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BARE BONES A Newsletterfor the AustrolionOrthopoedic Registrors Volume7. No.l Morch 2008

YOU SHOULD KEEP THIS NEWSLETTER AS A REFERENCE FOR DATES OF MEETINGS AND EVENTS Shouldyou have any copy you wish to have placedin the next newsletter, pleaseemail it to or fax it to 02-9221-8301. aaaaaaa a a a a a a a a a a a a a a a a a a a a a a


strongly opposed.A unanimous motion was passedto continuethe role of the AOA in this caoacitv, 2. SET As president of AORA I attend the Federal Training CommitteeMeetings.At the last one there was lengthy discussionregardinga proposedchangeand simplification of scoring system for CVs. Paul Pincus,Chairmanfor the RegionalTrainingCommitteein eueenslandis taking a leading role in developingthis fairer scoring system. 3. ELECTRONICLOG BOOKS The number of registrars usingthe e-logbookis increasing. The FederalTraining Committee has allowed Victorian registrarsto stop duplicatingthe e-logbookdata as put forwardbymyselfandsupportedstrongly by professorElton Edwardsat the last FederalTrainingCommitteeMeeting. 4.TRAINEESATTENDING AORA MEETINGS

Andrew Oppy Welcome to the first edition of Bare Bones for 2008. I would like to start by congratulatingour outgoing President, Nick Pourgiezis for his outstandino leadershipand representationover the past 12 monthsl We were pleased with the attendance at the AORA conference in Lorne last October. Over 65 registrars and families enjoyed a mix of scientificactivitieswith a baby arrival to add to the excitement.StephanieJayne Oppy was born on October29 and everyoneis very werr. A huge thank you to everyonewho helpedorganisethe conference with a special thanks to Marilyn Strauss, David Love and Nick Pourgiezis.A big thank you atso to the invited faculty at the conferencewhich consisted of: John North, AOA President, John Harris, AOA Past President, Professor peter Choong, Director of Training and Sam Patton, the overseasguest speaker. This year, I plan to represent all states at the FTC meeting, and as such, I require the contact details of each state representative, Could these people please contact me ASAp so I can arrange a teleconferencemeeting to discuss issues to be raised at the upcoming FederalTrainingCommittee meeting. At the last AORAmeetingvariousissueswere discussed. The followingissuesare relevantto us: 1.AOA versus RACS There was a robust discussionabout the continued relationshipof the AOA with was acknowledged that AOA members make up approximately25% of the RACSmembership- we couldhavegreaterrepresentation on seniorcommittees.A majoritysupportedthe continued affiliation with the RACS at this stage. The potential developmentof an academy to take over traininq was

Seniorcolleagueshave been very encouragingregarding attendanceat AORAmeetingsand have even suggested the possibility of providing a financial incentive to attend. 2OO7 was the first year SET 1 trainees were invitedto AORAmeetingif they were presentinga paper. 5. EXAMS The Writtenexam this year is on the 2"d of April and the Clinicalon the 2"d,3.d,and 4thof May. The reasonforthe early sitting is the RACSMeetingin Hong Kong and the Colleges'preferenceto move administrativemanpower to support the Meeting rather than the Fellowship E x a m . T h e r e w a s u n a n i m o u sd i s a p p o i n t m e nrte g a r d i n g this decision and it was the general opinion that the FellowshipExam should take priority in RACSevenrsat this time of vear. Due to the expandingnumber of traineesattendingthe trial exam the venue will have to be different to the actualexam. Queenslandwill host this year'strial exam and the dates are the 16th,17thand lBthof Aoril. 6. CONFERENCESPONSORSHIP After Stryker was forced to pull the pin on exclusive sponsorship,there was lengthy discussionat previous AORAmeetingson future sponsorshipstructure. As we haveseenfrom the i nterestdemonstratedfor sponsorsh ip rights in last year's meeting,it is obviousthat we are in a healthyfinancialsituationfor the future. Congratulations to the committee, in particular Tanya, for securing strong sponsorship. I am sure that this will continue to expand in the future, Future organisers need to be mindful of industry representative numbers at our Meetings and the avoidance of trade displays was emphasised.

Bare Bones - I

Dr Nico leWillia msf r om New Sout hW aleshas t he ho n o u r of organisingthis year'sAORA'sconference.We wish her and her team, all the best. We are looking forward to another great meeting,



AORA CohldiEii6' Co'i"ven or fo r 2 0 0 I Don't forget that AORA membership is a one off subscriptionfee of $50. lust download the application form from and return it with your money. In return, you will receive your AORAtie or scart which can be proudlyworn when presentingat the 2008 AORAconference. Andrew Oppy AORA President MESSAGEFROMTHE AOA PRESIDENT

As SET is still in a transitionalphase, I would urge all trainees to familiarise themselves with the current requ i rements for i n -tra i n i ng assessment a n d exam i nation. The AOA Guide to SET in orthopaedicSurgery has now been updated for the 2008 training year. Copiesof the guide can be downloadedfrom the "Trainees"section of the AOA website: <www,>. Further information regarding application requirements for t h e S E T 1 S S E e x a m i n a t i o n ,t h e O P B S m o d u l e a n d the Fellowshipexaminationcan be obtained from the ExaminationsDepartmentat RACS:<www.surgeons, o r g >' Finally,I cannotstressenoughthe importanceof working togetheras trainees,committingenergy and enthusiasm to your whole learningprocess.AORAis your Registrars' organisation.Plan now to attend your annualconference in November. In addition, AORA advocates for the interests and well-beingof all orthopaedictrainees.To this end, the AORA Presidentsits on the AOA Training Committee in the role of Registrar Representative. Traineesare remindedthat issuesand concernsrelating to the SET program can be brought to the Committee's attention via the RegistrarRepresentative. In closing,the collectivegood wishesof the orthopaedic communitygo out to those traineespreparingto present for the Fellowshipexaminationin April/May 2008. May you all preparewell and achievea successfulresult. aaaaaaaaaaaaaaaaaaaoaoaaaoaaaaaaaaaaaaa

RACS FELLOWSHIP EXAM by IAN INCOLL I recently attended the RACS Fellowshipexamination in OrthopaedicSurgery in Melbourne.I thought I would put a few observationsdown for you to look through. Remember,this is not coming from the view of an examiner or a candidate,but someone observing both sides of the process.Some of these points may be selfevident, but didn't seem so in the exams.

Welcome to the 2008 training year. On behalf of all AOA members, I would like to extend my warmest congratulationsto those trainees commencingSurgical Educationand Training(SET) in orthopaedicsthis year. Gaining selectioninto surgical training is a significant achievementof which you should be justly proud. The objective of SET is to train surgeons who will become compassionate physicians with sound orthopaedic knowledgeand excellentsurgicaltechnique,but who are also excellent communicators,professionalcolleagues and, ultimately,leadersin the surgicalcommunity.The professionofsurgery has a long and honourabletradition of public service and health advocacy, and I would to the encourageyou to reflecton these responsibilities broader community during your tenure on the training program and throughoutyour life in the future. 2008 is set to be a significant and exciting year in the development of the AOA SET program. AOA has identified the need to professionaliseeducation and training as a key strategicaoal in the immediate-term. To this end, additionalresourceshave been allocatedto a major upgradeof the AOA'sIT infrastructure.Similarly, the AOA Board has recently approved plans to appoint an EducationManagerto overseethe developmentand implementationof an integratedon-linelearningplatform. The EducationManagerwill alsoprovideessentialsupport to the TrainingCommitteeas it completesthe Curriculum ModularisationProject.Additionaladministrativesupport for ed ucatio na nd t r ainingwill als o be m ade av ailab l ea t the AOA'sSydney office.These measuresare designed to ensure that specialistorthopaedictraining in Australia remain sof th e h ighes tqualit yand s t andar d. 2 - Bare Bones

Don't rush - I don't think I saw one candidaterun out of time, but many that skippedover important points to get to the next image or patient. Rememberthat there are usuallyfour patientsto e x a m i n ei n 3 5 m i n u t e si n t h e c l i n i c a l ,a n d s o m e patientsmay only need five minutes. Washyour hands betweenpatientsin the clinical. We all do it in practice,so don't forget it in the exam. Common things occur commonly, even in the exam. Someone struggling with a complex brachial plexus lesion won't particularly worry you struggle on a the examiners, but if straightforward hip osteoarthritis, they'll prick up the ears. For example, know the difference betweena Trendelenburggait and a Duchenelurch. When asked to examine a patient, try to direct your examination toward your provisional diagnosis. Examining for peripheral neuropathy first up in a patient with knee arthritis wastes time and confuses the examiners. Most of the examinershave been involvedwith the training processin the past, and know what sort of preparationis involvedforthe examinations.Theywill expectyou to be nervousand excitedat the beginning of a station,and allowfor you to settle into the exam. The examinerswill do their best to pass you. This m a y n o t b e y o u r i m p r e s s i o nb, u t t i m e a n d t i m e a g a i n , I witnessedthe examinerstry different questioning linesand other tacks to extractknowledgeout of the Theyreallydo agoniseoveranyborderline candidates. candidate,and I believethe discussionafterwardsis even more thorough beforeany candidateis failed.

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that you are happy with your answer,but if you are asked twice, it probably means you are wrong. Listen to the prompts from the examiners and don't be afraid to retract something if you realisee it was incorrect. Being able to recognise your own mistakes andd correctingthem is one of the most important atrributes of a safe surgeon. Pleaserememberto thank the examinersat the end of each station. These orthopaedicsurgeons give up at least two weeks a year to be examiners.This is unpaid wor k , and m eanwhilet hey h a v e o n g o i n g costs in their practices. Similarly,thank the patientsfor giving up their day.

I hopethis has helpeda little and good luckfor the future.

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All traineesintendingto sit the FellowshipExam in May must have approvalfrom the RegionalTrainingChairman and the AOA Director of Traininq to take the exam. MAY: SYDNEY RACSClosingDate: l8th lanuary 2008 Written Papers:Wednesday2 April 2008 (MultipleCentres) Vivas and Clinicals:Sydney Friday2, Saturday3, Sunday4 and Monday5 May Court Meetings: Friday 2 May OUTSIDE AUSTRALIA



RACSClosingDate: l8th January2008 Written Papers:Monday1 September (multiple centres) Vivasand Clinicals:Auckland,NZ Friday 18, Saturday 1 9 , a n d S u n d a y2 0 A p r i l 2 0 0 8 Court Meetings: Friday 18 May

TELEPHONE:0409 833 529



RACSClosingDate: 4 July 2008 Written Papers:Monday1 September V i v a sa n d C l i n i c a l s F : r i d a y1 9 , S a t u r d a y2 0 , S un d a y2 1 and Monday22 September2008





YOUR 1st QUARTERLYREPORTFOR 2008 IS DUESOON! The Pre-Exam course for the RACS FellowshipExam will be held from Wednesday 16th Aprill until Friday 18th April 2OO7. The course will be held in Brisbane. Wednesday,16 April - GroupA Mater Hospital/Group B PrincessAlexanderHospital(Morning) Wednesday,16 April - GroupA PrincessAlexander Hospital/ Group B Mater Hospital(Afternoon)

Pleasemake sure that your repoft is returned no later than: Monday 21 April 2OO8 There is anotherquarterly report due in 2008. Please make sure it is returnedno later than: Monday 21 July 2OO

Thursday, 17 April - Group A PrinceCharlesHospital/ Group B RoyalBrisbaneChildrens' Hospital(Morning) Thursday, 17 April - Group A RoyalBrisbaneChildrens' Hospital/GroupB PrinceCharlesHospital(Afternoon)



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Friday.18 April - Group A QEII/GroupB Ipswich GeneralHospital(Morning) Friday,1B April - Group A IpswichGeneralHospital/ Group B QEII Hospital(Afternoon) Applicationsto attend the coursemust be made by email to Kim M adis on( k im . m adis on@aoa. or g. anuo) l a t e r t h a n Friday 28th March. Please either fax your registration formto02922l8301email: orpostitto: AOA Head Office Ground Floor. 229 MacquarieStreet. Syd ne yN SW 2000 Cost: AOA Registrars

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The Australian OrthopaedicAssociation68th Annual ScientificMeetingwill be held at the Grand Chancettor Hotel, Hobart from October 12th-16th 2008. For further information contact the Secretarirat: PO BOX 235, North Balwyn,Victoria3104, Australia.


Telephone:03 9859 6899 F a c s i m i l e :0 3 9 8 5 9 2 2 1 1 E m a i :l a o a h b a @ w i c k h a m s . c o m . a u Website: Bare Bones - 3


The FRACS 2 Exam by Emerick Trinajstic

the limitationsand advantagesof each and controversies associatedwith each. In conclusion,you need to nave a 'best option'and a good reasonfor its use, and reasons to excludethe others. Candidates were marked down if it was felt that their response would compromise patient safety. All the candidates made mistakes- most were errors of o m i s s i o no f s o m e m i n o r d e t a i l , O m i s s i o n sw h i ch n a ve repercussionsto patient well being/safetyresulted in a fail - if not corrected.

Thefollowing comments are the resultsof my observations of the viva voce exams at the May 2007 Examinations in Melbourne.I hope that the comments from someone who was not nervous may provide some beneftt and insight.

Examination technique You are putting on a show for the examiners,In this show you need to demonstratevery clearly what you are doing and that you understandit. The performance needs to be polishedand give the appearancethat you have done this a thousandtimes.

Format Clinical cases with a patient: You will be asked to take their history and do an examination or just do the examination. Sometimes general, sometimes specific to identify specific features of the problem. Bread and butter cases with classic signs and symptoms. Often with good imaging. Occasionally imaging is poo4 and is what happens in reality. If you get through this, discussion goes to further management(investigationand principlesof treatment)

It needs to be organisedand logical.As well as going through the motions, you need to demonstrate the signs, Make it clear, as if you were demonstratingthe technique to a medical student for the first time. The ability to think on your feet and redirectthe path of the examinationis useful. A reverse pivot shift is probably not relevantif the patient has tricompatmental OA and headingfor a TKR.

Suggestionsfor success . Answer the ouestion . Do not repeat everythingback- it wastes time and examiners are very consciousof time constraints and want to get through as many casesas possible to see what candidates know and don't know. . The examiners are not trying to trick you. If the subject knows the topic well, they may examine the matter in a subspecialistlevel or ask for greater detail, Occasionallythe line of questioning was deliberatelyto lead the candidate in another direction to see if they actually understand the topic in detail. This was rare and restrictedto the better candidates. If you do not know- don't Iiesay you don't know and they can move on to other topics. You cannot say 'I don't know' too often. The examiners were polite and courteousat all times, There was no bullying, sarcasm or being difficult. Only two of the examinersseemed tough in any way. Examinersare always in pairs to ensure that it is fair. The overwhelmingmajority of the discussionwas around ensuringthat the candidateclearlyunderstoodwhat they were talking about. You needto show the examinersyou know how to examine, and can illicit the clinical signs. You are putting on a polishedperformancefor a critical au die nce. It comes down to personalstyle, but I think it was useful to also demonstrate that you are thinking about the relevant differentialdiagnosesand elicit the signs that exclude those diagnoses.The better candidateswould often speak as they go. This shouldbe encouraged;you score points for doing and speakingat the same time. I got the impressionthat a candidatenot only needed to know all about the Dafticularcondition. but also needed to demonstratethat they knew this, could pull their thoughts together,interprettheir findings and had a clear logical plan of attack in terms of management. If there is one answer to a problem and other options are not practical,then it is easy.Often there are a series of options and an order in which they should be applied/ tried. You need to show that you understandthe options, 4 - Bare Bones

Likewiseyou need to be able to get on track again if interrupted. Practicethis because the examiners are likely to interrupt, often to help you 'tscorepoints" but then you must get back on track. Demonstrating a systemof thinkingabout a problemseemsto help.Again, this is what happensin the real world and mistakescan h a p p e nu s u a l l yf r o m 's i n s o f o m i s s i o n 'a f t e rh a v in gb e e n interrupted. Youlosepointsfor hurtingthe patients.Thiscanbe difficult if the man with the painful torn rotator cuff has already been manipulatedseverely by five of your colleagues. This is part of the art of examination,and it is expected that as final year trainees you have come across this and can elicit the signs with minimal discomfod to the patient. If you believe that further examinationwill be hurting the patient, say so, and wait for guidancefrom the examiners. Clinical imaging and investigation Again you do this every day, and even if you did no reading,you would have come acrossall the situationsin clinicalpractice.As in the real world, the patientdoesn't always come to you with appropriate investigations having been done. The majority of the imaging is clear, but on occasion,it did not elucidatea proDlem e.g.LateralX-ray of 13 year-old with osteoid osteoma in his lamina pointed you to where the problem was, but did not give a clear idea of what it was. A decent answer requiresidentificationof the problem and being awareof reasonabledifferentialdiagnoses.Theselists of differentialsshould be in your repertoireand you should be able to rattle them off without effort. You will not be asked for these, but they should act as a guide for your thinking. Whilst cost is not discussedawareness when it comes to makinq the decisions is of value. Content The cases I saw were practicaleverydaycasesI would see comingthrough my rooms.Thereare odd interesting rare casesthrown in (polio with a DDH and anterior hip dislocation),but even these have clear signs and it is possibleto work out what is going on with a good clinical

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examination. The important thing is that you need to know the common things very well and be aware of the traps and pitfallsthat await the unwary (what else could this be? How do I excludeit?)

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e l e m e n t s o n l a t e r a l a n d t h i c k e n i n g o f p e di cl e o n one side on AP. What could this be and how would you investigate?Bloodsnormal. Bone scan said to be slightly hot. CT showinglytic lesion in posterior elements(lamina and pars with surround sclerosis. PDx of osteoblastomaor osteoid osteoma. Biopsy done with irregularosteoidand vascularnidus.

Lastly The exam situation is stressful. It may be easier to think about it in terms of your examiners being your colleaguesand you are trying to show them you know your stuff and can discuss problems with them as a colleagueconsultantrather than as a registrar.After all, vou will be in a few months.


Three-year-old child with multiple fractures of different ages. Photoof happy mum with child and c h i l d h a s L a r m i n p l a s t e rs l a b a n d s l i n g . # d i sta l r a d i u s h e a l i n g . # p r o x i m a l h u m e r u s o n r i g h tnew. # proximal humerus on L with callus.Asked as to possiblecause, No weight loss or fevers in child. Not losing weight. Bloods normal excluded infection.Discussedwhat this could be and how you would investigate.PDx non-accidentalinjury. Plan of management-admit - socialwork and paediatrics etc.


50-year-old with painful hips- L>R. X-Ray of L h i p w i t h n a r r o wj o i n t s p a c e a n d m i n i m a l c h a n g e s of head and acetqabuilum.What could this be and how would you investigate.MRI- labral cyst o n s u p e r i o r m a r g i n o f a c e t a b u l u m . Wh atco u l d be done- arthroscopic debridement? THR etc.


17-year-oldwith R L thigh pain. GP thinks scitica and does a CT- no disc orr compression.Worsening and now cannot walk, Discusswhat this could be and how you would investigate.CT abdo or MRI abdo to identify retroperitoneal pathology and psoaspathology.Giventhe hint that the FABERtest was positive.Abscessarisingfrom SIJ.

My memo r iesof t he c as esI ac t uallys aw: Exa mc l i n i c a l s AM up pe r lim b, PM lower lim b. AM CASES . . .

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62 year-oldrotator cuff arthroplasty 61 year-oldwith injury of shoulderas the result of MBA40 yrs ago.arthritisof the shoulde4 42 year -old personaltrainer with ossiclein triceps tendon with spur on olecranonand overlying ole cra nonbur s a.Com plainsof pain in e l b o w a n d unableto work, well muscled?Steroiduse. 62 year -old lady with arthritis of base of thumb R hand. Minor arthritisin STTjoint/ previousCTR and de quervains 55 Italian pensionerwith gout and painfularc- rc tear 42 year old man with Hx of # calcaneus4 yrs ago. STJarthritis. Discussionabout Ddxs. Stiff and oainfulSTJ PM Lower Limb 10 year-oldboy from afgahanistan.Unableto walk until 4 yrs old. Had a deformityof the foot which was treated by visitinggerman medicalteam. ShortenedL leg and high dislocationof the hip and absent tibialisanteriorand posterior. No sensory deificit

PM Operative Surgery 2 Computerguided imageswith clinicalscenarios. .

Older lady with previousKeller'sand recurrent hallux valgusand crossoverof 2nd toe.


55 year-oldlady with severe OA of hip



61 year-old lady with OA hip. Painon and off for

50-year old man with spondyloepiphyseal dysplasia 140 cm tall, OA of hip with most of head gone, very short neck and very well covered femoral head. Head 35-40 mm diameter. No protrusio. What features concern you and what would you do prior to offering this man a hip replacement? Planningwith templates.Difficultygetting the head out- osteotomy and remove piecemeal.Relatively wide femoral canal and thin cortex. Advise against non-cemented femoral component. GO FOR CEMENTED.


Obese 30-year old female with fractured midshaft R femur for retrogradenail. How would you do it? Discussion-positioning.approach. Reductionand passageof the nail. reaming conisderingthat she has a very narrow femoralcanal. Entry point in the distal femur. Ensuringthat the rotation of the two fragments was correct. How do you do it safely? Commenton precautionsfor avoidingneurovascualr injury if cross boltingthe proximalend.


Hipaudit.Havingbeenappointedto a new pvt hospital. Audit at one-yearshowsthat you have a dislocation rate of 10VocomDaredto other consultants.What factorsare resoonsible for dislocations? What would you do about this consideringthat your next list is three days away and you have bookedthree hours? Correct response-gets help; stop doing them until problem is identifiedand help sought to correct it.


34 yrs. Then suddenonset of pain. Dysolastic hip with uncovered head and acetabularmargin osteophytewith cysts in joint edge. .

11 year- old girl with recurrentlysublsuxingpatella and hyperlaxity


15 year-oldgirl with disocationof patella hyperlaxity.


62 year--old lady with previous bunionsurgery (1 MT osteotomy)and ongoing pain from MTP



arthritis and IPJ arthritis. .

55 year-old lady with hallux valgus and crossover deformity of toes.

Imaging and Management Sunday 27 May 2OO7 .

15-year-oldgirl with thigh pain. xray- slight lucency distal femur reportedas normal. returnsone month laterwith lytic lesionon distalfemru with irregualrity and soft tissue swellingand breakthroughinto soft tissue s . W hat at c ould t his be? I m agin g s t u d i e s : MRI, bone scan, bloods. Discussionas to further stagn and definitive treatment. discussion of biopsy principles.Biopsy shows spindle cells with pleomorphismand increasednuclearto cytoplasmic ratios. Seven-year-oldwith back pain and night pain.

Bare Bones - 5

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The 20O7AustralianOrthopaedicRegistrars,Association Meetingwas held at Mantra ErskineBeachResortLorne. Victoria. The scientific programme was a demonstration of registrar commitment to clinical and laboratorv research. The International Guest speaker was Mr Sam Paton a Consultant OrthopaedicSurgeon at The Royal Infirmary of Edinburgh and an Honorary Senior Lecturer at Universityof Edinburgh.Over 65 registrars attended the meeting and 37 papers were presented. The internationalguests participatedin the judging of the "Allan FrederickDwyer Award". This is awarded to the registrarswho have presentedthe best two papers. A "Registrars Award" is also judged by all registrar attendants. This year's winnerswere: 1't Prize- Dr EugeneEk 2"d Prize- Dr Aman Sood Registrars'Prize - Dr Phong Tran

The RuralSurgicalTrainingprogram is a Commonwealth Governmentfunded intuitive,which the RoyalAustralian Collegeof Surgeonshas run successfullyfor 10 years, providing a wide range of initiative approaches to supportingtraineeswho wish to work in RuralAustralia. Currently,Australiais experiencinga workforceshortage in rural areas and the Rural SurgicalTrainingprogram encourages Trainees to consider establishinq their professionalpracticepost fellowship in a regiorialarea of Australia. Traineesare encouragedto become involved with the Mentor Program,which providesthe unique opportunity to develop ongoing relationshipsand professionallinks with seniorsurgicalcolleaguesthroughthe formal Mentor system (Mentorsin this context are not associatedwith supervisionbut providean ongoingsourceof adviceand friendship).

Dr Eugene Ek, winner of the Allan Frederick Dwyer prize for 2007 Dr Ek, a registrar from Victoria, won first prize with his paper entitled "Pigment epithetium-derived factor (pedf) inhibits osteosarcoma growth, angiogenesis and metastasis." The paper examined how novel agents could improve the outcomes for patients who develop metastaticdisease. Dr Ek's prize is for sponsoredattendanceat the 2008 American of Orthopaedic Surgeons meeting in San Francisco. Dr Aman Sood,a registrarfrom Adelaidepresentedhis paper on "9elf administered shoulder assessmentform - is it reliable as a triage tool in outpatient setting?,, The paper devised a self-evaluationquestionnaireto appropriatelytriage newreferralswith plaints. shouldercom Dr Soodt prize is for sponsoredattendanceat the 2008 Australian Orthopaedic Association ASM in Hobart. Dr PhongTran, a registrarcurrently living in the United Kingdom presentedhis paper on Blood usage in paediatric Spina.l Surgery - a multivariant analysis and protocol development. This paper analysedblood usage for elective paediatric blood surgery using patient records,anaestheticrecords and blood bank records. Dr Tran's prize is a 91000 book voucher. The "Allan Frederick Dwyer Award,' and the "Registrars Award" were donated by Stryker.

6 - Bare Bones

Encouragementis also given to active participationin on line discussionson both the Rural SurgicalTraining Program discussionforum and the provincialSurgeons of Australia e-mail network. Both chat rooms provide excellentopportunitiesto network with fellow trainees, fellowsand Committeemembers. Financialassistanceis also provided for Traineesto attend Educationaland TrainingEventssuch as Courses. Conferenceand Workshops,such as: o

ProvincialSurgeons of Australia Annual Scientific Conference




FellowshipExamination preparation courses and workshoos


DefinitiveSurgicalTraumaCare (DSTC)Course

Becominginvolvedin a program like the RSTpenables trainees with a true interest in practicing in regional Australiato meet a wide range of senior rural surgeons. This also provides the ability to successionplan for the future. Through the training program traineeswill have the opportunityto develop relationshipswith rural surgeonsfrom around Australiaand will becomeaware of opportunitiesand openingsthat may be of interestto you. There is no downsideto involvement in this program. AII trainees rotate through major metropolitantraining positions as well as rural terms. All positions use accreditedSurgicalEducationand are not limiting your future career opportunitiesin any way. If you are interested in this great opportunity please contact Sabina Stuart on +61 3 9276 7407 or rural@

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The Federal Training Committee believes the Hospital Post Evaluation Forms that submitted by trainees are of extreme quality of imp orta nc e in m aint aining t he training positionsand identifyingproblems.Registrars should be reassuredthat the forms are de-identified. is mandatory forms It that the are completed for each rotation and sent to the AOA. It is the mechanism to ensure that in the long term all positions are functioning well.

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LO CUM REG I STER The AOA has set-up a Locum Register on the Members site of the AOA website.If you are seeking a locum position you should contact Lisa McCarthy (p ho ne 02 9233 3018) or em ail lis a@ ao a . o r g . a au n d provide her with detailsto be placedon the website. Members using this service will be expected to comply with the terms and conditionsof appointmentas set out in the Register.


Funds are available to suDDort overseas travel for registrarsin trainingwho wish to gain surgicalexperience ab r o a d . 1,

The Fellowships are open to traineescompletingthe FRACSin 2008 who expectto spend a periodof not lessthan 12 months abroadin a recognisedtraining post.Appointmentsto non-specialised serviceposts do not qualifyfor support.

grant may be usedto assistan Australian 2, A Fellowship pre-arrangedexchange registrarto undertakea with a North Americanor Britishcounterpart. A Fellowship will not be awardedunlessconfirmatory documentary evidence of the overseas post is providedand state if and how the overseaspost is beingfunded. The funds available may vary according to the number of applicantsand are to be used to defray travel exDenses. All applicationsshould be accompaniedby a curriculum vitae with details of the proposedoverseas post and a letter of support from the Chairmanof the Regional TrainingProgramme.

Help out in the Asia Pacificby applyingfor this award, which is sponsoredby Stryker.It coversflights, accommodationand a pier diem allowanceto join a team of consultantson an internationalaid expedition to such countriesas Indonesia,Fiji, Tonga,PapuaNew Guineaand EastTimor. The award is open to all orthopaedicregistrarson the AdvancedTraining Programme.For more information or to download an applicationform visit contact Miffy Stephen at Stryker on (02) s467 10s8.

All applicationsare to be sent to: AustralianOthooaedic Association GroundFloor,William Bland Centre 229 MacouarieStreet SydneyNSW 2000 Closing date: 5 pm on Friday, 27 June 2OOB aaaaaaaaaaaaaaaaoaaaaaaaaaaaaaaaaaaaaaa

CONTINUING ORTHOPAEDIC EDUCATION MEETINGS 2OO8-2OO9 The AOAorganisestwo meetingseachyear to assistwith the continuingeducationof orthopaedicsurgeons.Trainee surgeonsare encouragesto attend these meetings. A discountedfee applies.

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KEEP US UP TO DATE! 14-16 May 20O8, Hand Wrist and Elbow, HiltonHotel,Adelaide Convener:Greg Bain 6-8 August 20O8, Trauma and Spinal Injury, Hiltonon the Park Hotel. Melbourne

As trainees,you will be moving from post to post and pla ceto p lac edur ingt he t r ainingpr ogr am m e .I t i s i m portant that you keep the AOA advised of changesin contactdetailsby loggingin to the Memberssite on the AOA websiteand changingyour detailsthere. This will automaticallyupdate your pageon the AOA database,

6-8 May 2O09, Shoulder SheratonHotel. Perth Convener:PeterCamobell 5-7 August 2OO9,Hips, Fracture and Arthroplasty Brisbane

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Elton Edwards Senior Examiner The final exam is approachingand I thought the fourth year registrarsand others may appreciatemy personal perspectiveon how to approachthe exam. All examiners appreciatethat this is a major milestoneand a massive effort of preparationis undertaken by each registrar. The training program should, in general terms, along with appropriate effort from the registrar, prepare you adequatelyfor the exam. Howeverno one feels confidentand most of you remain, understandablyapprehensive.This cannot and will not ever change,at leastin the foreseeablefuture. Howeveri you should feel confident if your preparationhas Deen appropriate.If you don't feel confident and vou know that your preparationhas not been "up to scratch,,then you should considerdelaying your sitting until later in the year. This advice will not apply to many but if you feel sure it applies,then give it more thought. Work hard at your study, work in groups and challenge each other. Acquire a wide range of knowledge in all areas of the syllabus. Don't worry about "resolving,, controversialareas.Have knowledgeofthe controversies but don't feel you have to providethe definitiveanswer. A broad knowledge of orthopaedics will inevitably demonstrateitself during the examination.

R e f i n e y o u r c l i n i c a l e x a m i n a t i o n .G e t i t sm o o th a n d professionallooking.Learnto talk as you are examininq. Tell the examiners what you are doing, what you aie looking for, what you expect to find and what you oo find. Communicatethroughout the clinicalexamination segment - its not just the examiner.twatching,,you, it is an interactiveexam where you have the opportunity to demonstrateyour knowledge.Take every case as a chanceto show your skillsand expertise.Insteadof being afraid of getting the right answer,use the opportunityto show the examiners how good you are. For example, with a shoulderexam, if you do a beautifulexamination but concluderotator cuff tear when the correct answer i s s h o u l d e r i m p i n g e m e n ty o u p r o b a b l y w o n,t d o b a d l y - examinerswill be impressedwith your exam and try to help you out of that situation. The computer based orals are very interactive- same advice, listen to the question and answer iil There are plenty of opportunitieshere to demonstrate vour knowledgeand if you head off on the wronq track vou can be easily brought back. I think this segment is easier becausethe interactionis close and errors can be correctedand you still earn a pass. Of coursethere is no substitutefor knowledgeand lots of experiencewhich then gives confidence.I strongry recommendthat you spendlotsof the last weeksin clinics seeing patientsand doing regionalclinicalexaminations - make it look professionaland smooth. Look at lots of X-rays and create a smooth presentationof the findings seen. Finally, approach the exam with a positive attitude. Examiners have a hurdle for you to jump over - the height does not vary - you should all be able to .1ump that height. Examinersexpect that you can pass and will assist you if you are stumbling, however repeated stumbling will be seen as inadequatepreparation.Work hard, approachwith confidence,be humble, listento the examinerand plan for success. Associate Professor Elton R Edwards Senior Examiner Orthopaedic Surgery RACS aaaaaaaaaaaaaaaaaaaoaaaaaa


The MCQ exam will only be passed by acquiring an adequate breadth of knowledge. This represents to a large extent 4 or more years of work - its probably nearingtoo late to alter your MCe outcomeby more than a tin y am ount now. With the essays my best advice is extremely simple - read the question and answer it! Regard this segment as an opportunityto display your knowledge. Write a comprehensiveand structured answer that demonstratesto the marking examinersthat you nave a grasp of the issues,Examinersare looking for higher clin ica lr eas oning,i. e. under s t andingof t h e i s s u e sa n o interpretationof the facts to providea reasonedproposal regarding the problem. It is possibleto show off your knowledgehere but don't do this at the expenseof some part of the questionwhich is answeredpoorlv. The ISAWE'sare markedto a pass mark individuallvand then an overall mark based on the number of passes. Thereforeyou cannotcompensatefor a poor mark in one with a better mark in another,as each is simply pass or fail. My recommendationis that you tackle the ISAWE,s with which you feel confidentand get them done to a pass level as quickiy as possible,thereby creatingsome "spare time", and then return to those that you find more ch alle ng ingand t ak e a lit t le longer wit h t h e m t o e n s u r e a Pa ss.

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Kim Madison Training Officer The AOA has a TrainingOfficerto assist Registrarson the training programmewith any queriesthey may have from time to time. The personoccupyingthis role is Ms Kim Madison,BA, DipEd.She is availableto assist you o n 0 7 3 8 3 5 8 6 0 4 o r e m a i l k i m , m a d i s o n @ a o a .o r g .aoun any businessday.

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