Head trauma management training

1. aimed at transferring basic knowledge and skills on surgical management of head trauma to the trainees who are general surgeons with minimal or no formal training on neurosurgery

2. didactic on common neurosurgical procedures in Bhutan, practical sessions in the  simulation lab and/or operation theaters or by directly observing and assisting with the trainer, case discussions either on the real case or case based scenarios

3. self-assessment is through checklist and recorded videos and finally assessing the trainee through formal written and viva vice  

1. Module name: Head trauma management training for general surgeons  

2. Objective of the module: to train general surgeons who has no formal neurosurgical training or minimal exposure to manage head trauma in the district settings where there is no neurosurgical services.

3. Module duration -3 months

4. didactic on principle of neurology, assessment of neuro-trauma cases, basic neurosurgical procedures, complications of neuro-trauma and management of neuro-trauma in a resource-constrained situations

5. Practical sessions in the operation theater and simulation lab

6. handling of basic Neurosurgical instrument

7. case based discussions  

8. formative and summative assessment and certification by the medical council and the university

9. Monitoring and evaluation of the outcome of the program regularly

10. technology used is basic neurosurgical instruments and basic IT facilities

1. To teach on overall management of head trauma in general and in particular to teach on simple burr hole to drain simple epidural and subdural hematomas -to teach on craniotomy and decompressive craniotomy for larger epidural and subdural hematomas -to teach how to repair scalp wounds - to elevate depressed skull fractures - to remove impaled objects from the head/ brain.

2. I am the first and only neurosurgeon in the country since 2008. Although, there are general surgeons in the districts, they are not trained in neurosurgery. There is an urgent need to train general surgeons in the districts on basic neurosurgical skills to operate on head trauma. Trauma in Bhutan is very common due to rugged mountainous motor roads, bad weather conditions, increased constructions, common farm works. Head trauma burden is significant that needs referral from all the districts to my hospital. The care is delayed due to long travel time and lack of early care in the districts. So training local general surgeons will recue the mortality and morbidity of head trauma.  

1. project is intended to serve our patients with head injury who need immediate care to prevent deaths and disability; at the closest level as far as possible to avoid long hours of transportation and delay in treatment.

2. the trainees will be the general surgeons with basic knowledge on general surgery but not undergone any formal neurosurgical training. These doctors are working in the districts alone with basic surgical facilities.

3. the doctors there need some additional knowledge and skills to manage such emergency cases as and when the patients come

4. this project will enhance their competency and confidence to deal with  head trauma emergencies

5. people will be benefited, travel cost is reduced, life can be saved and disability prevented

6. reduce social and economic burden of the community and country     

Multidisciplinary team will include :

1. Neurosurgeon, Anesthesiologist team, Radiologist, operation theatre assistants, nursing team of the hospital and emergency physicians to supervise the project

2. Academic dean and curriculum officer from the university to develop the curriculum and module and facilitate the project

3. Hospital management support to allow to carry out the project 

4. 10-15 young surgeons as the students

5. Ministry of health human resource officer as advisor  

6. program review by the medical council of Bhutan

7. Policy directives from the Ministry of Health, Bhutan Government

8. Project assistants  

as listed above