When Kent Jason Lowry, MD, of Rhinelander, Wis., performed an arthroscopic procedure 4 years ago on Ryley Zastrow, the 14-year-old remained awake—at her request, and with parental consent. Miss Zastrow watched intently as Dr. Lowry excised tissue and cauterized blood vessels. She eagerly noted the various anatomic structures he pointed out within her knee and answered his “quiz questions” about the ligaments and structures she saw on the monitor.

The arthroscopic procedure was the first of many experiences that Miss Zastrow, who had been interested in medicine from a very young age, would share with Dr. Lowry. During 2013, in collaboration with Rhinelander High School and the local hospital/clinic, Dr. Lowry and Miss Zastrow developed a year-long independent study program that gave the high school senior hands-on experience in orthopaedics. This one-of-a-kind learning experience has influenced Miss Zastrow to pursue a career in orthopaedics and provided Dr. Lowry the opportunity to foster a talented young person’s interest in medicine.

Developing the program
After recovering from her knee surgery, Miss Zastrow, then a high school freshman, contacted Dr. Lowry to ask about the possibility of developing a “job shadowing” program so that she could learn more about the field of orthopaedic surgery.

“I agreed to serve as Ryley’s mentor because there is a strong need to encourage the ‘best and the brightest’ medical students to specialize in orthopaedics,” said Dr. Lowry. “No matter what sorts of resources are available in a community, any orthopaedist can be a positive role model for young people by exposing them to the positive aspects of our profession.”

After Miss Zastrow received an equally positive response from her high school principal, she began scheduling her sophomore and junior classes to ensure that she would have ample time in her senior schedule to work with Dr. Lowry.

“In the spring of my junior year, I contacted Northland Orthopedics and Ministry St. Mary’s Hospital in Rhinelander to learn about the provisions of the Health Insurance Portability and Accountability Act (HIPAA) and gain clearance to be present in the operating room, respectively,” said Ms. Zastrow.

“I also worked closely with my school’s principal to develop an appropriate curriculum and obtain approved absences so that I could participate in the program,” she said.

Observation and hands-on experience
“During my first semester in the program, I spent one day each week observing in the clinical setting and during appointments,” explained Miss Zastrow. “In my second semester, I spent one day in the clinic and a second day in the operating room.”

Throughout the program, Dr. Lowry emphasized the importance of maintaining patient confidentiality and complying with HIPAA regulations.

“Before Ryley could observe a patient, we obtained the patient’s explicit consent for observation,” he said. “In addition, we did not allow her to observe any patients who were her classmates.”

Dr. Lowry taught Miss Zastrow about a broad spectrum of conditions and injuries, ranging from carpal tunnel syndrome to chondrocalcinosis to arteriovenous malformation. She observed a variety of surgeries, including an anterior cruciate ligament reconstruction, quadriceps tendon repair, and numerous total joint arthroplasties.

“I spent one afternoon at a local physical therapy center, so I could see the full continuum of orthopaedic patient care, from the initial appointment through nonsurgical clinical care, surgery, and eventually, postoperative physical therapy,” said Miss Zastrow.

Overall, Miss Zastrow observed 212 patient appointments and 43 surgical procedures.

“I not only learned about the interpersonal skills that facilitate successful patient-physician interactions, but also obtained a better understanding of the musculoskeletal system, including conditions, injuries, and treatments,” she said.

Although “job shadowing” may sound like a strictly observational experience, the program provided hands-on learning opportunities.

“I learned about the progression of fracture healing and callus formation by exploring chronologic radiograph series, and how to perform physical examinations for various orthopaedic conditions, often practicing specific tests on patients with their consent and Dr. Lowry’s guidance,” said Miss Zastrow.

She compiled a portfolio of detailed journal entries for each day she spent job shadowing and wrote a patient case study. She also labeled anatomic diagrams, composed a comprehensive research paper on total hip arthroplasty, and wrote a “final reflection” on what she learned.

A bright future
According to Miss Zastrow, this job shadowing experience had a profound impact on her educational goals and career path. When she began her freshman year at the University of Wisconsin–Madison in September 2013, she opted to major in biomedical engineering.

“I also plan to continue learning Spanish to help facilitate patient communication,” said Miss Zastrow. “Most importantly, this experience has significantly strengthened my desire to specialize in orthopaedic surgery following medical school.”

Miss Zastrow describes her experience working with Dr. Lowry as “invaluable.”

“It was the highlight of my high school academic career,” she said. “It really cemented my desire to become an orthopaedic surgeon. The insights I gained from discussions with Dr. Lowry opened my eyes to somewhat nontraditional undergraduate majors—in my case, biomedical engineering—in pursuit of that goal.”

Dr. Lowry is hopeful that he can repeat the program again with another student.

“Looking back,” he continued, “this program was much more successful than I would have expected. It gave Ryley the opportunity to gain real-world experience about a career in orthopaedics and renewed my enthusiasm for medicine.”

Jennie McKee is a senior science writer for AAOS Now. She can be reached at mckee@aaos.org