Problem-based learning medical courses are now in the majority in the UK. This type of teaching, based on research by Barrow in the 1960s, seeks to integrate basic sciences and clinical teaching, leading to the acquisition of an integrated knowledge base that is readily recalled and applied to the analysis and solution of problems. We noticed an apparent difference in the core anatomical knowledge in a group of 4th year medical students during their orthopaedic placement, some of whom had been taught a traditional course and some a PBL course. We set out to quantify this difference. 60 simple anatomy questions were asked, with 30 minutes allowed, and no negative marking. 33 students were PBL taught, and 27 by a traditional course, with a roughly equal male: female ratio. The average score in the PBL group was 39.2% (range 11–52%), whereas the traditional group averaged 73.7% (range 63–79%). A second study was undertaken on two groups of 80 second year medical students, at 2 different UK universities with comparable teaching standards and entry requirements, both being well-established courses. Again, a simple 50-question anatomy paper was used, without negative marking. The traditional course students scored a mean of 37.5 (25–46), and the PBL group scored a mean of 32.3 (18–45). The results were statistically significant (p< 0.0001). Our results suggest that the difference between the two groups with regard to core anatomical knowledge increases with progression through training. This has significant implications due to PBL courses being in the majority. During the usually short orthopaedic attachment, it will become increasingly difficult for clinicians to teach effectively due to the lack of this knowledge

Introduction. Current work-hour restrictions and cost pressures have highlighted the limitations of apprenticeship-based learning, and led to the development of alternative methods to improve the skills of orthopaedic trainees outside of the clinical environment. These methods include using synthetic bones and simulators in the laboratory setting. Educational theory highlights the importance of context for effective learning, yet full-immersion simulation facilities are prohibitively expensive. This study explored the concept of contextualised training day in trauma & orthopaedics. Methods. Fifteen novice surgeons provided feedback after completing three teaching modules:. 1). OSCE-style Problem-based Learning of Orthopaedic Trauma in the Fracture Clinic Setting, utilising an actor and radiographs to teach history, examination, diagnostic and management skills. 2). The positioning, preparing and draping of a patient, and Examination under anaesthesia (EUA) for arthroscopic knee surgery, utilising an operating table and theatre equipment to teach procedural and examination skills. 3). Simulator based training for diagnostic shoulder and knee arthroscopy; and Bankart repair, utilising arthroscopic stack and synthetic joint models to develop arthroscopic motor skill and procedural knowledge. Findings. The combination of simulated patients and part-task trainers (a simulator that simulates a limited component of a clinical procedure) created a multimodal clinical context. The three novel teaching modules allowed the integration of technical and non-technical skills in low-cost and high-fidelity orthopaedic simulation environments

Aims

Evidence exists of a consistent decline in the value and time that medical schools place upon their undergraduate orthopaedic placements. This limited exposure to trauma and orthopaedics (T&O) during medical school will be the only experience in the speciality for the majority of doctors. This review aims to provide an overview of undergraduate orthopaedic training in the UK.