| Program Description |
MS. ORTHOPEDICS
Goal
The goal of postgraduate medical education shall be to produce a competent specialist and / or a medical teacher as stated in the Post Graduate Medical Education Regulations 2000 and its amendments thereof [May2018]
(i) Who shall recognize the health needs of the community, and carry out professional obligations ethically and in keeping with the objectives of the national health policy.
(ii) Who shall have mastered most of the competencies, pertaining to the specialty, that are required to be practiced at the secondary and the tertiary levels of the health care delivery system.
(iii) Who shall be aware of the contemporary advances and developments in the discipline concerned.
(iv) Who shall have acquired a spirit of scientific inquiry and is oriented to the principles of research methodology and epidemiology, and
(v) Who shall have acquired the basic skills in teaching of the medical and paramedical professionals.
General Objectives
At the end of the postgraduate training in the discipline concerned the student shall be able to:
(i) Recognize the importance of the concerned specialty in the context of the health need of the community and the national priorities in the health sector.
(ii) Practice the specialty concerned ethically and in step with the principles of primary health care.
(iii) Demonstrate sufficient understanding of the basic sciences relevant to the concerned specialty.
(iv) Identify social, economic, environmental, biological and emotional determinants of health in a given case, and take them into account while planning therapeutic, rehabilitative, preventive and promotive measures/strategies.
(v) Diagnose and manage majority of the conditions in the specialty concerned on the basis of clinical assessment, and appropriately selected and conducted investigations.
(vi) Plan and advice measures for the prevention and rehabilitation of patients suffering from disease and disability related to the specialty.
(vii) Demonstrate skills in documentation of individual case details as well as morbidity and mortality data relevant to the assigned situation.
(viii) Demonstrate empathy and humane approach towards patients and their families and exhibit interpersonal behaviour in accordance with the societal norms and expectations.
(ix) Play the assigned role in the implementation of national health programs, effectively and responsibly.
(x) Organize and supervise the chosen/assigned health care services demonstrating adequate managerial skills in the clinic/hospital or the field situation.
(xi) Develop skills as a self-directed learner; recognize continuing educational needs, select and use appropriate learning resources.
(xii) Demonstrate competence in basic concept of research methodology and epidemiology, and be able to critically analyse relevant published research literature.
(xiii) Develop skills in using educational methods and techniques as applicable to the teaching of medical/nursing students, general physicians and paramedical health workers.
(xiv) Function as an effective leader of a team engaged in health care, research or training.
Statement of the Competencies
Keeping in view the general objectives of postgraduate training, each discipline shall aim at development of specific competencies, which shall be defined and spelt out in clear terms. Each department shall produce a statement and bring it to the notice of the trainees in the beginning of the program so that he or she can direct the efforts towards the attainment of these competencies.
Components of the PG Curriculum
The major components of the PG curriculum shall be:
• Theoretical knowledge
• Practical/clinical Skills
• Training in writing thesis/research articles
• Attitudes, including communication.
• Training in research methodology, medical ethics & medicolegal aspects
• Teaching skills to the undergraduates, juniors and support teams
The postgraduate course M.S. (Orthopedics) should enable a medical graduate to become a
competent specialist, acquire knowledge and skills in educational technology for teaching
medical, and health sciences and conduct research in bio-medical science.
GENERAL COMPETENCY STATEMENT
i) Who shall recognize the health needs of the community, and carry out professional
obligations ethically and in keeping with the objectives of the national health policy;
ii) Who shall have mastered most of the competencies, that are required to be practiced at
the secondary and the tertiary levels of the health care delivery system;
iii) Who shall be aware of the contemporary advances and developments in orthopedics;
iv) Who shall have acquired a spirit of scientific inquiry and is oriented to the principles of
research methodology and epidemiology; and
v) Who shall have acquired the basic skills in teaching of the medical and paramedical
professionals.
vi) Continue to evince keen interest in continuing surgical education irrespective of whether
he is in a teaching institution or is a practicing surgeon.
vii) Who shall have clear communication skills.
SUBJECT SPECIFIC LEARNING OBJECTIVES
• This will be dealt with under the following headings:
• Theoretical knowledge (Cognitive domain)
• Practical and clinical skills (psychomotor domain)
• Attitudes including communication skills (Affective domain)
• Writing thesis / Reviewing Research activities (Scholarly activity)
• Training in Research Methodology (Practice based learning, Evidence based practice)
• Professionalism
• Teaching skills
SUBJECT SPECIFIC COMPETENCIES
A. Cognitive domain
At the end of the M.S. Orthopaedics programme, the post graduate student should
be able to:
1. Demonstrate sufficient understanding of the basic sciences relevant to orthopaedic
speciality through a problem based approach.
2. Describe the Principles of injury, its mechanism and mode, its clinical presentation, plan
and interpret the appropriate investigations, and institute the management of
musculoskeletal injuries.
3. Identify and describe the surface anatomy and relationships between the various bones,
joints, ligaments, major arteries, veins and nerves of the musculoskeletal system of the
spine, upper limb, lower limb and the pelvis, chest, abdomen and head & neck.
4. Define and describe the pathophysiology of shock (circulatory failure).
5. Define and describe the pathophysiology of Respiratory failure
6. Describe the principles and stages of bone and soft tissue healing
7. Understand and describe the metabolic, nutritional, endocrine, social impacts of trauma
and critical illness.
8. Enumerate, classify and describe the various bony/soft tissue injuries affecting the axial
and appendicular skeletal system in adults and children.
9. Describe the principles of internal and external fixation for stabilization of bone and joint
injuries.
10. Describe the mechanism of homeostasis, fibrinolysis and methods to control
haemorrhage
11. Describe the physiological coagulation cascade and its abnormalities
12. Describe the pharmacokinetics and dynamics of drug metabolism and excretion of
analgesics, anti inflammatory drugs, antibiotics, disease modifying agents and
chemotherapeutic agents.
13. Understanding of biostatistics and research methodology
14. Describe the clinical presentation, plan and interpret investigations, institute management
and prevention of the following disease conditions
a. Nutritional deficiency diseases affecting the bones and joints
b. Deposition arthropathies
c. Endocrine abnormalities of the musculoskeletal system
d. Metabolic abnormalities of the musculoskeletal system
e. Congenital anomalies of the musculoskeletal system
f. Developmental skeletal disorder of the musculoskeletal system
15. Describe the pathogenesis, clinical features plan and interpret investigations and institute
the management in adults and children in
a. Tubercular infections of bone and joints (musculoskeletal system)
b. Pyogenic infections of musculoskeletal system
c. Mycotic infections of musculoskeletal system
d. Autoimmune disorders of the musculoskeletal system
e. Rheumatoid arthritis, Ankylosing spondylitis, seronegative arthropathy
f. Osteoarthrosis and spondylosis
16. Describe the pathogenesis, clinical presentation, plan and interpret investigations and
institute appropriate treatment in the following conditions:
a. Post polio residual paralysis
b. Cerebral palsy
c. Muscular dystrophies and myopathies
d. Nerve Injuries
e. Entrapment neuropathies
17. Identify the diagnosis and describe management of musculoskeletal manifestation of
AIDS and HIV infection
18. Describe the aetiopathogenesis, identify, plan and interpret investigation and institute the
management of osteonecrosis of bones.
19. Identify situations requiring rehabilitation services and prescribe suitable orthotic and
prosthetic appliances and act as a member of the team providing rehabilitation care
20. Identify a problem, prepare a research protocol, conduct a study, record observations,
analyse data, interpret the results, discuss and disseminate the findings.
21. Identify and manage emergency situation in disorders of musculoskeletal system
22. Understanding of the basics of diagnostic imaging in orthopaedics like:
a. Plain x-ray
b. Ultrasonography
c. Computerised axial tomography
d. Magnetic resonance imaging
e. PET scan
f. Radio Isotope bone scan
g. Digital Subtraction Angiography (DSA)
h. Dual energy x-ray Absorptiometry
i. Arthrography
23. Describe the aetiopathogenesis, clinical presentation, Identification, Plan investigation
and institute treatment for oncologic problems of musculoskeletal system both benign
and malignant, primary and secondary.
24. Understand the basics, principles of biomaterials and orthopaedic metallurgy
25. Describe the principles of normal and abnormal gait and understand the biomedical
principles of posture and replacement surgeries.
26. Describe social, economic, environmental, biological and emotional determinants of
health in a given patient with a musculoskeletal problem.
B. Affective Domain:
1. Should be able to function as a part of a team, develop an attitude of cooperation with
colleagues, and interact with the patient and the clinician or other colleagues to provide
the best possible diagnosis or opinion.
2. Always adopt ethical principles and maintain proper etiquette in dealings with patients,
relatives and other health personnel and to respect the rights of the patient including the
right to information and second opinion.
3. Develop communication skills to word reports and professional opinion as well as to
interact with patients, relatives, peers and paramedical staff, and for effective teaching.
Attitudes including Communication skills and Professionalism
a. Communication skills:
• Exhibits participation in honest, accurate health related information sharing in a sensitive
and suitable manner
• Recognizes that being a good communicator is essential to practice effectively
• Exhibits effective and sensitive listening skills
• Recognises the importance and timing of breaking bad news and knows how to
communicate
• Exhibits participation in discussion of emotional issues
• Exhibits leadership in handling complex and advanced communication
• Recognizes the importance of patient confidentiality and the conflict between
confidentiality and disclosure
• Able to establish rapport in therapeutic bonding with patients, relatives and other
stakeholders through appropriate communication
• Able to obtain comprehensive and relevant history from patients/relatives
• Able to counsel patients on their condition and needs
b. Teamwork: Seek cooperation. Coordination and communication among treating
specialties and paramedical staff
c. Counseling of relatives: regarding patients condition, seriousness, bereavement and
counseling for organ donation in case of brain death
d. Leadership: Trauma prevention, education of the public, paramedical and medical
persons.
e. Advocacy: with the government and other agencies towards cause of trauma care
f. Ethics: The Code of Medical Ethics as proposed by Medical Council of India will be
learnt and observed.
C. Psychomotor domain
I. At the end of the first year of M.S. Orthopaedics programme, the student should
be able to:
1. Elicit a clinical history from a patient, do a physical examination, document in a case
record, order appropriate investigations and make a clinical diagnosis
2. Impart wound care where applicable
3. Apply all types of POP casts/slabs, splints and tractions as per need
4. Identify shock and provide resuscitation
5. Perform aspiration of joints and local infiltration of appropriate drugs
6. Perform appropriate wound debridement
7. Perform arthrotomy of knee joint
8. Perform incision and drainage of abscess
9. Perform split thickness skin grafting
10. Perform fasciotomes
11. Apply external fixators
12. Apply skeletal tractions including skull tongs
13. Triage a disaster situation and multiple trauma patients in an emergency room
14. Perform on bone models, interfragmentary compression screws, external fixation,
Tension band wiring and various types of plating.
15. Perform closed reduction of common dislocations like shoulder and common fractures
like colles fracture, supracondylar fracture.
16. Perform on a cadaver standard surgical approaches to the musculo skeletal system
II. At the end of the second year of M.S. Orthopaedics course, the student should be
able to:
1. Take an informed consent for standard orthopaedic procedures
2. Perform closed/open biopsies for lesions of bone, joints and soft tissues
3. Perform split thickness skin grafting and local flaps
4. Perform on bone models, internal fixation with k-wires, screws, plates. Dynamic
hip/condylar screws/nailing.
5. Perform sequestrectomy and saucerisation
6. Perform arthrotomy of joints like hip/shoulder, ankle, elbow
7. Perform repair of open hand injuries including tendon repair
8. Perform arthodesis of small joints
9. Perform diagnostic arthroscopy on models and patients
10. Perform carpal tunnel/tarsal tunnel release
11. Apply Ilizarov external fixator
12. Perform soft tissue releases in contractures, tendon lengthening and correction of
deformities
13. Perform amputations at different levels
14. Perform corrective surgeries for CTEV, DDH, perthes/ skeletal dysplasia
III. At the end of the third year of M.S. Orthopaedics programme, the student
should be able to:
1. Assist in the surgical management of polytrauma patient
2. Assist in Arthroplasty surgeries of hip, knee, shoulder and the ankle
3. Assist in spinal decompressions and spinal stabilizations
4. Assist in operative arthroscopy of various joints
5. Assist /perform arthrodesis of major joints like hip, knee, shoulder, elbow
6. Assist in corrective osteotomies around the hip, pelvis, knee, elbow, finger and toes
7. Assist in surgical operations on benign and malignant musculoskeletal tumour including
radical excision and custom prosthesis replacement.
8. Assist in open reduction and internal fixations of complex fractures of acetabulum,
pelvis, Ipsilateral floating knee/elbow injuries, shoulder girdle and hand injuries.
9. Assist in spinal deformity corrections
10. Independently perform closed/open reduction and internal fixation with DCP, LCP,
intrameduallary nailing, Limb reconstruction system.
11. Assist in limb lengthening procedures
12. Assist in Revision arthroplasty.
13. Provide pre and post operative care
14. Perform all clinical skills as related to the speciality.
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