“The JOA presents more than 3,000 instructional course lectures each year for the education of young members,” said Prof. Iwamoto. When the earthquake forced cancellation of the 2011 JOA annual meeting, the research and education presentations were not lost. “All presentations and instructional lectures were given online. We found the online education was very useful and practical,” said Prof. Iwamoto, “and we will use it again.”

AAOS Now

Published 4/1/2012
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Mary Ann Porucznik

World Opinion Forum Examines Orthopaedic Education

International panel weighs impact of technology, emedia

“Throughout history, the term ‘physician’ has really been equivalent to the term ‘scholarship,’” noted David C. Templeman, MD, a member of the AAOS International Committee, as he introduced the 2012 World Opinion Forum. “But recently, the educational paradigm, the way we do things, has changed. Students—from small children to medical residents—are no longer assimilating information in the same way we did. They’re using computers, multitasking, acquiring information from a multitude of sources.”

Pointing to the increase in the number of personal computers (PCs)—the world average is one PC for every 10 people—Dr. Templeman asked, “How does this access to information through a medium where everyone is ‘equal’ challenge traditional teaching models? How do we protect the really important information in science and practice?”

Lessons from Japan
According to Prof. Yukihide Iwamoto, MD, president of the Japanese Orthopaedic Association (JOA), many companies and medical schools in Japan are using online education methods. Prof. Iwamoto, who earlier had accepted the 2012 Guest Nation Award from Jesse B. Jupiter, MD, chair of the AAOS International Committee, noted the value of online education in the wake of the devastating Tohoku earthquake and tsunami in 2011.

Experience in the Middle East
Saeed Althani, MD, of the Emirates Orthopaedic Association, shared a very different experience of orthopaedic education. “The United Arab Emirates (UAE)is a small country, with a population of 8 million people,” he noted, more than 80 percent of whom are expatriates. As yet, the country has no orthopaedic residency program, so physicians come from around the world to staff the public and private health services.

“We currently rely on international conferences such as the Academy’s to improve our education,” said Dr. Althani. “Our goal is to establish a residency program and unify our educational services by 2015.”

Cultures in transition
In Brazil, the orthopaedic residency program is well established; nearly 600 residents graduate each year, said Geraldo Motta, MD, of the Sociedade Brasileira de Ortopedia e Traumatologia (SBOT). At the end of their training, residents must take a board examination, similar to the U.S. situation.

Dr. Motta used an example to underscore the importance of maintaining basic skills from an earlier time in today’s advanced world. “Younger surgeons want to learn how to do arthroscopic shoulder repair, but they don’t know how to open a shoulder,” he said. “If a hospital has just one set of arthroscopic instruments, what happens if something goes wrong? We should not forget those surgical skills, and we can’t be trained without other surgeons.”

“The JOA presents more than 3,000 instructional course lectures each year for the education of young members,” said Prof. Iwamoto. When the earthquake forced cancellation of the 2011 JOA annual meeting, the research and education presentations were not lost. “All presentations and instructional lectures were given online. We found the online education was very useful and practical,” said Prof. Iwamoto, “and we will use it again.”
In the UAE, journal clubs play an important role in physician education. Journal clubs exist in each of the country’s major cities, enabling physicians to exchange information and discuss cases. Hospitals and medical device companies also provide education; most hospital contracts with device companies require the companies to spend a percentage of their sales income on physician education.
“We have to pay attention to technology, but our country has a lot of diversity, in technology and in hospitals, so we have to be very open minded,” explained Dr. Motta. “We have all the facilities to have online training but we also recognize the importance of learning surgical skills from another surgeon.”
The COA also has made forays into social media, with a Twitter account and a formal association with Orthopedia. “Interestingly enough, our Twitter account is followed more by nonmembers than members,” said Dr. Schemitsch.
“It’s an economic decision; more journals are becoming paperless or being published strictly online,” said Prof. Hoffmeyer. Echoing the words of Prof. Iwamoto, Prof. Hoffmeyer pointed out that “we need to be able to face natural catastrophes, not unlike what happened in Japan. We have volcano problems in Europe, and the EFORT Congress last year was threatened by a volcanic eruption that disrupted air travel.
As a user-driven site, OKO tracks how frequently materials are accessed and uses that information as a basis for developing future content. “Users want the ability to access any content as they need it; they don’t want to wait to get the answers to their questions,” said Dr. Grana, who also addressed some significant challenges facing U.S. educators.

Neighbor to the North
The Canadian Orthopaedic Association (COA) has adopted several electronic initiatives, despite the cost, noted Emil H. Schemitsch, MD. “We have developed an online tool that enables residents and attending physicians to download material from our annual meeting to their personal devices. We have an online surgery journal, an online quarterly bulletin, and a calendar of coming events. We are in the process of developing an online, orthopaedic-only journal.”

EFORT efforts
The European Federation of National Associations of Orthopaedics and Traumatology (EFORT) includes 27 nations and about 100 languages, noted Prof. Pierre J. Hoffmeyer, MD. To facilitate communication, English has become the national federation’s language, and electronic communications are being “thrust upon us.”

“I think the electronic venue is absolutely necessary today,” he continued. “An electronic system with all the lectures that enables participants to go online, find, listen, and participate, is what we need. Not only from the education standpoint, but also because our residents are from a generation that relies on the screen.”

Bringing it home
As the U.S. representative on the panel, William A. Grana, MD, MPH, editor-in-chief of Orthopaedic Knowledge Online (OKO), noted that its goal is “to provide basic knowledge and content that is peer-reviewed, evidence-based, and aimed at giving users the best practices that are available for promoting the best outcomes in patient safety.”

“The biggest challenge is to develop workable business models for this expensive technology,” he said. “We’re going to have to find ways to generate the revenue that we’ve been getting from print publications.”

Pointing out that at his institution, medical students get an iPad instead of a syllabus and that residents use iPads to access electronic medical records, Dr. Grana noted that “they’re learning from the beginning using online programming.”

This, however, points to another long-term challenge: to make sure that the content young physicians are using has a basis in fact and evidence.

Mary Ann Porucznik is managing editor of AAOS Now. She can be reached at porucznik@aaos.org