Opinions on Ethics and Professionalism

Continuing Medical Education

An AAOS Opinion on Ethics and Professionalism is an official AAOS statement dealing with an ethical issue, which offers aspirational advice on how an orthopaedic surgeon can best deal with a particular situation or circumstance. Developed through a consensus process by the AAOS Ethics Committee, an Opinion on Ethics and Professionalism is not a product of a systematic review. An AAOS Opinion on Ethics and Professionalism is adopted by a two-thirds vote of the AAOS Board of Directors present and voting.

Issue raised

What are the standards of continuing medical education to which orthopaedic surgeons should subscribe?

Applicable provisions of AAOS Standards of Professionalism on Orthopaedist-Industry Conflicts of Interest

Mandatory Standard 12: An orthopaedic surgeon shall accept no financial support from industry to attend industry-related social functions where there is no educational element.

Mandatory Standard 13: An orthopaedic surgeon who is attending a CME event shall accept no industry financial support for attendance at a CME event. Residents and orthopaedists-in-training may accept an industry grant to attend a CME event if they are selected by their training institution or CME sponsor and the payment is made by the training program or CME sponsor. Bona fide faculty members at a CME event may accept industry-supported reasonable honoraria, travel expenses, lodging and meals from the conference sponsors.

Mandatory Standard 14: An orthopaedic surgeon, when attending an industry-sponsored non-CME educational event, shall accept only tuition, travel and modest hospitality, including meals and receptions; the time and focus of the event must be for education or training.

Mandatory Standard 15: An orthopaedic surgeon, when attending an industry-sponsored non-CME educational event, shall accept no financial support for meals, hospitality, travel, or other expenses for his or her guests or for any other person who does not have a bona fide professional interest in the information being shared at the meeting.

Applicable provisions of AAOS Standards of Professionalism on Providing Musculoskeletal Services to Patients

Mandatory Standard 9: An orthopaedic surgeon shall commit to life-long medical and scientific learning.

Mandatory Standard 10: An orthopaedic surgeon shall provide only those services and use only those techniques for which he or she is qualified by personal education, training, or experience.

Applicable provision of the Principles of Medical Ethics and Professionalism in Orthopaedic Surgery

“VI. The orthopaedic surgeon continually must strive to maintain and improve medical knowledge and to make relevant information available to patients, colleagues, and the public.”

Applicable provision of the Code of Medical Ethics and Professionalism for Orthopaedic Surgeons

“IV.A. The orthopaedic surgeon continually must strive to maintain and improve medical knowledge and skill, and should make available to patients and colleagues the benefits of his or her professional attainments. Each orthopaedic surgeon should participate in relevant continuing medical educational activities.”

Other references

American Medical Association, Principles of Medical Ethics, Article V. “A physician shall continue to study, apply and advance scientific knowledge, make relevant information available to patients, colleagues, and the public, obtain consultation, and use the talents of other health professionals when indicated.”

Background

Every orthopaedic surgeon has an ethical and professional obligation to stay abreast of the developing knowledge in the musculoskeletal sciences. The contract that exists between surgeon and patient, and between the profession and society, requires the acceptance of this obligation. The rate of growth of scientific knowledge and clinical experience in our specialty place an extraordinary responsibility on each orthopaedic surgeon to maintain his or her knowledge base.

The American Academy of Orthopaedic Surgeons believes that a lifelong commitment to continuing medical education is essential for orthopaedic surgeons. This commitment is necessary if orthopaedic surgeons, as professionals, are to fulfill their obligation to provide high quality health care. The choice of educational methods or experience is the responsibility of individual orthopaedic surgeons. The Academy places no specific requirements on its Fellows in terms of areas or types of instruction, minimum number of hours of education during a particular time period, or preferred providers of educational programs. However, there are specific requirements from the American Board of Orthopaedic Surgery related to the Maintenance of Certification (MOC) program. In addition, some states and jurisdictions have specific requirements for licensure. The AAOS does expect practicing orthopaedic surgeons to fulfill the requirements of the MOC program and to meet the requirements for licensure in their state including the necessary CME hours in culturally competent care where appropriate.

The AAOS believes the goal of CME should be improved patient safety and practice improvement. Methods by which CME may achieve these goals include improved physician performance and competency leading to better outcomes. To achieve these goals ethically, CME must be independent of commercial interests. Furthermore, CME activities need to follow the guidelines of the Accreditation Council for Continuing Medical Education (ACCME), the U.S. Food and Drug Administration (FDA), and the U.S. Department of Health and Human Services (HHS) Office of the Inspector General (OIG).

The AAOS has created mandatory standards of professionalism related to the orthopaedic surgeons relationship with industry. The AAOS does expect all AAOS members to follow those guidelines as they pertain to CME activities and courses. Please refer to the Standards of Professionalism on Orthopaedist-Industry Conflicts of Interest.

Recommendations

The Academy believes that each orthopaedic surgeon must develop his or her own approach to knowledge maintenance in an organized and explicit manner to assure that it addresses content in all areas in which care is provided. To do this requires:

• A self-generated practice audit to determine the types of conditions, procedures, complications, etc. which comprise one’s practice experience, and to assess the results of treatment provided.
• A periodic self-assessment evaluation which addresses the knowledge and content areas relevant to the individual’s practice.
• The development of a personal education plan, to include study in identified areas of deficiency, and the subsequent scheduling of educational activities to fulfill the goals developed in the education plan.

As an organization devoted to the education of orthopaedic surgeons and others, the Academy makes available current authoritative and evaluative educational materials to enhance orthopaedic knowledge and to facilitate the provision of improved patient care. The Academy’s commitment to education is enduring and substantive. Every orthopaedist should make a similar commitment to excellence.

February 1992 American Academy of Orthopaedic Surgeons.
Revised December 1995, February 1997, May 2002, February 2009.

This material may not be modified without the express written permission of the American Academy of Orthopaedic Surgeons.

Opinion 1203

For additional information, contact Richard N. Peterson at 847-384-4048 or email peterson@aaos.org