AIIMS Orthopaedics Syllabus
An MBBS student should know about the commonly encountered conditions in orthopaedics pertaining to their diagnostic features, basic patholophysiological aspect and the general and basic management strategies. It is expected to learn basic skills such as application of splints, skin and skeletal traction, as well as plaster slab and casts (including special casts such as CTEV cast, hip spica, shoulder spica, cylinder cast, patellar tendon bearing casts).
An MBBS student should know the maneuvers for reduction of common fractures and dislocations such as colles’ fracture, supracondylar fracture of humerus, dislocation of shoulder, elbow and hip etc.
- Embryology, applied anatomy, physiology, pathology, clinical features, diagnostic procedures and the principles of therapeutics including preventive methods, (medical/surgical) pertaining to musculoskeletal system.
- Clinical decision making ability & management expertise: Diagnose conditions from history taking, clinical evaluation and investigations and should be able to distinguish the traumatic from infective and neoplastic disorders.
- Thrust areas
a) Pediatric orthopaedics- The student should be exposed to common congenital and developmental disorders such as CTEV (club-Foot), developmental dysplasia of hip, Perthe’s disease and infections, and also should acquire adequate knowledge about the principles of management of these disorders.
b) Orthopaedic oncology- The undergraduate is expected to be familiar with the common tumours encountered in orthopaedic practice. The student should be able to diagnose common bone tumors and should know principles of treatment
c) 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 fully conversant with trauma in its entirety including basic life saving skills, control of hemorrhage, splintage of musculoskeletal injuries and care of the injured spine.
d) Sports Medicine- The student should know about common orthopaedic pathologies encountered in sportspersons and their diagnostic and preventive aspects.
e) Physical Medicine and Rehabilitation- The student is expected to be familiar with common orthotic and prosthetic devices and their applications.
f) Orthopedic Neurology- The student should be exposed to all kinds of nerve injuries as regards their recognition & principles of management, cerebral palsy and acquired neurologic conditions such as post polio residual paralysis.
g) Disorders of Spine – The student is expected to be familiar with various kinds of spinal disorders such as scoliosis, kypho-scoliosis, spinal trauma, prolapsed intervertebral disc and infections (tuberculosis and pyogenic) as regards their clinical presentations and principles of management.
h) Radiology- Acquire knowledge about radiology/imaging and should be able to interpret radiographs typical of common orthopaedic pathologies.
- Patient doctor relation: UG should learn the skills 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: Undergraduate should acquire knowledge about prevention of some conditions especially in children such as poliomyelitis, congenital deformities, cerebral palsy and common orthopaedic malignancies.
TEACHING LEARNING ACTIVITIES Didactic Lectures
UG will attend didactic lectures on the following topics.
- Fracture:Definition, Classification, Principles of Management
- Fracture healing, delayed union
- Classification & Management of open fractures
- Management of fracture calvicle, dislocation shoulder &
- fracture shaft humerus
- Classificaton of injuries around elbow & management of
- supracondylar fracture & dislocation of elbow
- Monteggia fracture dislocation & fracture both bones of forearm
- Volkamann’s Ischaemic Contracture
- Fracture of lower end of radius fracture scaphoid and metacarpals
- Fracture pelvis & dislocation of hip
- Fracture neck of femur
- Fracture shaft of femur & tibia
- Internal Derangements of Knee, Injuries of ankle & foot
- Congenital malformations: CTEV Torticollis
- Congenital Malformation : CDH, Pseudoarthrosis tibia etc.
- Disorders of the hip : coxa vara, perthes diseases
- Deformities of the spine
- Acute Pyogenic Ostyeomyelitis
- Chronic Pyogenic Osteomyelities
- Septic Arthritis
- Other Arthritides (Rheumatoid/Ank.Spond.)
- Osteo-articular tuberculosis:
- General consideration & principles of management
- Tuberculosis: Spine
- Bone Tumours: Benign tumors
- Bone Tumours: Malignant tumors
Integrated Seminars – Combined interdisciplinary seminars on subjects like
Arthritis, Tuberculosis, Osteoporosis etc.
ACQUISITION OF BASIC ORTHOPAEDIC SKILLS
The undergraduate learns:
- Application of splints and tractions
- Application of plaster. Slabs and casts
- Manipulative reduction of common fractures and dislocations.
- Infiltration of tender periarticular lesions.
- Aseptic technique ofjoint fluid aspiration.
DURATION OF TRAINING AND ROTATION PROGRAMMES (WARD/OT/OPD):
– Spends 6 (six) hours in orientation programme in the ward/OPD in the third semester. Learns basic orthopedic examination skills and bedside manners.
– Spends 3 weeks in the department in the seventh semester.During this period he/she
– Learns bedside history taking in ward, OT exposures and casualty.
– Examine indoor (medical; preoperative and postoperative) patients learn examination, principles of treatment and techniques of traction would care and splintage
– Attends OPD, operation theatre and emergency operations for acclimatization.
– Attends ward rounds.
– Participates in the teaching sessions in ward for bedside clinical in the weekly afternoon seminar/ journal club.
– Attends the weekly Journal Club and seminar.
– Attends scoliosis, polio, hand, CTEV and arthritis clinics.
– Surgicopathological conference in Pathology Department, with surgeons.
SPECIFIC ACTIVITIES IN DETAIL
- Case presentation in the ward and the afternoon special clinics (such as scoliosis/Hand clinics). UG will present a clinical case for discussion before a faculty in the ward every morning.
- Case Conference- Undergraduate will attend case conference on every Monday afternoon where the 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 in its entirety.
- X-Ray Classes- UG should attend x-ray classes held twice weekly in morning in which the radiologic features of various problems are discussed.
- Surgicopathological Conference: UG should attend period surgicopathology conferences in which special emphasis is made on the surgical pathology and the radiological aspect of the case in the pathology department.
- UG should attend, during their posting, the following Afternoon clinics:
Scoliosis Clinic- Held once a week. Residents work up the cases of spinal deformity and present them to a faculty member and management plan recorded in case file.
Hand Clinic- Held once a week. All the cases of hand disorders are referred to the clinic and discussed in detail.
CTEV Clinic- Held once a week. Corrective casts are given and the technique learnt by the residents and the undergraduates. Surgical management in also planned & recorded in case file.
Polio Clinic- Held once a week. Various braces & Calipers are prescribed and surgical management planned.
- Besides clinical training for patient care management and for bed side manners:
Clinical training daily for 2% to 3 hours in the morning in the ward 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.
- Clinical teaching:
In OPD, ward rounds, emergency and the operation theatres:
By Residents/Senior Residents and Faculty on duty in respective places – make discussion on clinical diagnosis/surgical procedures/treatment modalities, including postoperative care and preparation of discharge slip.
TEXT BOOKS RECOMMENDED
|Title of the book||
|Outlines of Fractures||
|Closed Treatment of Fractures||H.John||Churchill Livingstone|
|Outlines of Orthopaedics||
ASSESSMENT AND EXAMINATION
Assessment will be done at the end of posting and the marks will be added to internal assessment for surgical disciplines.
The oral, clinical and Practical Examination at the end of 3 weeks’ ward posting:
(a) Clinical Patient presentation/discussion:
(i) The case will be structured comprising – history taking, clinical examination, investigations, decision making, proposed treatment modalities, ethical justification and personal attributes.
(b) Reading X-rays, identification of Instruments & discussion, identification of braces & calipers.
Undergraduates is assessed for orthopaedics in the preprofessional and professional examinations.
(a) The theory paper consists of 3-4 short notes in the Surgery (Paper-II) comprising of the 25% of the total marks for the Surgery theory (Paper-II).
The syllabus for the theory paper is as outlined above.
(b) The practical assessment is on the lines of the assessment done at the end of the clinical posting. A senior faculty member coordinates with the internal examiners of surgical disciplines and conducts the examinations.
Schedule of Teaching and Posting
- Orientation program: in ward
(3rd Semester 6-9 hours)
- DISCIPLINE TRAINING (Duration – 3 weeks)
- Ward class with faculty (Teaching)
- OPD – Case base learning & Patient care
- Demonstration of operative procedures in OT & Trauma Management in causality
- Case-presentation/discussion (Afternoon special clinics)
- Seminar weekly
- Surgicopathological conference – held monthly
Radiology Conference – weekly