Trauma & Orthopaedics has a long and illustrious history. Some of the most fundamental principles of orthopaedic care have only minimally changed over the centuries despite the acceleration of the 20th century that brings us to where we are today.
As a specialty T&O in the UK is the second largest surgical group after General Surgery. It has historically been a very competitive specialty and as such is seen as a pioneering speciality in all aspects of medicine.
Like all specialties there are considerations to make, and an application to T&O should not be made without commitment to the specialty. The same is true for all specialities.
A career in surgery is immensely rewarding, but like all specialities has its ups and downs. If a career in surgery is something you are interested but not sure on specialties check out the Career in Surgery Conference.
What is Trauma & Orthopaedics?
Trauma & Orthopaedics is two specialities rolled into one.
Trauma care involves the management of injuries ranging from simple ankle sprains through to complex cases as seen in car crashes and war zones. Patients range from the youngest of children to the oldest of adults and caring for them involves addressing their injuries in a manner and at a time that allows them the best possibly chance of survival, function and comfort.
Orthopaedic care involves the management of deformity, degeneration and dysfunction with the aim being to get patients comfortable and functional. Orthopaedics is divided into several different subspecialties.
What subspecialties are there in T&O?
Subspecialties are increasingly becoming anatomical, though there is overlap. General training in orthopaedics covers all of the subspecialties but the most surgeons opt to specialise in order to provide the highest level of consistent care.
- Paediatric Orthopaedics
- Upper Limb (Shoulder/Elbow)
- Lower Limb (Hip/Knee)
- Foot & Ankle
Increasingly with demand, some surgeons can maintain exclusive practice in one particular area such as Hip, Knee or Shoulder. In doing so they can offer surgeries and treatments that cover several different disciplines (e.g. arthroscopy, arthroplasty and trauma).
What does the day-to-day job involve?
As a consultant, it is dependent on where you work. We are fortunate to have several hospitals in the UK dedicated purely to orthopaedics such as the Royal Orthopaedic Hospital, Birmingham, which provides a combination of routine elective and complex tertiary services. Most hospitals in the UK offer both trauma and orthopaedics and as such consultant time tables may include:
- 2 days of operating (1 day trauma, 1 day elective)
- 1.5 days of outpatient clinic
- 1.5 day of administration, teaching and ward rounds
As a registrar your job plan may be similar but will include a bit more operating, and daily review of ward patients.
As a core surgical trainee, you competencies will include trauma theatres and fracture clinics, but managing the wards will be a core duty.
As a foundation doctor, your competencies are ward-based, but take any opportunity to get to theatre or clinic.
Are there on calls?
As a consultant it depends on where you work as to how busy it is. Even though as a consultant you may have to do on-calls there are very few problems that would require an immediate rush into the hospital. Some hospitals such as elective orthopaedic centres very rarely have any night time calls whereas a level 1 trauma centre may have a few calls a week.
As a registrar, you will do either residential or non-residential on calls depending on how busy your department is.
As a core surgical trainee or foundation doctor, you will always be resident.
What does Trauma & Orthopaedic training involve?
Training to become a T&O surgeon involves the following:
- Medical School (5-6 years)
- Foundation Programme (2 years)
- Core Surgical Programme (Orthopaedic Theme) (2 years)
- Specialty Training in Orthopaedics (6 years) e.g. BOTP
- Fellowship Training (1-2 years)
Although it is a long route, the pathway for other surgical specialties is similar.
What do I need to become a Trauma & Orthopaedic surgeon?
Enthusiasm, determination and an analytical mind. There is a reason why T&O is such a competitive specialty, and that is why it attracts the highest calibre of individuals to its ranks. The old stereotypes of T&O surgeons no longer hold true as we drive forward in all aspects of healthcare. Prominent orthopaedic surgeons in recent times include Miss Clare Marx (recent President of Royal College of Surgeons of England) and Professor Tim Briggs (Head of the Get It Right First Time initiative, a government funding national scheme to standardise healthcare)
What is so good about Trauma & Orthopaedics?
First and foremost, it is an incredibly challenging but rewarding speciality in which you help patients get over injuries and restore function. A lot of what T&O does is focused on helping patients regain independence that allows them to have the quality of life that they were used to prior to their conditions. We are the group that bring professional athletes back to the field of sport, or make sure that your grandmothers walks again after her fall.
As a surgical specialty we have our own trainees association (BOTA) who are incredibly proactive and driving forward an anti-bullying agenda that has been taken up by other groups #HammerItOut.
We are increasingly becoming the largest group of clinical researches by patients recruited and this website is an example of the development of online platforms for research collaboration.