TFF Awarded Runner-up for Tibial Fracture Fixation Training

Three years ago the Global Surgical Training Challenge set out to address the lack of access to safe surgery that hundreds of millions of people face around the world. Doctors Julielynn Wong and Habila Umaru answered the call for submissions of innovative modules that would teach surgical skills in low resource settings.

“When I first heard of this, I thought, ‘oh, this is not for me,’” recalls Dr. Umaru, chief consultant, orthopedic and trauma surgeon at the National Hospital Abuja, Nigeria. “Then a colleague introduced me to Dr. Julielynn Wong. I was initially skeptical, but she encouraged me to participate.”

Dr. Wong, co-lead for the Tibial Fracture Fixation team is a physician, educator and social entrepreneur; she founded Medical Makers, a global community of innovators, patients and healthcare providers who apply user-centered design and accessible technologies to make sustainable solutions to serve vulnerable populations in need.

The two set out to develop a module that teaches medical officers and non-orthopedic surgeons the essential surgical skills needed to treat tibial fractures, one of the most common orthopedic injuries in the world. These skills can be used to prevent needless suffering, disability, and deaths for the estimated 133 million patients who sustain extremity and pelvic fractures globally every year.

“Access to high-quality orthopedic surgical care in resource-constrained settings is limited by a lack of providers, resources and training programs,” says Dr. Umaru. In Nigeria, where he practices, there are only 400 orthopedic surgeons serving a population of over two hundred million people. The majority of those Nigerian orthopedic surgeons are located in four major cities, leaving patients in other areas without access to care.

While she had been part of the global maker community, Dr. Wong was curious about the novel approach to self-assessment that the Challenge was promoting. “This was my first exposure to self-assessment in training in any context, in healthcare or any other sector,” she says.

Leveraging her experience as a licensed pilot, she and the team developed checklists as part of the self-assessment. “We developed self-assessment frameworks that consist of a checklist review and an inspection of images taken of the bone simulator so learners can objectively confirm that they have performed the procedure safely and correctly,” she says.

Self-assessment is only one of the elements of the training module, which is designed for medical professionals who might have limited experience in orthopedics.

“Practitioners learn to evaluate their patients to determine if they’re suitable for this orthopedic surgical procedure, and how to manage them pre-operatively,” she says. “Then they learn how to perform the procedure in the operating room and how to take care of these patients afterwards, including during follow-up clinic visits.”

After this didactic, knowledge-based learning, the learner moves on to building a simulator to practice the techniques. “We created open-source, low-cost, and high fidelity 3D printed bone simulators that can be locally reproduced in makerspaces all over the world,” says Dr. Wong.

“Most learners have never drilled into bone before,” says Dr. Umaru. “They can identify the tactile and sound changes when drilling into our high fidelity bone simulators to teach themselves to avoid plunging beyond the far cortex.”

Procedural checklists break down each step of the procedure in a very concise but comprehensive way. As the learner goes through the skills training, an assistant or a colleague can monitor and ensure they are following all the steps.

“We wanted to make this as easy as possible for anybody, anywhere in the world at any stage in their career to be able to acquire these new essential surgical skills,” says Dr. Wong.

They have since developed other modules beyond the initial tibial fracture fixation module. The next modules address uniplanar external fixation and humeral fracture fixation. Last but not least, is a pediatric distal forearm fractures module, which is designed to teach traditional bone setters, pre-hospital providers, clinical officers, nurses, nurse practitioners, medical officers, and clinicians who are not radiologists or ultrasound technicians, on how to perform ultrasound diagnosis of the most common childhood fracture.

Both team leads are looking forward to continuing to develop and scale the modules. “The future of surgery is open-access, self-assessed simulation-based training to enable learners to develop new surgical skills,” says Dr. Umaru, who also encourages other innovators to step into the effort to innovate training modules. “Surgical practitioners, educators, and innovators can work together to transform the paradigm of surgical education to ‘see one,’ ‘self-teach one,’ and ‘do one,’” he says.

Learn more

Meet the team

Explore the TFF modules on Appropedia

Watch a brief video about TFF

Learn how to get involved with SELF: Surgical Education Learners Forum