Platooning Orthopaedic Residents Amid COVID-19
Under the best of circumstances, an orthopaedic residency requires trainees and trainers to balance clinical work, surgical skills, didactics, and academic investigations. The global COVID-19 crisis is certainly not the best of circumstances. A fast-track article just published in JBJS explains how the urban, high-volume orthopaedic department at Emory University School of Medicine in Atlanta created a two-team system that helps residents keep learning, helps maintain a healthy workforce, and addresses the needs of orthopedic patients amid this unprecedented situation.
Emory is now dividing its orthopaedic residents into “active duty” and “working remotely” teams. In observation of the presumed incubation period of COVID-19 symptoms, transitions between active and remote activities occur every two weeks. A similar “platooning” system is in place for both faculty and administrators to safeguard a healthy network of leaders and command-and-control decision makers.
Active duty residents participate in in-person surgical encounters and virtual ambulatory encounters. Orthopaedic surgical cases deemed essential present an ideal opportunity for active-duty education, the authors observe, and there is also a role for supplementation of surgical education in the form of virtual reality or simulation training. Faculty members cover their in-person clinics without resident assistance when possible, but most musculoskeletal subspecialty visits can be performed with video-enabled telemedicine, and active-duty residents are part of these virtual clinic visits in real time.
Remotely working residents participate by videoconference in daily faculty-led, case-based didactics. The authors recommend virtually conducted one-and-a-half-hour collaborative, interactive learning sessions on predetermined schedules and topics. Each session includes question-based learning, facilitated with the use of an audience-response system. Remotely working residents also study for their boards and work on clinical research projects, grant writing, and quality improvement projects.
Finally, this team system, championed by strong departmental leadership, allows for isolation of any resident who acquires COVID-19, allowing them time to recover, while diminishing the risk of rapid, residency-wide disease transmission.
Rotator Cuff Conundrums: JBJS Webinar-Feb. 24
Rotator cuff tears account for an estimated 4.5 million patient visits per year in the US, which translates into a $3 to $5 billion annual economic burden. Add to that the pain and disability associated with rotator cuff tears, and it’s understandable that many clinical questions arise regarding how best to help patients manage this common condition.
On February 24, 2020 at 8 pm EST, JBJS will host a complimentary 60-minute webinar focused on 2 frequently encountered rotator cuff dilemmas: surgical versus nonsurgical management, and surgical alternatives for irreparable cuff tears that don’t involve joint replacement.
Bruce S. Miller, MD, MS unpacks the findings from his team’s matched-pair analysis in JBJS, which revealed that patients receiving both surgical and nonsurgical management of full-thickness tears experienced pain and functional improvements—but that surgical repair was the “better of two goods.”
Some patients who opt for nonoperative management end up with a chronic, irreparable rotator cuff tear. Teruhisa Mihata, MD, PhD will present findings from his team’s JBJS study, which showed that, after 5 years, healed arthroscopic superior capsule reconstruction in such patients restored function and resulted in high rates of return to recreational sport and work.
Moderated by Andrew Green, MD of Brown University’s Warren Alpert Medical School, the webinar will feature additional expert commentaries. Grant L. Jones, MD will comment on Dr. Miller’s paper, and Robert Tashjian, MD will weigh in on Dr. Mihata’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!
JBJS Webinar on Feb. 24: Rotator Cuff Conundrums
Rotator cuff tears account for an estimated 4.5 million patient visits per year in the US, which translates into a $3 to $5 billion annual economic burden. Add to that the pain and disability associated with rotator cuff tears, and it’s understandable that many clinical questions arise regarding how best to help patients manage this common condition.
On February 24, 2020 at 8 pm EST, JBJS will host a complimentary 60-minute webinar focused on 2 frequently encountered rotator cuff dilemmas: surgical versus nonsurgical management, and surgical alternatives for irreparable cuff tears that don’t involve joint replacement.
Bruce S. Miller, MD, MS unpacks the findings from his team’s matched-pair analysis in JBJS, which revealed that patients receiving both surgical and nonsurgical management of full-thickness tears experienced pain and functional improvements—but that surgical repair was the “better of two goods.”
Some patients who opt for nonoperative management end up with a chronic, irreparable rotator cuff tear. Teruhisa Mihata, MD, PhD will present findings from his team’s JBJS study, which showed that, after 5 years, healed arthroscopic superior capsule reconstruction in such patients restored function and resulted in high rates of return to recreational sport and work.
Moderated by Andrew Green, MD of Brown University’s Warren Alpert Medical School, the webinar will feature additional expert commentaries. Grant L. Jones, MD will comment on Dr. Miller’s paper, and Robert Tashjian, MD will weigh in on Dr. Mihata’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!
The Evolution of Orthopaedic Surgical Skills Simulation
Surgical skills education in orthopaedics has changed dramatically from the “see one, do one, teach one” process of 30 years ago. These changes have come with a greater degree of supervision and formal skills assessments, and they have been aided by the visionary leadership at the Accreditation Council for Graduate Medical Education (ACGME) and our own orthopaedic Residency Review Committee. These skill-acquisition enhancements have benefited both our trainees and the patients we collectively care for.
A decade ago, we entered a new phase of skill development and enhancement with computer-based surgical simulators. With advances in software and widespread interest across North America in goal-driven learning through simulation, great progress has been made. In the November 20, 2019 issue of JBJS, Weber et al. report on the further validation of a surgical simulator focused specifically on percutaneous, fluoroscopically guided pin placement for femoral neck fractures. The simulator was developed in partnership between the AAOS and OTA.
This study sought to determine whether novice practitioners (medical students, in this case) who completed 9 training modules before using the simulator (the “trained” group) would perform the simulated pinning task better than peers who did not complete the presimulation training (the “untrained” group). It was no surprise to me that the trained group had a significantly higher overall performance score on the simulator. In addition, relative to the untrained group, the trained students also showed improved performance on 4 specific measures—3 of which were related to the angle between the placed pins.
These findings are clearly supportive of continued development of this and additional simulation environments. But at the same time, we need to move forward with improved documentation of surgical skill acquisition among orthopaedic residents and fellows. As simulator technology continues to improve, the next decade should yield even more positive results in skills acquisition than we saw in the last decade. We are clearly on the right path with the use of advanced technology for surgical skill development among orthopaedic trainees.
Marc Swiontkowski, MD
JBJS Editor-in-Chief
Orthopaedic Interns Across Chicago Learn and Bond in Journal Club
OrthoBuzz occasionally receives posts from guest bloggers. The following contribution comes from Rob Christian, MD and Maddy Lyons, MD.
Editor’s Note: The application deadline for the 2019-2020 JBJS Robert Bucholz Resident Journal Club Grant Program has been extended to November 1, 2019.
Junior residents often hear attendings, fellows, and senior residents quote landmark studies, but few find the time to track down and read these important papers on their own. So, when the Northwestern University Orthopaedic Residency Program was awarded one of the JBJS Robert Bucholz Resident Journal Club Grants, Haley Smith, MD (PGY-2) and I used the funding to pilot an Intern Journal Club, inviting all the interns in orthopaedic surgery residency programs across Chicago to read and discuss landmark studies.
Over the last decade, several hospitals in Chicago, such as John H. Stroger, Jr. Hospital of Cook County and Ann & Robert H. Lurie Children’s Hospital of Chicago, have trained teams of orthopaedic residents from multiple programs. Working in the hospital with residents from different programs is a great educational experience, and we thought these resident teams could be even more effective if they interacted with one another prior to working together in the hospital.
Our Intern Journal Club met quarterly, and had impressive attendance, especially considering the busy intern work schedule. Each journal club session featured 4 to 5 landmark studies (suitable for PGY-1s), and discussions were led by senior residents selected across the programs. Articles discussed came from all orthopaedic subspecialties. In addition to literature-based discussions, the get-togethers fostered collegial relationships among the different programs.
For me, the most rewarding part of the Intern Journal Club has been meeting the interns as they begin their residencies and guiding discussion to help them think critically about orthopaedic literature. With the continued support of the JBJS Robert Bucholz Resident Journal Club Grant, we look forward to continuing to host the Intern Journal Club for this year’s intern class.
Rob Christian, MD (PGY-5)
McGaw Medical Center of Northwestern University
* * * *
Initially, the JBJS Chicago Intern Journal Club felt like it was adding articles to an endless intern reading list. However, it turned out to be one of the more valuable and fun educational experiences of my intern year.
The meetings provided the unique opportunity to meet residents from the other Chicago programs. Exchanging stories of intern-year trials and tribulations quickly bonded our group. It was interesting to discover the differences and similarities in our programs, our rotations, and even in the ways in which we manage injuries. In addition to building relationships with peers across programs, the journal clubs allowed me to connect with senior residents who have similar career interests and build several new mentorships.
The articles that we read and discussed were landmark studies that shape the practice of orthopaedics on a daily basis. Through morning conferences, OITE practice questions, and clinical care, interns are exposed repeatedly to fundamentals of orthopaedics, such as open fracture management and functional bracing of humeral shaft fractures. However, without our Intern Journal Club, I may not have explored the studies on which these practice-shaping principles are built. An open, discussion-based format with senior residents helped me understand the “whys” of what we are taught.
We are fortunate to have so many great orthopaedic residency programs in Chicago, each with unique strengths. I hope that our Intern Journal Club continues in the years to come to inspire future collaboration in educational, social, and networking events among the local residency programs.
Maddy Lyons, MD (PGY-2)
Loyola University Medical Center
Seeking Trauma Section Head for JBJS Clinical Classroom
JBJS is currently seeking a Trauma Section Head for the JBJS Clinical Classroom learning system. Clinical Classroom is an interactive, adaptive learning tool featuring more than 3,500 questions and comprehensive responses across 10 orthopaedic specialties. Questions and responses are clinically relevant, peer reviewed, and authored by orthopaedic surgeons. The platform also provides substantive Learning Resources that enhance the user experience.
The Section Head is responsible for leading a team of authors and developing new trauma-related content on a yearly basis. In addition, the Section Head will address user challenges and feedback. Ideally, candidates should be fellowship trained, in orthopaedic practice for at least 5 years, and have a passion for clinical education.
Click here for more information on the Clinical Classroom product.
If you are interested in this opportunity, please contact Chris Chiodo, Editor, JBJS Clinical Classroom at cchiodo@jbjs.org. Please include your CV and a short statement describing your interest and experience in orthopaedic education.
Patient Discharge after Knee Replacement: How Soon Is Safe?
For most patients and payers, getting out of the hospital quickly after a knee replacement is very important. For orthopaedic surgeons, excellent patient outcomes are the top priority. The latest one-hour complimentary webinar from JBJS on Tuesday, October 1, 2019 at 8:00 pm EDT will reveal clinical practices that increase the odds of achieving both of those goals.
Co-authors Nelson SooHoo, MD and Armin Arshi, MD will explore data from their JBJS study comparing complication rates after outpatient and inpatient knee-replacement, emphasizing that outpatients must receive the same attention to infection prevention, thromboprophylaxis, and rehabilitation as inpatients.
Kurt Spindler, MD and Robert Molloy, MD will then delve into their JBJS study, which suggests that hospital site, surgeon, and day of the week are more accurate predictors of length of hospital stay after knee replacement than patient age, BMI, and comorbidities.
Moderated by Daniel Berry, MD of the Mayo Clinic, the webinar will also feature expert commentaries by Joseph Moskal, MD and Ronald Delanois, MD. 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 Now!
Not Your Grandparent’s Journal Club
OrthoBuzz occasionally receives posts from guest bloggers. The following commentary comes from Matthew R. Schmitz, MD, FAOA.
Medical education is a constant need, but how it’s delivered is always changing. When my grandfather was a surgeon, medical trainees brought their dusty textbooks and print journals to “fireside chats” at an attending’s home. Today, we have online journals, tablets and smartphones, podcasts, and “virtual” discussions on social media platforms. Although the technologies evolve, the need to discuss present and past literature remains constant.
These discussions often taken place nowadays through journal clubs. Medical residents across the continent routinely get together in formal or informal settings to discuss journal articles, not only to acquire the knowledge contained in the articles themselves, but also to learn how to properly read, critique, and digest the information.
JBJS provides medical education across multiple platforms, several of which I participate in. I strongly encourage residency programs to submit an application for the 2019-2020 JBJS Robert Bucholz Resident Journal Club Grant Program before the deadline of September 30, 2019. The grant allows medical educators to support their journal clubs in many ways:
- Investigating new and innovative alternatives to the traditional journal club.
- Bringing an author to your institution to discuss his or her articles.
- Hosting a virtual journal club with multiple authors via teleconference or social media.
- Purchasing food and refreshments within the “old school” method of a fireside chat at an attending’s home.
No matter the platform or methodology, journal clubs are a vital part of orthopaedic education, not only for interpreting literature, but also for incorporating knowledge into future clinical practice and for the joy and excitement of lifelong learning.
Matthew R. Schmitz, MD, FAOA is an orthopaedic surgeon specializing in adolescent sports and young adult hip preservation at the San Antonio Military Medical Center in San Antonio, TX. He is also a member of the JBJS Social Media Advisory Board.
“True Grit” Among Millennial Orthopaedists in Training
In a survey-based study published in the July 17, 2019 issue of The Journal of Bone & Joint Surgery, Samuelsen et al. made a hypothesis arising from a popularly held assumption about millennials: that orthopaedic residency applicants (predominantly millennials, with a mean age of 27.3) would have lower grit and self-control scores than attending orthopaedic surgeons (mean age of 51.3). The findings contradicted that hypothesis.
Surveys were completed by 655 (28%) of 2,342 attendings who received the questionnaire and by 455 (50.8%) of 895 orthopaedic residency applicants from the 2016-2017 resident match. The authors found that the residency applicants demonstrated higher mean grit scores (4.12 of 5.0) than the attending orthopaedic surgeons (4.03) (p <0.01). When compared to the general population, residency applicants and attendings scored in the 70th and 65th percentiles of grit, respectively.
The American Heritage Dictionary defines “grit” as “indomitable spirit” or “pluck.” In the medical literature, where “grit” has received a lot of attention lately, the concept is defined as “steadfast passion and perseverance for long-term goals, especially in the setting of hardship and setbacks.” However grit is defined, Samuelson et al. say it “has consistently been proven to be associated with success in…medical environments.”
Three other interesting findings:
- There were no significant differences in self-control or conscientiousness scores between the 2 groups.
- Both age and number of years in practice were positively correlated with self-control scores in the practicing-surgeon group.
- Among attending surgeons, the number of publications correlated with higher grit, self-control, and conscientiousness scores.
Samuelson et al. offer a possible explanation for the impressive grit scores among residency applicants: matching into orthopaedic residency has become increasingly competitive over the past several decades and “applicants to orthopaedic surgery…tend to represent the individuals at the top of their medical school classes.” Conversely, the authors suggest that grit, self-control, and conscientiousness scores could be used to identify applicants, residents, or junior staff “who are at risk for attrition during training or burnout in their careers.”
Having postulated that, however, the authors are quick to add that “it is unclear if [these findings] will be predictive of career success in the next generation of orthopaedists.”
Click here to see a 1-minute video commentary about these findings by Chad A. Krueger, MD, JBJS Deputy Editor for Social Media.
New Minute-Commentary Video
Here’s what JBJS Deputy Editor for Social Media Chad Krueger, MD concludes after reading a survey-based study from the Department of Orthopaedic Surgery at the Mayo Clinic, comparing “grit” and self-control among orthopaedic residency applicants and practicing orthopaedists:
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