Career In Orthopaedics Research Articles

What's Important: What Constitutes Success in an Orthopaedic Career?: Defining Success Your Way.

The Journal of Bone and Joint Surgery 99(23):p 2043-2044, December 06, 2017. | DOI: 10.2106/JBJS.17.00394

The Fourth Year of Medical School: Time for Reassessment: AOA Critical Issues.

Most U.S. medical schools follow the 4-year model, consisting of 2 preclinical years, core clinical experience, and a fourth year intended to permit students to increase clinical competency, to explore specialty areas, and to transition to residency. Although the design and delivery of Years 1 through 3 have evolved to meet new challenges and expectations, the structure of Year 4 remains largely unchanged. For most students considering a career in orthopaedics, Year 4 is a series of elective rotations in which educational objectives become secondary to interviewing for residency programs. Most accreditation bodies recognize the importance of attainment of competency over the duration of medical school as the goal of educating physicians, and thus, there is a growing interest in reexamining the traditional medical school curriculum with the goal of integrating the final phases of undergraduate education and the first phases of postgraduate education.A literature search was undertaken to identify publications on the duration of medical education. Pilot approaches to competency-based integration of undergraduate medical school and postgraduate training in orthopaedic surgery were reviewed.There have been few data suggesting that 4 years of medical education is superior to shorter-duration programs. Three approaches to competency-based integration of undergraduate medical school and postgraduate training are presented. Their goal is to use student and faculty time more effectively. Each approach offers the opportunity to lower the cost and to decrease the time required for Board Certification in Orthopaedic Surgery. Two approaches shorten the entire duration of medical school and graduate training by using various proportions of the fourth year to begin residency, and one approach expands the duration of orthopaedic training by starting in the fourth year of medical school and including training equivalent to a fellowship program into the residency experience.The effectiveness of such programs will form the basis for revisions to the current orthopaedic training paradigm, resulting in a more effective, efficient, and integrated orthopaedic training curriculum.

Factors affecting orthopedic residency selection: a cross-sectional survey.

Annually, orthopedic residency programs rank and recruit the best possible candidates. Little evidence exists identifying factors that potential candidates use to select their career paths. Recent literature from nonsurgical programs suggests hospital, social and program-based factors influence program selection. We sought to determine what factors influence the choice of an orthopedic career and a candidate's choice of orthopedic residency program. We surveyed medical student applicants to orthopedic programs and current Canadian orthopedic surgery residents (postgraduate year [PGY] 1-5). The confidential online survey focused on 3 broad categories of program selection: educational, program cohesion and noneducation factors. Questions were graded on a Likert Scale and tailed for mean scores. In total, 139 residents from 11 of 17 Canadian orthopedic programs (49% response rate) and 23 medical student applicants (88% response rate) completed our survey. Orthopedic electives and mandatory rotations were reported by 71% of participants as somewhat or very important to their career choice. Collegiality among residents (4.70 ± 0.6), program being the "right fit" (4.65 ± 0.53) and current resident satisfaction with their chosen program (4.63 ±0.66) were ranked with the highest mean scores on a 5-point Likert scale. There are several modifiable factors that residency programs may use to attract applicants, including early availability of clerkship rotations and a strong mentorship environment emphasizing both resident-resident and resident-staff cohesion. Desirable residency programs should develop early access to surgical and operative skills. These must be balanced with a continued emphasis on top-level orthopedic training.

Giants of Orthopaedic Surgery: Melvin J. Glimcher MD.

David R. Eyre was a newly minted PhD in biochemistry from the University of Leeds when he joined Melvin Glimcher’s lab in 1971. Eyre’s new lab in Boston, MA, USA was a far cry from his previous one in the United Kingdom, where he routinely had to hunt for well-worn equipment. Glimcher’s lab featured cutting-edge resources from state-of-the-art protein sequencers to electron microscopes and nuclear magnetic resonance equipment. There was an entire floor dedicated to biochemistry. The lab housed more than 100 scientists, a large program for its day, providing an atmosphere that encouraged collaboration. His lab was even a research center for the training of senior scientists and postdoctoral fellows who wished to develop their own research centers in the basic sciences and musculoskeletal system [9]. “The size and scale of the lab was like nothing I had ever seen before,” Eyre told CORR® in a phone interview. “No one had a lab of this scale. It takes a quite exceptional person to lead a lab of that magnitude.” Melvin J. Glimcher MD was that person (Fig. 1). The scale of Glimcher’s educational background and professional experience matched the scale of his lab. The first tenured Chair in Orthopaedic Surgery at Harvard Medical School at the age of 39, Glimcher was also Chief of Orthopaedic Surgery at Massachusetts General Hospital and Boston Children’s Hospital in Boston, MA, USA. His work in orthopaedics, clinical medicine, biology, mechanical engineering, and the basic sciences afforded him the opportunity to collaborate with exceptional scientists using the most advanced technological tools of the day. Fig. 1 The scale of Glimcher’s educational background and professional experience matched the scale of his lab. Published with permission from Boston Children’s Hospital. “The lab, and more specifically, Glimcher himself, could infuse you with his enthusiasm,” Eyre said. “You were on the cutting edge of everything. This was high-level basic research. It certainly sparked my interest in research.” Glimcher’s decision to pursue a career in orthopaedics reportedly was based on a conversation he had with one of his professors, who told him that orthopaedics was a “barren field” [6]. But Glimcher seemed to understand the potential in orthopaedics early on, and quickly recognized where the field was headed. In 1966, Glimcher told The Boston Globe, “Orthopaedics in the future will not be simply surgery, or medicine, but a combination of both plus knowledge of the whole area of skeletal structure, its biology, chemistry, and biomechanics” [13]. “He thought he could really make a difference in the field,” Laurie Glimcher MD, his daughter and Stephen and Suzanne Weiss Dean of Weill Cornell Medical College in New York, NY, USA told CORR® in a phone interview.

Obituary: a remembrance of William Fisher Enneking MD (1926-2014).

William “Bill” Fisher Enneking MD died peacefully on July 17, 2014. He had a remarkable life journey, which I was privileged to witness and participate in from several different vantage points. “The Boss,” as I always thought of him, had an enormous impact on my life and work. Most importantly, he and his wife Margaret produced a wonderful daughter, Kayser Enneking MD, an anesthesiologist, and my wife of 29 years. Beyond that, he was the inspiration for—and the hands-on guide of—my own career in orthopaedics.

Giants of orthopaedic surgery: Carlos E. Ottolenghi MD (1904-1984).

Giants of orthopaedic surgery: Carlos E. Ottolenghi MD (1904-1984).

Grateful for Medical Advancements

“Grateful” has been described as warmly or deeply appreciative of kindness or benefits received.This commentary will express my personal gratefulness for benefits received by recent Medical Advancements. Most readers are well aware of my orthopaedic career over the past forty-four years and the many benefits that my family and I have received. However, recent benefits received gives me reason to pause and reflect, and to acknowledge their receipt.

Giants In Orthopaedic Surgery: Jacquelin Perry MD, DSc (Hon)

A Note from the Column Editor: This issue of Clinical Orthopaedics and Related Research®is one of the first with the Ruth Jackson Orthopaedic Society (RJOS) as an affiliate society. Founded in 1983, the RJOS is named for Ruth Jackson MD, the first woman certified by the American Board of Orthopaedic Surgeons in 1937 [6]. Thirty years ago, she and five other women identified the need for a society of female orthopaedic surgeons to address common issues encountered by the increasing number of women surgeons in training, practice, and academia. As such, Dr. Jackson secured her place as an orthopaedic pioneer. Among this group was Jacquelin Perry MD, DSc (Hon). Dr. Perry was the second President of the RJOS, but this was not her first foray as a founding member of an orthopaedic society. In 1966, Dr. Perry was one of the 35 spine specialists, and solitary woman, to establish the Scoliosis Research Society [7]. Amy L. Ladd MD, Professor in the Department of Orthopaedics at Stanford University, currently serves as the President of the RJOS. She still marvels at how Dr. Perry exemplified focusing on patient care without being deterred by politics or other distractions. “She was very practical, yet so insightful,” Dr. Ladd said. “Her approach was a methodical analysis to improve patient care and everyone around her. She could be very intense and stern, but the endgame was improvement. She didn’t let anything distract her from this.” Dr. Perry’s long and highly productive career spanned seven decades. As an author of more than 400 publications, her commitment to teaching and improving the lives of patients remains legendary. Considered a relentless problem solver, Dr. Perry’s inquisitive mind, intellect, and no-nonsense approach found solutions where others did not even see problems. Her dedication to musculoskeletal health and disease reflected her educational background in physical education, physical therapy, and orthopaedic surgery. A pioneer in gait and motion, she analyzed normal and abnormal conditions, rehabilitation exercise, and sports. Dr. Perry’s orthopaedic career would seem to have no missteps, only a series of strides in a progression to innovation and discovery in surgery, clinical care, education, and research. As one of the first internationally prominent women in orthopaedic surgery, she helped promote and develop other women in the field through the RJOS, and more recently, in science through the Perry Initiative. Her humility would cause her to argue otherwise, but she more than earned the title of the “Grand Dame of Orthopaedics.” — Marlene DeMaio MD, MC, USN (retired) A young Jacquelin Perry knew by the age of 10 that she wanted to be a physician [4]. The work she went on to do throughout her lengthy and distinguished career — a career that stretched until the day before she died — changed lives and altered medical practice (Fig. 1). Fig. 1 Dr. Perry was one of 35 spine specialists, and the lone woman, to establish the Scoliosis Research Society in 1966. Photo courtesy of the Scoliosis Research Society Confucious said, Find a job you love and you will never work a day in your life. Her humble nature, despite countless achievements, awards, and acknowledgements, prove no greater example of this phrase. In 2010, Dr. Perry implied that she had “profited from several timely opportunities, and … grabbed each one” [6]. Lisa Lattanza MD and Dr. Perry met while working together at the biomechanics lab at Centinela Freeman Regional Medical Center in Inglewood, California. Dr. Perry was the research consultant at the time. By then, Dr. Perry had long been considered a world-renowned orthopaedic surgeon. Despite this acclaim, she always felt like she had not done anything special. “I think a lot of that came from the fact that she was always doing what she loved, and felt like it was an honor to be taking care of patients and teaching people,” Dr. Lattanza said. Although she would never admit it, countless patients and physicians have benefited from Dr. Perry’s clinical and surgical care, research, writing, teaching, and mentoring.

Orthopaedic Trauma Career and Employment Horizons

The trauma opportunities: The numbers are 260 verified sites (American College of Surgeons), 1100 Centers performing as Regional or Community Trauma Centers currently in the continental 48 states, and 3256 hospitals performing in-patient orthopaedic surgery. Orthopaedic trauma surgeons still represent <10% of the total national surgeon complement. This component speaks to the demand side. Presently, there are >60 Traumatology Fellows annually. This represents the supply side that has the potential to graduate in 2013 and beyond. These individuals face a wide variety of career options not previously available to past generations, but one has to know the business model differentiators to be successful: employed-employee (most common, least sustainable historically); employed-partner; partner-contract for service; partner-private practice; private practice-hospital partner (least common, most productive).

Why Do Medical Students Choose Orthopaedics as a Career?

The primary influence on medical students' career choice is their third-year clerkship. However, orthopaedics is not a required rotation in the curriculum of most medical schools. Our goals were to identify factors that motivate students to choose an orthopaedic career and to compare these with the factors that influence students to choose nonorthopaedic disciplines. Fourth-year medical students and orthopaedic residents at the postgraduate year (PGY)-1 level at eight orthopaedic training programs in the United States were surveyed to determine the reasons that they chose orthopaedics instead of other medical or surgical fields. Of the 622 individuals who responded to our survey, 125 were entering orthopaedics and 497 were not. Although career choice in both groups was most heavily influenced by third and fourth-year clinical rotations and faculty contacts, orthopaedics-bound respondents were more likely than non-orthopaedics-bound respondents to be strongly influenced by experiences and people prior to medical school. Orthopaedics-bound respondents were less likely to report a faculty member as the most important person influencing career choice. Fifty-one percent (sixty-three) of 124 students who selected orthopaedics had already decided to pursue this field prior to their third-year rotation. Patient care was chosen by 71% (347) of 490 non-orthopaedics-bound respondents and 75% (ninety-four) of 125 orthopaedics-bound respondents as the most important factor for pursuing a particular field. Income was not selected as the deciding factor by respondents in either group. Although faculty contacts and third-year clinical rotations played an important role in student selection of specialty training, they were less influential for those choosing an orthopaedic career than for those choosing other disciplines. Many students choosing orthopaedics made this decision prior to medical school. We believe that increased exposure to positive clinical role models and experiences during medical school would enhance medical students' options for choosing orthopaedic surgery as a career. Anticipated income did not play a deciding role in career selection.

Core skills in orthopaedic surgery

Core skills in orthopaedic surgery is a three day course run by the Royal College of Surgeons of Edinburgh. The course emphasises development of competency in basic emergency department, outpatient, and operative procedures in trauma and orthopaedics. The course is aimed at foundation year 2 doctors who wish to pursue a career in trauma and orthopaedics and year 1 and 2 specialty trainees currently working in a surgical post. Most participants are required to have at least some practical experience in trauma and orthopaedics. The candidates on my course were from foundation year 1 and 2 to specialty trainee 1 level from all over the United Kingdom and overseas, and all participants had worked in trauma and orthopaedics at some point. Having done four months as a foundation doctor in trauma and orthopaedics, I had a good understanding of the principles of orthopaedic management but wanted to gain more …

Factors Affecting Interest in Orthopedics Among Female Medical Students: A Prospective Analysis

The field of orthopedics has a limited ability to recruit high-quality female applicants. The purpose of this study was to determine whether early exposure to the field affects a woman's decision to pursue orthopedics. We performed a prospective, nonrandomized cohort study between academic years 2005 and 2009 and compared interest in orthopedic surgery among female (n=271) and male (n=71) medical students at 2 urban teaching institutions. Elective lectures and orthopedic literature were distributed via e-mail to the study participants. These materials included articles published in the medical literature, materials produced and distributed by the American Academy of Orthopaedic Surgeons, and Web sites providing educational materials. The primary outcome was the likelihood of application for orthopedic residency. We studied the influence of demographics, exposure, and attitudes on interest in pursuing an orthopedic career. Men had a significantly higher baseline level of interest in orthopedic surgery than women (P=.005). Younger age (P<.001) and personal (P<.001), independent (P<.001), and school (P=.023) exposures to orthopedics were significantly related to interest among women. At final follow-up, total personal exposures (P=.003) and total independent exposures (P<.001) in the form of our literature and lectures were correlated with final interest in women. Female interest was decreased by the long hours, physical demands, and predominantly male nature of the field. Early exposure to orthopedic educational resources may be useful in generating female interest. Perceptions and attitudes regarding orthopedic surgery must to be changed to attract the best and brightest minds, regardless of sex.

Giving Back to Your Country, the People, and Your Family

We are pleased to reproduce Dr. Chitranjan Ranawat’s address to the American Academy of Orthopedic Surgeons Class of 2009. This was delivered at the ceremony which honors their induction into the Academy. In this speech, Dr. Ranawat reflects on many of the responsibilities that accompany a career in orthopaedics, and he emphasizes that a truly dedicated surgeon is committed throughout his or her career to service to their community. Many of us might argue that the demanding education and training and the arduous work schedule and daily stress that are inherent to this career are obligations enough. However, Dr. Ranawat, whose career has exemplified the qualities of the master surgeon, argues that more is required from all of us. I believe that there is vital importance in the preservation of the thoughts and examples of the personal attributes of leaders. Leadership is not an innate characteristic. It must be learned, and the future of our profession will depend in many respects on how well our future leaders receive their training. Dr. Ranawat has performed a service towards this end by sharing his personal reflections. Please enjoy reading it. Charles N. Cornell, MD Editor-in-Chief

Factors Involved in Selection of a Career in Surgery and Orthopedics for Medical Students in Malawi

There is a critical shortage of Orthopedic Surgeons in Malawi as well as all countries in sub-Saharan Africa. To date, there is no published literature that has investigated surgical or Orthopedic career selection amongst African medical trainees. With the goal of facilitating recruitment into Surgery and Orthopedics in Malawi, we explored the key aspects of Malawian Medical Students' choice of careers in surgical disciplines. An on-line survey of all students in clinical years at the College of Medicine in Blantyre, Malawi was performed. The survey was anonymous and constructed de novo by a stringent process including Item Generation, Item reduction, Survey composition, Pre-testing, Assessment of Validity by a recognized survey expert, Pilot testing in on-line format by several Malawian Medical Students, and then formal survey testing. Surgery was the most popular specialty choice among the medical trainees (46%). General Surgery was the popular surgical specialty (27%), followed by Neurosurgery (22%) and Orthopedics (19%). The majority of students (67%) feared occupational exposure to HIV but this did not appear to be a factor in specialty choice (p = 0.9). Students with Orthopedic mentors were significantly more likely to choose Orthopedics as their first choice surgical specialty (p = 0.01). Despite limited resources and surgeons in sub-Saharan Africa, surgical specialties are desirable career choices. This is the first evaluation of factors involved in surgical or Orthopedic career selection in any African context. Future initiatives to improve exposure and mentorship in Orthopedics are fundamental to recruitment into the specialty.

Editorial: A Paucity of Women Among Residents, Faculty, and Chairpersons in Orthopaedic Surgery

Editorial: A Paucity of Women Among Residents, Faculty, and Chairpersons in Orthopaedic Surgery

Sex, power and orthopaedics

Sex, power and orthopaedics

So you want to be an orthopaedic surgeon?

“So you want to be an orthopaedic surgeon?” is a new course run by the Royal College of Surgeons of England, as one of the recently launched series of “So you want to be . . . ?” one day courses. It involves multiple interactive lectures presented by well known orthopaedic consultants. The course is designed to familiarise prospective trainees with the history of orthopaedics, its different aspects and subspecialties, and potential developments. It covers the changes in the recruitment process and orthopaedic training, and explores examinations and assessments that the trainee has to complete. The aim is to provide a better understanding of the scope of the subject and the route(s) for pursuing a career in orthopaedics. Junior doctors who have a potential interest in trauma and orthopaedics are encouraged to attend this course. It is aimed at new graduate doctors—that is, foundation year 1 and foundation year 2. Final year medical students are welcomed as well, (it’s never too early …

MD/MCh in orthopaedics

The MD (doctor of medicine)/MCh (master of surgery) can be done in ear, nose, and throat surgery, anaesthesia, and paediatrics as well as orthopaedics. It is the first “taught” MD programme in the United Kingdom as opposed to the traditional MD by research. University of Central Lancashire, Preston. It is mainly for doctors who have completed their basic surgical training and who wish to pursue a career in orthopaedics. The entry requirement for the MD/MCh is a professional qualification in medicine or health with relevant experience and evidence of aptitude to undertake this programme or a recent and relevant second class honours degree or equivalent. September 2004. I was among the first 27 students to join this course, …

Degree of Master of Surgery (Orthopaedics), MChOrth

FURTHER INFORMATION Department of Musculoskeletal Science, Royal Liverpool Hospital, Prescot Street, Liverpool L7 8XP. Tel 0151 706 4120, fax 0151 706 5815, www.liv.ac.uk/MusculoskeletalScience The degree is mainly for those interested in a career in orthopaedics who have completed or are about to complete their registrar rotation and who are waiting for a consultant post. It is also useful for international medical graduates planning to return home after a period of training in the United Kingdom. I completed it in December 2004. I did it as a specialist registrar. I was …

Short-listing for orthopaedic specialist registrar posts – what is important?

Competition for specialist registrar (SpR) posts in orthopaedics is high. The aim of the current study was to provide evidence-based advice for applicants applying for SpR posts in orthopaedics. The short-listing forms of 273 applicants for orthopaedic SpR posts in South Thames (West) were reviewed. The experience of short-listed candidates was compared with those that were not. We have shown a high chance of being short-listed between 5 and 6 years after qualification with a sharp fall off either side of this. It is clear that a wide range of appropriate experience is more important than high volume and low quality experience in orthopaedics alone. Candidates who plan ahead and gain a broad experience have a better chance of progressing in an orthopaedic career. Good, early career advice is essential to achieve this.