The British Orthopaedic Association's Instructional Course 2015 took place over the weekend of 10-11 January at the Manchester Conference Centre, taking on a bold new format. Intended not only as a preparation for the FRCS(Orth), the instructional course is designed to provide a rolling programme of education suitable for trainees at all stages. Expert lectures were strongly supplemented by detailed case reviews and discussions, but the most significant change came in the introduction of critical condition Case-Based Discussions (CBD). Delegates were asked to choose four topics from a selection of a possible eight critical conditions, giving them the opportunity to achieve the standard required for Certificate of Completion of Training (CCT) in each. Notification of which CBDs were to be offered was sent out in advance of the course, allowing preparation time beforehand to maximise the weekend. In addition, the BOA team provided a pre-course screencast which was sent out to faculty and trainees outlining the objectives and logistics for both days.
Saturday saw the tackling of spinal conditions, and on Sunday we covered trauma. In each small group, four trainees took the 'hot seats', and contributed to a group case-based discussion with at least one dedicated trainer. Room orientation prior to starting was extremely useful, as each CBD session of 25-30 minutes meant a quick turnover time, as fast-paced as some of the discussions. At the end of each session, trainees submitted CBD forms directly to the ISCP site, allowing time for the remainder of the participants to be involved in discussion with trainers. Faculty then validated WBAs on the same day.
“Fast moving questioning style allowed greater volume of material to be covered which meant that if there was a varying knowledge level in the group an adequate level could be reached.”
From over 80 evaluation responses, 92.5% would recommend the course to colleagues, 34% said that they would prefer fewer CBDs with more time spent on them, and 25% said they considered some of the CBDs unfair. The conclusions drawn by the BOA Education Board were that this format worked well and concerns around fairness would be monitored next year. As current WBA are not high-stakes summative assessments, but rather formative assessments for feedback to help trainees learn, we will focus on increasing accessibility and helpfulness rather than fairness.
“Case-based discussions were helpful for learning even if not in the hot seats.”
The unanticipated benefit of the weekend was the repetitive practice for trainers in the process of CBDs, linked with personalised feedback, which has had a significant reported impact on professional development.
As expected, the lecture series was also of a very high standard, with coverage of trauma, spinal malignancy, foot and ankle, lower limb arthroplasty and carpal instability. Large group case discussions kept participants on their toes between lectures, with highlights including James Davis' detailed foot and ankle cases, and an insight into Paul Partington's methodical approach to management of infected arthroplasty in the lower limb. Guest lecturer Professor Wallace gave an inspiring account of a number of his inventions over the years, while Phil Sell delivered an entertaining and memorable Alan Apley Memorial Lecture. Guest lectures on day two were more practical, with a focus on the FRCS exam structure from David Limb and David Stanley, and an address from BOA President Colin Howie on the future of our specialty.
Despite the size of the task, the brief set-up time and turnover between groups ran smoothly on both days, and the promise of WBA validation was delivered.
“The CBD sessions provided a good variety of learning environment and the awarded CBDs were appreciated greatly.”
A similar system has now been adopted into registrar teaching in a number of regions. At next year's Instructional Course we plan to run paediatric CBDs, and look forward to welcoming trainees from throughout the UK and Ireland.
