The new curriculum has moved towards a competency based system with Generic professional capabilities and capabilities in practice now being assessed. They are assessed during multi-supervisor reports which are performed twice during a placement. Assessment follows the following scale:

  • Observe only
  • Act with direct supervision
  • Indirect supervision
  • Act at the level of a day 1 consultant
  • Act at level beyond that of a day 1 consultant

The generic professional capabilities include a trainees ability to do the following:

  • Supports all specialties
  • Health promotion illness prevention
  • Research and scholarship
  • Education and training
  • Safeguarding vulnerable groups
  • Patient safety and quality improvement
  • Leadership and teamworking

The Capabilities in Practice include a trainees ability to do the following:

  • Manage an outpatient clinic
  • Manage the unselected emergency take
  • Manage ward rounds and care of in patient
  • Manage an operating list
  • Multi-disciplinary team working


The work based assessments are less specific and should cover the index procedures (see below for list) and management of common critical conditions (see below for list).

Critical conditions


  • Major joint arthroplasty
  • Osteotomy
  • Nerve decompression
  • Arthroscopy


  • Compression hip screw for intertrochanteric fracture neck of femur
  • Hemiarthroplasty for intracapsular fracture neck of femur
  • Application of limb external fixator
  • Tendon repair for trauma
  • Intramedullary nailing including elastic nailing
  • Plate fixation for fracture or arthrodesis
  • Tension band wire for fracture or arthrodesis
  • K wire fixation for fracture or arthrodesis
  • Children’s displaced supracondylar fracture

Critical conditions

  • Compartment syndrome
  • Neurovascular injury
  • Physiological response to trauma
  • Cauda equina syndrome
  • Assessment, care and referral-spinal trauma
  • Spinal infections
  • Complications – inflammatory spinal conditions
  • Metastatic spinal compression
  • Painful spine in the child
  • Painful hip in the child
  • Necrotising fasciitis
  • Diabetic foot
  • Primary musculoskeletal malignancy
  • Polytrauma

To complete orthopaedic training all trainees must be:

  • Fully registered with the GMC
  • Completed higher surgical training
  • Passed FRCS
  • Demonstrated appropriate generic professional capabilities
  • Achieved outcome 6 at ARCP. To obtain an outcome 6 trainees must:
    • Clinical experience: WBAs in critical conditions
    • Operative experience: 1800 cases
    • Operative competency: PBAs in index procedures
    • Research: Completed Good Clinical Practice course, journal club activity, 2 presentations, papers in 2 PubMed cited papers.
    • Quality improvement: 1 audit per year, 2 audits to full cycle
    • Medical education: training the trainer and 1 lecture per year
    • Management and leadership: Evidence of leadership and management
    • Additional courses: Valid ATLS
    • Educational conferences: demonstrated ongoing CPD by attending courses, meeting and training courses
  • Difficulty obtaining Index procedures/operative numbers
  • Difficulty obtaining multi-supervisor reports (will ensure I meet consultants early in placement to arrange this)