At the beginning of March 2013, because of the concerns which I had about the general standards of work in the plaster rooms in which I had worked as a locum cast technician, I composed and sent a discussion document to the British Orthopaedic Association Casting Committee (BOACC).
My intention was that it would be placed on a committee meeting agenda. That meeting was eventually held and a written response was sent to me. The letter which I had sent to the BOACC can be read by opening the following PDF document.
A short dialogue between myself and the BOACC chair then ensued. It resulted in the somewhat unsatisfactory conclusion that all was apparently well in field of casting practice. Many of the points which I had raised within the discussion document were supposedly incorporated into the learning package for the current British Casting Certificate (BCC) course of five weeks duration.
I am unsure whether the response was stating that the raised matters were already in hand so as to incorporate the points which I had raised or that my raising them had caused them to be incorporated. As to how one should interpret the word ‘many’ within the given context... it is pure guesswork. Follow this link to read the BOACC chair’s response to my initial letter.
One of the key issues for me was the length of the BCC course. The two years required in Australia, Canada and the USA, would suggest that casting course materials are considered differently when compared to the five week UK course.
The nub of the BOACC response to this issue was that the cast technicians (of north America and Australia) are “generally working within the offices or auspices of an orthopaedic surgeon” and “In essence therefore to my mind closely supervised”.
I did not understand the difference between the clinical supervision model of the UK and the places I mentioned. Nor can I understand the thinking behind the idea which believes that a closely supervised cast technician (in north America or Australia) mandates the inception of a taught course which is substantially longer than the BCC course that is available in the UK. Presumably these were far more detailed courses of instruction in Canada, America and Australia.
Implicit in the response from the BOACC was that in some as yet undefined manner, two years was an unnecessary length of course for a cast technician. I would beg to differ; given the complexities of the work which we are asked to carry out.
It is my firm opinion that the BCC course of instruction falls a considerable distance short of what is desirable when it comes to equipping the embryo cast technician for the work which they will be required to do. My second letter to the BOACC chair is found here.
The response from the BOACC chair was less than encouraging. It appeared to have entirely missed the point about the BCC being a rather short course which could not adequately prepare cast technicians for the work with which they would be faced.
The lack of any advanced and modular courses to continuously update the skills and knowledge of cast technicians was also high on my shopping list of things to implement and thereby enable clinical work standards to be raised. The less than helpful response to my second letter to the BOACC chair may be found here.
The 2nd response letter from the BOACC chair had prompted me to write to him yet again and my 3rd letter to the BOACC chair can be read here. What is difficult to understand is precisely why the dialogue between myself and the BOACC was not continued. No further reply was forthcoming from the BOACC chair.
Whether the absence of response from the chair of the BOACC can be ascribed to a personal lack of common courtesy or for some other reason, I cannot tell. I can say that it is beyond reasonable that the BOA, which is one of the supervising authorities for orthopaedic clinical practice in the UK, shows little to no interest in the standards of patient care being applied nationally by cast technicians (and by extension) the clinicians who prescribe casts.
The question posed at the top of the page was can we do better. Undoubtedly we CAN do very much better. The basic BCC course could be very much longer than five weeks and it could actually prepare people to work as cast technicians. There could be far more short courses provided to us (online courses are easy to attend) which could train all UK cast technicians to work at a much higher clinical standard. The ostrich-like approach of a soporific and supine BOACC, to the issues raised by me, is baffling and supports the notion that standards of work are unimportant.
It is an unwelcome impediment to promoting very much higher standards of clinical work among cast technicians. Everything in the garden of the cast technician is not rosy and the sooner our supervisory bodies, their personnel and the NHS managerial structures and staff realise that, the sooner that cast technicians can start to make a real difference to the quality of patient care in orthopaedics cases.