08 FYi • Careers


MENDING WHAT’S BROKEN


Are you considering a career in trauma and orthopaedic surgery? A


FRENCH physician named Nicolas Andry published a book in the year 1741 entitled Orthopédie, principally about correcting spinal and limb deformities in children. Though popular in its day, the book’s most enduring attribute is its title, from which the term orthopaedics is derived. Orthopaedics refers to the specialty of trauma and


orthopaedic surgery. It is one of the largest of the surgical specialties and deals with the treatment of musculoskeletal conditions – either traumatic injury or diseases and infection. Over 20 per cent of GP attendances are for musculoskeletal problems and this represents a massive cost to the NHS – over £3 billion per year. Orthopaedists work mostly in hospital settings, usually with accident


and emergency facilities and the role involves team working with surgical and medical colleagues (e.g. paediatricians, rheumatologists, geriatricians) as well as outpatient staff, theatre staff and hospital managers. UK consultants in orthopaedics operate around 40 per cent of the time, with the rest of their day divided between clinics, ward work and on-call commitments. An orthopaedic surgeon writing in the British Orthopaedic Association Undergraduate Guide 2011 comments: “One of the main attractions of Orthopaedics as a career is the fact that our interventions can rapidly and dramatically improve quality of life for patients. It combines theoretical knowledge with practical skills but also involves an interface with technology, industry and the multidisciplinary team unmatched by any other specialty.”


A long road Both “uncoupled” and “run-through” training posts in trauma and orthopaedic surgery are available upon completion of Foundation year 2. “Uncoupled” posts involve two years of core surgical training (CT1/2), followed by another competitive application system for higher specialist training (ST3+). “Run-through” training involves a commitment to orthopaedics in ST1 with automatic progression to ST3+, as long as a candidate satisfies the competency requirements.


The trauma and orthopaedic curriculum is governed by the


Intercollegiate Surgical Curriculum Programme (ISCP) and it breaks down into stages: intermediate (ST3-6) and final (ST6-8) years. The intermediate years offer focused orthopaedic training,


concentrating on trauma management and the generality of elective practice. Time will be spent in theatre both assisting the consultant and performing operations under supervision. In addition there are ward rounds and orthopaedic and fracture clinics dealing with referrals and follow-ups. The culmination of this phase of training is attainment of the FRCS (T&O) exam. In the final years of training, orthopaedic surgeons usually develop an


interest in one particular sub-specialty. These include: • foot and ankle surgery


• knee surgery • hip surgery • upper limb surgery • paediatric surgery • spinal surgery • sports injuries surgery • trauma surgery. Candidates at the end of a successful training programme are


awarded a Certificate of Completion of Training (CCT) and become eligible to join the specialist register and apply for consultant posts.


Getting in Competition for orthopaedic specialty training posts is fierce.


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