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EDITORIAL Table of Contents   
Year : 2003  |  Volume : 37  |  Issue : 2  |  Page : 1
Education in Orthopaedics; Is it going up or down

Former Director General Health Services, Government of India; Former Director, WHO;Former President, Indian Orthopaedic Association, India

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How to cite this article:
Sankaran B. Education in Orthopaedics; Is it going up or down. Indian J Orthop 2003;37:1

How to cite this URL:
Sankaran B. Education in Orthopaedics; Is it going up or down. Indian J Orthop [serial online] 2003 [cited 2020 Mar 29];37:1. Available from:
I thought I would write an editorial on the status of orthopaedic education in India and compare it to other major countries where orthopaedic education has progressed in the last several years.

I believe it is important and mandatory on the part of the Indian Orthopaedic Association to take a more active role, not only in education but also for certification for practice of orthopaedic surgery in the country. It should have the same role as the American Academy of Orthopaedic Surgeons which not only conducts but also supervises the examination and has also internal and external assessors for maintaining the standard of the examination. The theory and orals of this examination are normally conducted at the same time as the annual academy meeting, normally in January of the year. Since we already have a National Board of Examinations conducting examinations in orthopaedic surgery, it is extremely important that the Indian Orthopaedic Association creates a functional, educational academy, which would coordinate with the National Board and conduct examinations on par with the examinations conducted elsewhere. Unfortunately there is very little interaction between the Indian Orthopaedic Association and the National Board of Examinations.

We do not seem to have followed the UK system either. The only degree in United Kingdom was the MCh Orthopaedics from Liverpool, which was given at the end of a nine months course which did not include any practical training. Similarly fellowships of the Royal College of Surgeons of Glasgow, Edinburgh and Ireland have been in existence for the last few years but there are not too many candidates who are being attracted to such examinations. We fortunately have developed a junior residency and a senior residency program, patterned after the American system and university examinations of Diploma, Masters in Orthopaedic surgery have been in existence for almost half a century. The only difficulty is that the standard of the examinations conducted at various centers are not uniform and variations in the pass rates vary a great deal.

Again it is important that there is some mechanism by which the Indian Orthopaedic Association or a newly formed Indian Academy of Orthopaedic Surgeons plays a role in making the exams uniform, acceptable and up to international standards. It was sometimes disheartening to see an individual who has taken an MS in orthopaedic surgery be appointed as a senior house officer in a peripheral hospital in England just because of non- recognition of the masters in orthopaedics surgery obtained at an Indian university. This is not the entire fault of the foreign system alone but also that the Indian Orthopaedic Association has not taken an active interest in maintaining the standard of the examinations at par with other systems of education.

So how do we bring up the methods of teaching in orthopaedics and bring it on par or excel the standards set in well established institutions like the American Board and other equivalent examinations. I think it is important that the Indian Orthopaedic Association should aim at forming an academic body consisting of professors of orthopaedic surgery and heads of departments of orthopaedic surgery at various institutions of the country and there should be equitable distribution of such memberships throughout the country, with a minimum of two from each state. Such a supervisory body could and should ensure that standards are maintained in all facets of the teaching program.

I am sorry to note that in the last forty six years of my association with training and teaching in orthopaedic surgery in the country, there has been a considerable decline in standards of knowledge, particularly of the basic sciences, namely anatomy, embryology, physiology, pathology and the modern genetic engineering systems, which ultimately will play a vital role in the development of the specialty. In addition the standards of clinical examination of patients and the recording of clinical findings, writing of operative surgery notes, the discharge slips from institutions of patients and the management of acute multiple trauma have all suffered a set back and it is time we woke up with this reality particularly amongst the young active, practicing teachers to elevate these standards to a higher level, so that the individual that is being trained in orthopaedics becomes one with a multiple knowledge of the various areas of the body he has to tackle during an emergency.

Research in orthopaedic surgery in this country is at very low ebb and it is important that major teaching institutions should focus on research, particularly basic fundamental research in relation to orthopaedic surgery, bone and cartilage morphology and the role of genetic engineering in the field of orthopaedics. Similarly one of the basic drawbacks in present day orthopaedic education is inadequate knowledge of bio-materials and skeletal implants. This unfortunately is not adequately emphasised in the teaching process.

I would also like to mention that orthopaedic surgeons take very little interest in prosthetic and orthotic fitting of patients and regard physical medicine and rehabilitation as a second rate specialty. It is important that every candidate who appears for a post-graduate examination in orthopaedic surgery should have the basic concepts of physical medicine, rehabilitation, prosthetic and orthotics as absolutely fundamental.

I would also like to mention that during the training program in orthopaedic surgery, it is important to give emphasis to critical care, neurology, neuro-surgery, radiology including techniques of ultrasound, CT scan and MRI, rheumatology, radiotherapy and chemotherapy in malignant lesions so that an outgoing student would be conversant with associated and allied programs that would strengthen his general knowledge and thus the treatment of a patient.

I purposefully avoided mentioning of specialties that have come up in the field of orthopaedics in the last few years which is a most welcome progress - hand surgery, spinal surgery, arthroscopy, total joint replacement, pediatric orthopaedic surgery. These would ultimately become specialties in their own context but they should form an integral part of orthopaedic surgery and we should try to keep all these various diversionary forces together so that orthopaedic surgery can grow as a combined specialty and be like a tree with multiple branches but have strong base and a solid foundation.

I hope my dream comes true

Correspondence Address:
B Sankaran
Former Director General Health Services, Government of India; Former Director, WHO;Former President, Indian Orthopaedic Association
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Source of Support: None, Conflict of Interest: None

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