Introduction Carpal tunnel syndrome (CTS) causes significant morbidity with delayed diagnosis or management. The Boston Carpal Tunnel Questionnaire (BCTQ) is validated for monitoring CTS following diagnosis; however, it has not been trialed in a screening capacity. The study aimed to determine whether it can be utilized when screening a focused population in Singapore. Materials and Methods A single-center survey-based study was undertaken prospectively to identify whether positive symptoms could be identified among nursing and administrative staff. Results A total of 605 staff responded. Positive symptoms were identified in 317 (52.4%) of participants and 23 (3.8%) reported them to be severe. Functional limitations were detected in 157 (26.0%) of participants with 5 (0.8%) reporting these as severe. Positive symptoms (84.9%) and functional limitations (81.5%) were more prevalent among nursing staff. Cronbach’s α scores (0.896 for symptoms and 0.84 for functional limitations) suggested good reliability in matching symptoms and functional limitations. Conclusion The BCTQ can potentially be implemented as a screening tool for CTS among those without a prior diagnosis. It has a greater depth of questioning with symptomatic and functional limitations considered, and in situations where a formal diagnosis is subsequently made, the same tool can be subsequently used for progression tracking pre- and post-treatment. Level of Evidence This is a Level II study.
Singapore as an island nation is one of three countries in the world that has hand and reconstructive microsurgery (HRM) as an independent specialty. The 52 accredited hand surgeons serving a population of 5.7 million facilitate hassle free access to patients. Hand surgery historically is rooted very much in orthopaedic surgery as in most Asian countries with more than five decades of rapid evolution. Singapore pioneered a structured and systematic training program for HRM and the local surgeons have contributed significantly to the body of knowledge in hand surgery with targeted research and publications with three surgeons being awarded international recognition for their contributions. Singapore continues to contribute significantly to surgical volunteerism regionally through active involvement in the training of regional surgeons through their sustainable volunteer activities and through international fellowships in Singapore hospitals. The future of hand surgery in Singapore will be more competency and multidiscipline based on community-centered approach.
Hand surgery is very much a psychomotor dominant specialty requiring the need for predictable, reliable and cost effective means of transferring and developing surgical skills. The need for a high quality simulations model to acquire skills is important in skill training.In this paper we identified real world problems of skill gaps in hand surgery and used the theories of instructional design (ID) to analyse the instructional needs in the problems and then generated solutions using the principles of ID. Based on the individual needs of the learners and entry behavior and characteristics, the framework developed instructional activities and materials and used the concept of the flipped classroom, allowing for effective and efficient transfer of information and skills allowing for adequate feedback and assessment to achieve the stated objectives of the instructions. It included generation of appropriate tools to evaluate the effectiveness of the whole ID framework.This paper shows that the use of the Instructional Design models like ADDIE and Gagne's nine events and the use of open educational resources hosted on an open learning management system is a useful strategy in designing surgical skill workshops and is a reliable and predictable tool in producing learning programs for surgeons in a cost effective manner.
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