Musculoskeletal Training for Orthopaedists and Nonorthopaedists: Experiences in India

Abstract

In India, health policies, services, health indices, and medical education are improving despite the country's enormous population and limited resources. Orthopaedic training in India should be geared to serve the predominantly rural population (72% of total population) living in some 550,000 villages, but unless the basic amenities improve in villages and towns, orthopaedists will remain averse to serving in these areas. Traditional practitioners play an important role in musculoskeletal trauma care in villages and even some town and city areas, and hence cannot be ignored. We suggest a stratified system of orthopaedic training for medical graduates, postgraduates, and paramedics with a well-defined need-based curriculum, and a clear cut division of labor, terms, and conditions to suit the stratified social and demographic structure of India. This stratified system is intended to provide appropriate musculoskeletal trauma care services to the rural population, reduce neglected and mismanaged trauma, consequently avoiding subsequent orthopaedic disability, and reduce the financial burden of managing these cases. This system also intends to prevent overloading of teaching hospitals and apex institutes and ensure availability of subspecialized orthopaedic services in the country at designated centers. Traditional practitioners shall be periodically educated regarding safe orthopaedic practices, which are anticipated to yield improved trauma care services.

Orthopaedic Surgery Education in India

“…The decisive factor for admission into medical school is based upon a national written examination [1,9]. India has a large number of schools and applications.…”

“…Once completed, students earn a Bachelor of Medicine and Bachelor of Surgery (MBBS) degree. The MBBS curriculum includes gross anatomy, physiology, pathology, pharmacology, and other common topics followed by beginning clinical rotations in medicine (and subspecialties), surgery (and subspecialties), Obstetrics, and Pediatrics [1][2][3][4][5][6][7]9].…”

“…In order to apply for residency specialty training, MBBS graduates must pass a national level and/or state level ''postgraduate entrance exam'' -a written exam that is the deciding factor for placement in postgraduate training [1][2][3][4][5][6][7]9].…”

“…In order to gain eligibility for an exit examination, residents must pass the standard national curriculum for resident exposure and education, and successfully complete a required thesis ( Table 1). The curriculum covers all aspects of general orthopaedic surgery, including pathology (focusing on conditions commonly found in India, such as infections and tuberculosis) [1][2][3][4][5][6][7].…”

“…The World Bank [10] reports that 29.8% of the Indian population lived below the national poverty line in 2010. This diversity is also reflected in medicine, where the disease burden ranges from ''Western problems'' like heart disease and arthritis, to critical health concerns we associate with poverty, including Hansen's disease (leprosy), tuberculosis, neglected trauma, and untreated clubfoot [1,2,4,5]. Some medical centers in India provide quality care on par with the best in the world, yet others lack basic resources to care for the local population.…”