THE TAMIL NADU DR. M.G.R.

MEDICAL UNIVERSITY,
CHENNAI

REVISED CURRICULUM FOR COMPETENCY BASED

TRAINING OF M.S. ORTHO CANDIDATES

ORTHOPAEDICS 2010
CONTENTS

Major Goals

Objectives

Tentative schedule for training

Thesis

Methods of training

Concurrent assessment and final examination

Annexure

Annexure-I, Syllabus

Annexure-II, Details of the skills to be acquired during the train-

ing period

Annexure-III, Sample cases for presentation and discussion

Annexure-IV, Sample questions for concurrent assessment

Annexure-V, Suggested list of books and journals

Annexure-VI, Guidelines for writing thesis

Annexure-VII, Guidelines for local appraisers for six monthly

assessment

Annexure-VIII, Format for log boo k

MAJOR GOALS

Patient care ability: A candidate in orthopaedics surgery at the end of

its 3 year course should develop proper clinical acumen to interpret diagnostic
results and correlate them with symptoms. He should become capable to diag-
nose common clinical conditions/diseases in the speciality and to manage them
effectively with success without making any serious complications and sincere
to take such accurate decision for the patient’s best interest. He should be able
to decide for making a referral to consultation with a more experienced col-
league/professional friend while dealing with any patient with a difficult problem.

Teaching ability: He/she should be able to teach MBBS stu-

dents about the commonly encountered conditions in orthopaedics, per-
taining to their diagnostic features, basic pathophysiological aspects
and the general and basic management strategies.

Research Ability: He/she should also acquire elementary

knowledge about research methodology, including record-keeping
methods, and be able to conduct a research inquiry including making a
proper analysis and writing a report on its findings.

Team work: He/she should be capable to work as a team mem-

ber. He/she should develop general humane approach to patient care
with communicating ability with the patients‘ relatives, especially in
emergency situations such as in casualty department, while dealing
with cancer patients and victims of accidents.

Academic Activities: He/She should acquired theory knowledge

from the prescribed books which is the basic for application of the
clinical practice.

He/she should also maintain human values with ethical considerations.

OBJECTIVES TO BE ACHIEVED BY AN INDIVIDUAL AT
THE END OF 3 YEARS OF MS ORTHOPAEDICS:

A candidate at the end of a 3-year course should acquire the fol-

lowing:

Cognitive knowledge: Describe embryology, applied anatomy,

physiology, pathology, clinical features, diagnostic procedures and the
therapeutics including preventive methods (medical/surgical) pertain-
ing to musculoskeletal system.

Clinical decision making ability & management expertise: Di-

agnose conditions from history taking, clinical evaluation and investi-
gations and to develop expertise to manage medically as well as surgi-
cally the commonly encountered disorders and diseases in different areas.

Teaching: Acquire ability to teach the MBBS students in sim-

ple and straightforward language about the common orthopaedic ail-
ments/disorders, especially about their signs/symptoms for diagnosis
with their general principles of therapy.

Research: Develop ability to conduct a research enquiry on

clinical materials available in hospital and in community.

Patient doctor relation: Develop ability to communicate with

the patient and his/her relatives pertaining to the disease condition, its
severity and options available for the treatment/therapy.

Preventive Aspect: Acquire knowledge about prevention of

common conditions especially in children such as poliomyelitis, con-
genital deformities, cerebral palsy and common orthopaedic malignancies.

Tentative Schedule for three years of MS Orthopaedics

CLINICAL POSTING

Spend 3 (Three) months in orientation programme including ex-

posure to casualty.

Learns bedside history taking in ward, OT exposures, casualty,

ICU requirement and their visit to related disciplines such as physical
medicine and rehabilitation/Anaesthesia.

Care of indoor (medical preoperative and postoperative) patients

for a minimum period of 3 months and learn techniques of traction,
wound care and splintage.

Attends operation theatre and emergency operations for acclima-

tization. Assists ward rounds and visits other wards with senior col-
leagues to attend call/consultation from other departments.

Participates in the teaching sessions in wards for bedside clinical

teaching in the weekly afternoon seminar/journal club.

MAIN POSTINGS

Speciality Postings - 2 Months

Advanced Training in the centre of excellence – 1 Month

Attends orthopaedic OPD 2 days in a week

Discuss problematic cases with consultant (s) in OPD/ward

Attends operation room/theatre 2 - 3 days in a week

Attends 2 morning rounds/week

Care of the indoor patients on beds allotted to him/her.

Attends the weekly journal Club and seminar and presents the
same by rotation.

Attends speciality clinics, viz Sports medicine, Spine clinics,

polio, hand, Paediatric, arthritis clinics and presents cases; participates
in discussions including therapy-planning etc.

During the course, the resident must attend the combined teach-
ing Programme of the department of Pathology, Forensic Medicine,
Anatomy, Vascular Surgery and Plastic Surgery, i.e. clinical meetings,
CPC‘s of students and staff of the whole hospital.

Surgicopathological conference in pathology department, with

surgeons.

Does 24 hours-emergency duty once a week/as per roster of the

department.

Attends lectures by the visiting faculty to the department/college

from India/abroad.

Attends/participates/presents papers in State / Zonal /National /

International conferences.

Actively participates/helps in organization of departmental

workshop, courses in specialized areas like Arthroplasty, Arthroscopy,
Spine, and Hand Surgery from time to time.

Actively participate in the orthopaedic skills lab, Orthopaedic

Cadaveric Skills Lab training programmes Exposure to the bone bank
activities.
™ Continuous Medical Education (CME) – 50 hrs

™ Research Work – Atleast 2 in Number

™ National/ Regional Conferences – Minimum 3 Pa-

pers

™ Academic Activity – 100 Case Presentation in 3

years

™ 30 Academic Presentation inside the department

™ Compulsory programme of documentation, clinical

research and medico legal aspect to be the part of
curriculum.

THESIS

Research methodology/reporting on research: Learns the basics

in research methodology.

Problem oriented record keeping including the use of computer.

Use of medical literature search through the internet or library.

Attends Biostatistics classes by arrangement.

Research Report œ preparation and writing of Protocol for

Research/Thesis.

Writing an abstract/short paper/presentation style (slide-making

& audiovisual aids).

Preparation of a report on a research project/Thesis.

Humanity/Ethics: Lectures on humanity, personality develop-
ment, team spirit and ethical issues in patient care and human relation-
ship including, public relations, by Psychologist and public relation of-
ficers are to be arranged by the department/college.

METHODS OF TRAINING AND TEACHING

The following learning methods are to be used for the teaching

of the postgraduate students:

1) Journal Club : 1 hour duration œ Paper presenta-

tion/discussion œ once per week (Afternoon).

2) Seminar : One seminar every week of one hour

duration (Afternoon)

3) Lecture/discussion : Lectures on newer topics by

faculty, in place of seminar/as per need.

4) Case presentation in the ward and the afternoon

special clinical (such as Scoliosis/Hand clinics),
Resident will present a clinical case for discus-
sion before a faculty and discussion made per-
taining to its management and decision to be re-
corded in case files.

5) Case Conference œ Residents are expected to

work-up one long case and three short cases and
present the same to a faculty member and discuss
the management.

6) X-ray Classes œ Held twice weekly in morning in

which the radiologic features of various problems
are discussed.
7) Surgicopathological Conference : Special empha-
sis is made on the surgical pathology and the ra-
diological aspect of the case in the pathology de-
partment such exercises help the orthopae-
dics/Pathology/Radiology Residents.

8) Combined Round/Grand Round : These exercises

are to be done for the hospital once/week or
twice month involving presentation of usual or
difficult patients. Presentation of usual or diffi-
cult patients. Presentations of cases in clinical
combined Round and a clinical series/research
data on clinical materials for benefit of all clini-
cians/Pathologists/other related disciplines once
in week or fortnightly in the Grand round.

9) Emergency situation: Casualty duty to be ar-

ranged by rotation among the PGs with a faculty
cover daily by rotation.

10) Afternoon clinics: Clinical classes should be

taken in the afternoon from 2 to 4pm daily in the
form of case presentation, lectures, CME pro-
grammes.

11) Besides clinical training for patient care management

and for bed side manners : Daily for ² to one hour‘s
during ward round with faculty and 1-2 hours in the
evening by senior resident/faculty on emergency duty,
bed side patient care discussions are to be made.

12) Clinical teaching : In OPD, ward rounds, emer-

gency, ICU and the operation theatres: Resi-
dents/Senior Residents and Faculty on duty in re-
spective places œ make discussion on clinical di-
agnosis/surgical procedures/treatment modalities,
including postoperative care and preparation of
discharge slip.

13) Plaster room training: 1 month of posting at plas-

ter room in the time of OPD should be the part of
curriculum.

14) Special posting in paediatric orthopaedics, reha-

bilitation, hand and plastic surgery, vascular sur-
gery and anaesthesia each 15 days or mandatory
for completion of course.

15) Advanced technology exposure in centre of ex-

cellence is
optional 1 month duration in 3 rd year of curricu-
lum.
ASSESSMENTS/ EXAMINATIONS

CONCURRENT EXAMINATION/ASSESSMENT

The purpose of the c4oncurrent assessment is to give regular

feed back to the MS candidates about their performance and to prepare
them for the final terminal examination by giving them exposure to the
examination pattern. As a part of the concurrent evaluation the MS
candidates will be assessed every six months by an independent local
appraiser from the same institution (Professor/ Associate Professor)/
from the same university. This would include theory examination (100
marks of three hours duration) containing 10 short structured question
related to the topics covered during the preceding six months.

The practical examination (300 marks) will include long case,

short case, spots, ward round, viva voce on the topics covered during
the period by the hospital/institution.

FINAL EXAMINATION

The Final Examination shall consist of

1) Theory exams four papers

2) Practical Exams

THEORY PAPERS

Theory: There shall be total of four papers: Each being of three

hours duration. Each paper will have 2 essays and 6 short questions from the
curriculum (Old pattern).
Basic Sciences as applied to Orthopaedics (Anatomy,
PAPER I Physiology, Biochemistry, Pathology, Pharmacology,
Microbiology)
Traumatology and recent advances
PAPER II
Orthopaedics and recent advances
PAPER
III
Sub Speciality (Arthroplasty, Arthroscopy, Spine, Sports
PAPER Medicine, Oncology, etc)
IV

PRACTICAL EXAMINATION

Clinical Examination Total Marks: 200

No. of Cases Marks
1. Long Case One 80
2. Short Case Three 120
( 3 x 40 Marks)
Total 200

Viva Voce Examination Total Marks: 100

1. OSCE 50
2. Log Book (Evaluation & Questioning ) 20
3. Orals on Recent Advances 30
Total 100
Candidate must pass each component separately. Event if a can-
didate fails in one component, the candidate is deemed to have failed
in the whole examination.

GUIDE LINES

Each candidate should be examined by a minimum of One Inter-

nal and One External Examiner.

Long Case

1. For examining the candidate by the examiners, a

minimum of 30 minutes per candidate should be
taken.

2. 30 minutes for a student for examining long case

and 10 minutes for writing case sheet.

Short case

1. For examining the candidate by the examiners, a

minimum of 10 minutes for each short case should
be taken.

2. 10 minutes for examining each short case.

3. No case sheet writing for short case.

Hand Written Log Book

The Hand written Log Book must be presented to the examiners

for evaluation and questioning.

Hand written Log Book has to be maintained by the candidate

throughout the 2 years. It has to be certified by the Head of the De-
partment every year. Every quarterly it must be reviewed by the Unit
Chief. Every month it should be checked by the Unit Assistant Professor.
ANNEXURE- I, THEORY SYLLAB US

BASIC SCIENCES

Development of skeleton, histology of cartilage histology &

histopathology of bone, physiology of fracture healing, delayed and
non-union of bones, histology of skeletal muscle, collagen, physiology
and mineralization of bone, physiology of cartilage, biophysical prop-
erties of bony and bone disease and related dysfunction of parathyroid
glands.

PRINCIPLES & PRACTICE OF ORTHOPAEDICS

Bone infections (Pyogenic, tuberculosis, syphilis, mycotic infec-

tions, salmonella & brucella osteomyelitis), congenital deformities
(upper & lower extremities, spine and general defects), developmental
conditions (osteogenesis imperfecta, dysplasias, hereditary multiple
exostosis etc.) diseases of the joints (osteoarthritis, rheumatoid arthri-
tis, neuropathic joints, ankylosing spondylitis, sero-negative spondy-
loarthropathy, traumatic arthritis etc.) orthopaedic neurology, tumors
of bony. Disorders of hand & their management.

GENERAL SURGICAL PRINCIPLES & ALLIED SPECIALI-

TIES

General surgery, oncology, and medicine as applicable to the

musculo-skeletal disorders/disease.

Radiology, Imaging œ computed tomography and magnetic reso-

nance imaging and interventional radiology and angiography as related
to orthopaedics.

General pathologic aspects such as wound healing and also pa-

thology and pathogenesis of orthopaedic diseases, pharmacology, mo-
lecular biology, genetics, cytology, haematology, and immunology as
applicable to orthopaedics.

General principles of traumatology.

Plastic surgery as applicable to orthopaedics

Pediatric orthopaedics- The student should be exposed to all as-

pects of congenital and developmental disorders such as CTEV (club-
Foot), development dysplasia of hip, congenital deficiency of limbs.
Perthe‘s disease and infections, and also to acquire adequate knowl-
edge about the principles of management of these disorders.

Orthopaedic oncology- The resident is expected to be familiar

with the tumours encountered in orthopaedic practice. The recent
trends towards limb salvage procedures and the advances in chemo-
therapy need to be familiar to him.

Management of Trauma- Trauma in this country is one of the

main causes of morbidity and mortality in our demographic statistics.
The student is expected to be duly conversant with trauma in its en-
tirety. In any type of posting after qualification the orthopaedic sur-
geon would be exposed to all varieties of acute trauma. Hence, it is his
responsibility to be able to recognize, assess and manage it including
the medico legal aspects.

Sports Medicine œ A lot of importance is being given to sports

medicine especially in view of the susceptibility of the athlete to injury
and his failure to tide over them. Sport medicine not only encompasses
diagnostic and therapeutic aspects athletic injuries but also their pre-
vention, training schedules of personnel and their selection.

Physical Medicine and Rehabilitation œ The student is expected

to be familiar with this in all its aspects. Adequate exposure in the
workshop manufacturing orthotics and prosthetics is mandatory, as is
the assessment of the orthopaedically handicapped.
Orthopaedic Neurology œ The student should be exposed to all
kinds of nerve injuries as regards their recognition & management
cerebral palsy and acquired neurological conditions such as post polio
residual paralysis and peripheral nerve injuries also need to be empha-
sized in their entirety.

Spine Surgery -The student is expected to be familiar with vari-

ous kinds of spinal disorders such as scoliosis, kypho-scoliosis, spinal
trauma, PIVD, infections (tuberculosis and pyogenic), & tumours as
regards their clinical presentations and management.

Radiology œ Acquire knowledge about radiology/imaging and

to interpret different radiological procedures and imaging in musculo-
skeletal disorders.

There should be collaboration with Radiology department for

such activities.

Psychological and social aspect œ Some elementary knowledge

in clinical Psychology and social, work management is to be acquired
for management of patients, especially those terminally ill and dis-
abled-persons and interacting with their relatives.

YEAR WISE BREAK UP OF SYLLABUS

First Year
Humanity/Ethics -Lectures on humanity, personality develop-
ment, team spirit, Ethical issues in patients, Doctor- patient relation-
ship and interpersonal relationship- 3 lectures

Basic Sciences-Development of skeleton, Histology & Histopa-

thology of cartilage & bone, Histology of skeletal muscle, collagen,
Physiology of cartilage, Biophysical properties of bone and bone dis-
eases and related dysfunction of parathyroid glands, Physiology of
fracture healing, Delayed union & non-union of bones

Emergency management of the Injured patient including critical

care-lectures by Anaesthetist for airway maintenance & shock man-
agement, Basic splintage and transportation techniques, ATLS

Medical record keeping and bio-statistics

Preparation for thesis/ protocol

History taking and clinical examination of the patient

Common fractures/dislocations diagnosis and management in-

cluding traction techniques

Interpretation of plain x-rays and clinico-radiological co-relation

Diagnosis and management of acute and chronic orthopaedic in-

fections

Second Year

Pediatric Orthopaedics with emphasis on CTEV, CDH, Perthes

disease, S.C.F.E., club hand

Physical Medicine & Rehabilitation: with emphasis on electro

diagnosis and various physiotherapy and occupational therapy tech-
niques

Orthopaedic neurology including Polio, Cerebral palsy, spina-

bifida

♦ Hand Surgery

♦ Plastic Surgery related to orthopaedics

Interpretation of C.T., MRI, Bone Scanning - Techniques and

clinico- radiological co-relation.

Orthopaedic Oncology

Surgical stabilizations of orthopaedic trauma

Peripheral nerve injuries

Clinical orthopaedics

Biomaterials in orthopaedics

Vascular surgery

Third Year

Reconstructive orthopaedics

Sports medicine and arthroscopy

Arthroplasty

Spinal disorders including scoliosis, trauma, infections, degen-

eration and tumours

Clinical orthopaedics

Recent advances in orthopaedics

One month optional posting in Centre of Excellence

Thesis Submission

Research Publication

Revision courses
ANNEXURE-II, DETAILS OF THE SKILLS TO BE
ACQUIRED DURING THE TRAINI NG PERIOD
Clinical procedures, which the candidates must know

Number of
S. As As first procedure
Name of procedure
No Observer Assistant able to per-
form
FIRST YEAR
1 ORTHOPAEDICS
Skin traction Yes

2 Skeletal traction of upper Tibia, Yes

distal Tibia, lower Femoral,

Trochonteric screw, Olecranon,
Calcaneal and Skull traction

3 Closed reduction of Fractures Yes

& Dislocations: Clavicle,
Shoulder dislocation, proxi-
mal Humerus, shaft of Hume-
rus, supra-condylar / inter
condylar and distal humeral
fracture, dislocation Elbow,
Fracture of both bones fore-
arm, Monteggia and Galleagi
fracture- dislocation, Colles‘
and other distal radial frac-
tures, Scaphoid fracture, per-
ilunar dislocations, and re-
lated carpal dislocations, dis-
locations of hip, fracture shaft
of femur in children, tibial
Number of
S. As As first procedure
Name of procedure
No Observer Assistant able to per-
form
shaft fracture, Ankle frac-
tures& dislocations.

4 Management of open frac-

tures
Yes
- Debridement, external fixa-
tion Yes
- Soft tissue reconstruction
including bone coverage
SECOND YEAR
5. Open reduction and internal Yes
fixation of Fractures
Plate Osteosynthesis in shaft Yes
Humerus and both bones
forearm fractures
Yes
Tension band wiring of Ole-
cranon, Patella & Medial mal-
leolus fractures Yes

Kirschner wire fixation of su-

pra condylar fracture of hu- Yes
merus
Cannulated screw fixation for Yes
fracture neck of femur
Dynamic Hip Screw of tro- Yes
chanteric fracture
Intramedullary nailing for Yes
femoral shaft fracture - Fixa-
tion of Potts fracture
Excision of Head Radius
6 Bone & Joint Infections Aspi- Yes
ration of joint
Drilling/ Decompression of Yes
metaphysic
Number of
S. As As first procedure
Name of procedure
No Observer Assistant able to per-
form
Drainage of abscess Yes
Sequestrectomy& saucerisa- Yes
tion
Yes
Girdlestone/Excision arthro-
plasty of Hip
7. Bone tumors
Biopsy from tumor Yes
Excision of ostochondroma Yes
Curettage & Bone grafting Yes

THIRD YEAR
8. Fixation of Fractures like Yes
proximal Humeral, Supra-
condylar Femur, Proximal
tibia & Talus fracture - dislo-
cation Interlocking Nail- Fe-
mur, Tibia
9. Spine
Exposure to spine by poste-
Yes
rior, anterior and anterolateral
approaches
10. CTEV Manipulation and POP Yes
application Yes

Tendo Achilles lengthening

11. Postero-medial soft tissue re- Yes

lease
Yes
Bony procedures including
triple
arthrodesis
Number of
S. As As first procedure
Name of procedure
No Observer Assistant able to per-
form
12 High tibial osteotomy Yes

13 Tendon repair Yes

14 Poliomyelitis Hamstring Re- Yes

lease & Posterior Capsu-
lotomy Flexor Abductor re-
lease
Yes
Corrective osteotomies of
Humerus, Femur and Tibia
Yes
Knee & Ankle arthrodesis
Pantalar and triple arthrodesis
Yes Yes
Limbs lengthening / Illizarov
procedure
15 Arthrolysis of Elbow joint Yes Yes

16 Amputations Yes

17 Limbs salvage procedures Yes

DESIRABLE PROCE-
DURES Yes
Endoscopy
Yes Yes
Arthroscopy of knee
Joint replacement
Yes Yes
Hip joint
Yes Yes
Knee joint Yes
Peripheral nerve repair
Yes
Tendon transfer procedures Yes
Spinal stabilization proce-
dures like pedicular screw
INVESTIGATIONS/ TESTS WHICH THE CANDIDATES
MUST KNOW TO INTERPRET

Name of Investigations Tests

Hematological investigations in - CBC

- C-reactive protein,

Orthopaedic conditions like - Rheumatoid factor,

- HLA-B27,

- Serum Electrophoresis,

- Serum Ca, P, Alkaline phos-

phatase, Acid phosphatase,
Uric acid, Total proteins &
A.G. ratio

- Elisa

Urine - Bence Jones proteins,

- 24hr Urinary Ca

Radiological investigations - Plain radiography

- CT Scan, MRI

- Radio- isotope bone scan

Histopathological slides of common - Interpretation of Tubercle,

Orthopaedic conditions like - Myeloma

- Osteosarcoma

- Ewing Sarcoma

- Giant cell tumor

ANNEXURE III, SAMPLE CASES FOR PRESENTA-
TION AND DISCUSSION

LONG CASES

Fixed/ Ankylosed hip

Neglected fracture Neck of femur

Tubercular Hip

Neglected traumatic dislocation hip

Potts paraplegia

Extra dural cord compression

Prolapsed intervertebral disc

Spinal Canal stenosis

Cauda equina syndrome

Avascular Necrosis of Hip

Traumatic paraplegia

SHORT CASES

Cubitus varus/ Valgus

Non union Humerus with or without radial nerve palsy

Non union lateral condyle of Humerus

Infected non union

Chronic osteomyelitis
Post polio flail shoulder/ paralysed elbow

Neglected unreduced Dislocation Elbow

Neglected unreduced Dislocation Shoulder

Malunited Colles Fracture

Carpal tunnel Syndrome

Bone tumors like Ostesarcoma, Ewing‘s Sarcoma, Giant cell

tumor, Osteochondroma, Osteiod osteoma etc

Genu varum/ Genu Valgum

Ruptured Tendo Achillis

Erb‘s palsy/ Brachial plexus injury

Nerve injuries-Median Nerve, Radial Nerve, Ulnar Nerve, Sciatic

Nerve, Common Peroneal Nerve

SPOTS

Pathological Specimens-Giant cell Tumor, Osteosarcoma, Ew-

ings Sarcoma, Sequestrum, Madura foot

Bones

Instruments

X-Rays

Orthotics/ Prosthetics-Patellar tendon bearing prosthesis, Cock

up Splint, Denis brown splint, Ischial weight relieving caliper,
Jaipur foot
ANNEXURE-IV, SAMPLE QUESTIONS FOR SIX
MONTHLY ASSESSMENTS

What is informed consent? What is its relevance?

How would you declare the news of a dead patient to the rela-
tives?

How would you explain the complications of a surgical proce-

dure and its significance?

How much one should inform to patient about the disease?

Essay/ short notes on-Histology of Bone, Joint Lubrication, Car-

tilage/Chondrocyte Culture & its use in orthopaedics, Bone Me-
tabolism, Spaces of Hand, Posterior approach to hip, Initial re-
suscitation of a poly traumatized patient, Fat Embolism, Gas
gangrene, Tetanus, Tourniquet, Application of Chi Square test

Russel Traction

Techniques of application of skull traction

Thomas Splint

Clinical features, Diagnosis and Management of Supra condylar

fracture of Humerus

Myositis ossificans

Causes of Nonunion of bone

Principles of management of Nonunion

Acute osteomyelitis of Proximal tibia- Diagnosis & management

Tuberculosis of Hip- Clinical & radiological staging

Pathoanatomy of Congenital Talipes equinovarus

Classification of various stages of Perthes disease

Management of Perthes disease

Management of Dysplastic hip

Clinical manifestations of congenital dislocation of hip

Management of slipped capital femoral epiphysis

Short notes on-Club hand, Short wave diathermy, Electromyog-

raphy, Strength duration curve, Continuous passive motion,
Tecnicium 99 bone scan

Aneurysmal Bone cyst

Osteochondroma

Limb salvage in Tumors

Chemotherapy for Osteosarcoma

Multiple Myeloma

Claw Hand

Tendon transfer in Radian nerve injury

Foot drop

Nerve grafting

Silicon in orthopaedics

Ceramics in orthopaedics
Metal on metal joints

Bone cement

Clinical features of Meniscal Injury

Anterior cruciate ligament repair

Bankart‘s repair

Management of caries spine with neurological deficit

Spondylolisthesis- Its complications & Management

Lumbar Canal stenosis

Discography

Laminoplasty

Complication of Total Hip Replacement

Peri prosthetic fractures

Unicondylar Knee

Articular Surface replacement

ANNEXURE - V, BOOKS AND JOURNALS WHICH
THE CANDIDATE MUST READ

FIRST YEAR

1) Mercer‘s orthopaedics surgery, Duthie, Edward Arnold

2) Campbell’s Operative Orthopaedics, Canale and Beaty

3) Outline of orthopaedics, Crawford Adams, Churchill

Livingston

4) Closed treatment of fractures, H. John Charnley, Churchill

Livingston

5) Apley’s

SECOND YEAR

6) Text book of orthopaedics, Samuel Turek

7) Campbell’s Operative Orthopaedics, Canale and Beaty

8) Exposures in Orthopaedic Surgery, Hoppen Field

9) AO Principles of internal fixation

10) AO Principles of external fixation

11) Chapman’s Orthopaedics

12) Watson Jones fractures and joint injuries, J.N. Wilson,

Churchill Livingston

THIRD YEAR

13) Fractures in adults and children, Rockwood, Greens

14) Campbell’s Operative Orthopaedics, Canale and Beaty

15) AO Spinal fixation

16) KIRK

17) Orthopaedics diseases, Aegerter & Kirkpatrick, Saunders

18) Tumours and tumourous conditions of bones and joints,

Jaffe, Lea Febiger

19) Clinical Evaluation – DAS, McRay, Panday

20) SM TULI Tuberculosis of musculoskeletal system

21) Limb reconstruction procedures

22) Arthroscopy

JOURNALS

Indian journal of orthopaedics

Journal of bone and surgery ( British and American volumes0

Orthopaedics clinics of North America

Clinical orthopaedics and related research

Yearbook of orthopaedics

Journal of rehabilitation

INJURY

British journal of Rheumatology and physical medicine

Journal of Arthoplasty

Journal of Arthroscopy
ANNEXURE-VI, GUIDELINES FOR WRITING
THESIS/DISSERTATION

Research shall form an integral part of the education programme

MS Orthopaedics. The Basic aim of requiring the candidates to write a
thesis/dissertation is to familiarize him/her with research methodology.
The members of the faculty guiding the thesis/dissertation work for the
candidate shall ensure that the subject matter selected for the the-
sis/dissertation is feasible, economical and original.

GUIDELINES

1. The thesis may be normally restricted to the size to 100

pages. To achieve this, following points may be kept in
view;

i) Only contemporary and relevant literature may be re-

viewed.

ii) The techniques may not be described in detail unless any

modification/innovations of the standard techniques are
used and reference may be given.

iii) Illustrative material may be restricted.

iv) Since most of the difficulties faced by the residents relate

to the work in clinical subject or clinically oriented labora-
tory subjects the following steps are suggested:

For prospective study, as far as possible, the number of cases

should be such that adequate material, judged from the hospital atten-
dance, will be available and the candidate will be able to collect the
case material within a period of 6-12 months so that he/she is in a posi-
tion to complete the work within the stipulated time.

The objectives of the study should be well defined.

As far as possible, only clinical or laboratory data of investiga-

tions of patients or such other material easily accessible in the existing
facilities should be used for the study.

Technical assistance, wherever necessary, may be provided by

the department concerned. The resident of one speciality taking up
some problem related to some other speciality should have some basic
knowledge about the subject and he/she should be able to perform the
investigations independently, wherever some specialised laboratory in-
vestigations are required a co-guide may be co-opted from the con-
cerned investigative department, the quantum of laboratory work to be
carried out by the candidate should be decided by the guide and co-
guide by mutual consultation.

The Clinical residents may not ordinarily be expected to under-

take experimental work or clinical work involving new techniques, not
hitherto perfected or the use of chemicals or radio isotopes not readily
available. They should however, be free to enlarge the scope of their
studies or undertake experimental work on their own initiative but all
such studies should be feasible within the existing facilities.

The residents should be able to use freely the surgical pathol-

ogy/autopsy data if it is restricted to diagnosis only, if however, de-
tailed historic data are required the resident will have to study the
cases himself with the help of the guide/co-guide.

The same will apply in case of clinical data.

Statistical methods used for analysis should be described in de-

tail.
Rules for Submission of Thesis/ Dissertation by MS Orthopae-
dics candidates

(i) The protocol of Thesis/ Dissertation should be submitted to

the office of the Ethical Committee through head of the institutions
within three (3) months of joining the training in Medical col-
lege/university.

(ii) No correspondence will be made in regard to acceptance of

the protocol except only in the case of rejected protocols for which in-
dividual will be informed by office through mail/website.

(iii) The guide will be a recognized PG teacher in Medical col-

lege or university or NBE Accredited institutions. The teacher should
have the experience of 5 years in speciality after obtaining the post
graduate degree. The certificate of PG teaching and being Guide rec-
ognized by University/NBE must be enclosed along with the-
sis/dissertation. The Guide can guide one MD/MS candidate and one
university diploma candidate desirous of taking the DNB examination,
or one direct NBE candidate. Total number of candidates should be two
including all sources.

(iv) Candidates who will be appearing in the subject under the

heading Super Speciality (like Cardiology & Cardio Thoracic Surgery
etc.) need not write their thesis/dissertation if they have already written
their thesis during their MD/MS/NBE examinations. However they
have to submit a proof in support of their having written thesis during
their MD/MS examination.

(v) If the candidates appearing in the broad specialities have al-

ready written their thesis in the MD/MS examination, they need not
submit the thesis/dissertation. However they are required to submit a
copy of the letter accepting the thesis by the University.
(vi) If thesis is rejected or needs to be modified for acceptance,
the University will return it to the candidate with suggestion of asses-
sors in writing for modification. The result of such candidate will be
kept pending till the thesis is modified or rewritten, accordingly as the
case may be and accepted by the assessors of the University

(vii) If any unethical practice is detected in work of the Thesis,

the same is liable to be rejected. Such candidates are also liable to face
disciplinary action as may be decided by the University.

NOTE

Thesis will be sent to two external examiners evaluating for 50

marks each, who will be different from the examiners coming for the
Clinical Examinations.

The last date for submitting the Thesis will be four months be-
fore the schedule date of Exam April 15 th (i.e. 31 st December).

1) If the candidate has failed in the thesis, the examiners have

to furnish their comments on the thesis and the rectifica-
tion to be done in the thesis.

2) The result of the candidate will be withheld.

3) The candidate has to rectify the deficiencies pointed out by

the examiners and resubmit the thesis to the University
within 3 (three) months.

4) The resubmitted thesis will be sent to the 3 rd examiner for

their opinion. After the report received from the 3 rd exam-
iner the result for the PG examination will be published.

5) The Report on the thesis evaluated alone b obtained from

the
examiners and the thesis evaluated is not required.

GUIDELINES FOR WRITING OF THESIS/DISSERTATION

Title - Should be brief, clear and focus on the relevance of the

topic.

Introduction œ Should state the purpose of study, mention lacu-

nae in current knowledge and enunciate the Hypothesis, if any.

Objectives of the study

Review of Literature œ Should be relevant, complete and cur-

rent to date.

Material and Methods- Should include the type of study (pro-

spective, retrospective, controlled double blind) details of material &
experimental design procedure used for data collection & statistical
methods employed; statement of limitations ethical issues involved.

Observations œ Should be Organized in readily identifiable

sections Having correct analysis of data be presented in appropriate
charts, tables, graphs & diagram etc. These should be statistically in-
terpreted.

Discussion- Observations of the study should be discussed and

compared with other research studies. The discussion should highlight
original findings and should also include suggestion for future.

Summary and Conclusion

Bibliography - Should be correctly arranged in Vancouver pat-

tern.

Appendix– All tools used for data collection such as question-

naire, interview schedules, observation check lists etc should be put in
the annexure.
ANNEXURE-VII, GUIDELINES FOR LOCAL APPRA-
IZAL

1) Prepare one paper containing ten short

questions in the areas covered by the
hospital/ institution in the last six
months.

2) Conduct the theory examination for

the candidates in the subject in the
hospital.

3) Review the thesis progress and log

book records for each candidate.

4) Conduct practical examination for the

MS candidates in the discipline.

5) Should be kept as internal assessment

6) Give suggestion for improving the MS

training and appraisal.
GUIDELINES FOR LOCAL APPRAISERS

1. University is pleased to suggest your name as local ap-

praiser. The purpose of introducing six monthly appraisals in institu-
tions is to further improve the quality of training, assess the training
infrastructure for the MS candidates and also assist the local institu-
tions to develop in to a centre of academic excellence. This would fur-
ther add value to the services being rendered in these accredited hospi-
tals/institutions. Please do not think that this assessment has negative
connotation. Please plan your appraisal in such a way as to minimally
affect the routine working of the department.

2. The University expects the local appraiser to be a post

graduate in the speciality with teaching and research experience.
He/She should have enough time and expertise to carry out the follow-
ing activities in the allotted hospitals/Institutions:

2.1 He/she should participate in thesis protocol/progress pres-

entation & discussion; assist the MS candidates in their thesis work by
giving them suggestions and monitoring their progress. He/she should
give specific remarks to improve the Thesis work after reviewing the
objectives, methodology (sample size, sampling technique, data collec-
tion tools etc.), data analysis plan and statistical tests, results and dis-
cussion plan etc. of thesis of each candidate. These remarks should
also be communicated in writing to the supervisor and the concerned
candidate by the appraiser and a copy be sent to University.

2.2. He /she is expected to examine the log book maintained by

the candidates and give specific remarks to improve the log book main-
tenance after reviewing the contents of the log book ( name of proce-
dure, details of the case, salient findings, remarks of the supervisor for
the improvement of the candidate etc). These remarks should also be
communicated in writing to the supervisor and the concerned candidate
by the appraiser and a copy be sent to University.

2.3 He/ should prepare question paper containing ten short

structured questions in the speciality on the topics covered during the
preceding six months and evaluate the answer sheets. He/she will
maintain total confidentiality in these activities. The arrangements for
six monthly theory and practical examination will be made by local ac-
credited hospitals/institutions.

2.3. He/she will formally conduct practical examination (On the

topics/areas covered in preceding six months). The practical will have
long case, short cases; ward round, spots and viva voce.

2.4. He/she will communicate the result of assessment to the

concerned candidates along with detailed feed back on their perform-
ance. He/she will give detailed suggestions to each candidate in writ-
ing for improving his/her performance. He/she will act as counsellor
and give specific remarks for improving the overall performance level
of the candidate. These remarks should also be communicated in writ-
ing to the supervisor and the concerned candidate by the appraiser and
a copy be sent to University.

2.5. He/she will prepare the Examination worksheet for each

candidate and submit the same to the concerned hospital for records
with a copy of the same to the University.

2.6. He/she will submit the report to the Executive Director,

University on the format (enclosed herewith).

2.7. He/she will also send six monthly report on the infrastruc-
ture, patient load and manpower in the concerned speciality of the ac-
credited hospital, to the University
FORMAT FOR ASSESSOR FOR DOING ASSESS-
MENT OF THE MS CANDIDATES AT THE END OF
SIX MONTHS

FROM_____________TO ____________

Name and registration Score in Score in Remarks of

the assessor for improving the overall number of the candidates
Theory Practical performance level of the candidate in the ex-
amination, like examination how to improve attempting theory and
practical. These held at the held at the remarks should also be com-
municated in writing to the end of six end of six supervisor and the
concerned candidate by the appraiser months and a copy be sent to
University
THESIS WORK ASSESSMENT

Name and Specific remarks of the assessor to improve the The-

sis work after reviewing registration number the objectives, methodol-
ogy ( sample size, sampling technique, data of the candidates
collection tools etc.), data analysis plan and statistic al tests, results
and discussion plan etc. of thesis of each candidate. These remarks
should also be communicated in writing to the supervisor and the con-
cerned candidate by the appraiser and a copy be sent to University
LOG BOOK ASSESSMENT

Name and Specific remarks of the assessor to improve the log

book maintenance after registration number reviewing the contents of
the log book ( name of procedure, details of the of the candidates
case, salient findings, remarks of the supervisor for the improvement
of the candidate etc. These remarks should also be communicated in
writing to the supervisor and the concerned candidate by the appraiser
and a copy be sent to University
WORK- SHEET FOR ASSESSMENT OF CANDIDATE
BY LOCAL APPRAISER

Date:___________

Name & Address of Hospital ___________

Name of the candidate and registration No.

Training Year of the candidate - First/ second/ Final

Name of Appraiser ___________________

Clinical Examination

Marks Awarded Total Marks

Max.

Case Agreed

Diagnosis Marks History Clinical

Examination Diagnosis Management In words In Figure

Long 60

case -I

Short 40

case -I

Short 40

case -II

Short 40

case-III

Total 180
Sub Total I + II (Max. Marks = 220)

II. Ward Round Marks in Awarded in

M. Marks = 40 words figure In words

In figure

III. Viva voce Max. Marks = 80

Instrument

Operative

Marks Pathology X-rays Orthotics

surgery Total

prosthetic

Maximum

Marks Awarded (In words)

Marks Awarded (In figure)

IV. Grand Total (Sum of I+II+III) Max. Marks = 300

Marks Awarded in words

Marks Awarded in figure

V. Result ______________________________________________
VI. Specific description of the strong points in case of pass candidate
and of weak points in case of failed candidate. Please list out the spe-
cific details which need to be communicated to the candidate to help
him improve.

VII. Examiner‘s Name & Signature ____________________

BACK FORMAT FROM MS CANDIDATES UNDER-
GOING TRAINING IN THE HOSPITAL

Instructions to the MS candidate-This feedback format is meant

for knowing your views and suggestions for improving training pro-
gramme in your hospital. You may not reveal your identify on the for-
mat. The information given by you will be used for improving your
training.

Name of the Hospital and Address

II. Name of the department

III. Please respond to the following questions related to your MS

training in past six months

3.1 Have you refereed to the MS curriculum for your specialty in the
last six months, if yes how many times ?

3.2 How many times you have consulted the MS coordinator in your
hospital in the last six months?

3.3 How many seminars you have attended in the last six months?

3.4 How many cases you have presented to your consultant(s) in last
six months?

3.5 How many times you have attended the formal lectures covering
various aspects of your speciality curriculum?

3.6 How many guest lectures have been held in your speciality in the
last six months in your hospital?
3.7 How many times you have used internet for your studies in your
hospital in the last six months?

3.8 How many times your thesis progress has been reviewed by your
thesis guides/ external appraiser in the last six months?

3.9. Please mention the names of any three standard text books in
your speciality which are available in the library of your hospi-
tal and you have referred to them in the last six months-

3.10. Please mention the names of any one National and any one In-
ternational journal which you have referred to in your hospital
library in the last six months-

3.11. How many clinical procedures you have done under supervision
in last six months Please mention names and number of any
three of them

3.12. How many clinical procedures you have done independently in

last six months Please mention names and number of any three of
them.

3.13. Please give five suggestions to improve your training in your

speciality
ANNEXURE- VIII, FORMAT FOR LOG BOOK

Instructions for the supervisor

P.G. Training Programme - The post graduate programme

broadly should include lecture/demonstration on applied basic sci-
ences, bed side clinics, case presentations. Faculty lectures, sympo-
sia/seminar journal clubs, biopsy, radiology discussions and graded
clinical responsibility.

Evaluation - It is essential that the trainee maintains a detailed

account of the work done by him.

The record book will in addition remind the trainee of what he

should observe, learn and perform in a programmed and phased manner
during the course of training. It is hoped that this record will stimulate
the trainee towards greater effort in areas where he is below par and
also record his progress. It forms the basis for assessment and evalua-
tion of the trainees progress. Some of the possible criteria on the basis
of which a trainee could be evaluated are - soundness of knowledge,
application & judgment, keenness to learn, punctuality and prompt-
ness, initiative, reliability, clinical skill, behaviour with patients, atti-
tudes towards patient‘s relatives, colleagues, seniors and other staff,
ability to express

Depending on the qualities and the level of attainments a candi-

dates could be considered for appraisal, on the basis, for example, of
the following 5 letter grading system.
A Excellent Above 75% B Good 60% - 65%

C Satisfactory 50%- 60% D Poor 30% - 50%

E Bad Below 30%

Besides the grading as indicated above, each student should also

be given a formal feed back on his/her weak points and how to over-
come his/her deficiencies.

ALL THE CANDIDATES MUST WRITE THE LOG BOOK IN

DETAILS WITH REMARKS FROM

THE SUPERVISORS AND THESE ENTRIES MUST BE

CHECKED BY THE LOCAL

APPRAISERS EVERY SIX MONTHS.

1. Name of Trainee :_________________________________

2. Name of Hospital/Institution :_____________________________

3. Address :_________________________________

4. Specialty :_________________________________

5. Name of Supervising Specialist :__________________________

6. Name of Medical

Director/Superintendent :_________________________________

Date :_______________ Signature of Supervising Specialist

Name (Block Letters) :

Passport Permanent Address :

Photograph

Date of Birth :

Fathers Name & Address :

Education :

MBBS Specimen Signature

Name of the College Date of Date of No. of Prizes

Joining Passing attempts

House-job

Subject Date of Date of Period

joining leaving
Primary Diplomat of N.B.

Subject Date of Passing No. of Attempts

Final Diplomat of N.B.

Subject Date of joining

Posting schedule

S. Specialty From To Period

No.

Lectures

S. Date Topic and name of the resource person

No.

Seminars

S. No. Date Topic and name of the facilitators Evaluation

Journal Clubs

S. No. Date Topic and name of the facilitators Evaluation

Clinical Procedures/Operations Performed

S. No. Date Details of the patients and the procedures/Operations performed;

names and signatures of the supervisors

Clinical Procedures/Operations Assisted

S. No. Date Details of the patients and of the procedures/Operations

performed along with the names signatures and of the

supervisors

Presentations

S. No. Date Details of the Case Names and signatures

Evaluation

of the consultants

/resourc e persons

Emergencies

S. No. Date Details of the patients and management of emergency

cases

Panel Discussions

(A) Radiology

S. No. Date Details of the case discussed Names of panelists

(b) Biopsy

S. No. Date Details of the case discussed Names of panelists

(C) Death review

S. No. Date Details of the case discussed and names of the resource
persons

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