Rural Surgery Innovation in training KM Shyamprasad, Vice-President National Board of Examinations (Postgraduate Medical Education) Ministry of Health, Government of India

NATIONAL BOARD OF EXAMINATIONS Apex post graduate medical education body Under the Ministry of Health, Government of India Accredits institutions for training and conducts post graduate examinations in 42 disciples of medicine both in broad and sub/superspecialities

Need for Rural Surgical Training Surgical training focused on surgical burden of disease in India The current Euro-western models of medical education- depriving health care providers for rural India ( 70% of population) 25% of all deaths in India are due to two surgical causes: Maternal Mortality Injuries

INJURIES 11% of all deaths and 170,00,000 hospitalizations. A further 5,00, seek hospital care for injuries according to the estimation of the NCMH.

INJURIES Blunt and penetrating injuries- 3 rd leading cause of death and disability Decreasing in developed countries Increasing in developing countries

What is Rural Surgery Surgical emergencies and problems causing rural morbidity and mortality Training on a different model- new paradigm Training should be in rural settings Cost containment Less reliance on sophisticated investigations and equipment

Syllabus Syllabus ensures knowledge, competencies and skills to function as an independent surgeon in resource limited settings of a rural surgical centre

Syllabus Management of a Rural Surgical Centre Management of Urological, Pediatric, Thoracic, Plastic, and Neurosurgical emergencies, Management of Abdominal emergencies, Essential elective general surgery, Essential Orthopedics and Trauma, Obstetrics and Gynecology Emphasis on prevention and management of obstetrical emergencies

Essential Orthopedics and Trauma Acute trauma Injuries of upper limb Injuries of lower limb Injuries of the spine Amputations

SKILLS TO BE LEARNT IV access, Intubations CPR Splintage, Skin and Skeletal traction CTEV cast correction Close Reduction of fractures and dislocations Debridement and management of open fractures -external fixators

SKILLS TO BE LEARNT Hand injury Amputation Sequestrectomy Arthrotomy Use of tongs and calipers Bone Biopsy

INNOVATIVE MODEL A model of training is on trial in 6 centers across India Each centre has been chosen for its commitment to provide surgical care for the rural population. A peripheral rural and a nodal center have been connected for training The nodal center provides the variety of surgical training opportunities needed

Peripheral Center Prepares the candidate for the living conditions Economics of rural health care Infrastructural constrains Helps develop the right attitude

ROTATIONS General Surgery- 1 year Obstetrics and Gynecology -6 months Orthopedics and Trauma - 5 months Anesthesia – 1 month Peripheral Centre- 1 year

Learning Resources Emergency and Essential Surgical Care E- learning Tool Kit developed by the Emergency and Essential Surgical Care project of the World Health Organisation, which includes and the Text Book on Surgery at the District Hospital. A detailed modular Syllabus and Curriculum for Rural Surgical training developed by the Indira Gandhi National Open University. Audio Visual learning material developed by NBE in various disciples of medicine and surgery.

Review of the Program 10 candidates have been registered Nodal and peripheral centers have to define their roles more clearly Faculty training required Emphasis on life saving skills/hands on training Log Book Thesis

FUTURE NEEDS Text Book of Rural Surgery Faculty Development Programs Standardized courses in Basic Surgical Skills and Trauma Identifying experts for evaluation, TOT, examiners Methodology for final summative examination

“STEPS” Sequential Trauma Education ProgramS Global Injury Solutions

Future perspectives Teams for Rural Surgery Anesthetists Surgical Care providers-Pre- Hosp care Family Physicians- +PAs’ Force Multipliers Alternative Health Care Delivery Systems- Suitable for regional needs Appropriate Technology

Thank you for the Attention