‘Thailand Model’: AO Trauma basic principles

The AO Trauma Course—Basic Principles of Fracture Management can be cost-effectively conducted anywhere in the world, as shown by the ‘Thailand Model’.

19 September 2019

When it comes to cost-effective course organization, there may be no better model than AO Trauma Thailand which, despite formidable early challenges, has been economically conducting the AO Trauma Course—Basic Principles of Fracture Management since 1985.

That success continued in July 2019, when 160 people took part in the course conducted by 46 Thai faculty members and two regional faculty members. The cost-effective course format represents a solution for countries that have long been on the waiting list for the course, according to AO Trauma Asia Pacific Education Chairperson Dr Vajara Phiphobmongkol, MD, and past AO Foundation President Dr Suthorn Bavonratanavech, MD.

In their paper, AO Trauma Course—Basic Principles of Fracture Management: The “Thailand Model”, Dr Vajara and Dr Suthorn describe the history of the course in Thailand and how its unique and cost-effective format established a foundation that has held fast for the past 34 years. In early 1984, with limited teaching materials, Dr Suthorn approached Prof Hans Willenegger, a founding father of the AO, with a request for instruments key to teaching orthopedic surgeons. AO International—now known as AO Education—provided the instruments and Thailand’s first two basic principles courses were conducted in June and August 1985.

The major challenge for these first courses was the availability of only one set of instruments for each procedure in the practical exercises, meaning that course participants could not simultaneously practice the procedures as is typical in AO courses. To overcome that hurdle, course organizers scheduled lectures and practical exercises so that the 60 participants took part in nine exercises over a four-week period. That format made it possible to conduct the course with limited existing materials.

In 1994, AO East Asia was founded, uniting orthopedic surgeons from ten East Asian countries with the aim of collaboration for education, research, etc., and with the expectation of more AO courses in the region and the need for workshop instruments located in Asia—rather than shipping them from Switzerland for each course in the region. The AOEA Permanent Workshop (PWS) was established, yet a challenge remained: In a course with 60 participants performing the same exercise simultaneously, 30 sets of instruments would be needed for each of the nine exercise instrument sets—a significant investment. Course organizers again showed their ingenuity by employing an economical format allowing three groups of participants to rotate through three different exercises at the same time. That approach required only 10 sets of instruments for 20 participants, cutting costs by one-third.

This three-group workshop rotation system since then has become the established format for the basic principles course in Thailand, even as course participation has continued to increase. In addition to significant savings, the format offers appreciable opportunities to develop young faculty members from generation to generation. That is because all discussions and practical exercises are conducted four times in the same faculty group, with senior faculty conducting the initial sessions. Subsequent sessions are conducted with assistance from younger faculty members, representing a valuable transfer of experience and skills to the next generation through course activities.

When AO Trauma Thailand conducts its 2020 basic principles courses, the ‘Thailand Model’ will continue as an example of cost-effectiveness and generation-to-generation skills transfer—and a cornerstone of creative thinking established 34 years ago.

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