An academic compensation plan for an orthopaedic department

The academic orthopaedic department has the primary goal of providing clinical services, educating orthopaedic surgeons, providing advancements through research and technology development, and creating and maintaining the administrative infrastructure that monitors and enables the department's overall mission. Simultaneous reductions in revenues and increases in the cost to practice medicine pose the greatest challenge to maintaining the academic orthopaedic department. Fundamental differences exist between the private practice and academic orthopaedic surgeon. Most importantly, while their value systems may differ, appropriate incentives (tangible and intangible) must exist to promote growth and retention in a non-private practice setting. A proper compensation plan must consider revenue and non-revenue-generating activities within the context of the academic orthopaedic department to maintain the department's mission. This article discusses these issues and provides an overview of solutions available to structure an appropriate compensation plan that encourages academic and clinical productivity yet remains sensitive to divergent goals and values of the department's members.

The impact of the accreditation council for graduate medical education work-hour regulations on the surgical experience of orthopaedic surgery residents

BACKGROUND

The advent of the eighty-hour workweek regulations generated a great deal of controversy over the potential loss of operative experience for general surgery and surgical specialty residents. We believed an investigation to review the operative experience of orthopaedic surgery residents before and after the adoption of the Accreditation Council for Graduate Medical Education duty-hour guidelines would provide important information in this debate.

METHODS

The total number of surgical Current Procedural Terminology codes logged in the case-log database of the Accreditation Council for Graduate Medical Education by each second through fifth year orthopaedic resident at a single university-based program was collected from July 1, 2001, to June 30, 2005. Two groups were created from the data obtained. Group I (thirty-nine residents) included surgical codes logged for the two years prior to the implementation of the eighty-hour workweek (July 1, 2003), while Group II (forty residents) included the codes for the following two years. The average number of codes was determined for Group I and Group II. The two groups were then subdivided by postgraduate year of training. The average number of surgical codes per training year was calculated. Then the second and third year (junior) resident and fourth and fifth year (senior) resident groups were combined to create two subgroups. The mean number of surgical codes was determined for each group, and the groups were compared.

RESULTS

The surgical case logs of thirty-five orthopaedic residents were reviewed during the study period. One resident left the program during the first year of the study and was excluded because of incomplete data. A total of 36,464 surgical codes were logged. The average yearly number of surgical codes per resident was 461.4. The average total number of coded procedures per resident before and after the start of the eighty-hour workweek were 455.4 and 467.3, respectively. The average yearly number of surgical codes was 432.5 for the junior residents and 491.1 for the senior residents. The average number of codes logged before and after the start of the eighty-hour workweek were 407.3 and 455.3, respectively, for the junior residents compared with 501.2 and 480.6 for the senior residents. No significant differences between the groups in any category were identified.

CONCLUSION

Although many aspects of surgical training may be affected by the new work-hour restrictions, our review of the operative experience of orthopaedic surgery residents at a single institution demonstrated no significant differences before and after the implementation of the eighty-hour workweek.

[Knowledge transfer and student's satisfaction in orthopaedics--a survey of 476 students]

AIM

The aim of the current study was to find out about the student's growth of knowledge and satisfaction in orthopaedics. We performed a survey among 476 students of one faculty.

METHOD

We performed an anonymous survey in which the students had to answer a questionnaire which consisted of items according to knowledge in orthopaedics, subjective satisfaction and according to the difficulty of the asked questions.

RESULTS

74% of students disliked the so-called "hammerexam." 56% believe that the transfer of knowledge is good in lectures and bedside teaching courses. 20% prefer to cancel the "hammerexam," 30% would prefer to spend more time for important sections such as surgery and internal medicine and 20% would prefer it if the practical aspects of medicine were placed in the foreground. During the third and fourth semesters, the increase of knowledge is at its highest but is reduced later. 4% of all asked students are planning to become orthopaedic surgeons.

CONCLUSION

Our study demonstrates that good knowledge transfer within the modified lectures and bedside teaching lessons is achieved. Student satisfaction is high. Only very few students are critical about their current situation.

Measuring the attitudes and impact of the eighty-hour workweek rules on orthopaedic surgery residents

BACKGROUND

The literature on graduate medical education contains anecdotal reports of some effects of the new eighty-hour workweek on the attitudes and performance of residents. However, there are relatively few studies detailing the attitudes of large numbers of residents in a particular surgical specialty toward the new requirements.

METHODS

Between July and November 2004, a survey created by the Academic Advocacy Committee of the American Academy of Orthopaedic Surgeons was distributed by mail, fax, and e-mail to a total of 4207 orthopaedic residents at the postgraduate year-1 through year-6 levels of training. The survey responses were tabulated electronically, and the results were recorded.

RESULTS

The survey response rate was 13.2% (554 residents). Sixty-eight percent (337) of the 495 respondents whose postgraduate-year level was known were at the postgraduate year-4 level or higher. Attitudes concerning the duty rules were mixed. Twenty-three percent of the 554 respondents thought that eighty hours constituted an appropriate number of duty hours per week; 41% believed that eighty hours were too many, and 34% thought that eighty hours were not sufficient. Thirty-three percent of the respondents had worked greater than eighty hours during at least a single one-week period since the new rules were implemented; this occurred more commonly among the postgraduate year-3 and more junior residents. Orthopaedic trauma residents had the most difficulty adhering to the new duty-hour restrictions. Eighty-two percent of the respondents indicated that their residency programs have been forced to make changes to their call schedules or to hire ancillary staff to address the rules. The use of physician assistants, night-float systems, and so-called home-call assignments were the most common strategies used to achieve compliance.

CONCLUSION

Resident attitudes toward the work rules are mixed. The rules have forced residency programs to restructure. Junior residents have more favorable attitudes toward the new standards than do senior residents. Self-reporting of duty hours is the most common method of monitoring in orthopaedic training programs. Such systems allow ample opportunity for inaccuracies in the measurement of hours worked. Although residents report an improved quality of life as a result of these new rules, the attitude that the quality of training is diminished persists.

[Orthopaedics on the Internet]

The Internet is becoming a more integral part of daily education for all orthopaedic surgeons. Author presents web sites, which are interesting resources of orthopaedic knowledge.

[A web-based e-learning tool in academic teaching of trauma surgery. First experiences and evaluation results]

There are lots of possibilities for universities to offer contents of teaching to students by the Internet. Often the students can download slides or a special lecture note from the intranet of the university. Another way is to make a movie of the lecture and post this lecture movie on the Internet. In the Hanover Medical School we employed an alternative. It was developed by the Trauma Surgery Clinic and the Institute of Medical Informatics at the Hanover Medical School. Our goal was to use just one web-based content resource for the lecture and for the work at home. The Institute of Medical Informatics used a web-based content management system (CMS) Schoolbook to implement this e-learning application.Since October 2005 the Trauma Surgery Schoolbook has been used in the lecture on trauma surgery in all terms, and we evaluated the academic year 2005/2006. The results of the evaluation showed us that the students were very interested in using this e-learning application. The possibility to reinforce the learning material at home is a good chance for the students. Also the organisation of lectures was improved because the materials were all in one place. The lecturer needs to learn several new tasks, but we also got a positive response. Our experiences of the last academic year showed that it was a good way to use one web-based content resource for teaching and learning in the context of a lecture.

Does teaching style matter? A randomised trial of group discussion versus lectures in orthopaedic undergraduate teaching

OBJECTIVES

Educational theory suggests that lectures may not be the best way to impart knowledge to students. The aim of this study was to compare the use of didactic lectures with that of interactive discussion sessions in undergraduate teaching of orthopaedics and trauma.

METHODS

A total of 77 medical students were assessed in 3 consecutive cohorts. The students were randomised into 2 groups. The first group received a series of 12 formal lectures. The second group covered the same topics in 12 group-discussion sessions with self-directed learning.

RESULTS

The students in the interactive discussion group rated the presentation of their teaching more highly than those in the lecture group (P = 0.003). However, there was no difference in their rating of the content of the sessions. The students in the discussion group also performed better on their end-of-placement written test (P = 0.025).

CONCLUSIONS

We found that interactive teaching styles are more popular than didactic lectures in undergraduate orthopaedic and trauma teaching. We also found some evidence that knowledge retention is better following an interactive teaching style.

The 88-hour family: effects of the 80-hour work week on marriage and childbirth in a surgical residency

The restriction of the resident physician work week to 80 hours has had dramatic affects on resident education and life-style. While effects on mood, psychological distress, and burn-out have been studied, the resultant changes in tangible quality of life have received little attention. Birth rate was considered a measurable, relevant outcome. The resident marital and parental status by duty month was collected from a single orthopaedic surgical residency program for the four academic years preceding and following the implementation of the 80-hour work week. The number of births to residents during these periods were also tallied. The relative prevalence of positive marital status changed very little between residents in the two time durations from 66 to 71 percent, but parental status increased from 27 to 43 percent. The number of births per married resident duty year also increased from 0.23 pre-restrictions to 0.32 post-restrictions. While the individual decisions involved in generating these observed changes are complex and difficult to entirely decipher, it is thought that an increased perception of life-control within the work-hour restrictions may have prompted the dramatic changes in birth rate among resident families.

Orthopedics surgery trainer with PPU-accelerated blood and tissue simulation

This paper presents a novel orthopedics surgery training system with both the components for modeling as well as simulating the deformation and visualization in an efficient way. By employing techniques such as optimization, segmentation and center line extraction, the modeling of deformable model can be completed with minimal manual involvement. The novel trainer can simulate rigid body, soft tissue and blood with state-of-the-art techniques, so that convincing deformation and realistic bleeding can be achieved. More important, newly released Physics Processing Unit (PPU) is adopted to tackle the high requirement for physics related computations. Experiment shows that the acceleration gain from PPU is significant for maintaining interactive frame rate under a complex surgical environments of orthopedics surgery.

The role of the department chair in promoting diversity

The department chair has a broad sphere of influence in which to promote diversity. The most immediate sphere of influence is on the department physicians(faculty, residents, and fellows) as well as administrators and support staff. The chair also can potentially influence this same group of individuals throughout the medical school as well as throughout the hospital. In addition, the chair can be extremely influential in her or his interactions with the community. Effectively promoting diversity can be accomplished by terminating the employment of individuals who discourage or minimize diversity, educating those who ignore diversity, and cultivating and encouraging constituents who value and manage diversity. If our goal as orthopaedic surgeons is to provide the most effective care to our diverse patient base, we must expand our level of care beyond the "three A's" that have for so long determined clinical success-affability, availability, and ability-to the "four A's:"affability, availability, ability, and awareness.

Current activities in orthopaedic culturally competent care education

Culturally competent care education, which involves educating physicians on being sensitive to the diverse characteristics and traits of each patient (eg, race, ethnicity, sex, faith background), is vital for the well-being of all patients. All medical disciplines are grappling with the best way to provide culturally competent care education. The Diversity Advisory Board of the American Academy of Orthopaedic Surgeons is charged with advancing diversity in the field of orthopaedic surgery. Diversity symposia were presented at the 2005 and 2006 Annual Meetings. In 2006, the AAOS developed the Cultural Competency Challenge CD-ROM, followed in 2007 by the Culturally Competent Care Guidebook, a companion to the CD-ROM. Culturally competent care legislation has been enacted in California and New Jersey, and legislation is pending in Arizona, Illinois, New York, and Texas, making these resources even more timely. To best care for all patients, each physician must be aware of his or her own identity and be sensitive to the unique realities of each patient with whom the physician comes into contact.

Women and minorities in orthopaedic residency programs

Women and underrepresented minorities make up smaller proportions of orthopaedic residency programs than their numbers in medical school would predict, according to our evaluation of self-reported orthopaedic residency data from 1998 and 2001, as well as information on medical students published in 2002. Based on race, ethnicity, and sex, comparisons were made between students entering and graduating from medical school and those in orthopaedic residency programs. With few exceptions, the percentages of women and underrepresented minorities were statistically significantly lower among those training in orthopaedic residency programs compared with those same groups entering and graduating from medical school. The percentage of women and minorities in orthopaedic residency programs remained constant between 1998 and 2001. Further study is necessary to determine whether fewer students of color and women apply to orthopaedic residency programs because of lack of interest, lack of appropriate mentoring and role models, or other factors.

Management of open fractures in adult patients: current teaching in ACGME accredited residency programs

The purpose of this study is to determine the methods of treatment for open fractures that are currently used by academic orthopaedic residency programs. A Web-based survey was constructed and e-mailed to program directors of orthopaedic residencies. Seventy-four programs out of a total of 140 (53%) surveyed programs responded. Data were tabulated and charts were created in an Excel spreadsheet. Type I fractures were treated by most with a cephalosporin alone (99%) for less than 48 hours (86%). Type II fractures were treated by most programs with a cephalosporin alone with no aminoglycoside (85%) for less than 48 hours (81%). Type IIIa fractures were treated by most programs with a cephalosporin and an aminoglycoside (55%) for less than 48 hours (54%). Type IIIb fractures were treated by most with a cephalosporin and aminoglycoside (55%) for less than 48 hours (54%). Type IIIc fractures were also treated by most with a cephalosporin and an aminoglycoside (57%) for less than 48 hours (49%). Wounds were closed by most responders for type I (88%), type II (86%), and type IIIa (57%), but not type IIIb (5%) and type IIIc (11%) fractures. Fifty-four percent of programs reported having trauma rooms and 58% of programs allow residents to irrigate and débride wounds in the emergency room. The study concluded that most orthopaedic residencies utilize a cephalosporin alone for types I and II open fractures with an aminoglycoside added for type III fractures. Antibiotic treatment is typically given for 48 hours or less. A delay of 6 hours is accepted for types I and II fractures but not type III fractures.

Improving diversity in orthopaedic residency programs

Achieving a balanced diversity in orthopaedic residency programs is a critical component in improving the quality of orthopaedic care delivered to all patients. Compared with the demographics of medical school classes, women are notably underrepresented in orthopaedic residency programs, and racial and ethnic minority groups are unevenly represented. Diversifying residency programs positively affects all residents and their ability to deliver care and create positive physician-patient relationships.

Culturally competent care education: overview and perspectives

Health care disparities are a serious problem in the United States, for which an immediate and multifaceted response is required. A critical component in addressing these disparities is culturally competent care education. To that end, Harvard Medical School has established a Culturally Competent Care Education Committee, which drives key efforts in curriculum and faculty development. Although Harvard Medical School has substantial ongoing culturally competent care education practices, pedagogic methods for achieving the formidable objectives of culturally competent care education are not yet fully defined or developed. It is hoped that this report of current Harvard Medical School practices,perspectives, and experiences will help others institute or continue to develop culturally competent care education-related plans and activities. With time and study, the best and most efficient practices will emerge.

Peer-assisted learning and orthopaedic evaluation psychomotor skills

CONTEXT

Athletic training educators often anecdotally suggest that athletic training students enhance their learning by teaching their peers. However, peer-assisted learning (PAL) has not been examined within athletic training education to provide evidence for PAL's current use or for its use as a pedagogic tool.

OBJECTIVE

To assess the effectiveness of intentional, formal PAL on the performance of psychomotor skills and to identify students' perceptions of PAL.

DESIGN

Randomized, pretest-posttest experimental design.

SETTING

Athletic Training Research and Education Laboratory.

PATIENTS OR OTHER PARTICIPANTS

Fifty-one undergraduate students (27 athletic training majors, 24 nonmajors).

INTERVENTION(S)

Review sessions led by either an Approved Clinical Instructor or peer tutor.

MAIN OUTCOME MEASURE(S)

We assessed pretest and posttest performance scores (number of correct skills) and the amount of time to complete the psychomotor skills in 3 categories of orthopaedic evaluation of the hand and wrist for subjects assigned to either a peer tutor or an Approved Clinical Instructor review group. Using the Athletic Training Peer-Assisted Learning Assessment Survey, we evaluated the perceptions of students assigned to the peer-tutor group regarding the benefits of, and preferences for, PAL.

RESULTS

Differences in the pretest-posttest skill scores were noted in both groups (P < .05). No differences in the posttest skills scores or the times to perform the skills were seen between the groups. The Athletic Training Peer-Assisted Learning Assessment Survey revealed that most (n = 19, 70.4%) of the subjects felt less anxious when practicing psychomotor skills with peer tutors than with the laboratory instructor, and many students (n = 12, 44.4%) felt more self-confident when practicing psychomotor skills with a peer tutor.

CONCLUSIONS

Peer-assisted learning appears to be a valid method for improving athletic training psychomotor skills. Peers can be resources for practicing clinical skills and report benefiting from the collaboration. Peer-assisted learning should be deliberately integrated into athletic training education programs to enhance student learning and collaboration.

The effect of resident work hour regulations on orthopaedic surgical education

Accreditation Council for Graduate Medical Education (ACGME) resident work hour regulations have been effective since July 2003. Several areas affected by these changes have been identified, including surgical education. In the current study, the authors evaluated the impact of these changes on surgical education at a two-person-per-year orthopaedic training program. Operative case experiences of PGY 2 and 3 residents during the academic years 2002-2003 and 2003-2004 were compared utilizing ACGME case logs. A data entry log was also distributed to examine subjectively the effects on operative case load. ACGME data showed that PGY 2 and 3 residents performed 21.5% fewer cases between years. The average number of cases per rotation decreased by 20.44% (p =.009, paired t-test). Subjective results also showed a decrease, with an average of 10.8% of cases missed per resident. This study shows that residents who have begun training post-80-hour work week will do fewer procedures. This may result in a decreased level of skill, or it may shift operative experience to the senior resident years, prolonging the learning curve. Regardless, future analysis must be done to determine the full impact on training of the orthopaedic resident.

The application of critical psychology to facilitate reflective clinical practice in orthotics/prosthetics

The co-construction of a psychology module for a postgraduate training course in orthotics/prosthetics is socially constructed for the first time in Southern African history. This paper elucidates the integration of theory and practice in a model for the development of a professional identity as orthotist/prosthetist. In creating a context where trainees can learn to develop their practice while also enabling them to deconstruct notions of 'expert knowledge', orthotist/prosthetists move from a position of scientist-practitioner to negotiating an alternative position of reflective practitioner. In the process of co-constructing knowledge, an alternative story of teaching and learning evolves. The result is a celebration of life as it is really lived by health professionals.