Undergraduate Teaching in Orthopaedic Surgery

The New Medical Curriculum

The undergraduate medical curriculum was changed in 1997. The most important concept and practice being introduced into the new curriculum is problem-based learning (PBL). The number of lecture is reduced, and there is increased emphasis on small group teaching. The philosophy is to cultivate life-long learning. The syllabus is therefore not comprehensive. It covers the core knowledge and skills.

Years 1 & 2

In the first 2 years of the curriculum, they go through different system blocks, one of which is the musculoskleletal system. The musculoskeletal system block is a 5 weeks module. The basic sciences are integrated with the disease processes, and the teaching sessions include PBL case tutorials, about 25 lectures (mostly basic sciences), 10 practicals (anatomy – but no need to dissect cadaver anymore; physiology; pharmacology; pathology), and a 3-hour clinical skills teaching session.

PBL case tutorial is an important element of the new curriculum. The students form small groups (usually 8 students), and go through 4 PBL cases (each case spends through 2-3 tutorial sessions). The faculty member discloses the information bit by bit. At each stage, the students discuss with one another, identify problems and learning issues. They then study and find relevant information, and return to the PBL case in the second tutorial. More information will then be provided. The faculty member may be a clinician, may be a scientist, and is usually not an expert in the field, and serves as “facilitator”. The emphasis is on “learning” (student-centered) ,not “teaching” (teacher-directed). The 4 cases selected are spinal muscular atrophy, humeral shaft fracture after arm wrestling, osteoarthritis of the hip, and sciatica after lifting heavy objects.

In the clinical skills session, the students are introduced to ‘look’, ‘feel’, ‘move’. They study the normal range of motions of the joints in the body on one another (Figure 1). They are also exposed to the clinical features of common conditions such as rheumatoid arthritis, osteoarthritis, gout and cervical and lumbar spondylosis.

Year 3

The integrated block is an 8 weeks block. The class is divided into 2 groups, one goes through 4 weeks of either medicine-related or surgery-related teaching, and then they swab. During this block, there are 4 impact lectures (Time table 1) and 4 clinical skills sessions on orthopaedic surgery (Time table 2). Each clinical skills session lasts for 3 hours. The themes are 1. history taking and principles of fracture management 2. upper limbs – physical examination and common problems 3. lower limbs – physical examination and principles of joint reconstruction 4. spine – physical examination ; approach to neck and back pain and recognition of major spinal problems

Phase I lasts for 24 weeks and consists of 3 blocks – medicine block, surgery block and multidisciplinary block. Orthopaedic surgery is taught only during the multidisciplinary block. The latter aims at better integration of certain topics, such as infection and tumour. We arrange 4 seminars, each lasts for 3 hours. Two of them are on tumours, and 2 are on infections of the musculoskeletal system. The format is very similar to a PBL case tutorial, except that it is a large group environment. The students are urged to learn by self study between the two related sessions. At the same time, the students also need to attend some didactic lectures related to the musculoskeletal system.

Phase II lasts for 24 weeks and also consists of 3 blocks – medicine block, surgery block and multidisciplinary block. During this period, the students will attend about 15 whole class sessions on topics related to orthopaedic surgery (Time table 3). Orthopaedic surgery is taught during the surgery block and the multidisciplinary block. During the surgery block, students are attached to the network hospitals – Caritas Medical Centre, Kwong Wah Hospital, Pamela Youde Nethersole Eastern Hospital and Queen Elizabeth Hospital (Time table 4 – just pick any hsoptial). The will be divided into small groups and have 8 bedside teaching sessions. In addition, there are four interactive seminars on common or office orthopaedic problems, principles of fracture management, diagnostic imaging, orthopaedic emergencies etc. During the multidisciplinary block, the students will visit MacLehose Medical Rehabilitation Centre and learn about the principles of musculoskeletal rehabilitation.

Year 4 and 5

The class is divided into 6 groups and they go through 6 rotations in turn. Each rotation lasts for 8 weeks, and there are about 27 – 28 students each time (Time table 5 – just orthopaedic surgery and condensed down the weeks 3-7). The orthopaedic surgery teaching is done together with family medicine and private practice attachment. There are 14 to 15 seminars (each of 2 hours), 6 bedside teaching sessions 7 to 8 new case clinics (each of 3 hours), 4 clinical case conference (each of 2 hours), 3 grand rounds (each of 2 hours) and 1 OT session (each of 4 hours). For the seminars, they consist of short case scenarios; the latter are posted on the web and the students are asked to read them and do self-learning before attending the seminar. The PBL spirit is also followed with the bedside teaching – they choose their own patients and ample time is allowed for them to revise their knowledge and skills before the teacher comes. Their skills will be assessed by a clinical competency test (Figure 2) which is conducted at the end of each rotation. It consists of 10 stations, usually 3 to 4 are X-rays / clinical photos, and 6 to 7 are on specific tests in physical examination.

Assessment and Evaluation

In the new medical curriculum, much more emphasis is put on continuous assessment of the students’ performance than before. The summative assessments are in the form of written paper and objective structured clinical assessments (OSCA). The faculty and the department are also very keen on getting feedbacks from the students. The students have so far highly rated the undergraduate teaching in orthopaedic surgery.

Clinical skills session (Year 1&2)

Clinical competency test (Year 5)

Specialty clerkship - new case clinic