The program is offered for 2 years in Iceland but it is expected that the latter part of the program will be conducted abroad.

The project is based on the SOURCE Manual of Orthopaedic Surgeons, the goal description is made by the Swedish Orthopaedic Association (SOF), localized and adapted to Icelandic conditions by the Icelandic Orthopaedic Association.

The handbook is based on 20 steps:

• Phase 1-12 clinical knowledge

• 13-18 Communication and management skills

• 19-20 quality management and research.

Structure of special education

Special education in orthopaedic surgery should be conducted in orthopaedic units that have been assessed as qualified by the assessment and qualification committee according to the applicable rules. All special education doctors should have an instructor who has knowledge of supervision and has completed an instructor course. The promotion of teamwork, management and teaching skills, as well as basic knowledge in scientific methodology, should be continuous throughout the special education program.

Special education in orthopaedic surgery can be divided into four stages based on theoretical knowledge and clinical work. In Iceland, emphasis is placed on stages 1 and 2.

• Level 1 - Accidents and injuries. Acute orthopedic surgery, musculoskeletal injuries.

• Step 2 - Basic orthopaedic surgery. Musculoskeletal surgery of the hip, knee surgery, simple hand and foot surgery and operations for fractures.

• Step 3 - Side learning. Mandatory side learning is in anaesthesia, but specialized medical students are given the possibility of side learning in hand surgery, brain and nerve surgery, general surgery, vascular surgery, plastic surgery, rheumatoid medicine as per the wishes of each specialized medical student.

• Step 4 - More detailed training in orthopaedic surgery. Further training in the specialty and sub-disciplines, such as musculoskeletal tumours, artificial joint surgery, pediatric orthopaedic surgery, spinal orthopaedic surgery and in diseases and injuries in upper and lower limbs.

Supervision and work

The first part of the special education programme is to be conducted by a specialist medical educator, a supervisor, a teacher and a supervisor. The specialist medical educator must evaluate whether the physician is suitable for continuing special education in the specialized discipline. The performance of the specialist medical educator must be evaluated regularly and he/she is given feedback with the help of assessment sheets.

• mini-CEX (mini-clinical evaluation exercise)

• (Direct Observation of Procedural Skills)

• CbD (Casebased Discussion)

A more extensive evaluation:

• after about 1 year of special education: (SPRAT - Sheffield Peer Review Assessment Tool)

• after about 1.5-2 years of special education: where the clinical skills, knowledge and competence of the medical educator are reviewed.

Specialist physician

Is responsible for his own education and is responsible for making all registrations according to the target profile and decision tool available.

The document outlines the goals that the special education physician must achieve for an acceptable annual progress. The document is also an instruction for the special education physician and the instructor regarding the organization and meeting materials at each time.

The role of the head teacher

The role of the head teacher is to coordinate the curriculum and teaching. The head teacher works under the supervision of the specialist medical practitioner. The head teacher, together with the instructor and the specialist medical practitioner, must ensure that progress is according to the plan. At the end of each year, the head teacher and the teaching council must compile data that underpins the assessment of progress and evaluate whether the specialist medical practitioner has fulfilled all the requirements required by the decision-making tool.

The role of mentors

The instructor should follow the special education doctor during the course of study and ensure that progress is in accordance with the program and the goal description. The instructor and the special education doctor should make an annual evaluation of the results of the study.

Courses and seminars

It is desirable for a specially trained physician to attend courses and seminars as much as possible. The Swedish Orthopaedic Association holds a number of approved courses in orthopaedic surgery aimed at physicians in special training in orthopaedic surgery. The same applies in Norway and Denmark. It is desirable for a specially trained physician to attend ATLS courses in Iceland and one larger foreign seminar.

Theoretical knowledge

The special education doctors' training takes place last Wednesday of the month.

Theoretical knowledge is based on reading professional journals and professional books (see list in the Handbook) as well as reading in orthobullets. It is assumed that there is time for reading, ca. 2 hours per week. Specialist physicians follow the orthobullets program and prepare well for case meetings that are 1-2 answers per week.

Practical training is held regularly, including:

• Tendon suturing at Keldur

• Cast application training in G3

• Review of volar plate set

• Review of small fracture set

• Feedback on suturing technique

Expert examination in Orthopaedic surgery

The Swedish Orthopaedic Association has been holding special tests for specialists since 1985, both written and oral. The test can be exhausted at the end of the special education programme. The EFORT exams can also be taken based on European rules and are in English. The Swedish model of the specialist medicine examination in orthopaedic surgery will be presented annually.

Last Updated: 9.2.2021 / Osá