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Journal Club Resident Spotlight: Abdulaziz Ahmed

JBJS is pleased to highlight the orthopaedic residents who help implement the Robert Bucholz Resident Journal Club Grants at their institutions. The grant program promotes career-long skills in evaluating the orthopaedic literature. Click here for more information.

Name: Abdulaziz Ahmed, MD

Affiliation: Hamad Medical Corp., Doha, Qatar

What was the topic of the most “dynamic” journal club meeting you have had so far this year?

One distinctive journal club evaluated two Level-I studies that addressed common sports-medicine procedures. One article was a randomized clinical trial (RCT) that evaluated the effectiveness of acromioplasty when added to full-thickness rotator cuff tear repair (Abrams GD, et al. Arthroscopic Repair of Full-Thickness Rotator Cuff Tears with and Without Acromioplasty: Randomized Prospective Trial With 2-Year Follow-up. Am J Sports Med. 2014 Jun;42[6]:1296-303). The second article was a trial that compared hip arthroscopy versus nonoperative treatment for femoroacetabular impingement (Griffin DR, et al. Hip arthroscopy versus best conservative care for the treatment of femoroacetabular impingement syndrome [UK FASHIoN]: a multicentre randomized controlled trial. Lancet. 2018 Jun 2;391[10136]:2225-2235). By completing systematic critical-appraisal forms, the residents were able to dissect and digest complex methodology and statistics. Both articles provided high-value learning points on evaluating the mechanics and limitations of randomized trials.

What are the top 3 characteristics of an engaging, enlightening journal club presentation?

First, audience preparedness is essential to an engaging journal club. Thus, articles should be distributed in advance for prereading. In our program, we circulate articles 4 weeks in advance. In addition, we highlight important educational objectives for each article. This allows residents to concentrate on crucial elements of selected articles, especially when analyzing several articles in one sitting. Second, selected articles have to be pertinent to the residents’ curriculum and clinical exposure. Our journal club articles are hand-picked jointly by senior residents and research-oriented faculty. The senior residents ensure the article’s relevance to residents, while experienced faculty provide oversight and refine article selection. Third, a systematic approach maximizes the beneficial value of the journal club. We provide participants with a systematic critical-appraisal checklist that not only enhances the residents’ critical appraisal, but also helps them adopt efficient lifelong reading tactics.

Aside from orthopaedic content, what have you been reading lately?

I have been reading the book Deep Work by Cal Newport. The book teaches valuable strategies for optimizing productivity and getting the most out of our cognitive abilities—a much-needed skill in our currently fast-paced, distracted world.

How has the COVID-19 pandemic affected your journal-club activities?

The COVID-19 pandemic has profoundly affected residency training around the globe. Although the pandemic limited our in-person journal club format, like many others, we have transitioned to virtual education. Currently, our journal club is conducted through online meetings. As much as we loved the in-person format, the online format made the journal club more accessible to faculty members. Moreover, the virtual setting motivated us to invite experts in the field. Recently, Dr. Bashir Zikria from Johns Hopkins moderated an exciting journal club on the long-term outcomes of matrix-induced autologous chondrocyte implantation.

How has free access to JBJS Clinical Classroom benefited you and your journal club?

JBJS Clinical Classroom has been a useful source for article selection in our journal club. It also provides an exciting opportunity to evaluate our knowledge by strengthening deficient areas and steering us away from mastered topics. The recharge feature provides a time-efficient way to reinforce knowledge.  Clinical Classroom presents questions that are based on the best available evidence, and cited references feature both classic and most recent articles.

 

Making History Together

JBJS announces its new, interactive website, Making History Together, which celebrates 130 years of history at JBJS and the collective history of the field of orthopaedic surgery. The focal point of the new site is a dynamic timeline highlighting key moments and people in orthopaedics from 1887 to the present.

“We designed this site to give you a glimpse into our shared, collective past and show you how JBJS and the field of orthopaedic surgery have evolved over the last century-plus,” says JBJS Editor-in-Chief Marc Swiontkowski, MD. “The site is both informative and entertaining, and we hope that it helps you to feel more closely connected to those who paved the way for current and future orthopaedic surgeons.”

Browse the Making History Together timeline here.

Watch the introductory video:

The Making History Together site also spotlights:

  • The people responsible for leading and producing JBJS, including our Editors-in-Chief, journal editors, reviewers, board of directors, and staff members
  • JBJS products, including our flagship Journal of Bone & Joint Surgery, additional print and digital publications, podcasts, videos, and educational events and offerings
  • Classic JBJS articles, including early and more recent practice-changing discoveries that were first described in our pages
  • How the JBJS organization has grown in size and scope over the years, from a small, scholarly, printed journal to a multimedia content hub that meets the needs of a global, interconnected community of orthopaedic surgeons

JBJS is proud of its role in helping to advance the field of orthopaedic surgery over the last 130 years and is honored to be part of an orthopaedic community with a shared dedication and commitment to improving the musculoskeletal care of patients worldwide.

Journal Club Resident Spotlight: Praharsha Mulpur

JBJS is pleased to highlight the orthopaedic residents who help implement the Robert Bucholz Resident Journal Club Grants at their institutions. The grant program promotes career-long skills in evaluating the orthopaedic literature. Click here for more information.

Name: Praharsha Mulpur, MD

Affiliation: Sunshine Bone and Joint Institute, Hyderabad, India

What was the topic of the most “dynamic” journal club meeting you have had so far this year?

Tuberculosis (TB) of the hip joint is still prevalent in India. We are often faced with situations of advanced destruction of the hip joint requiring total hip replacement (THR), but THR is usually delayed until the disease condition becomes quiescent. However, TB is known to persist subclinically and to reactivate after surgery. One of the journal club articles we discussed was a “practice changer” as far as THR in active TB was concerned: Kim et al. Total hip replacement for patients with active tuberculosis of the hip. Bone Joint J, 2013; 95-B:578-82.

What are the top 3 characteristics of an engaging, enlightening journal club presentation?

The most important characteristics include: (1) Clinical relevance: The article chosen should generate discussion on a topic that is clinically relevant and not one that has already been “settled” or “dismissed.” Not all “historical” articles are clinically relevant in the 21st century. (2) Participation: Participants should be well-versed with the topic prior to the meeting, which allows detailed discussion with different perspectives. (3) Brevity: Presentations of the article(s) being discussed should be clear and concise.

Aside from orthopaedic content, what have you been reading lately?

I am following several podcasts, both clinical and nonclinical. I am also reading articles from the Farnam Street blog by Shane Parrish, The New York Times, and a nonfiction book titled Nothing to Envy by Barbara Demick.

How has the COVID-19 pandemic affected your journal-club activities?

Unfortunately, our in-person journal clubs have been halted due to the ongoing risk of COVID transmission, and our institute and department have adopted a completely virtual academic program. This has advantages and disadvantages. On the positive side, we are able to involve senior faculty, both national and international, to participate in the journal club discussions. Apart from our monthly internal journal club, we have an ongoing academic relationship with the department of orthopaedics at the University of Miami for a monthly journal club. With this, our residents and fellows gain international perspectives on topics of clinical significance. On the downside, nothing beats an in-person meeting. Group dynamics and participation are always better in a room than on a Zoom screen.

How has free access to JBJS Clinical Classroom benefited you and your journal club?

JBJS Clinical Classroom is a valuable educational resource and is highly recommended for orthopaedic residents. The content is excellent and helped me cover a lot of topics without having to go back to a reference textbook. The progress meter is useful to assess personal progress. One of the best features is the JBJS Clinical Classroom Library. Every topic has links to the best or most-cited references, which makes studying easy.

Journal Club Resident Spotlight: Agustin Albani Forneris

JBJS is pleased to highlight the orthopaedic residents who help implement the Robert Bucholz Resident Journal Club Grants at their institutions. The grant program promotes career-long skills in evaluating the orthopaedic literature. Click here for more information.

Name: Agustin Albani Forneris, MD

Affiliation: Hospital Italiano de Buenos Aires, Argentina

What was the topic of the most “dynamic” journal club meeting you have had so far this year?

Many articles presented in our journal club ignited debate, not only about their findings but also their design and methodology. One standout was the article by Matsunaga et al. (Minimally Invasive Osteosynthesis with a Bridge Plate Versus a Functional Brace for Humeral Shaft Fractures: A Randomized Controlled Trial. J Bone Joint Surg Am. 2017 Apr 5;99[7]:583-592), which is a prospective randomized study comparing minimally invasive osteosynthesis vs functional bracing for the treatment of humeral shaft fractures. It is quite unusual that a Level-I prospective study like this was designed in Latin America. Our debate focused primarily on identifying which patients in our population would benefit from one treatment or another, in order to apply specific indication criteria to our daily practice. In turn, several hypotheses were raised that stimulated ideas for future projects.

Based on your journal club experiences, what are the top 3 characteristics of an engaging, enlightening journal club presentation?

(1) The commitment of the participants. We encourage all of our 43 residents to not only read the article in advance but also to write a critical review as if they were reviewers of a journal.

(2) Selection of the article. We encourage residents to select controversial studies that trigger debate about results and methodology. It is often valuable to criticize an article whose methodology is controversial to analyze which aspects would make the same study more solid (i.e., selection bias, randomization, data collection, statistical analyses, etc.)

(3) Inviting an experienced faculty surgeon. This is always inspiring to all residents, helping us to write and review articles and transmitting to us their passion for research.

Aside from orthopaedic content, what have you been reading lately?

I am a technology fan, so I usually read specialized magazines on electronic devices and reviews about new gadgets on the market. During holidays, I love to read historical novels that transport me to another place and time. Reading about the achievements of people living at a time when life expectancy did not exceed 30 years amazes me.

How has the COVID-19 pandemic affected your journal-club activities?

Paradoxically, the pandemic empowered our journal-club activities. The substantial decrease in elective surgery to prioritize medical resources for Covid-patients, in addition to the proliferation of virtual applications, gave residents more accessibility to and availability for academic activities. The pandemic also enabled several staff surgeons to join our program, and that enriched the discussions.

How has your free access to JBJS Clinical Classroom benefited you and your journal club?

JBJS Clinical Classroom provides us the opportunity to link one of our most valuable learning tools with the journal club by synchronizing the topics from the resident program classes with the selected journals. JBJS Clinical Classroom also enables us to individualize each resident’s progress and to reinforce the areas that present the greatest difficulty.

Strengthening Our Residency Programs through Robust Research

Residency training is an essential pipeline to keeping the field of orthopaedics strong. As I tell the surgeons in my department, we should always be looking for our replacement. Who is going to carry the flag of orthopaedics after our time has passed?

Research related to education and training helps guide us. Continuing a collaboration between the American Orthopaedic Association’s (AOA) Council of Orthopaedic Residency Directors (CORD) and JBJS, the top abstracts from research presented at the 2019 CORD Summer Conference are now available in an article by Weistroffer and Patt on behalf of the CORD/Academics Committee.

Ten studies are featured, with a number looking at aspects of resident screening and selection. For instance, Pacana et al. evaluated use of the standardized letter of recommendation (SLOR) form; while widely adopted, it may not be a cure-all in evaluating applicants, as most applicants were “highly ranked” or “ranked to match.” Work by Secrist et al. suggests that 59 is the number of programs that medical students should target in order to obtain 12 residency interviews (with previous work showing that the average matched applicant attends 11.5 interviews). Alpha Omega Alpha status was the strongest determinant of an applicant’s interview yield. Crawford et al. surveyed residency applicants to find out which characteristics they felt were important to success in an orthopaedic residency. Hard work, compassion, and honesty made the top-10 list each year.

The importance of diversity within orthopaedics is also echoed in the included research. It is well documented that orthopaedic surgery falls far behind other specialties in this area. Among topics explored: potential differences in descriptive terms used in letters of recommendation for male and female candidates, and perceptions of pregnancy and parenthood during residency. Illustrating the importance of exposure and access to role models in orthopaedics, Samora and Cannada found that 80% of female medical students who received a scholarship to attend the Ruth Jackson Orthopaedic Society/AAOS annual meeting eventually pursued a career in orthopaedic surgery. I agree with the authors, who stated, “We must work on diversifying our field and providing opportunities for women and underrepresented minorities to consider a career in orthopaedics.”

I know we will continue to make positive change as a profession. Moreover, I am convinced that the future of orthopaedics is strong, with many with top-notch candidates ready and able to help shape our path.

Matthew R. Schmitz, MD
JBJS Deputy Editor for Social Media

Surgical-Technique Videos Focus on Pediatric Fractures

Many orthopaedic surgeons who take emergency-department or trauma call are confronted with a pediatric patient presenting with a fracture. However, very few of those orthopaedists are pediatric subspecialists. In fact, Geisinger researchers recently reported that the median number of pediatric orthopaedists per state in the US is only 23 (range 0 to 134).

To address these demographic realities, JBJS Essential Surgical Techniques has launched a video-based, point-of-care resource to help any orthopaedic surgeon manage the most common pediatric fractures with the highest level of quality, helping ensure excellent outcomes for young patients and their parents. Most of the authors of these pediatric-focused procedural videos are members of CORTICES—a collaboration of pediatric orthopedic surgeons dedicated to improving the management of emergent orthopedic conditions through education, research, and development of optimal care guidelines.

Here are links to the 5 already-published video articles in this series:

Upcoming videos in this special series will cover the following 5 topics:

  • Screw Fixation of Pediatric Proximal Tibial Tubercle Fractures
  • Reduction and Internal Screw Fixation of Transitional Ankle Fractures
  • Flexible Intramedullary Nailing of Pediatric Femur Fractures
  • Intramedullary Fixation of the Ulna for Monteggia Fracture Management
  • Open Reduction and Internal Fixation of Pediatric Medial Epicondyle Humerus Fractures

JBJS Essential Surgical Techniques is the premier online journal describing how to perform orthopaedic surgical procedures, verified by evidence-based outcomes, vetted by peer review, and utilizing video to optimize the educational experience, thereby enhancing patient care.

JBJS Clinical Classroom: A Better Path to Orthopaedic Proficiency

In 2017, JBJS partnered with NEJM Group to launch JBJS Clinical Classroom—an adaptive learning platform that meets the unique learning needs and requirements of orthopedic training programs worldwide. Clinical Classroom identifies gaps in individual users’ knowledge and assesses their self-confidence in 11 orthopaedic subspecialties. Curated by orthopaedic experts and powered by leading-edge learning technology, Clinical Classroom has quickly become a leading platform for helping orthopaedic residency programs to:

  • Identify residents’ knowledge gaps through detailed reports and monitoring
  • Improve residents’ knowledge and critical thinking skills
  • Keep residents up-to-date with the latest and highest-quality orthopaedic findings
  • Better prepare residents for OITE and board certification exams

To meet changing user needs and implement technological advancements, JBJS has improved the overall user experience in Clinical Classroom. These significant enhancements were made possible by upgrading from the original NEJM Knowledge+ platform to the new Rhapsode platform by Area9.

Highlights of JBJS Clinical Classroom on Rhapsode include the following:

  • Updated adaptive algorithm that incorporates the most advanced adaptive tools for more efficient individualized learning
  • Improved reporting and metrics providing residents and residency directors with a more comprehensive dive into individual and group performance
  • In-platform coaching delivers helpful tips tailored to resident progress and confidence as they progress through subspecialties
  • Enhanced look and feel: The clean, modern Dashboard and improved navigation allow residents to interact with and move effectively throughout the product for optimal learning
  • And so much more

To learn more about the enhanced JBJS Clinical Classroom on Rhapsode and how Clinical Classroom can best serve your program, click here.

JBJS Clinical Classroom: A Better Path to Orthopaedic Proficiency

In 2017, JBJS launched JBJS Clinical Classroom on NEJM Knowledge+, an adaptive learning platform that meets the unique learning needs and requirements of orthopedic surgeons worldwide. Clinical Classroom identifies gaps in individual users’ knowledge and assesses their self-confidence in 11 orthopaedic subspecialties. Curated by orthopaedic experts and powered by leading-edge learning technology, Clinical Classroom has quickly become a leading platform for orthopaedic surgeons who want to:

  • Improve their knowledge and critical thinking skills
  • Stay up-to-date with the latest and highest-quality orthopaedic findings
  • Earn AMA PRA Category 1 Credits™ (for US learners who successfully answer questions), and
  • Earn SAE credits for Maintenance of Certification (for US learners who successfully answer questions)

To meet changing user needs and implement technological advancements, JBJS has improved the overall user experience in Clinical Classroom. These significant changes were made possible by upgrading from the original Knowledge+ platform to the new Rhapsode platform by Area9.

Highlights of JBJS Clinical Classroom on Rhapsode include the following:

  • Enhanced look and feel: The clean, modern Dashboard and improved navigation allow you to interact with and move effectively throughout the product for optimal learning.
  • Updated adaptive algorithms that incorporate the most advanced adaptive tools for more efficient individualized learning
  • All-device access: Clinical Classroom is now user-friendly on all devices, with special enhancements for the mobile experience.
  • In-platform coaching delivers helpful tips tailored to your performance and confidence as you progress through subspecialties.
  • And so much more

To learn more about the enhanced JBJS Clinical Classroom on Rhapsode, and to stay up-to-date with ongoing developments, click here.

To explore Clinical Classroom pricing and subscription options, visit the JBJS Store today.

The Journal of Bone and Joint Surgery, Inc. is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

The Need for Preop Psych Evals in Orthopaedic Surgery

OrthoBuzz occasionally receives posts from guest bloggers. This guest post comes from Impact Science, in response to a recent ”What’s Important” article in JBJS.

In orthopaedic surgery, pre-existing psychiatric conditions in patients can have a detrimental effect on outcomes. Previous studies have shown poor improvement in postoperative self-reported pain scores among patients with psychosomatic conditions or mood disorders. Robust published evidence also suggests that psychiatric conditions can lead to complications in the treatment course, including an increased length of hospital stay and higher total systemwide costs. However, despite compelling evidence in the literature, orthopaedic surgeons—especially those early in their career—lack protocols to evaluate a patient’s current and past psychiatric history and symptom severity.

A recent “What’s Important” article in The Journal of Bone & Joint Surgery emphasizes the need for such an assessment tool. In the article, Albert T. Anastasio, MD, a resident in orthopaedic surgery at Duke University Medical Center, cites the example of bariatric surgery, where protocols have long existed for preoperative patient assessments for a history of alcohol and drug abuse. He argues convincingly that the development and use of such tools should be extended to orthopaedic procedures. For example, Dr. Anastasio questions the wisdom of a hypothetical elective spine surgery in a patient with an unaddressed psychosomatic disorder and borderline pathology on advanced imaging.

At the same time, Dr. Anastasio is quick to highlight the challenges of developing such a tool, mainly because of the subjective nature of psychiatric symptoms. But he cites existing tools that attempt to objectively evaluate psychiatric symptoms, such as the Patient Health Questionnaire-9, which is used to quantify the severity of major depressive disorder. Dr. Anastasio also cautions that any such metric should not serve as a “definitive cutoff” for surgery.

Underlying Dr. Anastasio’s call for psychiatric risk-assessment protocols is the importance of developing and enhancing collaboration between orthopaedics and psychiatry, two disciplines that he says are often “considered very far removed from each other.”

Impact Science is a team of specialized subject-area experts (Life Sciences, Physical Sciences, Medicine & Humanities) who collaborate with authors, societies, libraries, universities, and various other stakeholders for services to enhance research impact. Impact Science aims to democratize science by making research-backed content accessible to the world.

JBJS Extends Deadline for International Journal Club Grants

For the first time, JBJS is expanding its Robert Bucholz Resident Journal Club Grant Program to orthopaedic residency programs beyond North America.

The deadline for international applicants has been extended until 31 October 2020.

Grants of US$1,500 will be awarded to support selected Journal Club programs for the coming academic year. Funds can be used for subscriptions to orthopaedic journals and resources, travel grants for guest speakers, and costs associated with the monthly journal club meetings.

To apply, click here, download and fill out the form, and return it to journalclub@jbjs.org by 31 October 2020.