For the past 5 years Edward Akelman, MD, has chaired the AAOS Continuing Medical Education (CME) Courses Committee, which prepares an annual schedule of courses to meet the educational needs of AAOS members and orthopaedic residents. Dr. Akelman, whose tenure ends in February 2009, has overseen several changes in the Academy’s continuing education program, which he discussed with AAOS Now recently.

AAOS Now

Published 11/1/2008
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Elaine Fiedler

Changes in CME: Innovations and challenges

An interview with Edward Akelman, MD

AAOS Now: What challenges did the CME Committee face during your tenure as chair? How did you respond to those challenges?

Dr. Akelman: We faced three significant challenges: First, implementing a set of educational programs to prepare orthopaedic surgeons for the certification examination developed by the American Board of Orthopaedic Surgery (ABOS); second, developing orthopaedic unity; and finally, continuing to meet the members’ expectations for the highest quality CME courses.

In 2003, the committee adopted a plan to offer a new Board Preparation and Review course for the Part 1 certifying examination. Frank J. Frassica, MD, of Johns Hopkins, was put in charge and Frederick M. Azar, MD, a committee member at the time, was designated as course co-director. Dr. Frassica put the focus on the fundamentals of orthopaedics, including content that might appear on the ABOS certifying examination. He set a high standard for faculty presentations, and we now have an outstanding Board Preparation and Review course.

The program includes lectures, self-assessment tools, a refresher course presented just prior to the examination date, and a syllabus. Each registrant can also access a set of basic science lectures created by the Orthopaedic Research Society.

After the ABOS announced the Maintenance of Certification™ (MOC) program, the committee created the MOC Board Preparation and Review course. We encourage members to attend this course, read Orthopaedic Knowledge Update, attend the Annual Meeting to gain answers to open questions, and take a practice examination using one of the Academy’s many self-assessment programs to prepare for the ABOS examination. Course directors Joseph M. Lane, MD, and Barry L. Riemer, MD, helped us create the MOC Board Preparation CME course, which is presented in two separate locations.

We then turned to helping candidate members prepare for the ABOS Part 2 examination. Brian J. Harley, MD, FRCSC, organized the program, which helps candidates complete the ABOS application and case selection processes and prepare for the oral examination.

Our next challenge was supporting the Academy’s orthopaedic unity program. After the 2004 Orthopaedic Summit, we worked on developing joint venture courses with the orthopaedic specialty societies. In 2009, about 75 percent of comprehensive and surgical skills programs will be jointly sponsored with an orthopaedic specialty society. One of our most exciting new programs is the International Pediatric Orthopaedic Symposium, jointly sponsored with the Pediatric Orthopaedic Society of North America.

Finally, the challenge of setting high standards for course directors and faculty is ongoing. We inherited a tradition of excellence, and each committee member has worked to ensure our programs meet member expectations.

AAOS Now: What other innovations have you and the committee implemented?

Dr. Akelman: In 2008 we presented “Cutting Edge Developments and Controversies in Total Joint Arthroplasty” with the American Association of Hip and Knee Surgeons. This program represents an entirely new approach to CME. The course was presented in three sites, each with its own faculty complement, and the sites were linked via satellite and the Internet to create a conversation across the country. Faculty in Los Angeles presented talks that were heard by participants in Rosemont and Boston. Debates between faculty in Boston and Rosemont were seen in Los Angeles. Surgical demonstrations in Rosemont were viewed by participants in Boston and Los Angeles. The 6-hour course, under the direction of Daniel J. Berry, MD; William A. Jiranek, MD; David G. Lewallen, MD; and Thomas P. Vail, MD, got high marks from attendees. Plans are now underway for the 2009 course.

To meet requirements established by the Accreditation Council for Continuing Medical Education, other innovations have included the implementation of pre- and posttesting at comprehensive review courses, the use of procedural checklists for self-assessment at skills courses, the development of peer-review processes to ensure unbiased programs and the development of course evaluation questionnaires focusing on what is learned.

AAOS Now: How do you think medical education will change in the coming years? Are you anticipating any new and promising teaching techniques?

Dr. Akelman: Change has been the byword for Academy CME courses since I first became involved as a course faculty member. Recently, we conducted a study on teaching methods. At the May 2008 wrist injuries surgical skills course, course directors Douglas P. Hanel, MD, and Leon S. Benson, MD, divided the participants into three groups for the portion of the program focusing on ligamentous anatomy of the wrist.

All three groups took a pretest. Group 1 heard a traditional lecture. Group 2 participated in a small group, case-based learning session. Group 3 did independent study using a computer program. After taking a posttest, participants completed their learning in the laboratory. Staff is analyzing the results and we expect to author a paper for publication comparing the results of the three teaching methods.

We hope this study will help us refine how we teach different content. Alan M. Levine, MD, chair of the Council on Education, has established a project team on faculty development. We are developing a program to teach our future CME course faculty how to teach effectively. Our faculty may be skilled surgeons but are missing the teaching skills they need. Teaching is part art and part science, whether the format is lecture, case-based, or surgical skills.

AAOS Now: What impact has the Department of Justice (DOJ) settlement had on CME education? Will the orthopaedic industry be more or less involved with training?

Dr. Akelman: The recent DOJ actions have changed the playing field quite dramatically. The bottom line is that we are unable to teach surgical skills without equipment loaned to us by our industry partners. Now industry is approaching equipment loan with new policies and procedures. The Academy’s legal staff is engaged in this matter, but it is too early to know how changes will affect our programs.

Even before the DOJ took action last year, new requirements for grant requests went into effect. I anticipate more changes as we go forward. I expect that the AAOS will continue its policy of using grant funds to offset registration fees when possible.

At the same time, we must adhere to our fair and balanced policy for CME courses. We don’t teach doctors how to use a specific device maker’s equipment—we teach the principles and techniques of orthopaedic surgery.

AAOS Now: Do you have any words of advice for the Committee’s next chair?

Dr. Akelman: Leading the CME Courses Committee has been an honor and a privilege. I want to recognize and thank all of the Committee members who have served, as well as the course directors, the faculties, and the staff. It is a team effort that creates the finest CME courses in orthopaedics. I recommend that the next chair count on Committee members for their excellent knowledge of our programs, rely on staff for excellent support, and have fun!

Elaine Fiedler is a freelance writer specializing in medical topics. She can be reached at elainefiedler@comcast.net