EXPERIENCES

1)ORTHOPAEDIC SUB SPECIALITIES FELLOWSHIP IN THE
MINISTRY OF HEALTH, MALAYSIA.

The objectives of the Orthopaedic Sub Speciality Training Programme are: -

1. To produce competent and safe Orthopaedic & Traumatology sub specialists
capable of independent practice.
2. To further improve the quality and standards of Orthopaedics & Traumatology in
the country.
3. To enhance and make accessible the delivery of high quality Orthopaedics &
Traumatology care to the public.

Areas of Training
1. General Orthopaedics and Advance Musculoskeletal Traumatology
2. Spinal Surgery
3. Joint Arthroplasty
4. Hand and Microsurgery
5. Sport Injuries and Arthroscopy
6. Pediatric Orthopaedics
7. Orthopaedic Oncology

DURATION OF TRAINING

Total duration of training is 4 years, which is divided into 2 parts. Entry into the 2nd
part is only possible after successful completion of the 1st part and the candidate passed the required assessment.

1st Part (1st & 2nd years) – In house training, preferably with rotation to different centers
under different trainers. Part of this training can be done in
local Universities.

2nd Part (3rd & 4th years) – The candidate works in partial independence and is supervised
by his/her mentor from time to time. Part of this training can
be done in recognized oversea centers, preferably during the
3rd year.

TRAINING CENTERS

1st Part of training - in house training
Regional centers to be maintained as the hub of training because of their established
supporting services; allied departments; and teaching facilities. Such centers also have a
high patient volume turnover with a good yield of operative and non-operative cases.
From here the trainees can be rotated and networked to other centers, attend short courses
and attachments.

2nd Part of training – partial independence
In any General Hospitals or DGH with specialists which is able to support the sub
speciality. Trainees can attend short courses and attachments. Trainers must visit and
supervise / audit the trainee’s work at least 4 times a year if not working in the same
hospital. Part of this 2nd part training can be done in recognized oversea centers
preferably during the 3rd year.

Overseas Training
To be undertaken preferably during the 3rd year of training. Application for scholarships,
bursaries, paid leaves or other forms of aid to be done early. The respective sub specialty
training committee will attempt to procure a suitable overseas training center for the
trainee.
It should be noted here that this Fellowship is not tied to any form of Scholarship /
Bursary / Paid Leaves or Sabbaticals. But the reverse applies, one has to be in the
Fellowship to qualify for the scholarship.
However, every effort will still be made to obtain scholarships and other forms of
financial support for the candidates to enable them to attend overseas training.
Unfortunately, such scholarships are very limited; hence not all candidates will be
successful in obtaining a scholarship for overseas training. Joining this Fellowship
is not a guarantee to overseas training.

CERTIFICATION
After having satisfied all the requirements of the training programme, the trainee will be
recommended to the Orthopaedic Sub Speciality Training Committee by their respective
Sub Specialties and peers for the purpose of certification. The certificate of successful
completion of sub specialty training will be issued by The Ministry of Health, Malaysia.

RE-CERTIFICATION
Successful candidates are subjected to re-certification every few years and their work
audited according to the rules and regulations set up by the National Credentialing
Committee.

ACHIEVEMENT

2)Associate Professor Dr. Robert Penafort

Associate Professor Dr. Robert Penafort

MBBS Masters in Surgery

Clinical Associate Professor – Orthopedic Surgery

Dr Penafort did his undergraduate studies at Trivandrum Medical College in India and graduated with an MBBS degree in 1990. After working as a house officer in University Hospital, he served as a Medical Officer in Sarawak for three years before commencing his post graduate training in University Malaya Medical Center in 1994. He graduated with a Masters in Orthopedic Surgery in 1998 was awarded the Subramaniam Gold Medal for being the top student. Subsequent to this he served as a Orthopedic Specialist in Hospital Kuala Lumpur from 1998 to 2000. In the year 2000 he joined the University Malaya Medical Center as a lecture in the Department of Orthopedic Surgery where he served until the year 2004. Since 2004, he has been a Consultant Orthopedic Surgeon in Damansara Specialist Hospital. Dr Penafort has a special interest in pediatric orthopedic surgery and also adult and pediatric orthopedic trauma. He has also attended various fellowships around the world. Among them were Australian Orthopedic Assoication-S&N Fellow 1999, Illizarov Fellowship Kurgan 2003, Japanese Pediatric Orthopedic Fellow 2002 and British Orthopedic Assoication-ASEAN Fellow 2005. He has also been very active in the Malaysian Orthopedic Association for the past seven years and has served in different posts over the years. He is at present the President of the Malaysian Orthopedic Association. He has a very keen interest in teaching.

General duties of a surgeon is specialize in the treatment of injury, disease, and deformity through operations. Using a variety of instruments, and with patients under anesthesia, a surgeon corrects physical deformities, repairs bone and tissue after injuries, or performs preventive surgeries on patients with debilitating diseases or disorders. Although a large number perform general surgery, many surgeons choose to specialize in a specific area. One of the most prevalent specialties is orthopedic surgery: the treatment of the musculoskeletal system. Others include neurological surgery (treatment of the brain and nervous system), cardiovascular surgery, otolaryngology (treatment of the ear, nose, and throat), and plastic or reconstructive surgery. Like other physicians, surgeons also examine patients, perform and interpret diagnostic tests, and counsel patients on preventive healthcare.But we just want to focus on Traumalogist duties.

Job Description

Surgeon - Trauma
1)Examines the patients,
2)Diagnoses, and
3)surgically treats critically injured patients.Normally,it is minimal in case that doctors take history from patient because it usually involves severe case.
4)Performs emergency procedures including endotracheal tube intubation, tube thoracostomy, pericardiocentesis, ultrosonographic evaluation, and peritoneal lavage. Requires a degree in medicine from an accredited school and is licensed to practice. May require at least 2-4 years of surgery experience.
5)Familiar with standard concepts, practices, and procedures within a particular field. Relies on experience and judgment to plan and accomplish goals. Performs a variety of tasks. A wide degree of creativity and latitude is expected.
6)May report to the chief of surgery or consultant.

Working Conditions

• Medical assistants work in well-lighted, clean environments. They constantly interact with other people, and may have to handle several responsibilities at once.
• Need to be expert in handling the medical instruments for the surgery
• Co-operate effectively with other sub-specialist like anaesthesiologist,& radiologist.

QUALIFICATION:(taken from Orthopaedic Department Of HUKM)

Applicants must possess either M.B.B.S., M.B.Ch.B., M.D. or its equivalent from a recognised University.
Applicants must have at least 2 years clinical experience after graduation.
Applicants must be registered with the Malaysian Medical Council.


Masters of Surgery (Orthopaedics)


INTRODUCTION :This shall be the highest professional qualification to be awarded by this University in the field of Orthopaedic and Traumatology.
On completion of the course and passing the required examinations, the candidate shall be conferred the degree M.S. (Orth.).
On obtaining the M.S. (Orth.) degree, the candidate is eligible for registration in the Medical Gazette as a specialist in Orthopaedic and Traumatology, after a period of 6 months supervision under an orthopaedic surgeon.

LANGUAGE OF INSTRUCTION :Bahasa Malaysia and English are the languages of instruction.

DURATION OF THE COURSE :The course is conducted over a period of 4 years.

COURSE STRUCTURE Year I : Orthopaedics (Accredited Hospital)General Surgery (Accredited Hospital)
Year II :Orthopaedics (Accredited Hospital)Accident & Emergency (Accredited Hospital)
Year III and Year IV :General Orthopaedics,Traumatology,Rehabilitation,Orthotics & Prosthetics ,Orthopaedic Radiology ,Orthopaedic Pathology.

COURSE SCHEDULES See Appendix.

EXAMINATIONS :The examintions shall be held in 2 parts:-
Part I :To be held every 6 months in the 1st year. It will comprise written and viva voce examinations in Basic Medical Sciences and principles of Orthopaedic Surgery.
Part II :The final examination will be held at the end of 4th year and will comprise written, clinical and viva voce examinations in :-General Orthopaedics and TraumatologyPrinciples of Operative OrthopaedicsClinical examination of casesOrthopaedic RadiologyOrthopaedic PathologyOrthotics and Prosthetics.

SUPERVISION :At the recommendation of the Head of Department, a supervisor will be appointed for each candidate for the purpose of guidance and monitoring during the course.
The supervisor shall be an orthopaedic surgeon from the Department of Orthopaedic & Traumatology UKM (for candidates posted to HUKM) or from an accredited hospital (for candidates posted to other hospitals).
The supervisor is required to submit a progress report on each candidate via the Head of Department to the Postgraduate Committee at least every 6 months.

THE LOG BOOK :Every candidate is required to log his independently-performed work in a prescribed book to ensure the adequacy of his practical training.
Entry into the book is to be done sequentially and not in retrospect.The book must be available for inspection on request by the supervisor.
Any deficiencies therein must be rectified to the satisfaction of the supervisor before allowing the candidate to proceed for the part II examination.
The log book will remain the property of the University.

CASE REPORTS :The case reports must be approved by the Examiner/Postgraduate Committee before it can be formally accepted as a complete work enabling the candidate to be eligible for the Part II examination.
The candidate is required to complete 15 case reports.The case reports should contain the following :-
Patient identification dataHistory and physical examinationDiagnosisInvestigationsOperative record which includes the names of Surgeon, Assistant, Anaesthetist and type of anaesthesia givenPost operative managementDiscussion and relevant references.

DISSERTATION/THESIS :The dissertation/thesis must be approved by the Examiner/Postgraduate Committee before it can be formally accepted as a complete work enabling the candidate to be eligible for the Part II examination.
The dissertation/thesis must be written in comprehensible language either in Bahasa Malaysia or English.
It must be preceded with a title and a synopsis and followed by references. It should be on 210 x 280mm paper, double-spaced type written with 40mm margin on all sides. The covers should be of hard cloth-covered cardboard. On completion of the course, 2 copies shall become the property of the University – one for the library and the other for the Department/Faculty.
The dissertation/thesis should not exceed 30,000 words and must bear relevant histograms, tables, charts, figures, photographs or schematic representation and should broadly follow the format below :-
Abstract not exceeding 300 wordsIntroductionMaterials and methodsResultsDiscussionConclusionAcknowledgement andReferences.
The dissertation/thesis shall be presented orally to members of the Department/Faculty prior to submission to the Board of Examiners.

AWARD OF M.S. (ORTHOPAEDICS)The award will be made after the candidate has :-
Fulfilled all the conditions specified in the Graduate Studies Act and its schedules, and Paid up all necessary fees.

• The broad scope of their surgical critical care training enables the trauma surgeon to address most injuries to the neck, chest, abdomen, and extremities (other than fractures). Injuries to the central nervous system are generally treated by neurosurgeons. Skeletal injuries are treated by orthopaedic surgeons. Facial injuries are often treated by maxillofacial surgeons. There is significant variation across hospitals in the degree to which other specialists, such as cardiothoracic surgeons, plastic surgeons, vascular surgeons, and interventional radiologist are involved in treating trauma patients.
  
• Trauma surgeons must be familiar with a large variety of general surgical, thoracic, and vascular procedures and must be able to make complex decisions, often with little time and incomplete information. Proficiency in all aspects of intensive care medicine/critical care is required. Hours are irregular and there is a considerable amount of night, weekend, and holiday work. Salaries for trauma surgeons are comparable to that of general surgeons.
  
• Most patients presenting to trauma centers have multiple injuries involving different organ systems, and so the care of such patients often requires a significant number of diagnostic studies and operative procedures. The trauma surgeon is responsible for prioritizing such procedures and for designing the overall treatment plan. This process starts as soon as the patient arrives in the emergency department and continues to the operating room, intensive care unit, and hospital floor. In most settings, patients are evaluated according to a set of predetermined protocols (triage) designed to detect and treat life-threatening conditions as soon as possible. After such conditions have been addressed (or ruled out), non-life-threatening injuries are addressed.

Definition:

Traumatology (from Greek "Trauma" meaning injury or wound) is the study of wounds and injuries caused by accidents or violence to a person, and the surgical therapy and repair of the damage. Traumatology is a branch of medicine. It is often considered a subset of surgery and in countries without the specialty of trauma surgery it is most often a sub-specialty to orthopaedic surgery. Traumatology may also be known as accident surgery. Traumatology can also refer to the study, development and application of psychological and counseling services for people who have experienced extreme events - e.g. see Wiki Glossary of Traumatology

Factors in the assessment of wounds are:
1)the nature of the wound, whether it is a laceration, abrasion, bruise or burn
2)the size of the wound in length, width and depth
3)the extent of the overall area of tissue damage caused by the impact of a mechanical force, or the reaction to chemical agents in, for example, fires or fires or exposure to causatic substances.

Forensic physicians, as well as pathologists may also be required to examine wounds (trauma) on persons alive or deceased.Orthopaedic trauma surgeons have the expertise to treat complicated or multiple injuries to the extremities, spine, and pelvis. Reconstructive procedures are performed for treatment of the late effects of traumatic injuries