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Competent Trauma Care

Competent Trauma Care. Experience from Mozambique & Sri Lanka. Richard Fisher, MD University of Colorado Health Science Center. Premise. Trauma occurs in areas with access only to District Hospitals Staffed by recently graduated General Medical Officers

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Competent Trauma Care

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  1. Competent Trauma Care Experience from Mozambique & Sri Lanka

  2. Richard Fisher, MD • University of Colorado Health Science Center

  3. Premise • Trauma occurs in areas with access only to District Hospitals • Staffed by recently graduated General Medical Officers • Musculoskeletal Education is lacking in Medical Schools THEREFORE • Addressing the Medical School Curriculum -> Increased Competence

  4. Mozambique / Sri Lanka • Similar 20 million population Former European colonies Prolonged internal armed conflicts Socialist economies

  5. Mozambique / Sri Lanka • In contrast • Mozambique • 1 Medical School • 50 graduates / year • Sri Lanka • 6 Medical Schools • 1000 graduates / year

  6. Mozambique • Independence in 1975 • Internal conflict for 15 + years • Lost 30% of health care capacity • Facilities / Staff • Injuries in the rural areas / civilians • Referral not possible

  7. Mozambique • District Hospitals • GMO’s • Expatriate physicians • Surgical Technicians

  8. Mozambique • Surgical Technicians • 36 Month Training • Emergency Surgery • 80 now Functioning

  9. Universidade de Eduardo Monlane • Musculoskeletal curriculum • 12 Lectures 3rd year • Basic topics / No texts • General Surgery - clinical rotation • PGY 1 - one month outpatient Orthopaedics

  10. Mozambique • General Medical Officers • To District Hospital 2- 4 years • Competence level below presenting trauma Surgical Technicians • Surgical problems

  11. Sri Lanka • Armed conflict NE 1/3 • Restricted area - many medical needs • SW 2/3 of the Island • Minimal civilian involvement • Trauma - RTA / Civilian -fights and falls • Surgical service 75% trauma

  12. Sri Lanka • Motor Vehicles • 2000 1.7M • 2006 2.8M • New registration • 300,522 / year • 3X increase

  13. Sri Lanka • University of Ruhuna • Traditional Curriculum • Ortho Lectures Series • 4 week clinical rotation • General Surgery • 16 weeks • PGY 1 - no orthopaedics

  14. Sri Lanka • District Hospitals • Staffed by new General Medical Officers • Stay at post a short time 1-2 years • 1000 grads / year - enough staff • Trauma competence better - ??

  15. Sri Lanka • More Musculoskeletal Medicine - Traditional • Two Schools have changed curriculum • Added Musculoskeletal time • 6 week basic • 4 week clinical

  16. Education • Musculoskeletal Education lacking in Medical School Curriculum - • WHO Bulletin 2003 • Global Problem • MSK < 3 % of curriculum time • < 3.5% of PGY1 year

  17. Medical Education • AAOS - Project 100 • AAMC - Essential Competency Document • NBME - Standardized Shelf Exam • Bone & Joint Decade

  18. Global InitiativeEmergency & Essential Surgical Care • WHO Program • First Referral Hospital • General Medical Officer • Other Providers • Use in Medical Schools ?

  19. Curriculum • Curriculum change is a difficult process • Increasing the musculoskeletal content to the required level - is even harder However • The importance surgical expertise is becoming recognized slowly - • WHO, BJD, this conference

  20. Conclusion • Considering the staffing patterns of District Hospitals • Addressing the need within the Medical Schools could be an important strategy • We all need to participate

  21. Thank you - Have a Great Day

  22. Mozambique 1990-92 Prosthetics program HVO ICRC Save the Children USAID Funded Sri Lanka 2007-08 Medical School Curriculum Fulbright Fellowship

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