1. Managing severe hand deformities
in Cambodia
V Rajaratnam, Senior Consultant Hand Surgeon
Khoo Teck Puat Hospital, Singapore
W Lam, J K Yong, Keo V, J Gollogly
This work is licensed under a Creative Commons Attribution 4.0 International License.
2. Aim:
Developing a targeted surgical
training programme for the
sustainable ,management of severe
hand Deformities in CSC
3. Methodology
Severe trauma
Severe burn contractures
Severe venomous injuries
• Community-oriented curriculum
• Needs analysis of surgeons
• Personalised programme
• Targeted training
• Feedback and Practice
• Assessment
• Evaluation of the programme
4. Methods – Community-oriented Curriculum
DELIVER Curriculum (Pedagogy Specific to Cambodia)
Assessments
INDEPENDENT PRACTICE &
TEACH OTHERS
DESIGN Curriculum (around Training Needs)
Targeted Competency Based
DISCERN Community Needs
Visiting Centre Plan Training Needs based on
Community Needs
5. Discerning the Community Needs:
A Compilation of 600 Cases (before visit)
Cases Percentage
Burns and trauma
deformity 453
76%
Congenital 142 23.2%
Nerve
(not brachial plexus) 5 0.80%
Total 600 100%
6. Designing the Curriculum
TOPICS LEARNING PROCESS TIME
Basic Science Hand Assessment
Workshop
6 mths
Deformity 1:
Burn contractures
Flap design
workshop
1-2 yrs
Deformity 2: Tendons Tendon workshop 6 mths
Deformity 3
Fracture and dislocations
Osteomyelitis
Fracture fixation
workshop
1 yr
Nerve 1:
Paralysis, cerebral palsy and
spasticity
Micronueral
workshop
1-2 yrs
Nerve 2:
Brachial plexus
Micronueral
workshop
1-2 yrs
Congenital Hand Deformities Lectures, tutorials,
supervised operating
2-3 yrs
✔
✔
✔
✔
7. Learning needs analysis of surgeons
1. Identify surgeon
2. Assess skill level
3. Develop personalized training program
4. Show and Supervise
5. Assess independent practice
11. English slides, but local language
(Khmer)
Live and Online
Information Technology Workshop Nov 2014
GoPro Camera
https://www.youtube.com/channel/UCbjUKspmSoIuOq2FUi
PGt_g
12. Personalised program
• Deformity assessment - CBD
• Decision making and planning - CBD
• Surgical option generation – Lectures, CBD
• Selection/execution under supervision - DOP
• Deliberate practice - DOPS
• Independent performance/assessment - DOP
18. Evaluation of
the programme
BEFORE AFTER THE FUTURE
1.375 4.46 4.875
DEFORMITY
BEFORE AFTER THE FUTURE
1.625 4.41 4.5
CONGENITAL HANDS
BEFORE AFTER THE FUTURE
1.25 4.375 4.28
BRACHIAL PLEXUS INJURIES
Not confident Very confident
1 2 3 4 5
Good morning Mr Chairman, ladies and gentleman. My name is Ratha Soum and I am a surgeon at the CSC in Cambodia. It is my honour to present my experience of how I received hand surgery training from visiting surgeons to CSC.
So how do we teach them how to fish? Well, by developing a curriculum, and making sure we are intentional about it. So that we do not just go there to do the work and neglect the training. We develop a three part process of discerning, designing and delivering the curriculum, so that the curriculum we developed is relevant to the needs of the community, and not just what we want to teach, with the eventual aim to facilitate independent practice.
Back to Barbara’s analogy of fishing…if we can teach them how to fish, its great but if we can teach them how to fish so well they can teach others…then we are on to a winner. And in developing a sustainable service, we began to think about how to develop a faculty of trainers. And so on this most recent trip, we conducted an IT workshop, where we taught them learning through mobile devices, and also taught them how to record lectures into a video format, in their own language using English slides, so they can store it on their own URL, and so they can share it with the rest of their own people in Cambodia. Just imagine the impact this will have.
Again, thanks to Bfirst for sponsoring some of the editing software.
Snake bites are very common in Cambodia. And these injuries often require flap reconstruction. And this defect has been adequately treated, again with a reversed radial forearm flap which can be taught, and passed on. As Barbara said, I believe reconstructive surgery can be taught, and it has enormous implications in a country like Cambodia, where just learning two flaps can often make all the difference in restoring function to a hand.