OBSTETRIC SKILLS



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|Tools for Orthopedic Surgery Self-Assessment |

|(Please answer as honestly as you can in order for us to assess better which orthopaedic trauma surgical project would best fit your skills and experience) |

|Experience in working in conflict situations or war context - please list |Yes/No |Dates |Which organization/hospital |

|down all relevant work experience related to this question) | | | |

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|Ex. Syria | | | |

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|Please state the number of times you have personally performed the |Number of times you have performed casting for the following fractures in the last 5| | |

|following for closed fractures |years | | |

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|Casting of a closed fracture of the humerus ------( | | | |

| |. . . . . . . . . . . | | |

|Casting of a closed fracture of the radius ----------( | | | |

| |. . . . . . . . . . . | | |

|Casting of a closed fracture of the ulna ------------( | | | |

| |. . . . . . . . . . . | | |

|Casting of a closed fracture of the radius ---------( | | | |

| |. . . . . . . . . . . | | |

|Traction and casting of a femoral neck fracture -( | | | |

| |. . . . . . . . . . . | | |

|Traction and casting of a femoral fracture ---------( | | | |

| |. . . . . . . . . . . | | |

|Casting of a tibial fracture -----------------------------( | | | |

| |. . . . . . . . . . . | | |

|Application of hip spica -------------------------------( | | | |

| |. . . . . . . . . . . | | |

|Please state the number of times that you have personally used the SIGN |Number of times you have inserted the SIGN nail for closed fractures in the last 5 | | |

|nail |years | | |

| | | | |

|Closed fracture of the femur --------------------------( |. . . . . . . . . . . | | |

| | | | |

|Closed fracture of the tibia ---------------------------( |. . . . . . . . . . . | | |

| | | | |

|Please state the number of times you have performed internal fixation on |Number/ year for the last 5 years | | |

|the following fractures | | | |

| | | | |

|Closed fracture of the humerus ----------------------( | | | |

| |. . . . . . . . . . . | | |

|Closed fracture of the radius ----------------------( | | | |

| |. . . . . . . . . . . | | |

|Closed fracture of the ulna ----------------------( | | | |

| |. . . . . . . . . . . | | |

|Fracture of the patella ----------------------( | | | |

| |. . . . . . . . . . . | | |

|Fracture of the tibia ----------------------( | | | |

| |. . . . . . . . . . . | | |

|Intertrochanteric Fractures of the Femur ----------( | | | |

| |. . . . . . . . . . . | | |

|Please state your experience with the following internal fixation | | | |

|materials: | | | |

| | | | |

|Dynamic Hip Screw ----------------------------( | | | |

| |. . . . . . . . . . . | | |

|Gamma Nail ----------------------------( | | | |

| |. . . . . . . . . . . | | |

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|Which internal fixation systems are you familiar with and are using on a regular basis? Please underline all | | | |

|answers which are applicable. | | | |

| | | | |

|Synthes | | | |

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|Stryker | | | |

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|Zimmer | | | |

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|Other systems you are familiar with. Please state which system. | | | |

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|A. Describe your experience with an electric drill. |

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|B. Describe in detail your experience with a manual drill. If you have no experience please state this also. |

| Please state the number of amputations that you have performed |Number performed in the last 5 years | | | |

| | | | | |

|Finger or Toe--------------------------( |. . . . . . . . . . . | | | |

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|Hand -----------------------------------( |. . . . . . . . . . . | | | |

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|Forearm -------------------------------( |. . . . . . . . . . . | | | |

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|Humerus --------------------------( |. . . . . . . . . . . | | | |

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|Forequarter --------------------------( |. . . . . . . . . . . | | | |

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|Syme’s -------------------------( |. . . . . . . . . . . | | | |

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|Below the knee -----------------------( |. . . . . . . . . . . | | | |

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|Above the knee -----------------------( |. . . . . . . . . . . | | | |

|Please state the number of tendon repairs that you have performed/year in |______/year | | | |

|the last 5 years | | | | |

|Please state the number of skin grafts that you have performed per year in |_______/year | | | |

|the last 5 years | | | | |

|Please state the number of flap coverage operations that you have performed|______/year | | | |

|per year in the last 5 years | | | | |

|Are you able to use the C arm yourself or are you dependent on the |Please describe your experience with the C arm in this column. |

|technician to manipulate and position the C arm? | |

| | |

|What is your experience with physiotherapy? Do you give advice to the |Please describe in detail your experience with physiotherapy or working with a physiotherapist. |

|physiotherapist? Do you work alone and decide the physiotherapy for your | |

|patients? | |

| | |

|Please describe how you teach your operating room nurse on the use of the |Please describe in detail your collaboration with the OT scrub nurse assisting you during your previous operations |

|different orthopaedic materials during the operation. If you have no | |

|experience, please describe this also. | |

|Describe your teaching and training experience in orthopaedic surgery. If | |

|you do not have any experience in this, please also describe it. | |

| Please describe your experience with osteomyelitis. If you do not have | |

|experience in this, please also state this. | |

| Describe your experience in sterilization of your orthopaedic instruments.| |

|If you have no experience, please state this. | |

| Describe your experience in supervising the operating room. Include the | |

|number of staff you are supervising and your daily responsibilities. | |

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| Describe your experience in supervising the orthopaedic surgery ward. | |

|Include the number of staff you are supervising and your daily | |

|responsibilities. | |

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| Describe your experience in supervising the outpatient surgery ward. | |

|Include the number of staff you are supervising and your daily | |

|responsibilities | |

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