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A Creative Approach to COVID-Era Journal Clubs

All recipients of the JBJS Robert Bucholz Journal Club Grant are asked to complete an end-of-year survey that includes a question about how they used the grant money. This interesting reply comes from Kyle Morgenstern, MD, an orthopaedic resident at the University of Minnesota.

Resident engagement in journal clubs has been a challenge over the last couple of years. In our hard-working residency it is tough for residents to take time out of their evening every month for journal club. Formerly, we used the JBJS grant funds to purchase food and drinks for attendees. But with the virtual nature of journal club this past year, we saw our attendance start to slide and had to find other ways to recruit residents and boost morale.

So at the beginning of the COVID era, we utilized the grant money to purchase items awarded to attendees for their participation. I figured that if we couldn’t offer food and drink in person, we could at least do it virtually, and we awarded DoorDash gift cards.

Later, we transitioned to awarding a textbook to one presenter at each Journal Club. The winner of the textbook for best presentation was selected via an anonymous Zoom-poll vote of the faculty in attendance. We do Journal Club “Specialty Nights,” so, for example, we awarded Operative Techniques in Shoulder and Elbow Surgery during our shoulder-and-elbow night.

Those who received a textbook were quite thankful, especially those entering their trauma rotations or going into a particular subspecialty. I think this is something we will continue to budget for in the future, as we return to in-person meetings coming out of the pandemic.”

Applications for the 2021-2022 Robert Bucholz Journal Club grant will be available soon. Please stay tuned!

Journal Club Resident Spotlight: Jui-Yo Hsu

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 literatureClick here for more information.

Name: Jui-Yo Hsu

Affiliation: National Taiwan University Hospital

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

In March 2021, we hosted a spine journal club focusing on adolescent idiopathic scoliosis (AIS). It was our pleasure to have Prof. Andrew J. Schoenfeld, deputy editor of JBJS, join our discussion. His remarkable advice and unique insight inspired in-depth discussion. Our advisor and moderator, Prof. Shu-Hua Yang (楊曙華), chairperson of Taiwan Spine Society, who is also a pioneer in the field of AIS research, also provided great support to our journal club. The paper we presented was “Selecting the ‘Touched Vertebra’ as the Lowest Instrumented Vertebra in Patients with Lenke Type-1 and 2 Curves” (J Bone Joint Surg Am. 2020 Nov 18;102(22):1966-1973.) by Beauchamp, et al. All the faculty and residents were highly involved in the discussion. Due to the high relevance of this topic to clinical decision making in surgical correction of AIS, both Prof. Schoenfeld and Prof. Yang shared their viewpoints and precious clinical and surgical experiences with the audience.

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

First, it’s important to keep the journal club intriguing to the participants. Therefore, choosing a good topic plays a key role. Residents will be more involved if the topic is clinically important, related to a familiar surgery, or connects to their own ongoing research. Second, because knowledge of the topic may vary between senior and junior residents, we assign one of our senior residents to provide background knowledge before the discussion. Reading the article and preparing in advance are required for every participant, and we also encourage everyone to come up with several questions before the journal club. Finally, support and participation from the faculty are crucial to the journal club. They can provide clinical experiences to residents and provoke further discussion. It is even more beneficial if the participants discuss their own cases with both colleagues and instructors.

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

In Taiwan, fortunately we were able to maintain normal lives and all residents and staff were able to participate in the journal club in person, despite the global pandemic. However, due to a local outbreak in Taiwan in early May 2021, restrictions were imposed on indoor gatherings. We therefore decided to host our journal club online. In fact, residents were more engaged in online journal club. Using the chatroom feature, residents were able to ask question at any time without interrupting the speaker, and supplementary materials could be shared by anyone at any time. I believe online meetings may become mainstream in the post COVID-19 era.

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

I have been reading Cribsheet: A Data-Driven Guide to Better, More Relaxed Parenting, from Birth to Preschool, by Emily Oster. It is a remarkable and useful book for first-time parents. I just welcomed my first child in April 2021, and this book provides practical advice in parenting with enormous medical references. Surprisingly, it was written by an economist. I feel more relieved and confident in parenting my son after reading this book.

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

JBJS Clinical Classroom is very helpful in terms of learning orthopaedic knowledge for both junior and senior residents. Its innovative design makes it very easy and efficient to review previously learned concepts. The content is also very neat but with wide coverage across different specialties, which is also very helpful for orthopaedic board exam preparation.

JBJS Webinar June 28–Femoral Neck Fractures: The THA vs Hemi Toss-Up

Consulting with their patients, orthopaedic surgeons make many decisions each day by weighing the best evidence available. One frequent—and controversial—decision is how best to treat displaced femoral neck fractures, a common injury among elderly patients.

Often this choice comes down to hemiarthroplasty (HA) or total hip arthroplasty (THA). The preponderance of evidence suggests that outcomes from both procedures are nearly equivalent. On Monday, June 28, 2021 at 8 pm EDT, JBJS will host a complimentary 1-hour webinar delving into the most recent findings about this dilemma. 

Mohit Bhandari, MD, PhD will present findings from a 2020 Level-I meta-analysis of 16 randomized controlled trials. Functional outcomes and 5-year rates of revision and dislocation were similar between groups. THA eked out a small advantage in health-related quality of life, and HA yielded minor reductions in operative time.

Bheeshma Ravi, MD, PhD will discuss data comparing the 2 procedures in terms of complications and costs. Based on findings from this propensity score-matched analysis, the nod goes to THA, with lower 1-year rates of revision surgery and lower health-care costs. 

Moderated by Bassam A. Masri, MD, FRCSC, the webinar will feature expert commentaries on these “neck-and-neck” findings. Pierre Guy, MD will comment on Dr. Bhandari’s paper, and Kelly Lefaivre, MD will weigh in on Dr. Ravi’s paper. 

The webinar will conclude with a 15-minute live Q&A session during which attendees can ask questions of all the panelists. 

Seats are limited–so Register Today!  

CME credit will be available for surgeons and PAs attending this event live for a minimum of 50 minutes. Directions to claim your CME credit will be sent out within 48 hours of the broadcast. 

Journal Club Resident Spotlight: Jacob Wilson

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: Jacob Wilson, MD

Affiliation: Emory University School of Medicine, Atlanta

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

We recently held an arthroplasty-themed journal club that was well received. We discussed 4 different papers, but I found the discussion on 2 to be particularly interesting. This included a study on long-term outcomes of cemented versus cementless total knee arthroplasty[1] and a randomized controlled trial on the use of virtual physical therapy visits after total knee arthroplasty.[2] These studies were well-designed and stimulated lively discussion.

  1. Kim, Y.H., J.W. Park, and Y.S. Jang, The 22 to 25-Year Survival of Cemented and Cementless Total Knee Arthroplasty in Young Patients. J Arthroplasty, 2021. 36(2): p. 566-572.
  2. Prvu Bettger, J., et al., Effects of Virtual Exercise Rehabilitation In-Home Therapy Compared with Traditional Care After Total Knee Arthroplasty: VERITAS, a Randomized Controlled Trial. J Bone Joint Surg Am, 2020. 102(2): p. 101-109.

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

In my experience, journal club can be one of the better educational opportunities as a resident. There are a few things that are critical to making this the case. 1) Obviously, everyone needs to read the articles that are being discussed. This goes a long way in making the journal club interactive and constructive. 2) Attendance, particularly by faculty, is critical. I have found that when faculty from a variety of subspecialties attend, good discussions are generated. 3) Proper article selection. While landmark papers are important and should be reviewed by all residents, for the purposes of journal club, recent, clinically applicable articles that have the potential to change practice seem to be more interesting to those in attendance.

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

Like essentially all aspects of our lives, COVID-19 significantly changed our journal-club activities over the past year. Given national, regional, and institutional guidelines, our program moved all educational activities, including journal club, to virtual formats. While different than what we were previously accustomed to, this has made attendance easier for some faculty. That said, we are looking forward to a return to some degree of academic normalcy when we are able.

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

I’ve admittedly slacked on reading outside of orthopedics during residency. However, I have always been a fan of narrative nonfiction and am currently reading Dead Wake by Erik Larson.

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

I have found JBJS Clinical Classroom to be a good resource. As I prepare for Part I of my board exam, Clinical Classroom has been an easy and nice way to review concepts quickly. The app has made it easy to quickly do a few questions between cases. The content in Clinical Classroom is linked to primary literature, and this has led to some articles being selected for discussion at journal club.

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.