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Rural Surgery Innovation in training

Rural Surgery Innovation in training. KM Shyamprasad , Vice-President National Board of Examinations (Postgraduate Medical Education) Ministry of Health, Government of India. NATIONAL BOARD OF EXAMINATIONS. Apex post graduate medical education body

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Rural Surgery Innovation in training

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  1. Rural SurgeryInnovation in training KM Shyamprasad, Vice-President National Board of Examinations (Postgraduate Medical Education) Ministry of Health, Government of India

  2. NATIONAL BOARD OF EXAMINATIONS • Apex post graduate medical education body • Under the Ministry of Health, Government of India • Accredits institutions for training and conducts post graduate examinations in 42 disciples of medicine both in broad and sub/superspecialities

  3. Need for Rural Surgical Training • Surgical training focused on surgical burden of disease in India • The current Euro-western models of medical education- depriving health care providers for rural India ( 70% of population) • 25% of all deaths in India are due to two surgical causes: • Maternal Mortality • Injuries

  4. INJURIES • 11% of all deaths and 170,00,000 hospitalizations. A further 5,00, 00 000 seek hospital care for injuries according to the estimation of the NCMH.

  5. INJURIES • Blunt and penetrating injuries- 3rd leading cause of death and disability • Decreasing in developed countries • Increasing in developing countries

  6. What is Rural Surgery • Surgical emergencies and problems causing rural morbidity and mortality • Training on a different model- new paradigm • Training should be in rural settings • Cost containment • Less reliance on sophisticated investigations and equipment

  7. Syllabus • Syllabus ensures knowledge, competencies and skills to function as an independent surgeon in resource limited settings of a rural surgical centre

  8. Syllabus • Management of a Rural Surgical Centre • Management of Urological, Pediatric, Thoracic, Plastic, and Neurosurgical emergencies, • Management of Abdominal emergencies, Essential elective general surgery, • Essential Orthopedics and Trauma, • Obstetrics and Gynecology • Emphasis on prevention and management of obstetrical emergencies

  9. Essential Orthopedics and Trauma • Acute trauma • Injuries of upper limb • Injuries of lower limb • Injuries of the spine • Amputations

  10. SKILLS TO BE LEARNT • IV access, Intubations CPR • Splintage, Skin and Skeletal traction • CTEV cast correction • Close Reduction of fractures and dislocations • Debridement and management of open fractures -external fixators

  11. SKILLS TO BE LEARNT • Hand injury • Amputation • Sequestrectomy • Arthrotomy • Use of tongs and calipers • Bone Biopsy

  12. INNOVATIVE MODEL • A model of training is on trial in 6 centers across India • Each centre has been chosen for its commitment to provide surgical care for the rural population. • A peripheral rural and a nodal center have been connected for training • The nodal center provides the variety of surgical training opportunities needed

  13. Peripheral Center • Prepares the candidate for the living conditions • Economics of rural health care • Infrastructural constrains • Helps develop the right attitude

  14. ROTATIONS • General Surgery- 1 year • Obstetrics and Gynecology -6 months • Orthopedics and Trauma - 5 months • Anesthesia – 1 month • Peripheral Centre- 1 year

  15. Learning Resources • Emergency and Essential Surgical Care E-learning Tool Kit developed by the Emergency and Essential Surgical Care project of the World Health Organisation, which includes and the Text Book on Surgery at the District Hospital. • A detailed modular Syllabus and Curriculum for Rural Surgical training developed by the Indira Gandhi National Open University. • Audio Visual learning material developed by NBE in various disciples of medicine and surgery.

  16. Review of the Program • 10 candidates have been registered • Nodal and peripheral centers have to define their roles more clearly • Faculty training required • Emphasis on life saving skills/hands on training • Log Book • Thesis

  17. FUTURE NEEDS • Text Book of Rural Surgery • Faculty Development Programs • Standardized courses in Basic Surgical Skills and Trauma • Identifying experts for evaluation, TOT, examiners • Methodology for final summative examination

  18. “STEPS” Sequential Trauma Education ProgramS Global Injury Solutions

  19. Future perspectives • Teams for Rural Surgery • Anesthetists • Surgical Care providers-Pre- Hosp care • Family Physicians- +PAs’ • Force Multipliers • Alternative Health Care Delivery Systems- Suitable for regional needs • Appropriate Technology

  20. Thank you for the Attention

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