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SICOT e-Newsletter

Issue No. 71 - December 2014

Training Around the World

Residency in the Republic of Moldova

Ion Stupac
Chisinau, Moldova

The Republic of Moldova is a developing country, famous for its wine industry and tourism located in the eastern part of Europe, between Romania and Ukraine. The health sector knowledge is based on the State University of Medicine and Pharmacy 'Nicolae Testemiţanu', which was founded on the basis of the Institute of Medicine No. 1 from St. Petersburg, transferred to Chisinau together with teaching staff and students. The Institute began its activity on 20 October 1945.

The Traumatology, Orthopaedics and Campaign Surgery Department was founded on 1 September 1962. Now, the chief of the Orthopaedics and Traumatology Department is Prof N. Caproş. There are 10 professors, who are renowned personalities in Moldova and abroad.

After a 6-year university degree, the residency consists of a 5-year training period and is recognised in hospitals accredited by the university.

In order to be accepted in a trauma residency, the student has to obtain high marks on the final exams, which is composed of a final oral exam, practical exam, multiple choice test, graduation thesis, 20 subjects linked to the specialty and the 6-year general mark.

The training period has specific educational issues introduced for different years, which are developed and realised by each resident. The trainee is expected to rotate through adult and paediatric trauma subspecialties for at least 11 months. To qualify for the exams, the candidate must have submitted his log book with other documents showing the performed procedures each month. At the end, the examinations test the summative knowledge of the candidate involved.

If a trainee is successful, he/she will progress to the next 11-month phase of education, where he/she is expected to rotate through various surgical subspecialties, such as topographic anatomy and operative surgery, anaesthesia, intensive care, clinical toxicology, clinical pharmacology, general surgery, thoracic surgery, vascular surgery, neurosurgery, oral maxillofacial surgery, oncology, urology, osteoarticular tuberculosis and burn injuries in specialised and accredited hospitals. The resident is required to perform established procedures and surgeries, ending with a module finalisation exam.

The third year of training is dedicated to paediatric orthopaedics, based on adult orthopaedics and a continuation of adult traumatology. Each candidate must have submitted his log book of performed procedures while sitting for a final year MCQ and oral exam.

The fourth and fifth years have the purpose of reaching the adult orthopaedics knowledge. During 5 years of training, the doctor must carry out an original research and write a thesis which will be presented and defended orally at the final examinations. At all stages, the candidate is expected to be actively involved in the management of all patients and carry out procedures on them. He is entitled to a 9 months' clinical attachment which he can do in any hospital during the third, fourth, and fifth years (3 months).

Teaching during the residency periods consists of informal and formal teachings. The informal teaching is in the form of outpatient clinics, ward rounds and theatre sessions, while the formal teaching takes place during the update courses, annual conference, national congresses, and meetings abroad. The resident is also expected to present a preliminary thesis and follow up patients at such meetings.

After satisfactory completion of each of the stages, the resident will have to take exams, which consist of an unknown patient for surgical intervention that will be done by the resident, multiple choice tests, and oral exams. There is also a presentation of the final thesis with viva at the fellowship examinations. The resident then qualifies as a general orthopaedic surgeon, if successful in the fellowship examinations. However, the resident is encouraged to proceed to a post-fellowship training in any subspecialty in orthopaedics that is of interest to the individual.

Orthopaedic training in the Republic of Moldova can be very demanding and challenging due to the population of the country and the few numbers of training centres. The orthopaedic surgeons and orthopaedic residents are exposed to a wide variety of cases, the bulk of the work being trauma cases.

The journey to becoming an orthopaedic surgeon can be very tough like running a marathon. It gets tougher with each mile but finishing the course with the reception of the fellowship award always overshadows the difficulties.