Surgical training throughout the surgical subspecialties has typically followed a so-called apprenticeship model. Experience has been measured on the basis of case log documentation, and competency has been determined by senior mentors. Recently, a paradigm shift in medical education has led to an increasing emphasis on competence—specifically, competence with regard to operative skills, surgical knowledge, professionalism, and the use of assessment tools that can provide credible, accurate, reproducible, and transparent forms of evaluation. Indeed, medical education has become more complex, and the delivery of excellence in education has become more difficult. As an example, restrictions imposed by duty-hour limits and requirements for onsite direct supervision by teachers and mentors has changed the education experience.
Residents-in-training are now required to demonstrate proficiency and knowledge as well as performance in six core competencies: patient care, medical knowledge, practice-based learning and improvement, interpersonal and communication skills, professionalism, and systems-based practice. As of July 1, 2013, the Accreditation Council for Graduate Medical Education (ACGME), in conjunction with the American Board of Orthopaedic Surgery and the Residency Review Committee for Orthopaedic Surgery, has implemented the Orthopaedic Surgery Milestone Project, which includes new requirements for training and the assessment of motor skills during basic orthopaedic education.
The introduction to these and other measures such as simulation is rapidly improving orthopaedic medical education. The article by Samora et al. in the November 2014 issue of JBJS Reviews provides a clear window into the immediate future of graduate medical education in orthopaedics. I strongly encourage you to read this article and to be familiar with its contents. Simply stated, it is the way of the future.
Thomas A. Einhorn, MD, Editor