LEARNING NEEDS FOR MILITARY ORTHOPAEDIC SURGEONS OF THE FUTURE: A SURVEY OF UNITED KINGDOM ORTHOPAEDIC TRAINEES EXPOSURE TO LIMB THREATENING TRAUMA

Abstract

Aim: To establish confidence and perceived adequacy of training of UK Orthopaedic Specialist Trainees in assessment of limb viability and amputation.

Methods: A web based survey of orthopaedic trainees using scenarios centred around limb viability assessment and amputation resultant from trauma. 225 responses obtained, achieving a < 0.05 error rate with 90% confidence.

Results:

Limb viability:

• 27.8% were fully confident. A positive correlation exists between training year and fully confident reports. 68.6% encounter such injury either every six months or less frequently. 18.6% regard their training in these cases inadequate. No correlation seen between experience and perceived adequacy of training.

Amputation:

• 10.3% were fully confident. A positive correlation exists between time in training and perceived fully confident reports.

57.3% encounter such injury either every six months or less frequently. 36.3% regard their training in these cases inadequate. No correlation seen between experience and exposure to cases or perceived adequacy of training.

Conclusion: Current training provides limited opportunities for decision making in limb viability and amputation. Confidence in dealing with such cases is seen to increase with training. Perceived adequacy of training did not change over time.

Military orthopaedic surgeons are providing injured service personnel and civilians with the best possible chance of successful rehabilitation from these injuries. It is fundamental that the experience of these individuals is accessible to their successors.

For military trainees, this reinforces the need for participation in closely supervised secondments on deployment, attendance at established military surgical training courses and appropriate fellowships to maximise exposure prior to completion of training and first consultant deployment.