Master of Philosophy in Trauma Surgery

Purpose

The purpose of this qualification is to equip the surgeon to care for critically ill and injured patients and an advanced level of skills to manage critically injured patients.

On completion of this qualification graduates will be in a position to

• Competently resuscitate, assess, diagnose and manage victims in need of trauma care.
• Competently apply the operative and non-operative techniques of trauma surgery.
• Competently manage the critically ill patient requiring intensive care admission and on-going surgical care.
• Use advanced technology and instrumentation to monitor the physiological status of trauma patients of all ages.
• Demonstrate a high level of knowledge of organisational and administrative aspects of a trauma care system.
• Foster the development of skills in research and in teaching related to trauma and critical care.
• Consistently act according to the ethical, economic, and legal issues pertinent to trauma care.

Rationale

South Africa is encumbered with a disproportionately large burden of trauma. Despite the reduction in political conflict in the post-apartheid era, interpersonal violence has continued to plague South Africa and especially the Western Cape, and has actually increased over the past 20 years. The homicide rate for the year 2000 of 64.8 per 100,000 members of the population is seven times the global rate.

Road traffic fatality rates in South Africa are also among the highest in the World and are estimated to be double the global average. The most recent National Injury and Mortality Surveillance data indicate that Cape Town has the highest homicide rate in South Africa and the second largest number of transport deaths of all the major cities.

There is a desperate need for trauma surgeons in South Africa and in response to this the Health Professions Council of South Africa (HPCSA) recognised the Trauma Surgery sub-specialty in 2008.

The College of Surgeons of South Africa Regulations for admission to the examination for the post-specialisation sub-specialty certificate in Trauma Surgery (Cert Trauma Surgery) have been established.

Qualified trauma surgeons have been demonstrated to reduce the mortality rates associated with traumatic injuries and there is the worldwide recognition that training in this subspecialty is essential for the provision of care to the injured.

• Knowledge of basic surgical anatomy.
• Knowledge of physiology, pathology and pharmacology related to surgery.
• The ability to operate safely and skilfully.

Recognition of Prior Learning

Admission to this Master's Degree could be granted to learners not in possession of the specified Degree that meets the admission requirements at the discretion of the Institution and in accordance with the relevant legislation.

Access to the Qualification

Learners accessing this qualification must be in possession of

• A specialist Degree (MMed in General Surgery or an approved equivalent).
• Appointment as a learner by the HPCSA.

This qualification comprises two compulsory parts, viz., theory related to trauma surgery and prescribed practical procedures, together worth 120 credits and a dissertation not exceeding 50 000 words, worth 60 credits. All the credits are at NQF Level 9. Total required credits for the qualification: 180.

Modules

• Epidemiology: Prevention and Disaster Management.
• Immunologic and Metabolic Response to Injury.
• Transfusion and Fluid Theory.
• Head Injury.
• Neck and Spinal Cord Injury.
• Chest Trauma.
• Abdominal and Pelvic Trauma.
• Vascular Trauma.
• Fracture Biology and Extremity Trauma.
• Burns and Wound Healing.
• Critical Care and Trauma.

Dissertation

The research topic/problem is selected in consultation with the supervisor. The work involves

• The preparation of a research proposal.
• A literature review.
• Data collection (possibly including empirical research).
• Analysis of finding/s.
• Drawing of conclusions.
• Making recommendations.
• The preparation of the dissertation of not more than 50 000 words.

1. Demonstrate a high level of competence in the resuscitation, assessment, diagnosis and management of trauma care.
2. Demonstrate a high level of competence in the operative and non-operative techniques of trauma surgery.
3. Manage the critically ill patient requiring intensive care admission and on-going surgical care.
4. Use advanced technology and instrumentation to monitor the physiological status of trauma patients of all ages.
5. Demonstrate a high level of knowledge of the organisational and administrative aspects of a trauma care system.
6. Foster the development of skills in both teaching and research related to trauma and critical care.
7. Manifest consistent awareness of the ethical, economic, and legal issues as they pertain to trauma care.

Critical Cross-Field Outcomes

All the Critical Cross-Field Outcomes are addressed in the qualification.

The following Assessment Criteria are applied in an integrated manner to encompass all the Exit Level Outcomes

- A trauma service is organised and directed, which actions include the ability to

> Appoint, train and supervise specialised personnel.

> Manage a trauma registry.

> Use trauma scoring systems.

> Establish protocols.

> Apply clinical governance and quality assurance.

All of which will be achieved through daily consultant lead academic ward rounds, weekly seminars and monthly morbidity and mortality meetings.

• Surgical skills and techniques in the theatre environment are demonstrated.
• The special body of knowledge required for the comprehensive management of the trauma patient is taught to undergraduates (5th and 6th year medical students), medical officers and post-graduate surgical registrars in training.
• Decisions are made in complex and unpredictable situations for the immediate management of traumatic injuries following experience in the management of:

> Surgical and non-surgical therapy of injured patients.

> Preoperative and postoperative care of injured patients who require critical care.

> Patients of all age groups, particularly those with critical injuries complicated by chronic cardiac, respiratory, renal or metabolic dysfunction.

• The various areas of trauma care such as prevention, acute care, and rehabilitation are interrogated with a view to developing further research.
• A broad and critical understanding of the science of trauma is manifested and encompasses:

> Trauma epidemiology.

> Mechanisms of trauma.

> Immunological and metabolic responses to trauma.

> Principles of pre-hospital care.

> Trauma triage and mass disaster.

> Fluid and transfusion practice.

> Application of damage control strategies.

> Imaging in the trauma patient.

> Critical understanding of organ and system specific injuries.

> Application of surgical techniques.

> Critical care.

> Rehabilitation.

> Prevention.

• A research dissertation of the required length is produced after completing the relevant stages of the research process such as:

> Identifying a research theme.

> Undertaking a comprehensive and critical review of current literature and investigations.

> Analysing and describing the theoretical arguments.

> Applying the selected research processes and/or methodology.

> Recording results, conclusions and recommendations.

• All actions undertaken in the management of traumatic injuries are applied in accordance with the ethical principles of the medical profession.
• Decisions taken in the comprehensive management of the trauma patient reflect attention to the relevant legal and economic constraints without compromising the ethical requirements of treatment.

Integrated Assessment

Each module will have continuous assessment of both theoretical and clinical skills.

There will be a review of the log-book every quarter.

The dissertation is externally examined.