The Wellcome Tropical Institute has assisted countries in the tropics to establish viable systems of continuing medical education, particularly for young doctors practising in rural areas. As part of this strategy the Institute has developed material for use in distance learning. The first attempt to apply the problem-based learning approach to written material for use by an individual learner in the absence of a tutor led to a trial in Ghana, Kenya and Pakistan to compare a conventionally designed module with a problem-based learning module on the same topic for their respective acceptability, effectiveness and efficiency. The design, implementation and results of these three comparative trials are presented.

Background: Applicants to orthopaedic surgery residency programs face a competitive match. Internet resources such as program websites allow prospective applicants to gauge interest in particular programs. This study evaluated the content and accessibility of orthopaedic surgery residency program websites. Methods: Existing orthopaedic surgery residency programs for the 2020 application cycle were identified on the Electronic Residency Application Service (ERAS) website. Individual program websites were accessed through links directly from the ERAS website, and a Google search for each program was performed to corroborate accessibility. Programs websites were then reviewed and evaluated on the presence of 20 criteria selected for their potential to influence resident recruitment (10) and education (10), respectively. The results were compared with the lone 2001 study and with orthopaedic fellowship website analyses. Results: One hundred eighty-nine orthopaedic surgery residency programs were accredited at the time of the study. Only 6 programs (3.2%) did not have a website identifiable through ERAS or Google searches, leaving a final sample size of 183 websites. Approximately 73.3% of all recruitment content and 44.9% of education content were present on the websites available. There was a significant increase in all available recruitment and education content (p < 0.05) when compared with the lone 2001 study. Orthopaedic residency program websites provide comparable recruitment content at a higher rate (71.1%) than orthopaedic fellowship websites (59.6%) but fall slightly below average in presentation of education content (44.9% vs 45.9%). Conclusion: This is the first study in nearly 20 years to assess the content and accessibility of orthopaedic residency program websites. There is noticeable variability in the presentation of website content, but approximately 73.3% of recruitment content and 44.9% of the educational content were easily accessible through internet search. Orthopaedic surgery residency programs and their applicants may benefit from standardization of program websites and an increase in recruitment and education content.

Background: The content and accessibility of foot and ankle fellowship websites impact applicants and fellowship programs. This study aimed to evaluate the accessibility provided via the American Orthopaedic Foot & Ankle Society (AOFAS) websites and individual websites. Methods: The AOFAS website was used to identify existing foot and ankle fellowship programs. The database information was reviewed for links to fellowship program websites, which was corroborated through a Google search for accessibility. Information from fellowship program websites and the AOFAS was analyzed for the presence of recruitment and educational content, and this analysis was compared to previously reported metrics. Results: Forty-eight orthopedic foot and ankle fellowship programs were identified. The AOFAS database featured direct links to 19 (40%) fellowship websites with the Google search providing direct links to 35 (73%) websites. Foot and ankle fellowship information markedly improved in domains of Salary/Benefits (+233%), Rotations/Curriculum (+199%), and Faculty Listing (+67%), but there was a reduction in available content in the domains of Operative Experience (–79%), Office/Clinic information (–78%), and Didactics (–39%) compared with the lone existing study. Conclusion: There continues to be variability between foot and ankle fellowship websites and the AOFAS website regarding program content and descriptions. Some information is more readily available, but other domains have less information now than in previously reported research.

Background Terrible triad injuries of the elbow, defined as elbow dislocation with associated fractures to the radial head and coronoid, are associated with stiffness, pain, and loss of motion. Studies to date have consisted of small sample sizes and used heterogeneous surgical techniques, which render comparisons difficult and unreliable. Questions/purposes In a group of patients treated under a standard surgical protocol, we sought to determine the early dislocation rate, the range of motion in those not undergoing secondary procedures, the frequency and types of secondary surgical interventions required, the difference in motion between those undergoing secondary surgery and those who did not, and the frequency of heterotopic ossification and patient-reported stiffness. Methods Patients underwent a surgical protocol that involved fixing the coronoid, fixing the radial head if possible, otherwise performing radial head arthroplasty, and repairing the lateral ligamentous structures. Patients were excluded if ipsilateral upper extremity fractures from the humerus to the distal forearm were present. Fifty-two patients had a minimum followup of 6 weeks and were included for the early dislocation rate, and 34 of these (65%) had a minimum of 6 months followup and were included for the rest of the data. Eighteen of the 52 (35%) were considered lost to followup because they were seen for less than 6 months postsurgically and were excluded from further analysis. Chart review was performed to determine the presence of early dislocation within the first 6 weeks after surgery, range of motion in patients not requiring a secondary procedure, the frequency and types of secondary procedures required, the range of motion before and after a secondary procedure if it was required, and postoperative stiffness. Postoperative radiographs were analyzed to determine the presence and severity of heterotopic ossification. Results One of 52 patients sustained a dislocation within the first weeks of surgery (1.9%). Those not undergoing a secondary procedure were able to achieve a flexion arc of 110°and a supination-pronation arc of 148°. Nine of 34 patients (26%) underwent a secondary surgical procedure with stiffness, heterotopic ossification, and ulnar neuropathy being the most common surgical indications. Before secondary surgical procedures, patients had a flexion arc of 57°a nd a supination-pronation arc of 55°, which was less than those only requiring primary surgery alone (p \ 0.001). After secondary surgery, patients were able to achieve a flexion arc of 96°and a supination-pronation arc of 124°, which was not different from those who did not undergo reoperation (p = 0.09 and p = 0.08, respectively). Twentyeight of 34 patients demonstrated evidence of heterotopic ossification on radiographs, whereas 20 patients, including all nine undergoing secondary procedures, reported stiffness at the elbow.