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NATIONAL ORTHOPAEDIC HOSPITAL, ENUGU.

RESIDENTS’ TRAINING MANUAL.

TABLE OF CONTENTS PAGE

SECTION ONE

BACKGROUND - - - - - - - - - 2

VISION AND MISSION - - - - - - - - 2

THE POST GRADUATE MEDICAL COLLEGES - - - - 2

EXPECTATIONS/ OBLIGATIONS OF THE TRAINER - - - 3

EXPECTATIONS/OBLIGATIONS OF THE RESIDENTS - - - 4

SECTION TWO

THE PROGRAMME - - - - - - - - - 5

ADMISSION INTO THE PROGRAMME - - - - - 12

PROGRESSION - - - - - - - - - 13

SPONSORSHIPS TO EXAMINATIONS AND COURSES - - - 13

ELIGIBILITY - - - - - - - - - - 14

WITHDRAWAL FROM PROGRAMME - - - - - - 14

RESEARCH GRANT - - - - - - - - 14

OVER-SEA CLINICAL ATTACHMENT - - - - - - 15

DISCIPLINE - - - - - - - - - 15
1. BACKGROUND

The National Orthopaedic Hospital, Enugu, is a 250 bedded hospital which offers services and training in Orthopaedics & Trauma Surgery, Burns & Plastic Surgery and Anaesthesia. The training is accreditated by both the National Postgraduate College of Nigeria and the West African College of Surgeons. Services and training are offered in the sub-specialties of General Orthopaedics as well as Trauma, Arthroplasty, Arthoscopy, Spine surgery, Paediatric Orthopaedics, General Plastic surgery, Burns, Craniofacial surgery, Hand Surgery, Microvascular surgery, Aesthetic surgery, Plastic Surgical oncology and Paediatric Plastic Surgery. Recently, the hospital decided to start training in Anaesthesia.

The institution provides training for an average of 50 residents with a yearly intake of 10 – 12 residents. At the end of the training programme residents are expected to have acquired proficiency in their chosen specialty to be appointed consultants.

They are expected to have acquired definite competencies in the four areas of professional practice namely, clinical problem solving, research, education and Health services management.



MISSION AND VISION STATEMENT OF NATIONAL ORTHOPAEDIC HOSPITAL, ENUGU.

OUR MISSION:

To provide the highest quality of services, training, and Research in Orthopaedics. Accidents and Emergency care, Burns & Plastic Surgery and Rehabilitation.



OUR VISION

To be a state-of-the art hospital with highly trained and motivated manpower where, Orthopaedic, Accident & Emergency Care, Burns, Plastic and Reconstructive surgery, Medical diagnostics, Rehabilitation and Efficient management are offered to all levels comparable to similar hospitals in any part of the world and to improve the quality of life of Nigerians.



THE POSTGRADUATE MEDICAL COLLEGES.

There are two postgraduate Medical Colleges involved in the training and certification of our residents.



  1. THE NATIONAL POSTGRADUATE MEDICAL COLLEGE OF NIGERIA.

Address: Km 26, Lagos – Badagary Expressway

PMB 2003, Ijanikan, Lagos, Nigeria.

Email: enquiry@npmcn.edu.ng

Website: www.npcn.edu.ng

Time of Examinations: May and November.


  1. WEST AFRICAN COLLEGE OF SURGEONS

Address: 8, Taylor Drive, off Edmund Crescent, Medical compound

PMB 2023, Yaba, Lagos, Nigeria.

Email: registrar@wac-physicians.org

admin@wac-physicians.org

Website: www.wac-physicians.org

Time of Examinations: April and October

EXPECTATIONS FROM/OBLIGATIONS OF TRAINERS/HOSPITAL.


  1. Trainers are committed to creating an environment conducive to the educational needs of all residents.

  2. Trainers are committed to provide clear rotation charts/plans for all residents from admission to completion of or withdrawal from programme.

  3. Trainers should provide timely discussion of unit based rotation specific goals, be available to ensure the actualization of such goals and ensure constructive and fair assessment of the residents based on the parameters in the Residents Evaluation & Assessment Form (REAAF).

  4. The trainer is expected to actively engage in regular teaching and discussions with the residents

  5. He/She is expected to be present at surgical sessions and to develop a systematic module for skill transfer to the residents.

  6. The trainer is expected to help the resident learn the tenets of biomedical research.

  7. The hospital is to encourage unit sub-specialization to enhance optimal learning during rotations.

  8. In all cases where residents are required to go to other centers for specific rotations, as may be required by either of the two colleges, the hospital will provide adequate and timely support to such residents.


EXPECTATIONS FROM/OBLIGATIONS OF THE RESIDENTS

  1. The resident is expected to be well motivated and dedicated in applying himself to mastery of the requirements of the programme.

  2. The resident is expected to demonstrate a collegial and professional attitude at all times towards graduated learning and responsiblity process. This is expected to conform to the ethics of the profession and code of conduct of the hospital.

  3. The resident is expected to demonstrate compassionate exemplary clinical care in the context of a multidisciplinary team environment.

4. Residents are expected to seek appropriate back up from trainers or seniors in the face of clinical uncertainty beyond their level of training or competence. At no time shall a resident embark on any procedure beyond his level of training or competence.

5. Residents Availability: The resident is obliged to be available, for services and training, at all times in compliance with requirements of the programme.

6. The resident is expected to request for and participate in regular unit based academic discussions and teaching programmes.

7. The resident is expected to request for and participate in regular tutored operative sessions geared towards skill transfer and acquisition

8. The resident is expected to acquire teaching, communication, research and management skills.

9. The resident is obliged to fill and sign off his log book at the end of each theatre session.

10. The resident is obliged to promptly present himself for assessment at the end of each posting.

11. The resident is expected to assess his trainer(s) at the end of each posting by appropriate use of the feedback system as provided in the REAAF.

NB: Residents are in training to become life-long learners to the practice and art of their respective disciplines.

PROGRAMME – Culled from the Harmonized Curriculum.
LEARNING OBJECTIVES

GENERAL EDUCATIONAL OBJECTIVES

By the end of his over-all training in the Residency programme, each resident in Surgery

should be able to:

1. Obtain, at first consultation, as complete a data base (History, Physical Examination) and Laboratory data) as is compatible with the urgency and complexity of the patient’s problems.


2. Recognise within the database, problems that:

(a) require further investigation or

(b) require therapeutic or supportive intervention.

 

3. Investigate clinical problems using relevant tests and other appropriate tools in order to clearly define the patient’s problems.


4. Interprete clinical findings and the results of diagnostic investigations, and by a clear process of deductive reasoning reach appropriate decision on clinical management and therapeutic intervention.

 

5. Perform all common operative procedures required for the restoration and/or maintenance of health for the individual patient.


6. Explain and defend the rationale of, and the technique and procedure employed in standard surgical operations.

 

7. Effect adequate post-operative care and full rehabilitation of his patient.



 

8. Demonstrate a clear, knowledge of the pathology, pathophysiology, clinical features, management options and result of therapy of common surgical diseases.


9. Provide effective supervision for his junior professional colleagues in their performance of simple surgical procedures.
10. Teach surgical concepts and operating skills to Junior colleagues.

 

11. Explain concepts of surgical diagnosis and treatment not only to his patients, but also to other members of the health team, so as to facilitate successful surgical care.



12. Demonstrate problem-solving ability by designing and implementing a simple research project relevant to the needs of his local environment.

 

13. Demonstrate general management competence in the appropriate use of resources (man, materials and money) to achieve effective surgical care.


14. Provide effective and purposeful leadership of the surgical team.

 

15. Ability to set up, organise and manage surgical services in any health care facility.




COURSE DURATION

The duration of the courses shall be as follows:

Part I Fellowship: 24-36 months.
Part II Fellowship: 24 - 36 months depending on the sub-specialty.
COURSE STRUCTURE

PRIMARY


The Primary Fellowship examination seeks to establish the Candidate’s trainability in Surgery by certifying that he is able to demonstrate adequate knowledge of basic medical sciences as applied to surgery in

(a) Human Anatomy (including cell biology, histology, embryology and osteology)


(b) Human Physiology (including biochemistry and pharmacology)

(c) Human Pathology (including haematology, chemical pathology, immunology and microbiology) as applied to surgery.



THE PRIMARY EXAMINATION
 The Primary examination now features:
Two sections of a single Paper :A 3 hour MCQ objective paper consisting of 150 stem Questions made up of:
-75 in Anatomy (including Embryology, histology and genetics).
- 75 in Pathophysiology of surgical conditions (including Microbiology and Pharmacology)


FORMAT FOR TRAINING

Training consists of two successive phases each lasting a minimum of twenty-four months viz:

 

(a) Junior Residency,


(b) Senior Residency.
JUNIOR RESIDENCY TRAINING- EDUCATIONAL OBJECTIVES
Resident should be able to
1. Successfully conduct the pre and post operative management of surgical diseases common in this environment.
2. Carry out all simple elective surgical procedures including skin incision and closure, herniorrhaphies, etc as well as perform the incision, exposure and wound closure for major operative procedures.
3. Perform common emergency surgical procedures, e.g. closed reduction and immobilization of fractures, laparotomy, appendicectomy, tube drainage of the pleural space, catheterization for the relief of urinary obstruction, burrhole for evacuation of extradural haematoma etc.

4. Manage


(a) the critically ill patient
(b) simple head injured patient
(c) the multiple-injured patient

FORMAT OF TRAINING – Junior Residency


 
A. Core Postings Duration
1. Accident and Emergency (Casualty) 6 months
 
2. General Surgery 6 months
 
3. Urology 3 months
 
4. Orthopaedics and Trauma 3 months

TOTAL = 18months
FORMAT OF TRAINING – Junior Residency
B. Elective Postings Durations
  1. Anaesthesia 3 months
  2. Burns and Plastic Surgery 3 months
  3. Cardiothoracic Surgery 3 months
4. Neurosurgery 3 months (now mandatory for the faculty of Orthopaedics)
  5. Paediatric surgery 3 months
In order to enhance the overall competence in surgical practice, even when a resident, has not rotated through a particular Elective posting, there should be opportunities for learning through the departmental didactic sessions covering ALL disciplines.

SENIOR RESIDENCY ENTRY REQUIREMENT
 
A candidate is eligible to be admitted to a Senior Residency Training in Surgery only on successful completion of the Junior Residency Training and passing the Part I Examination or exempted from Part I by the Faculty Board after passing any of its recognized equivalents.
GENERAL EDUCATIONAL OBJECTIVES

During this phase of training, residents are expected to perform at a higher proficiency level than they did during their junior residency, to assume a greater degree of responsibility for decision making in patient care as well as cover a much wider scope of surgical techniques and procedures.

By the end of the senior residency programme, each successful resident is expected to be able to perform effectively as a consultant surgeon.

SENIOR RESIDENCY

The senior residency training in Surgery lasts a period of twenty-four to thirty six months.

During his senior residency each resident is expected to execute a research project on a topic of his choice in any aspect of clinical surgery, under the supervision of at least two Consultants (at least one supervisor should be a Fellow of the College in Surgery).

GOAL OF THE DISSERTATION PROJECT
 
The goal of the dissertation exercise is to enable the resident to acquire skills for research and problem solving. It is not mandatory that, he breaks a completely new ground; the essence is for the resident to make contribution to knowledge.

To handle the Materials and Method of the study to obtain results relevant to the stated goals;


To analyze the results using appropriate statistical tools, and draw logical conclusions
To discuss his findings in relation to existing body of knowledge on the subject.
OBJECTIVES OF THE DISSERTATION PROJECT

To select and define clearly the research problem

To delineate the scope of the study bearing in mind the resources available

To define the objectives of the study in precise, clear terms leaving no doubt as to feasibility.

To review critically (not merely cite references from) available literature on the subject.
Course Structure for the Part II Training Programme
The sub-specialties in surgery are the following:


  • GENERAL SURGERY

  • ORTHOPAEDICS

  • PAEDIATRIC SURGERY

  • UROLOGY

  • BURNS, PLASTIC AND RECONSTRUCTIVE SURGERY

  • CARDIOTHORACIC SURGERY

  • NEUROSURGERY

1. GENERAL SURGERY

Following successful completion of the part I examination, the candidate wanting to

train in GENERAL SURGERY should seek admission into an accredited hospital for training in this specialty.

The training is for a period of 24-36 months and training is in various aspects of general surgery.

Each candidate should keep a daily and up to date record of operative procedures he/she participates in during this period of training, using the prescribed logbook for general surgery published by the faculty.

During this period, the candidate is encouraged to attend the integrated revision course in surgery regularly organized by the college.


CORE POSTINGS

These shall be the core postings;

a. Surgical Oncology [including Breast diseases, Surgical endocrinology and Skin / soft tissue lesions] - 6 months

b. Gastroenterology [including upper GIT, Colo-proctology, Laparoscopic and Endoscopic Surgery] - 12months

c. Hepatopancreaticobiliary surgery [may be combined with Gastroenterology but ideally should have a separate unit] - 6 months
ELECTIVE POSTING: The remaining 12 months

should be undertaken in 4 of the following areas:

Burns & Plastic Surgery 3 months

b. Paediatric Surgery 3 months

c. Orthopaedics/Trauma 3 months

d. Neuro Surgery 3 months

e. Urology 3 months

f. Cardio thoracic/Vascular Surgery 3 months


2. ORTHOPAEDICS

Following successful completion of the part I examination, the candidate wanting to train in ORTHOPAEDICS should seek admission into an accredited hospital for training in this specialty.

The training is for a period of 24-36 months and training is in various aspects of

Orthopaedic surgery and 6 months of elective postings.


The Core postings are:

Trauma


Arthroplasty

Arthroscopy

Paediatric Orthopaedics

Spine
The elective postings are:


Orthopaedic oncology
Burns and Plastic surgery

3. BURNS, PLASTIC AND RECONSTRUCTIVE SURGERY

Following successful completion of the part I

examination, the candidate wanting to train in

Burns, Plastic and Reconstructive Surgery

should seek admission into an accredited

hospital for training in this specialty.

The training is for a period of 36 months and

training is in various aspects of Burns, Plastic

and Reconstructive Surgery
The rotations are as follows:

General Plastic surgery

Trauma surgery

Burns surgery

Paediatric plastic surgery

Oncological surgery

Hand surgery

Reconstructive and aesthetic plastic surgery

Reconstructive genitalia surgery

Microsurgery


4. ANAESTHESIA


EVALUATION

PART 1 FMCS

Formative Assessment is done by the Training institutions.

Summative assessment is done by the Colleges.


PART II FMCS

Formative Assessment (Training institutions)

Summative (the College)

ADMISSION INTO THE PROGRAMME

Admission into the Residency Training Programme in the hospital is open to all medical practitioners with basic medical degrees registrable with the relevant National body for the regulation of Medical and Dental practice.


A pass in the surgery or anaesthesia specialty primary fellowship examination is mandatory for admission.

There are two modes of admission into the programme:



(a) Regular Residency

(b) Supernumerary

(A) Regular residency requires MBBS, full registration with Medical and Dental council, NYSC discharge certificate, a current practicing license and success at the selection interview.

(B) Supernumerary residents require MBBS, registration with Medical and Dental Council , NYSC discharge certificate, current practicing licence and a sponsor. The admission is subject to availability of vacancy and payment of stipulated bench fee.

PROCEDURE FOR ADMISSION

1. Admission shall be in October each year for regular residents.

2. All new residents will be expected to pass through an orientation programme within the first three months of admission.

3. All residents shall have copies of the hospital training manual and be aware of the requirements of the programme.

4. All new residents shall be included in the flow chart within the first rotation.

5. All residents shall be assessed on completion of each rotation. The assessment form must be submitted to the RET secretariat not later than two weeks from the completion of each posting.



PROGRESSION

  1. A Resident shall be admitted as Junior Resident II.

  2. A Junior Resident II shall be promoted to Junior Resident I after 12 (twelve) months of satisfactory posting.

  3. A Junior Resident I shall be promoted to Senior Resident II on passing the Part I fellowship examination.

  4. A Senior Resident II shall be promoted to Senior Resident I after 12 (twelve) months satisfactory posting.

SPONSORSHIP TO EXAMINATIONS & COURSES

Only regular residents are entitled to sponsorships.



EXAMINATION

  1. Sponsorship for part I examinations shall be for a maximum of 3 (three) examinations irrespective of college.

  2. Senior Residents shall be sponsored to a maximum of 3 (three) part II examinations of the college passed first at Part I or as determined by the resident provided success in the second Part I examination is within the same examination season as the first.

COURSES

Residents shall be sponsored to attend the following courses.

1. 2 (two) update courses for Part I and one (1) update course for Part II.

2. 1 (one) research methodology course or Manuscript writing course.

3. 1 (one) management course.

NB: Sponsorship opportunities for part I examinations automatically terminates following success in any of the colleges within an examination season.



ELIGIBILITY

To be certified fit to sit for examinations and to enjoy sponsorship to courses, a resident must score at least 70% in attendance to RET organized academic programmes and have a satisfactory REAAF assessment.

1. Application for sponsorship should be done at least one month from the intended examination or course

2. A resident is qualified for sponsorship to examination and/or course if he/she meets the requirements of the colleges and the hospital as outlined in this manual.

3. A resident is eligible to sit for an examination on satisfactory completion of stipulated postings.

WITHDRAWAL FROM THE PROGRAMME

4. A Resident shall automatically withdraw from the programme if he fails to pass the Part I Fellowship examination 18 months after the date of the first Part 1 examination you become eligible to sit.

5. If he fails to pass the Part II Fellowship examination 18 months after the date of the first Part II examination you become eligible to sit.

6. Six months after successful completion of the Part II examination or

7. If there is an established case of gross misconduct against the resident or

8. The resident may voluntarily withdraw from the programme in accordance with civil

service rules.

RESEARCH GRANT

A research grant of one hundred thousand naira only shall be awarded to post part I residents on presentation of an approved dissertation proposal. This grant will is subject to periodic review.



OVERSEAS CLINICAL ATTACHMENT

Post part I residents may be sponsored to overseas clinical attachment based on hospital needs and National Policy.



DISCIPLINARY MEASURES

Residents are expected to comport themselves and comply with the laid down rules of the hospital and civil service.

Residents should avail themselves of a copy of the public service rules.

Stipulated disciplinary actions in the public service rules shall apply to erring residents.



It is proposed that the Education Advisory Committee for Surgeons be re-christened Residency Training Committee.



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