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Pacific Islands Orthopaedic Association

Report for MODULE 1, Honiara, 11.-23. February 2013

  1. What have I learnt?

    1. How to take a full history of the patient and the importance of history taking.
    2. Proper documentation of the Range of motion of the important joints
    3. Proficient examination of the Shoulder, knee, ankle, elbow and the wrist
    4. Learn how to perform the neurological examination of the Upper and lower limbs.
    5. The importance of ethics in the practice of clinical medicine. Patient-Doctor relationship
    6. Importance of the crisp algorithm in the care of the critically ill patients.
    7. The importance of the urine output in the critically ill. It should be more than 30ml/hr in an average 70kg person. Thus, the important 5 rules of the kidney: Kidney perfusion is dependent on the cardiac output and blood pressure, low urine output does not mean furesimide deficiency, Anuria is almost due to obstruction, when there is oliguria a fluid bolus challenge is important, kidneys need good perfusion.
    8. How to fix the patella fracture, the olecranon process with a Tension band wire. Principles behind it being learnt.
    9. How to fix the long bones fractures with a lag screw. The principles and the technique being learnt.
    10. How to communicate with a sick patient or the relatives using "IS BAR"

  2. How will the knowledge influence our daily work.

    1. Simply knowing the Ccrisp algorithm will certainly make a lot of changes to our very sick patients, both preop and post op patients. ABCDE, a simple but very important tool in resuscitation, and the rest of the algorithm
    2. Again history taking is very important. With a good history, a good idea of the diagnosis is already established before doing the examination and it also directs one to the necessary examination.
    3. Urinary output is a very important facet to monitor in the critically ill or post-operative patients. Fluid challenge being very important. Thus all sick patients or those after big major operation to go on urinary output monitor.
    4. Communication is very important tool in the medical practice, especially with patients, relative and a colleague. The importance of it cannot be over emphasized. A good communication with everyone involved in the care of the patient avoids any errors in patient care.
    5. I have taken to fully examine the complete neurological examination of a patient. I don't think I would have done these 3 months back.
    6. It makes me think more widely and strategically when confronting a critically ill patient. Having a system leaves us with a very small margin for critical error.
    7. It certainly has changed my approach in the fracture clinic. I am now very thorough when examining a patient and I am seeing a patient more completely and not just a "sore knee".
    8. I have a plan for my patient in the ward. I guess I am more organised in ensuring all the necessary things are done, and at the same time having more time to listen to them.
    9. I am much better with interpretation of blood results than I used to.
    10. I have a system of interpreting x-rays. I still need more practice.

  3. What do I do now, what do I want to learn next.

    1. First and for most is to ensure that all knowledge learnt to be put into practice in everyday life. And to have a log book to remind me of the cases I have examined.
    2. I want to attend more hand workshops to ensure I develop my special interest.
    3. I want to attend the advanced AO work shop. that will certainly advance my knowledge and skills of internal fixation.
    4. To learn more about the physiology of the kidneys.
    5. To attend further Crrisp courses or the EMST.
    6. To develop further my judgemental skill in looking after the critically ill.
    7. To learn more about respiratory medicine and its relevance in the critically ill.
    8. To be attached at another centre for trauma care.
    9. To be proficient and to know how to interpret the ECG.
    10. To fine tune my surgical skills further with a very good knowledge of anatomy

Dr. George Kabwere, Registrar, Orthopaedic Department
National Referral Hospital, Honiara, Solomon Islands

© April 2013, Dr George Kabwere