Orthopaedic surgery (incorporating peri-operative care of the elderly)
This unit includes all aspects of elective and emergency orthopaedic surgery. It is anticipated that this unit of training will not be delivered as a dedicated block and that the learning outcomes will be gained throughout the entire duration of Core Level training and that these should be achievable in most general hospitals at this level.
Learning outcomes:
- To gain knowledge, skills and experience of the perioperative anaesthetic care of patients requiring orthopaedic surgery including the elderly and patients with long-bone fractures
- To understand the relevance of diseases of bones and joints to anaesthesia
- To be able to recognise and manage the perioperative complications of orthopaedic surgery relevant to anaesthesia
Core clinical learning outcome:
- Deliver perioperative anaesthetic care to uncomplicated ASA 1-3 adult patients for straightforward elective and emergency orthopaedic/trauma surgery to both upper and lower limbs, including Open Reduction Internal Fixation [ORIF] surgery [which includes fractured neck of femur], under distant supervision
NB: All competencies annotated with the letter ‘E’ can be examined in any of the components of the Primary examination identified in the FRCA examination blueprint on page B-99 or in the Final examination identified in the Final FRCA blueprint on page C72 of Annex C.
| Knowledge |
|---|
|
Competence |
Description |
Assessment Methods |
GMP |
|---|---|---|---|
|
OR_BK_01 |
Recalls/describes the perioperative implications of rheumatological disease, including but not limited to rheumatoid arthritis, osteoarthritis, osteoporosis and ankylosing spondylitis |
A,C,E |
1 |
|
OR_BK_02 |
Recalls the complications of prolonged immobility, including those due to traction |
A,C,E |
1,2 |
|
OR_BK_03 |
Recalls the problems associated with limb tourniquets |
A,C,E |
1,2 |
|
OR_BK_04 |
Recalls/explains the potential hazards associated with positioning [supine, lateral, prone, sitting] |
A,C,E |
1,2 |
|
OR_BK_05 |
Recalls/explains the problems associated with anaesthesia for surgery in the prone and lateral positions |
A,C,E |
1,2 |
|
OR_BK_06 |
Recalls/describes the pathophysiology, diagnosis and management of specific orthopaedic surgical complications that are relevant to anaesthesia including but not exclusively:
|
A,C,E |
1 |
|
OR_BK_07 |
Discusses strategies for blood conservation in major orthopaedic surgery |
A,C,E |
1,2 |
|
OR_BK_08 |
Describes the principles of perioperative anaesthetic care for elective and emergency upper and lower limb orthopaedic surgery, including primary arthroplasty |
A,C,E |
1,2,3 |
|
OR_BK_09 |
Discusses the current guidance on early surgical management of hip fractures and the necessary assessment for anaesthesia |
A,C,E |
1,2 |
|
OR_BK_10 |
Discusses the timing of surgery, and the need for investigations in urgent [surgical] cases with cardiovascular signs |
A,C,E |
1,2 |
|
OR_BK_11 |
Describes the different surgical procedures for managing hip fractures, the anaesthetic requirements for each and the current evidence for the choice of anaesthetic technique |
A,C,E |
1 |
|
OR_BK_12 |
Discusses the importance of consistent decision making on fitness for surgery in elderly patients |
A,C,E |
1,4 |
|
OR_BK_13 |
Recalls/describes the peri-operative care of the elderly |
A,C,E |
1,2 |
| Skills |
|---|
|
Competence |
Description |
Assessment Methods |
GMP |
|---|---|---|---|
|
OR_BS_01 |
Demonstrates the provision of perioperative anaesthetic care for patients requiring orthopaedic surgery to the upper and lower limbs including but not exclusively:
|
A,D,M |
1,2 |
|
OR_BS_02 |
Demonstrates sensitive handling of the patient with cognitive disturbance or communication problems |
A,D,M |
1,3,4 |
|
OR_BS_03 |
Demonstrates correct assessment and perioperative management of the elderly patient with a hip fracture |
A,D,M |
1,2,3,4 |
|
OR_BS_04 |
Shows sensitive handling of patient with cognitive impairment in anaesthetic room |
A,D,M |
1,2,3,4 |