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Dr. Weinstein, at center, poses with his operating room team at the Hospital for Trauma and Orthopaedics in Ho Chi Minh City.

AAOS Now

Published 2/1/2012
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Jennie McKee

AAOS-Vietnam Program Completes Successful Third Year

Program that has made major inroads in improving care will continue

Since May 2009, the AAOS-Vietnamese Orthopaedic Association (VOA) Visiting Faculty and Professional Development Program has provided critical support, guidance, and education to Vietnamese orthopaedic surgeons to help raise the quality of orthopaedic care in Vietnam. The program—one of the Academy’s most successful international education outreach programs—completed its third year in 2011 and will continue for three more years.

Much of the program’s success is due to the efforts of AAOS course directors Stuart L. Weinstein, MD (pediatric spine), Pietro Tonino, MD (knee and shoulder arthroscopy), and Miguel Cabanela, MD (adult reconstruction), who have led courses in three of Vietnam’s largest population centers—Ho Chi Minh City, Hue, and Hanoi.

The course directors all report that Vietnamese orthopaedic surgeons have “demonstrated better basic knowledge of orthopaedic concepts in each successive year.”

Teaching and learning
From the program’s inception, each course has included lectures, actual surgeries by AAOS and VOA faculty, and sawbones surgical skills workshops and demonstrations. Course directors have led case discussions and demonstrated how to evaluate and diagnose patients.

Another important component of the program has been ongoing pre- and post-program reviews and discussion of cases and diagnoses. Vietnam program participants and AAOS faculty members used both email and Skype to communicate with each other.

To date, 91 surgical procedures have been performed as part of the program and several hundred patients have been seen in outpatient clinics. In addition, surgical skills workshops, grand rounds, and live patient case study sessions have been held with more than 400 Vietnamese participants.

Dr. Cabanela, who led a course in adult reconstruction at Viet Duc Hospital and St. Paul Hospital in Hanoi in August 2011 with Dr. Dac Nghia Nguyen, the VOA course co-director, found that significant progress in joint replacement had occurred as the AAOS-Vietnam program progressed.

“The Vietnamese surgeons feel more comfortable addressing the worst problems and are teaching others how to treat them,” said Dr. Cabanela. “Additionally, some progress in joint replacement has occurred at the district level. For example, several joint replacements were performed for the first time in 2010 at a hospital in Cn Thơ, a city near the Mekong Delta.”

AAOS faculty members provided advanced training to several Vietnamese attendees as part of the “train-the-trainer” model. By 2011, many of the advanced trainers served as lead surgeons for surgical cases.

This teaching strategy has reaped many benefits. According to Academy faculty members, local Vietnamese faculty who attended previous programs have given lectures and performed surgeries during later courses.

Attendance has also grown significantly. The programs in Ho Chi Minh City and Hue had a 35 percent increase in attendance in 2011. The Hue and Hanoi hospitals purchased a camera for their operating rooms to broadcast surgeries into lecture halls, enabling more attendees to observe the surgeries.

Measuring and enhancing patient safety
In the first 2 years of the program, AAOS faculty members emphasized the importance of patient safety strategies, introducing concepts such as preoperative checklists, time-outs before surgery, and “Sign Your Site.” After the 2010 program, however, three specific patient safety measures (PSMs) were established for each facility. Then, after the PSMs were selected, individualized PSM learning objectives were developed for the 2011 program.

The learning objectives were discussed every day of the program, during lectures and prior to each live surgery. The objectives focused on increasing adherence to “Sign Your Site,” use of a preoperative checklist, postoperative patient follow-up, and routine preoperative antibiotic administration. Laminated copies of World Health Organization preoperative checklists were provided to operating room staff members and all VOA participants.

According to AAOS faculty members, this approach had a significant impact. Signing the surgical site became one of the formalized PSMs and will be tracked in 6-month post-program evaluations.

“All patients undergoing arthroscopic procedures in 2011 came in for surgery with their sites signed. This was not the case in the first year of the program,” noted Dr. Tonino.

Drs. Weinstein, Tonino, and Cabanela have noticed other improvements, including better hand hygiene among hospital staff and more pediatric spine referrals to the Hospital for Trauma and Orthopaedics in Ho Chi Minh City.

“In St. Paul Hospital,” noted Dr. Cabanela, “two brand-new surgical suites were built between 2009 and 2010 specifically for adult reconstruction surgeries in a more infection-free environment.”

All three faculty members are eager to help Vietnamese orthopaedic surgeons continue to enhance their skills.

“The Vietnamese orthopaedic surgeons in this program have shown a remarkable interest in improving their surgical skills,” they said.

Future plans
In 2012–2014, each specialty program will rotate among the three cities and participating hospitals. The arthroscopy course will move to Ho Chi Minh City, adult reconstruction to Hue, and pediatric spine to Hanoi. The goal is to expose more Vietnamese orthopaedic surgeons to the principles taught in each specialty area.

Additionally, more advanced orthopaedists will be taught through the “train-the-trainer” model, with the hope that these specialists will teach at the district level in the future. AAOS faculty will continue to monitor the results of previously held programs to check on participants’ progress, as well as adherence to the educational principles and PSM learning objectives from the first 3 years of the program.

The AAOS-Vietnamese Orthopaedic Association (VOA) Visiting Faculty and Professional Development Program would not be possible without the support of the following: the AAOS Board of Directors, Council on Education, and International Committee; the VOA leadership; the Orthopaedic Learning Center; the Arthroscopy Association of North America; and The Joint Commission; as well as the support of industry sponsors Stryker, DePuy, Smith and Nephew, ConMed/Linvatec, Medtronic Spine and Biologics, Sawbones, and Thanhan Company.

Jennie McKee is a staff writer for AAOS Now. She can be reached at mckee@aaos.org