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International Orthopaedics Elective in Chennai, India

Introduction

Beginning in the fall of 2016, DHMC Orthopaedics started a new partnership with Sri Ramachandra Medical Center (SRMC) in Chennai, India, to facilitate a unique educational opportunity for residents and staff. This partnership has been the result of department leadership addressing the perennial requests from residents to open the door to international experiences. The rotation has been approved by the ACGME and the Residency Review Committee, making it the first of its kind among US orthopaedics training programs.

Sri Ramachandra Medical Center

SRMC is a large private medical center with a well-established orthopaedics department and highly regarded residency training program. It is located in Chennai, which serves as a major intersection of commerce and culture in southern India. Situated on the Bay of Bengal in the state of Tamil Nadu, Chennai is the 4th largest city in India with a population of 7.08 million. The medical center campus is situated on a 175 acre property of lush trees and landscaping on the outskirts of the city. It houses two hospitals that function to take care of well-insured and poor patients alike. In total, the institution contains 1,500 inpatient beds, 114 ICU beds, and 25 operating rooms.

The orthopaedics training program includes 54 residents that undergo 3 years of training after medical school, and many will seek fellowships abroad in Europe or North America before returning to practice in India. The residents actively participate in a bioskills program and independent research projects. The training program is divided into six clinical units with a hierarchy that includes a Unit Chief, 3-4 junior consultants and 6-8 residents each.

Rotation Structure

The rotation is designed to expose DHMC residents to orthopaedic surgical practice in a unique clinical and cultural environment. The resident is housed on campus and participates in all aspects of patient care in a busy department. This includes clinic and emergency department visits, inpatient and outpatient surgical procedures and active participation with rounding on the wards. The rotation has proven to be eye opening to the many challenges of health care delivery in India. There is a focus on the burden of healthcare costs as well how a low level of healthcare education affects everything from implant selection to rehabilitation protocols.

The rotation is optional and currently open to 4th year residents. It is scheduled as a 4-week block. The visiting Dartmouth resident functions in the role of a “junior consultant” owing to the advanced level of training compared to the Indian residents, which allows some independence in the operating room and a good hands on learning opportunity. The rotation exposure can be tailored to meet the interests of the visiting resident with emphasis on arthroplasty, deformity, trauma, spine, etc., as desired.

As of this writing, two DHMC residents have participated in the rotation and have found it to be rewarding. The other two 4th years will be scheduled to go in the spring and early summer after completion of fellowship interviews. Early feedback has been positive in terms of the operative experience and the opportunity to see traditional orthopaedics techniques, like ilizarov frame applications, utilized on a daily basis. Many efforts have been made to reduce costs in the Indian ORs including using locally made implants that are often designed (with varying degree of success) from the North American or European patents. The inferior metallurgy and decrease in manufacturing precision often results in technical challenges in the OR that are not encountered back at DHMC. One element that is unique to Indian culture is the traditional “bone setter” that is often the first person to treat anything from open fractures from motorbike accidents to elderly individuals with femoral neck fractures. Patients are treated with splinting and traditional curry-based salves that, in the words of one staff member, are “non union machines.”

There is also tremendous opportunity for cultural immersion and the staff and residents at SRMC have proven to be great hosts. From enjoying the regional delicacies and arts to traveling to nearby fishing villages or beyond, India has endless opportunities for exploration.

Going Forward

The residents have been excited by the prospect of expanding our training to include this international experience. In the next few months, we are expecting to have our colleagues from India coming to visit DHMC as a part of the exchange. In the future, some DHMC staff have also expressed interest in joining the resident for a part of their stay in India and holding seminars and surgical demonstrations related to their area of expertise. The Orthopaedics Department Chair, Dr. Jevsevar, has already done a demonstration on anterior total hip replacement that has made a large impact. On top of that, the rotation has been a hot topic during recent resident interview days and is already serving as a recruitment tool.

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