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Year : 2022  |  Volume : 5  |  Issue : 3  |  Page : 115-116

Postgraduate orthopedic training – Where are we today?

Department of Orthopaedics, IGIMS, Bihar, India

Date of Submission18-Aug-2022
Date of Decision19-Aug-2022
Date of Acceptance19-Aug-2022
Date of Web Publication1-Sep-2022

Correspondence Address:
Ritesh Runu
Department of Orthopaedics, IGIMS, Patna, Bihar
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jodp.jodp_70_22

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How to cite this article:
Runu R. Postgraduate orthopedic training – Where are we today?. J Orthop Dis Traumatol 2022;5:115-6

How to cite this URL:
Runu R. Postgraduate orthopedic training – Where are we today?. J Orthop Dis Traumatol [serial online] 2022 [cited 2023 Jun 6];5:115-6. Available from: https://jodt.org/text.asp?2022/5/3/115/355249

The subject of orthopedic postgraduate training and assessment has remained a debatable issue amongst the academicians and the administrators.[1],[2],[3],[4],[5],[6],[7],[8],[9] The curriculum and methods of training have been discussed at the various levels of government and the institutions.[1],[2],[3],[4],[5],[6],[7],[8],[9] This debate persists due to the changing pattern of disease, incidence of trauma, change in rural and urban population, technological advancement, economy advancement and change in treatment methodology.[3] Change in curriculum of orthopedics has been done from time to time by General Medical Council (GMC) in the United Kingdom and National Medical Commission (NMC) in India.[7],[8]

The preamble of orthopedic curriculum published by NMC states that “The purpose of PG education is to create specialists who would provide high quality health care and advance the cause of science through research and training.” “A postgraduate undergoing training MS in Orthopaedics should be trained to identify and recognize various congenital, developmental, inflammatory, infective, traumatic, metabolic, neuromuscular, degenerative and oncologic disorders of the musculoskeletal systems. She/he should be able to provide competent professional services to trauma and orthopedic patients at a primary/secondary/tertiary healthcare centres.” The document mentions the competencies based on cognitive, affective, and psychomotor domains of learning. Apart from learning the subject, the residents are supposed to learn the research methodologies and teaching skills.[7]

Are we able to achieve the targets as stated in the preamble in 3 years of postgraduate training?

Probably NO.

The duration of 3 years of orthopedic postgraduate training seems inadequate. Although NMC has mentioned the topics to be taught under the cognitive domain, nothing has been mentioned regarding year-wise training. Topics to be covered in 1st year, 2nd year and 3rd year are not clear. Under psychomotor domain, the postgraduate students have to perform the surgical procedures mentioned year-wise. However, how to assess the skill of a trainee is missing.[7] Competency-based grading and up gradation of a trainee is an essential aspect of training. As mentioned in GMC guidelines, the competency is graded from 0 to 5. Competency levels 0 is defined as = No experience expected, 1 = has observed or knows of, 2 = Can manage with assistance, 3 = Can manage whole but may need assistance, 4 = Able to manage without assistance including potential common complications.[8]

Apart from clinical skill enhancement, a postgraduate is taught teaching and research methodologies in India. This is essential to introduce a postgraduate to basics of research and teaching. However, a definite structure of training in this aspect is missing.

Compared to NMC, the duration of orthopedic training in the UK is of 8 years. It is divided in three phases. Phase 1 is core surgical training curriculum of 2 years. After clearing the summative assessment, trainee proceeds to Phase 2. This phase is of 4 years, where trainee has to gather knowledge and experience related to trauma and orthopedics including emergency case take up and to develop generic professional capabilities. After Phase 2 examinations, the trainee can apply for fellowship examinations for sub-speciality training during 2 years duration. The outcome of this phase is to have a day – 1 consultant and now trainee can be awarded certificate of completion of training. Day – 1 consultant is expected to perform a high-level clinical task as a consultant surgeon. This approach produces a confident and competent consultant at the end of training.[8]

To achieve excellence in our training system, we can introduce several changes. First, the duration of training should be increased from 3 to 5 years. 1st year should be dedicated to basic surgical and orthopedic training, biostatistics, holistic approach in patient care, training in professional values and behavior. During the 2nd year, the trainee is exposed to basic orthopedic procedures, basic sciences, fracture care and infection control. Third year should be dedicated to pediatric conditions, arthroscopy, arthroplasty, and thesis research topics. Fourth year should be dedicated to subspecialty training such as spine, oncology, rheumatology, hand and foot sections. The trainee should complete his thesis. Fifth year should be dedicated to complex trauma and overall completion of topics in trauma and orthopedics.

Second, the assessment system should be strengthened. Every year divided in two semesters should have competency-based examination system. After clearing the examination, the trainee should be promoted to the next year. At the end of 5th year, the orthopedic trainee should get a certificate and should be able to perform as a confident consultant. Those who want to pursue subspecialty can apply for fellowship of 12–24 months.

In the changing socioeconomic and political scenario, the patient expectations have gone high, their tolerance to unfavorable surgical outcome has become low and medical litigations have increased. It is the time to bring change in orthopedic postgraduate training. A robust curriculum and robust training is must to have a better orthopedic surgeon for our society and nation.


The authors would like to thank Dr. Shweta Lall, Associate Professor, Endodontics and Conservative Surgery, B R Ambedkar Dental College, Patna.

  References Top

Jain AK. Orthopedic services and training at a crossroads in developing countries. Indian J Orthop 2007;41:177-9.  Back to cited text no. 1
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Arora A, Agarwal A, Gikas P, Mehra A. Musculoskeletal training for orthopaedists and nonorthopaedists: Experiences in India. Clin Orthop Relat Res 2008;466:2350-9.  Back to cited text no. 2
Natarajan MV. Orthopaedic training in India: Time to change. Indian J Orthop 2012;46:257-8.  Back to cited text no. 3
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Douherty Paul J, Sethy A, Jain AK. CORR curriculum – Orthopaedic education. Clin Orthop Relat Res 2014;472:410-4.  Back to cited text no. 4
Jain AK. Minimum (optimum) standard of orthopedic care for all: An achievable target. Indian J Orthop 2014;48:541-4.  Back to cited text no. 5
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Jain AK. Current state of orthopaedic education in India. Indian J Orthop 2016;50:341-4.  Back to cited text no. 6
[PUBMED]  [Full text]  
Available from: https://www.nmc.org.in/wp-content/uploads/2019/09/MS-Orthopedics.pdf. [Last accessed on 2022 Aug 18].  Back to cited text no. 7
James HK, Gregory RJ. The dawn of a new competency-based training era. Bone Jt Open 2021;2:181-90.  Back to cited text no. 8
Mohan L, Pant J, Agrawal M, Shah Z. Postgraduate training in medical colleges in India: Resident physicians' perspective. Indian J Physiol Pharmacol 2021;65:245-55.  Back to cited text no. 9


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