2
Tingkat Kompetensi Psikomotor Peserta Didik
Berdasarkan Topik dan Tahapan
Tingkat Kompetensi
C1 : Melihat dan asimilasi
C2 : Mengerjakan dengan bimbingan
C3 : Mengerjakan mandiri dengan pengawasan
TOPIC
OD
OL1
CR
OL 2
TRAUMA
TRAUMA GENERAL
Free flap
Full thickness skin graft
Muscle flap
Nerve repair
Pedicle flap
Removal external fixator or frame
Removal foreign body from skin / subcutaneous tissue
Removal K wires or skeletal traction
Split skin graft
Transpositional flap
Wound closure, delayed primary or secondary
Wound Debridement
Internal Fixation of Long Bone
Internal fixation of complex fracture
External fixation
Periarticuler fracture
Tendon repair
Vascular repair
Casting and splinting
C1
C1
C1
C1
C1
C2
C2
C3
C1
C1
C3
C2
C2
C2
C2
C1
C2
C1
C2
C1
C2
C1
C2
C1
C3
C3
C3
C2
C1
C3
C3
C3
C3
C3
C2
C3
C2
C3
C1
C3
C3
C3
C3
C3
C3
C3
C3
C3
C3
C3
C3
C3
C3
C3
C3
C3
C3
C1
C1
C1
C1
C1
C2
C2
C2
C2
C2
C2
C2
OD
OL1
CR
AXIAL SKELETON:
Cervical Spine
Anterior fixation fracture/dislocation cervical spine
Application halo / tong traction cervical spine
MUA fracture / dislocation cervical spine
Posterior fixation fracture/dislocation cervical spine
TOPIC
75
OL 2
Thoracic Spine
Anterior decompression / fixation thoracic spine
Posterior decompression / fixation thoracic spine
Lumbar Spine
Anterior decompression / fixation lumbar spine
Posterior decompression / fixation lumbar spine
Pelvis
Simple acetabular fracture ORIF
Complex acetabular fracture ORIF
Pelvic fracture:
Pelvic fracture external fixator application
Simple pelvic fracture ORIF
Complex pelvic fracture ORIF
UPPER LIMB:
Brachial Plexus
Exploration / repair / grafting brachial plexus
Clavicle
ORIF clavicle fracture
ORIF non-union clavicle fracture
Shoulder
Anterior dislocation shoulder
Anterior dislocation shoulder closed reduction
Anterior dislocation shoulder open reduction +/- fixation
Acromioclavicular joint dislocation acute ORIF
Fracture proximal humerus ORIF
Glenoid fracture ORIF
Posterior dislocation shoulder closed reduction
Humerus
Fracture diaphysis humerus non-op:
Non-union ORIF +/- bone grafting
Fracture diaphysis humerus IM nailing
Fracture diaphysis humerus MUA +/- POP
Fracture diaphysis humerus ORIF plating
Elbow
Dislocated elbow +/- fracture:
Dislocated elbow +/- fracture closed reduction
Dislocated elbow +/- fracture open reduction +/- fixation
Intraarticular distal humerus fracture ORIF
Lateral condyle fracture ORIF
Medial condyle / epicondyle fracture MUA / K wire / ORIF
Olecranon fracture ORIF
76
C1
C1
C2
C2
C3
C3
C1
C1
C2
C2
C3
C3
C1
C1
C2
C2
C3
C2
C1
C1
C1
C2
C2
C2
C3
C3
C2
C1
C1
C2
C1
C1
C2
C2
C3
C3
C2
C1
C1
C2
C1
C2
C3
C2
C2
C2
C2
C3
C3
C3
C3
C3
C3
C3
C3
C1
C1
C2
C2
C3
C2
C2
C3
C3
C3
C3
C3
C3
C3
C2
C2
C2
C2
C2
C2
C3
C2
C2
C2
C3
C3
C3
C3
C3
C3
C3
C3
TOPIC
Dislocated elbow +/- fracture:
Radial head / neck fracture MUA +/- K wire
Radial head / neck fracture ORIF
Radial head replacement for fracture
Supracondylar fracture:
Supracondylar fracture MUA +/- K wires
Supracondylar fracture ORIF
Forearm
Fasciotomy for compartment syndrome
Fracture distal radius:
Fracture distal radius – closed non-op
Fracture distal radius external fixation
Fracture distal radius MUA & percutaneous wires
Fracture distal radius MUA & POP
Fracture distal radius ORIF
Fracture shaft radius / ulna:
Fracture shaft radius / ulna IM nailing
Fracture shaft radius / ulna MUA & percutaneous wires
Fracture shaft radius / ulna MUA & POP
Fracture shaft radius / ulna ORIF
OD
OL1
OL 2
CR
C2
C2
C1
C3
C3
C2
C3
C3
C3
C2
C1
C2
C2
C3
C3
C1
C3
C3
C1
C2
C2
C2
C2
C2
C2
C2
C3
C2
C3
C3
C3
C3
C3
C1
C2
C2
C2
C2
C3
C3
C3
C3
C3
C3
C3
C2
C2
C1
C2
C1
C1
C1
C2
C4
C2
C3
C2
C2
C2
C3
C3
C3
C3
C3
C3
C3
C2
C2
C3
C3
C3
C3
C2
C2
C2
C3
C3
C3
C3
C3
C3
C2
C2
C3
C3
C3
C3
Wrist
Carpal fracture / dislocation:
Carpal fracture / dislocation MUA & percutaneous wires
Carpal fracture / dislocation MUA & POP
Carpal fracture / dislocation ORIF
Scaphoid fracture non-op
Scaphoid fracture ORIF
Scaphoid fracture MUA & percutaneous wires
Scaphoid fracture non-union ORIF +/- graft
Hand
Carpal fracture / dislocation:
5th metacarpal fracture / dislocation non-op
5th metacarpal fracture / dislocation MUA & percu-taneous
wires
5th metacarpal fracture / dislocation MUA & POP
5th metacarpal fracture / dislocation ORIF
Finger tip reconstruction
Infection:
Infection hand drainage (not tendon sheath)
Infection tendon sheath drainage
77
OD
OL1
OL 2
CR
C2
C2
C2
C2
C2
C2
C3
C3
C3
C2
C3
C3
C3
C3
C3
C3
C3
C3
C2
C2
C2
C2
C2
C2
C3
C3
C3
C3
C3
C2
C3
C3
C3
C3
C3
C3
Tendon repair extensor
Tendon repair flexor
CPJ fracture / dislocation:
C2
C2
C3
C3
C3
C3
MCPJ fracture / dislocation MUA & Percutaneous wires
C2
C2
C2
C2
C2
C2
C3
C3
C3
C2
C1
C1
C3
C2
C2
C3
C3
C2
C2
C2
C2
C3
C3
C3
C3
C3
C3
C2
C2
C2
C3
C3
C2
C3
C3
C3
C1
C2
C2
C2
C2
C3
C3
C3
C3
C3
C3
C3
TOPIC
IPJ fracture / dislocation:
IPJ fracture / dislocation MUA & percutaneous wires
IPJ fracture / dislocation MUA +/- POP
IPJ fracture / dislocation ORIF
Ligament repair hand
Metacarpal fracture (not 1st or 5th) non-op
Metacarpal fracture (not 1st or 5th) MUA & Percutaneous
wires
Metacarpal fracture (not 1st or 5th) MUA +/- POP
Metacarpal fracture (not 1st or 5th) ORIF
Phalangeal fracture non-op
Phalangeal fracture MUA & percutaneous wires
Phalangeal fracture MUA +/- POP
Phalangeal fracture ORIF
Tendon repair:
MCPJ fracture / dislocation MUA +/- POP
MCPJ fracture / dislocation ORIF
LOWER LIMB:
Hip
Dislocated hip:
Dislocated hip closed reduction
Acute dislocated hip open reduction +/- fixation
Neglected dislocated hip open reduction +/- fixation
Extracapsular fracture:
Extracapsular fracture CHS / DHS
Extracapsular fracture intramedullary fixation
Extracapsular fracture other fixation
Intracapsular fracture:
Intracapsular fracture hemiarthroplasty
Intracapsular fracture internal fixation
Intracapsular fracture intracapsular fracture THR
Femur
Diaphyseal fracture closed:
Diaphyseal fracture traction or spica in child
Diaphyseal fracture intramedullary nailing
Diaphyseal fracture plate/screw fixation
Fasciotomy for compartment syndrome
78
TOPIC
Subtrochanteric fracture:
Subtrochanteric fracture intramedullary fixation
Subtrochanteric fracture plate/screw fixation
Supracondylar fracture (not intraarticular):
Supracondylar fracture (not intraarticular) DCS / blade plate etc
Supracondylar fracture (not intraarticular) intra-medullary
fixation
Knee
Acute haemarthrosis arthroscopy
Acute ligament repair
Intraarticular fracture distal femur ORIF
Patella dislocation closed reduction +/- open repair
Patella fracture ORIF
Patella tendon repair
Quadriceps tendon repair
Simple tibial plateau fracture
Complex tibial plateau fracture
Tibial plateau fracture arthroscopically assisted fixation
Tibial plateau fracture ORIF with plates & screws
Tibial plateau fracture treatment with circular frame
Tibia & Fibula
Diaphyseal tibial fracture external fixation (including
frame)
Diaphyseal tibial fracture intramedullary nailing
Diaphyseal tibial fracture MUA & POP
Tibial shaft plating
Fasciotomy for compartment syndrome
Tibial non-union:
Tibial non-union circular frame management
Tibial non-union intramedullary nailing +/- bone grafting
Ankle
OD
OL1
OL 2
CR
C2
C2
C3
C3
C3
C3
C2
C2
C2
C2
C3
C3
C1
C1
C1
C2
C2
C2
C2
C1
C1
C1
C1
C1
C2
C2
C2
C3
C3
C3
C3
C2
C2
C2
C2
C2
C3
C3
C3
C3
C3
C3
C3
C3
C2
C3
C3
C3
C2
C2
C3
C2
C2
C2
C1
C3
C3
C2
C2
C3
C3
C3
C3
C1
C1
C2
C2
C3
C3
C2
C2
C3
C3
C3
C3
C1
C1
C1
C2
C2
C2
C2
C3
C3
C2
C3
C3
C2
C1
C3
C2
C3
C3
Ankle fracture / dislocation:
Ankle fracture / dislocation MUA & POP
Ankle fracture / dislocation ORIF
Pilon fracture:
Simple pilon fracture ORIF
Complex pilon fracture ORIF
Pilon fracture with circular frame
Tendoachilles repair
Foot
Amputation toe / ray for trauma
Simple calcaneal fracture ORIF
79
TOPIC
Complex calcaneal fracture ORIF
Metatarsal fracture ORIF
Phalangeal fracture MUA +/- K wire +/- ORIF
Talar, subtalar or midtarsal fracture / disloc:
Talar, subtalar or midtarsal fracture / dislocation MUA +/POP +/- K wires
Talar, subtalar or midtarsal fracture / dislocation ORIF
Achilles Tendon Repair
ELECTIVE
ELECTIVE SITE NON SPECIFIC
Aspiration / injection joint
Benign tumour excision (not exostoses)
Biopsy bone - needle
Biopsy bone - open
Bursa excision
Cyst bone curettage +/- bone graft
Epiphysiodesis
Malignant tumour excision
AXIAL SKELETON:
Cervical Spine
Anterior decompression +/- fixation / fusion (C2-C7)
Atlantoaxial fixation +/- fusion
Biopsy cervical spine
Excision cervical / 1st rib
Nerve root / facet joint injection cervical spine
Occipito-cervical fusion +/- fixation
Posterior decompression +/- fixation / fusion (C20C7)
Thoracic Spine
Anterior decompression +/- fixation / fusion
Biopsy thoracic spine
Posterior decompression +/- fixation / fusion
Scoliosis correction - anterior release +/- instrumentation
Scoliosis correction - posterior fusion +/- instrumentation
Lumbar Spine
Caudal epidural injection
Decompression lumbar spine with fusion +/- fixation
Decompression lumbar spine without fusion (not disectomy
alone)
Discectomy open / micro
Nerve root / facet joint injection lumbar spine
80
OD
OL1
OL 2
CR
C1
C2
C3
C3
C3
C3
C1
C2
C3
C1
C1
C2
C2
C3
C3
C2
C2
C1
C1
C2
C1
n/a
C1
C3
C3
C3
C3
C3
C3
C2
C2
C3
C3
C3
C3
C3
C3
C3
C2
n/a
n/a
n/a
n/a
n/a
n/a
n/a
C1
C1
C2
C1
C1
C1
C1
C2
C2
C3
C2
C3
C2
C2
n/a
n/a
n/a
n/a
n/a
C1
C1
C2
C1
C1
C2
C2
C3
C2
C2
n/a
n/a
n/a
C2
C2
C2
C3
C3
C3
C1
C1
C2
C2
C3
C3
TOPIC
Brachial Plexus
Exploration / repair / grafting brachial plexus
UPPER LIMB:
Shoulder
Acromioclavicular joint excison - arthroscopic /open/lateral clavicle
Acromioclavicular joint reconstruction (e.g. Weaver Dunn)
Acromioplasty open
Anterior repair for instability arthroscopic
Anterior repair for instability open including capsular shift
Arthroscopic subacromial decompression
Arthroscopy diagnostic
Rotator cuff repair (open or arthroscopic) +/- acromioplasty
Total shoulder replacement
UPPER ARM:
OD
OL1
OL 2
CR
C1
C1
C2
n/a
n/a
n/a
n/a
n/a
n/a
C1
n/a
C1
C2
C2
C2
C2
C3
C2
C3
C2
C2
C3
C3
C3
C3
C3
C3
C3
C3
C3
n/a
n/a
C1
C2
C1
C1
C1
C1
C1
C2
C2
C2
C3
C2
C2
C2
C2
C3
C3
C3
C3
C3
C3
C3
C3
C3
C3
n/a
n/a
C1
C1
C1
C2
C1
C1
C2
C1
C3
C3
C2
C3
C2
C3
C3
C2
C3
C3
C3
C3
C3
C3
C1
C1
C1
n/a
C1
C1
n/a
C1
C1
C2
C3
C2
C2
C2
C2
C2
C3
C3
C3
C3
C3
C3
C3
C3
C3
C3
C3
Elbow
Arthrolysis elbow (open/arthroscopic)
Arthroscopy elbow diagnostic
Arthoscopy elbow therapeutic
Arthrotomy elbow
Excision radial head +/- synovectomy
Radial head replacement
Tennis / golfer elbow release
Total elbow replacement
Ulnar nerve decompression / transposition
FOREARM:
Wrist
Arthrodesis wrist (includes partial arthrodesis)
Arthroscopy wrist
Carpal tunnel decompression
De Quervain's decompression
Excision distal ulna
Ganglion excision at wrist
Ulna shortening
Ulnar nerve decompression at wrist
Hand
Dupuytrens contracture operation
Excision synovial cyst
Fusion of MCPJ or IPJ
MCPJ replacement
Soft tissue reconstruction hand
Tendon transfer hand
Trapezium excision or replacement
Trigger finger release
Trigger thumb release
81
TOPIC
LOWER LIMB:
HIP
Arthrodesis hip
Arthrogram hip
Arthroscopy hip - diagnostic
Arthroscopy hip - therapeutic
Arthrotomy hip
Excision arthroplasty hip (e.g. Girdlestone)
Open reduction for DDH
Osteotomy hip - pelvic for DDH
Osteotomy hip - proximal femoral for DDH
Osteotomy pelvis - not for DDH
Revision Total Hip Replacement
Revision THR acetabular component
Revision THR both components
Revision THR femoral component
Slipped upper femoral epiphysis:
Slipped upper femoral epiphysis open reduction
Slipped upper femoral epiphysis pinning
Total Hip Replacement:
THR cemented
THR hybrid
THR surface replacement
THR uncemented
Femur
Amputation above knee
Femoral lengthening
Osteotomy corrective (not for DDH)
Knee
Open ACL reconstruction
Arthroscopy ACL reconstruction
Arthroscopic lateral release
Arthroscopic partial meniscectomy
Arthroscopic removal loose bodies knee
Arthroscopic synovectomy
Arthroscopic knee diagnostic
Osteotomy distal femoral
Osteotomy proximal tibial
Patella realignment
Patella resurfacing alone
Revision TKR
TKR
Unicompartmental knee replacement
82
OD
OL1
OL 2
CR
n/a
n/a
n/a
n/a
C2
n/a
n/a
n/a
n/a
n/a
n/a
n/a
n/a
n/a
C1
C1
C1
C1
C3
C2
C2
C2
C2
C2
C2
C2
C2
C2
C2
C3
C3
C3
C3
C3
C3
C3
C3
C3
C3
C3
C3
C3
n/a
n/a
C2
C2
C2
C2
C1
C1
C1
C1
C3
C3
C2
C2
C3
C3
C3
C3
C1
n/a
n/a
C3
C2
C2
C3
C3
C3
C1
C2
C3
C1
C1
C1
C1
C2
n/a
n/a
n/a
n/a
n/a
n/a
n/a
C2
C2
C2
C2
C3
C2
C2
C2
C2
C2
C3
C2
C3
C3
C3
C3
C3
C3
C3
C3
C3
C3
C3
C3
TOPIC
Tibia & Fibula
Amputation below knee
Tibial lengthening
Ankle
Arthrodesis ankle
Arthroplasty ankle
Arthroscopy ankle diagnostic
Arthroscopy ankle therapeutic
Arthrotomy ankle
Decompression tendons at ankle
Tendoachilles lengthening
Foot
Amputation toe / ray
Calcaneal osteotomy
CTEV correction
Fifth toe soft tissue correction
First metatarsal osteotomy
First MTPJ arthrodesis
First MTPJ excision arthroplasty
First MTPJ soft tissue correction
Hindfoot arthrodesis
Ingrowing toenail operation
Lesser metatarsal osteotomy
Lesser toe arthrodesis
Lesser toe excision part/all phalanx
Lesser toe tenotomy
Tendon decompression or repair
Tendon transfer foot
Wedge tarsectomy
OD
OL1
OL 2
CR
C1
n/a
C3
C2
C3
C3
C1
n/a
n/a
n/a
n/a
n/a
n/a
C2
C2
C2
C2
C3
C3
C3
C3
C3
C3
C3
C3
C3
C3
C1
n/a
n/a
n/a
n/a
n/a
n/a
n/a
n/a
C2
n/a
n/a
n/a
n/a
n/a
n/a
n/a
C3
C2
C2
C2
C3
C3
C3
C3
C2
C3
C2
C3
C3
C3
C3
C2
C2
C3
C3
C3
C3
C3
C3
C3
C3
C3
C3
C3
C3
C3
C3
C3
C3
C3
83
LAMPIRAN 3
Tingkat Kompetensi Afektif Peserta Didik
Berdasarkan Topik dan Tahapan Pendidikan
Profesionl Behaviour
1.Patient assessment
1. Obtains, records and presents accurate clinical history
and physical examination relevant to the clinical
presentation, including an indication of patient’s views
2. Uses and interprets findings adjuncts to basic
examination appropriately e.g. internal examination,
blood pressure measurement, pulse oximetry, peak
flow
3. Responds honestly and promptly to patient questions
4. Knows when to refer for senior help
5. Is respectful to patients by:
a. Introducing self clearly to patients and indicates own
place in team
b. Checks that patients comfortable and willing to be
seen
c. Informs patients about elements of examination and
any procedures that the patient will undergo
Clinical reasoning
1. In a straightforward clinical case develops a
provisional diagnosis and a differential diagnosis on
the basis of the clinical evidence, institutes an
appropriate investigative and therapeutic plan, seeks
appropriate support from others and takes account of
the patients Wishes
Record keeping
1. Is able to format notes in a logical way and writes
legibly
2. Able to write timely, comprehensive, informative
letters to patients and to GPs
Time management
1. Works systematically through tasks and attempts to
prioritise
2. Discusses the relative importance of tasks with more
senior colleagues.
3. Understands importance of communicating progress
with other team members
84
OD
OL
1-2
CR
Profesionl Behaviour
OD
OL
1-2
CR
Patient safety
1. Participates in clinical governance processes
2. Respects and follows local protocols and
guidelines
3. Takes direction from the team members on patient
safety
4. Discusses risks of treatments with patients and is
able to help patients make decisions about their
treatment
5. Ensures the safe use of equipment
6. Acts promptly when patient condition deteriorates
7. Always escalates concerns promptly
Infection control
1. Performs simple clinical procedures whilst
maintaining full aseptic precautions
2. Follows local infection control protocols
3. Explains infection control protocols to students
and to patients and their relatives
6. Aware of the risks of nosocomial infections.
2. Being a good communicator
Objective
Communication with patients
1. To establish a doctor/patient relationship characterised
by understanding, trust, respect, empathy and
confidentiality
2. To communicate effectively by listening to patients,
asking for and respecting their views about their health
and responding to their concerns and preferences
3. To cooperate effectively with healthcare professionals
involved in patient care
4. To provide appropriate and timely information to
patients and their families
Breaking bad news
1. To deliver bad news according to the needs of
individual patients
Communication with Colleagues
1. To recognise and accept the responsibilities and
role of the doctor in relation to other healthcare
professionals.
2. To communicate succinctly and effectively with
other professionals as appropriate
3. To present a clinical case in a clear, succinct and
systematic manner
85
Profesionl Behaviour
Descriptors
1. Conducts a simple consultation with due empathy and
sensitivity and writes accurate records thereof
2. Recognises when bad news must be imparted.
3. Able to break bad news in planned settings following
preparatory discussion with seniors
4. Accepts his/her role in the healthcare team and
communicates appropriately with all relevant
5. members thereof
3.Teaching and Training
1. To teach to a variety of different audiences in a variety
Objectives
Descriptors
of different ways
2. To assess the quality of the teaching
3. To train a variety of different trainees in a variety of
different ways
4. To plan and deliver a training programme with
appropriate assessments
1. Prepares appropriate materials to support teaching
episodes
2. Seeks and interprets simple feedback following
teaching
3. Supervises a medical student, nurse or colleague
through a simple procedure
4. Plans, develops and delivers small group teaching to
medical students, nurses or colleagues
4. Keeping up to date
1. To understand the results of research as they relate to
Objective
medical practise
2. To participate in medical research
3. To use current best evidence in making decisions about
the care of patients
4. To construct evidence based guidelines and protocols
5. To complete an audit of clinical practice
6. At actively seek opportunities for personal
development
7. To participate in continuous professional development
activities
8. To understand the results of research as they relate to
medical practise
9. To participate in medical research
10. To use current best evidence in making decisions
about the care of patients
11. To construct evidence based guidelines and protocols
12. To complete an audit of clinical practice
13. At actively seek opportunities for personal
development
14. To
participate
in
continuous
professional
development activities
86
OD
OL
1-2
CR
Profesionl Behaviour
OD
OL
1-2
CR
4. Keeping up to date
1. Defines ethical research and demonstrates awareness of
Descriptors
GMC guidelines
2. Differentiates audit and research and understands the
different types of research approach e.g. qualitative and
quantitative
3. Knows how to use literature databases
4. Demonstrates good presentation and writing skills
5. Participates in departmental or other local journal club
6. Critically reviews an article to identify the level of
evidence
7. Attends departmental audit meetings
8. Contributes data to a local or national audit
9. Identifies a problem and develops standards for a local audit
10. Describes the audit cycle and take an audit through the
first steps
11. Seeks feedback on performance from clinical supervisor
/ patients / careers / service users
5. Manager
Objective
Self awareness and self management
1. To recognise and articulate one’s own values and
principles, appreciating how these may differ from those of
others
2. To identify one’s own strengths, limitations and the impact
of their behaviour
3. To identify their own emotions and prejudices and
understand how these can affect their judgment and
behavior
4. To obtain, value and act on feedback from a variety of
sources
5. To manage the impact of emotions on behaviour and
actions
6. To be reliable in fulfilling responsibilities and
commitments to a consistently high standard
7. To ensure that plans and actions are flexible, and take into
account the needs and requirements of others
8. To plan workload and activities to fulfill work
requirements and commitments with regard to their own
personal health
Team working
1. To identify opportunities where working with others can
bring added benefits
2. To work well in a variety of different teams and team
settings by listening to others, sharing information, seeking
the views of others,
3. empathising with others, communicating well, gaining
trust, respecting roles and expertise of
4. others, encouraging others, managing differences of
opinion, adopting a team approach
87
Profesionl Behaviour
Objective
(cont.)
Leadership
1. To develop the leadership skills necessary to lead
teams effectively. These include:
2. Identification of contexts for change
3. Application of knowledge and evidence toproduce
an evidence based challenge to systems and
processes
4. Making decision by integrating values withevidence
5. Evaluating impact of change and taking corrective
action where necessary
Principles of quality and safety improvement
1. To recognise the desirability of monitoring
performance, learning from mistakes and adopting
no blame culture in order to ensure high standards
of care and optimise patient safety
2. To critically evaluate services
3. To identify where services can be improved
4. To support and facilitate innovative service
improvement
Management and NHS culture
1. To organise a task where several competing
priorities may be involved
2. To actively contribute to plans which achieve
service goals
3. To manage resources effectively and safely
4. To manage people effectively and safely
5. To manage performance of themselves and others
6. To understand the structure of the NHS and the
management of local healthcare systems in order to
be able to participate fully in managing healthcare
provision.
Descriptors
88
Self awareness and self management
1. Obtains 360° feedback as part of an assessment
2. Participates in peer learning and explores leadership
styles and preferences
3. Timely completion of written clinical notes
4. Through feedback discusses and reflects on how a
personally
emotional
situation
affected
communication with another person
5. Learns from a session on time management
OD
OL
1-2
CR
Profesionl Behaviour
Descriptors
(Cont.)
OD
OL
1-2
CR
Team working
1. Works well within the multidisciplinary team and
recognises when assistance is required from the
relevant team member
2. Invites and encourages feedback from patients
3. Demonstrates awareness of own contribution to
patient safety within a team and is able to outline the
roles of other team members.
4. Keeps records up-to-date and legible and relevant to
the safe progress of the patient.
5. Hands over care in a precise, timely and effective
manner
6. Supervises the process of finalising and submitting
operating lists to the theatre suite
Leadership
1. Complies with clinical governance
requirements of organisation
2. Presents information to clinical and service managers
(e.g. audit).
3. Contributes to discussions relating to relevant issues
e.g. workload, cover arrangements using clear and
concise evidence and information
Quality and safety improvement
1. Understands that clinical governance is the overarching framework that unites a range of quality
improvement activities
2. Participates in local governance processes
3. Maintains personal portfolio
4. Engages in clinical audit
5. Questions current systems and processes
Management and NHS Structures
1. Participates in audit to improve a clinical service
2. Works within corporate governance structures
3. Demonstrates ability to manage others by teaching and
mentoring juniors, medical students and others,
delegating work effectively
4. Highlights areas of potential waste
6. Promoting good health
Objectives
1. To demonstrate an understanding of the determinants
of health and public policy in relation to individual
patients
2. To promote supporting people with long term
conditions to self-care
89
Profesionl Behaviour
Descriptors
1. Understands that “quality of life” is an important goal of
care and that this may have different meanings for each
patient
2. Promotes patient self care and independence
3. Helps the patient to develop an active understanding of
their condition and how they can be involved in self
management
4. Discusses with patients those factors which could
influence their health
7.Probity and Ethics
1. To uphold personal, professional ethics and values, taking into
Objective
account the values of the organisation and the culture and
beliefs of individuals
2. To communicate openly, honestly and inclusively
3. To act as a positive role model in all aspects of communication
4. To take appropriate action where ethics and values are
compromised
5. To recognise and respond the causes of medical error
6. To respond appropriately to complaints
7. To know, understand and apply appropriately the principles,
guidance and laws regarding medical ethics and confidentiality
as they apply to surgery
8. To understand the necessity of obtaining valid consent from
the patient and how to obtain
9. To understand the legal framework within which healthcare is
provided
10. To recognise, analyse and know how to deal with
unprofessional behaviours in clinical practice, taking into
account local and national regulations
11. Understand ethical obligations to patients and colleagues
12. To appreciate an obligation to be aware of personal good
health
Descriptors
90
1.
2.
3.
4.
Reports and rectifies an error if it occurs
Participates in significant event audits
Participates in ethics discussions and forums
Apologises to patient for any failure as soon as an error is
recognised
5. Understands and describes the local complaints procedure
6. Recognises need for honesty in management of complaints
7. Learns from errors
8. Respect patients’ confidentiality and their autonomy
9. Understand the Data Protection Act andFreedom of
Information Act
10. Consult appropriately, including the patient, before
sharing patient information
11. Participate in decisions about resuscitation status,
withholding or withdrawing treatment
12. Obtains consent for interventions that he/she is
competent to undertake
13. Knows the limits of their own professional capabilities
OD
OL
1-2
CR
LAMPIRAN 4
MODUL-MODUL
MODUL 1: BASIC SCIENCE
1. Objective

To acquire and demonstrate underpinning basic science knowledge appropriate for
the practice of surgery, including:
o Applied anatomy: Knowledge of anatomy appropriate for surgery
o Physiology: Knowledge of physiology relevant to surgical practice
o Pharmacology: Knowledge of pharmacology relevant to surgical practice
centred around safe prescribing of common drugs
o Pathology: Knowledge of pathological principles underlying system specific
pathology
o Microbiology: Knowledge of microbiology relevant to surgical practice

Imaging:
o Knowledge of the principles, strengths and weaknesses of various diagnostic
and interventional imaging methods
1. Knowledge



Applied anatomy:
o Development and embryology
o Gross and microscopic anatomy of the organs and other structures
o Surface anatomy
o Imaging anatomy
This will include anatomy of thorax, abdomen, pelvis, perineum, limbs, spine,
head and neck as appropriate for surgical operations that the trainee will be
involved with during coretraining (see Module 2).
Physiology:
o General physiological principles including:

Homeostasis

Thermoregulation

Metabolic pathways and abnormalities

Blood loss and hypovolaemic shock

Sepsis and septic shock

Fluid balance and fluid replacement therapy

Acid base balance

Bleeding and coagulation

Nutrition
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o
This will include the physiology of specific organ systems relevant to surgical
care including the cardiovascular, respiratory, gastrointestinal, urinary,
endocrine and neurological systems.

Pharmacology:
o The pharmacology and safe prescribing of drugs used in the treatment of
surgical diseases including analgesics, antibiotics, cardiovascular drugs,
antiepileptic, anticoagulants, respiratory drugs, renal drugs, drugs used for the
management of endocrine disorders (including diabetes) and local
anaesthetics.
o The principles of general anaesthesia
o The principles of drugs used in the treatment of common malignancies

Pathology:
o General pathological principles including:

Inflammation

Wound healing

Cellular injury

Tissue death including necrosis and apoptosis

Vascular disorders

Disorders of growth, differentiation and morphogenesis

Surgical immunology

Surgical haematology

Surgical biochemistry

Pathology of neoplasia

Classification of tumours

Tumour development and growth including metastasis

Principles of staging and grading of cancers

Principles of cancer therapy including surgery,
chemotherapy,

immunotherapy and hormone therapy

Principles of cancer registration

Principles of cancer screening
radiotherapy,

The pathology of specific organ systems relevant to surgical care including
cardiovascular pathology, respiratory pathology, gastrointestinal pathology,
genitourinary disease, breast, exocrine and endocrine pathology, central and
peripheral, neurological systems, skin, lymphoreticular and musculoskeletal
systems

Microbiology:
o Surgically important micro organisms including blood borne viruses
o Soft tissue infections including cellulitis, abscesses, necrotising fasciitis,
gangrene
o Sources of infection
o Sepsis and septic shock
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
Microbiology: (Cont.)
o Asepsis and antisepsis
o Principles of disinfection and sterilisation
o Antibiotics including prophylaxis and resistance
o Principles of high risk patient management
o Hospital acquired infections

Imaging:
o Principles of diagnostic and interventional imaging including x-rays,
ultrasound, CT, MRI. PET, radiounucleotide scanning
MODULE 2 : COMMON SURGICAL CONDITIONS
This section assumes that candidates have general medical competencies consistent
with a doctor leaving Foundation in the UK. It also assumes an ongoing commitment to
keeping these skills and knowledge up to date as laid out in GMP. It is predicated on the
value that surgeons are doctors who carry our surgery and require competencies.
Objective
To demonstrate understanding of the relevant basic scientific principles for each of
these surgical conditions and to be able to provide the relevant clinical care as defined in
modules assessment and management as defined in Modules 1 and 4.
2. Knowledge
 Presenting symptoms or syndromes
o Abdominal pain
o Gastrointestinal haemorrhage
o Rectal bleeding
o To include the following conditions

Appendicitis

Adhesions

Abdominal hernias

Peritonitis

Intestinal perforation

Presenting symptoms or syndromes

Peripheral vascular disease
Presenting symptoms or syndrome
o Chronic and acute limb ischaemia
o Transient ischaemic attacks
o Varicose veins
o Leg ulceration
o To include the following conditions
 Atherosclerotic arterial disease
 Embolic and thrombotic arterial disease
93
o



To include the following conditions (Cont.)

Venous insufficiency

Diabetic ulceration
Cardiovascular and pulmonary Disease
To include the following conditions
o Coronary heart disease
o Space occupying lesions of the chest
Genitourinary disease
Presenting symptoms or syndrome
o Haematuria
o Lower urinary tract symptoms
o Urinary retention
o Renal failure
o Scrotal swellings
Trauma and orthopaedics
Presenting symptoms or syndrome
o Traumatic limb and joint pain and deformity
o Chronic limb and joint pain and deformity
o Back pain
o To include the following conditions

Simple fractures and joint dislocations

Fractures around the hip and ankle

Basic principles of Degenerative joint disease

Basic principles of inflammatory joint disease including bone and joint
infection

Compartment syndrome

Spinal nerve root entrapment and spinal cord compression

Metastatic bone cancer

Common peripheral neuropathies and nerve injuries
MODULE 3 : BASIC SURGICAL SKILLS
1. Objective
• Preparation of the surgeon for surgery
• Safe administration of appropriate local anaesthetic agents
• Acquisition of basic surgical skills in instrument and tissue handling.
• Understanding of the formation and healing of surgical wounds
• Incise superficial tissues accurately with suitable instruments.
• Close superficial tissues accurately.
• Tie secure knots.
• Safely use surgical diathermy
• Achieve haemostasis of superficial vessels.
• Use suitable methods of retraction.
• Knowledge of when to use a drain and which to choose.
• Handle tissues gently with appropriate instruments.
• Assist helpfully, even when the operation is not familiar.
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1. Objective (Cont.)
• Understand the principles of anastomosis
• Understand the principles of endoscopy
2. Knowledge
Principles of safe surgery
• Preparation of the surgeon for surgery
• Principles of hand washing, scrubbing and gowning
• Immunisation protocols for surgeons and patients
Administration of local anaesthesia
• Choice of anaesthetic agent
• Safe practise
Surgical wounds
• Classification of surgical wounds
• Principles of wound management
• Pathophysiology of wound healing
• Scars and contractures
• Incision of skin and subcutaneous tissue:
o Langer’s lines
o Choice of instrument
o Safe practice
• Closure of skin and subcutaneous tissue:
o Options for closure
o Suture and needle choice
• Safe practice
• Knot tying
o Range and choice of material for suture and ligation
o Safe application of knots for surgical sutures and ligatures
• Haemostasis:
o Surgical techniques
o Principles of diathermy
• Tissue handling and retraction:
o Choice of instruments
• Biopsy techniques including fine needle aspiration cytology
• Use of drains:
o Indications
o Types
o Management/removal
• Principles of anastomosis
• Principles of surgical endoscopy
3. Clinical Skills
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Preparation of the surgeon for surgery
• Effective and safe hand washing, gloving and gowning
• Administration of local anaesthesia
• Accurate and safe administration of local anaesthetic agent
Preparation of a patient for surgery
• Creation of a sterile field
• Antisepsis
• Draping
4. Technical Skills and Procedures
Preparation of the surgeon for surgery
• Effective and safe hand washing, gloving and gowning
Administration of local anaesthesia
• Accurate and safe administration of local anaesthetic agent
• Incision of skin and subcutaneous tissue:
o Ability to use scalpel, diathermy and scissors
• Closure of skin and subcutaneous tissue:
o Accurate and tension free apposition of wound edges
• Knot tying:
o Single handed
o Double handed
o Instrument
o Superficial
o Deep
• Haemostasis:
o Control of bleeding vessel (superficial)
o Diathermy
o Suture ligation
o Tie ligation
o Clip application
o Transfixion suture
• Tissue retraction:
• Tissue forceps
• Placement of wound retractors
• Use of drains:
o Insertion
o Fixation
o Removal
• Tissue handling:
• Appropriate application of instruments and respect for tissues
• Biopsy techniques
• Skill as assistant:
• Anticipation of needs of surgeon when assisting
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MODULE 4: THE ASSESSMENT AND MANAGEMENT OF THE
SURGICAL PATIENT MODULE 4
1. Objective
To demonstrate the relevant knowledge, skills and attitudes in assessing the
patient and manage the patient, and propose surgical or non-surgical management.
2. Knowledge
The knowledge relevant to this section will be variable from patient to patient
and is covered within the rest of the syllabus – see common surgical conditions in
particular (Module 2).
As a trainee develops an interest in a particular speciality then the principles of
history taking and examination may be increasingly applied in that context.
3. Clinical Skills
• Surgical history and examination (elective and emergency)
• Construct a differential diagnosis
• Plan investigations
• Clinical decision making
• Team working and planning
• Case work up and evaluation; risk management
• Active participation in clinical audit events
• Appropriate prescribing
• Taking consent for intermediate level intervention; emergency
and elective
• Written clinical communication skills
• Interactive clinical communication skills: patients
• Interactive clinical communication skills: colleagues
MODULE 5 : PERI-OPERATIVE CARE
1. Objective






To assess and manage preoperative risk
To manage patient care in the peri-operative period
To conduct safe surgery in the operating theatre environment
To assess and manage bleeding including the use of blood products
To care for the patient in the post-operative period including the assessment of
common complications
To assess and plan perioperative nutritional management
97
2. Knowledge
Pre-operative assessment and management:
• Cardiorespiratory physiology
• Diabetes mellitus and other relevant endocrine disorders
• Fluid balance and homeostasis
• Renal failure
• Pathophysiology of sepsis – prevention and prophylaxis
• Thromboprophylaxis
• Laboratory testing and imaging
• Risk factors for surgery and scoring systems
• Pre-medication and other preoperative prescribing
• Principles of day surgery
Intraoperative care:
• Safety in theatre including patient positioning and avoidance of nerve
injuries
• Sharps safety
• Diathermy, laser use
• Infection risks
• Radiation use and risks
• Tourniquet use including indications, effects and complications
• Principles of local, regional and general anaesthesia
• Principles of invasive and non-invasive monitoring
• Prevention of venous thrombosis
• Surgery in hepatitis and HIV carriers
• Fluid balance and homeostasis
Post-operative care:
• Post-operative monitoring
• Cardiorespiratory physiology
• Fluid balance and homeostasis
• Diabetes mellitus and other relevant endocrine disorders
• Renal failure
• Pathophysiology of blood loss
• Pathophysiology of sepsis including SIRS and shock
• Multi-organ dysfunction syndrome
• Post-operative complications in general
• Methods of postoperative analgesia
To assess and plan nutritional management:
• Post-operative nutrition
• Effects of malnutrition, both excess and depletion
• Metabolic response to injury
• Methods of screening and assessment of nutritional status
• Methods of enteral and parenteral nutrition
98
2. Knowledge (cont.)
Haemostasis and Blood Products:
• Mechanism of haemostasis including the clotting cascade
• Pathology of impaired haemostasis e.g. haemophilia, liver disease,
massive haemorrhage
• Components of blood
• Alternatives to use of blood products
• Principles of administration of blood products
• Patient safety with respect to blood products
Coagulation, deep vein thrombosis and embolism:
• Clotting mechanism (Virchow Triad)
• Effect of surgery and trauma on coagulation
• Tests for thrombophilia and other disorders of coagulation
• Methods of investigation for suspected thromboembolic disease
• Principles of treatment of venous thrombosis and pulmonary embolism
including anticoagulation
• Role of V/Q scanning, CTpulmonary angiography, D-dimer and
thrombolysis
• Place of pulmonary embolectomy
• Prophylaxis of thromboembolism:
• Risk classification and management of DVT
• Knowledge of methods of prevention of DVT, mechanical and
pharmacological
Antibiotics:
• Common pathogens in surgical patients
• Antibiotic sensitivities
• Antibiotic side-effects
• Principles of prophylaxis and treatment
Metabolic and endocrine disorders in relation perioperative management
• Pathophysiology of thyroid hormone excess and deficiency and
associated risks from surgery
• Causes and effects of hypercalcaemia and hypocalcaemia
• Complications of corticosteroid therapy
• Causes and consequences of Steroid insufficiency
• Complications of diabetes mellitus
• Causes and effects of hyponatraemia
• Causes and effects of hyperkalaemia and hypokalaemia
3. Clinical Skills
Pre-operative assessment and management:
• History and examination of a patient from a medical and surgical
standpoint
• Interpretation of pre-operative investigations
99
3. Clinical Skills (cont.)
• Management of co morbidity
• Resuscitation
• Appropriate preoperative prescribing including premedication
Intra-operative care:
• Safe conduct of intraoperative care
• Correct patient positioning
• Avoidance of nerve injuries
• Management of sharps injuries
• Prevention of diathermy injury
• Prevention of venous thrombosis
Post-operative care:
• Writing of operation records
• Assessment and monitoring of patient’s condition
• Post-operative analgesia
• Fluid and electrolyte management
• Detection of impending organ failure
• Initial management of organ failure
• Principles and indications for Dialysis
• Recognition, prevention and treatment of post-operative complications
Haemostasis and Blood Products:
• Recognition of conditions likely to lead to the diathesis
• Recognition of abnormal bleeding during surgery
• Appropriate use of blood products
• Management of the complications of blood product transfusion
Coagulation, deep vein thrombosis and embolism
• Recognition of patients at risk
• Awareness and diagnosis of pulmonary embolism and DVT
• Role of duplex scanning, venography and d-dimer measurement
• Initiate and monitor treatment of venous thrombosis and pulmonary
embolism
• Initiation of prophylaxis
Antibiotics:
• Appropriate prescription of antibiotics
Assess and plan preoperative nutritional management
• Arrange access to suitable artificial nutritional support, preferably via a
nutrition team including Dietary supplements, Enteral nutrition and
Parenteral nutrition
Metabolic and endocrine disorders
• History and examination in patients with endocrine and electrolyte
disorders
• Investigation and management of thyrotoxicosis and hypothyroidism
• Investigation and management of hypercalcaemia and hypocalcaemia
100
3. Clinical Skills (cont.)
• Peri-operative management of patients on steroid therapy
• Peri-operative management of diabetic patients
• Investigation and management of hyponatraemia
• Investigation and management of hyperkalaemia and hypokalaemia
4. Technical Skills and Procedures
• Central venous line insertion
• Urethral catheterization
MODULE 6: ASSESSMENT AND MANAGEMENT OF PATIENTS
WITH TRAUMA (INCLUDING THE MULTIPLY
INJURED PATIENT)
1. Objective
Assess and initiate management of patients with chest trauma
• who have sustained a head injury
• who have sustained a spinal cord injury
• who have sustained abdominal and urogenital trauma
• who have sustained vascular trauma
• who have sustained a single or multiple fractures or dislocations
• who have sustained traumatic skin and soft tissue injury
• who have sustained burns
• Safely assess the multiply injured patient.
• Contextualise any combination of the above
• Be able to prioritise management in such situation as defined by ATLS,
APLS etc
2. Knowledge
General
• Scoring systems for assessment of the injured patient
• Major incident triage
• Differences In children
Shock
• Pathogenesis of shock
• Shock and cardiovascular physiology
• Metabolic response to injury
• Adult respiratory distress syndrome
• Indications for using uncross matched blood
101
2. Knowledge (cont.)
Wounds and soft tissue injuries
• Gunshot and blast injuries
• Stab wounds
• Human and animal bites
• Nature and mechanism of soft tissue injury
• Principles of management of soft tissue injuries
• Principles of management of traumatic wounds
• Compartment syndrome
Burns
• Classification of burns
• Principle of management of burns
Fractures
• Classification of fractures
• Pathophysiology of fractures
• Principles of management of fractures
• Complications of fractures
• Joint injuries
Organ specific trauma
• Pathophysiology of thoracic trauma
• Pneumothorax
• Head injuries including traumatic intracranial haemorrhage and brain
injury
• Spinal cord injury
• Peripheral nerve injuries
• Blunt and penetrating abdominal trauma
• Including spleen
• Vascular injury including iatrogenic injuries and intravascular drug abuse
• Crush injury
• Principles of management of skin loss including use of skin grafts and
skin flaps
3. Clinical Skills
General
• History and examination
• Investigation
• Referral to appropriate surgical subspecialties
• Resuscitation and early management of patient who has sustained
thoracic, head, spinal, abdominal or limb injury according to ATLS and
APLS guidelines
• Resuscitation and early management of the multiply injured patient
102
3. Clinical Skills (cont.)
Specific problems
• Management of the unconscious patient
• Initial management of skin loss
• Initial management of burns
• Prevention and early management of the compartment syndrome
4. Technical Skill and Procedures
• Central venous line insertion
• Chest drain insertion
• Diagnostic peritoneal lavage
• Urethral catheterisation
• Suprapubic catheterization
MODULE 7: SURGICAL CARE OF THE PAEDIATRIC PATIENT
1. Objective
To assess and manage children with surgical problems, understanding the similarities
and differences from adult surgical patients
To understand the issues of child protection and to take action as appropriate
2. Knowledge
• Physiological and metabolic response to injury and surgery
• Fluid and electrolyte balance
• Thermoregulation Safe prescribing in children
• Principles of vascular access in children
• Working knowledge of trust and Local Safeguarding Children Boards
(LSCBs) and Child Protection Procedures
• Basic understanding of child protection law
• Understanding of Children's rights
• Working knowledge of types and categories of child maltreatment, presentations, signs and other features (primarily physical, emotional,
sexual, neglect, professional)
• Understanding of one personal role, responsibilities and appropriate
referral patterns in child protection
• Understanding of the challenges of working in partnership with children
and families
• Recognise the possibility of abuse or maltreatment
• Recognise limitations of own knowledge and experience and seek
appropriate expert advice
• Urgently consult immediate senior in surgery to enable referral to
paediatricians
103
2. Knowledge (cont.)
• Keep appropriate written documentation relating to child protection
matters
• Communicate effectively with those involved with child protection,
including children and their families
3. Clinical Skills
• History and examination of the neonatal surgical patient
• History and examination of paediatric surgical patient
• Assessment of respiratory and cardiovascular status
• Undertake consent for surgical procedures (appropriate to the level of
training) in paediatric patients
MODULE 8: MANAGEMENT OF DYING PATIENT
1. Objective :
Ability to manage the dying patient appropriately.
Palliative Care: Good management of the dying patient in consultation with the palliative
care team.
2. Knowledge
Palliative Care:
• Care of the terminally ill
• Appropriate use of analgesia, antiemetics and laxatives
Principles of organ donation:
• Circumstances in which consideration of organ donation is appropriate
• Principles of brain death
Understanding the role of the coroner and the certification of death
3. Clinical Skills
Palliative Care:
• Symptom control in the terminally ill patient
Principles of organ donation:
• Assessment of brain stem death
• Certification of death
104
MODULE 9: ORGAN AND TISSUE TRANPLANTATION
1. Objective
To understand the principles of organ and tissue transplantation
2. Knowledge
• Principles of transplant immunology including tissue typing, acute,
hyperactute and chronic rejection
• Principles of immunosuppression
• Tissue donation and procurement
• Indications for whole organ transplantation
105