The use of journal clubs and, more recently, case-based discussions in order to stimulate debate among orthopaedic surgeons lies at the heart of orthopaedic training and education. A virtual learning environment can be used as a platform to host virtual journal clubs and case-based discussions. This has many advantages in the current climate of constrained time and diminishing trainee and consultant participation in such activities. The virtual environment model opens up participation and improves access to journal clubs and case-based discussions, provides reusable educational content, establishes an electronic record of participation for individuals, makes use of multimedia material (including clinical imaging and photographs) for discussion, and finally, allows participants to link case-based discussions with relevant papers in the journal club.

The Leicester experience highlights the many advantages and some of the potential difficulties in setting up such a virtual system and provides useful guidance for those considering such a system in their own training programme. As a result of the virtual learning environment, trainee participation has increased and there is a trend for increased consultant input in the virtual journal club and case-based discussions.

It is likely that the use of virtual environments will expand to encompass newer technological approaches to personal learning and professional development.

Nationwide changes in the organisation of specialist medical training present a challenge to surgical trainees in terms of exposure to an adequate case load, the acquisition of practical experience and therefore also of judgement and decision-making. When accompanied by accredited trainers exposure to practice in the developing world offers trainees the opportunity to enhance their clinical exposure as well as skills in communication, teaching, management and leadership. This paper analyses the training value for orthopaedic trainees of a novel orthopaedic project undertaken in Kenya in February 2009 utilising an entire UK orthopaedic team. The first Kenya Orthopaedic Project (KOP) was organised by an orthopaedic trainee and took place at Nanyuki District General Hospital in February 2009. Kenya does not have the luxury of a national health service and patients must pay for any clinics or surgery. The cost of orthopaedic surgery in this environment is prohibitive and many fractures go untreated, as do other common pathologies such as severe osteoarthritis and osteomyelitis. The UK team undertaking the project included two accredited consultant orthopaedic surgeons and an orthopaedic trainee. Clinics, surgery and teaching sessions were performed for one week with the aim of relieving the sheer volume of orthopaedic cases and to provide those impoverished patients with treatment they would not otherwise receive. Data was taken from elogbook to analyse the average number of cases performed by an orthopaedic ST3 in one week, and a survey was sent to all Southwest trainees (n=25) for information on how many competencies and work placed based assessments were completed in one week. Daily challenges of health care budgeting, negotiating, organisational and intercultural communication skills are not often encountered by UK orthopaedic trainees, and bring with them a realisation of the wider picture of health care economics and appreciation of the benefits of a National Health Service. The results showed that in one week during KOP over seventy patients were seen in clinic and eighteen operations performed. Of the 18 operations performed the orthopaedic trainee assisted in 15 of these operations and performed 3 under supervision. An average week log book entry for ST3 trainees, taken from elogbook statistics, contains six elective and three trauma operations. The figures from one week Kenya Orthopaedic Project double these operative numbers. Six workplace based assessments were completed in one week on the project, significantly more than an average of 0.16 per week in UK. (p=0.0003). In conclusion Kenya Orthopaedic Projects offer a unique experience for orthopaedic trainees and all members of the multidisciplinary team. Trainees are offered the opportunity to put into practice managerial, teaching, organisational and communication skills as well as the chance to see and treat pathologies that would not be encountered in the UK. The experience of operating in third world conditions with minimal equipment available, communicating with patients and theatre staff from a different culture whilst ensuring all possible western world safety measures are adhered to offers a wholly challenging and valuable perspective to an orthopaedic trainee. Both operative experience and workplace based assessments statistically surpassed that of an average week of a UK trainee. We can therefore conclude that a week’s orthopaedic experience in a third world country is not only beneficial to the patients but offers excellent training opportunities in all aspects of the delivery of health care and makes a positive contribution to orthopaedic training

The maintenance of quality and integrity in clinical and basic science research depends upon peer review. This process has stood the test of time and has evolved to meet increasing work loads, and ways of detecting fraud in the scientific community. However, in the 21st century, the emphasis on evidence-based medicine and good science has placed pressure on the ways in which the peer review system is used by most journals.

This paper reviews the peer review system and the problems it faces in the digital age, and proposes possible solutions.

Cite this article: Bone Joint J 2014;96-B:436–41.