Bricolage IS WRITTEN by Jeff Cable and is based in the United Kingdom.

This blog aspires to provide COHERENT and relevant Material for all cast TECHNICIANS. 

Dismal Standards

It is a source of great dismay to me that there is a very low standard of entry to undertake and complete the severely truncated 5 week course entitled, The Theory and Practice of Musculoskeletal Casting and Splinting. (TPMCS) My ire was raised when recently meeting a candidate who had "completed" the five week course as a series of day attendances. Many of the days were not attended and after performing the required end of course tasks, a pass was evidently issued.

One is likely to expect that the successful candidate would have added to their knowledge concerning the theory and the practical application of casts and splints. This particular candidate displayed almost no knowledge and was unwilling or unable to work in cast room with the patients that were the ultimate object of creating a taught course.

The course motivation was apparently to move from an HCA band two position to a band 3 post which required the TPMCS certification. This has to be deemed wholly unacceptable on several fronts. Completing a course of study while failing to attend the taught components merely devalues the course for candidates who have completed the training course.

Candidates who pass the course are required to work autonomously, according to the rubric on the British Orthopaedic Association (BOA) site. It is beyond risible that the TPMCS certificate holders are compared with orthotists and physiotherapists. Both of those initial training courses require a candidate to undertake a minimum of three years full time training for the basic qualification.

Why is there the reluctance to offer real training to candidates who wish to undertake the work of a cast technician? Canada, The USA and Australia all offer a basic two year taught course to cast technicians and they would not accept that UK 'qualified' casts technicians know anywhere near enough to be allowed to practice unsupervised.

TPMCS graduates have a wide range of duties to cover and the course is completely inadequate for equipping the candidates for clinical work. I could not put any trust in the recently qualified TPMCS holder, who had undertaken the course to improve their personal salary banding; rather than improving the lot of the orthopaedic patient.

The failure of the TPMCS course to move its curriculum out of the 1950s, while turning out clones of the teaching staff, is a source of shame. Orthopaedic clinicians (and their patients) have a right to demand and expect professional conduct from the people who will become the surgeon's proxy, while treating patients for their orthopaedic conditions. The course is the only available training in the UK and it has been running largely unchanged for several decades.

How can people with little to no interest in the work become 'qualified' and be permitted to undertake the work of treating patients? The BOA site lists the possible complications with which cast technicians are faced during their work. I challenge the notion that sufficient detail can be taught in a five week course of instruction.

The highly prescriptive approach of the course tutors of the TPMCS course ends with the imprecation to candidates to work in their own way! The TPMCS course cannot contain enough information to inculcate candidates with sufficient understanding to work in a cast room. That cast technicians appear to be paid band 3 or band 4 salaries even after 25 years in the role, strongly suggests that the course value is either unrecognised or... it is being fairly remunerated.

Fixing this issue requires the standards of conduct and technical knowledge to be explicit, the collective will of our leaders to change for the betterment of all and the base point to be centred on medical facts and excellence in clinical practice. It is shocking to me that there is no acknowledged set work for instruction. We have all read the works of Charnley, Adams and McRea and while helpful, they do not give us the precise information which is relevant to cast technicians.

The seminal work, Casts, Splints and Support Bandages - Nonoperative Treatment and Perioperative Protection written by Dresing, Trafton & Engelen and published by Thieme for AOTrauma in December 2014, should be our guiding light and set text. It details nonoperative treatments, AO classifications and comes complete with 55 videos of techniques. It is heavily illustrated and contains thousands of technique photographs. It is also massively well-referenced and written by many experienced orthopaedic clinicians.

This 652 page tome required 5 years and many people to write it and edit it. It should be our standard text and it should be found on every cast room shelf. Furthermore it should provide us with the foundations of any course purporting to teach cast technicians about the work and their role within it. Would that our leaders would listen and start providing real tuition along with advanced and modular courses with which cast technicians can add to their knowledge. We owe it to the cast technicians of tomorrow (and their patients) to find a better way to provide our services.

A three year course based upon the AOTrauma book which speaks directly to our work would be a highly suitable starting place. Our casting overseers have been getting it wrong for rather too many years and it is long past the time when changes for the profession of cast technician should have been initiated. This does not negate their previous work but it is intensely irritating that our casting overseers do not listen. q.v. Can We Do Better?




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