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Evandro P. Palacio, MD

AAOS Now

Published 10/1/2013
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Terry Stanton

New Program Helps Mold International Leaders

Advanced learning experience provides administrative and clinical education

For a dozen years, the Academy’s International Surgical Skills Scholarship Program (ISSP) has helped improve the quality and outcomes of orthopaedic care worldwide through scholarships awarded to applicants who demonstrate the desire and ability to have a positive impact on their communities. Now, past participants in that program have the opportunity to participate in an advanced experience.

This month, two ISSP alumni journey to the United States as inaugural recipients of the new AAOS International Emerging Leaders (IEL) scholarship. Evandro P. Palacio, MD, of Brazil, and Domagoj Delimar, MD, PhD, of Croatia, were selected by the International Committee Scholarship Project Team for 2013.

Dr. Palacio will participate in an IEL program that he designed from a variety of choices. After taking part in a Flap Course under the auspices of the University of California in San Francisco, San Francisco General Hospital, the Institute for Global Orthopaedics and Traumatology (IGOT), and SIGN Fracture Care International, Dr. Palacio will attend the SIGN Annual Conference and then complete a week-long observership with IGOT. His program will end with participation in the AAOS Course for Orthopaedic Educators.

Dr. Delimar, who heads the department of orthopaedic surgery at the University of Zagreb hospital in Zagreb, Croatia, will travel to Boston to participate in an intensive 2-week observership at Massachusetts General Hospital (Mass General). There, he will shadow Harry E. Rubash, MD, chief of the hospital’s department of orthopaedic surgery, and observe subspecialty surgeries such as hip and knee arthroplasty, his professional focus. This IEL track was created to meet the special needs of orthopaedic surgeons who are recently appointed heads of department, service chiefs, or leads.

Prospective IEL scholars completed a comprehensive application that included five essays. The general program had 24 applicants, and the Mass General opportunity had 10 applicants. The project team graded the applications and selected the general-program recipient, as well as three finalists for the Mass General track. Dr. Rubash interviewed all three candidates, and Stefano A. Bini, MD, project team chair, made the final selection.

Funding for the two programs came from Mass General, the AAOS, and outside supporters.

‘Unprecedented experience’
Dr. Palacio was appointed chief of the residency program of the Marilia State Medical School in Marilia, Brazil, in 2012. He credits his participation in the 2008 ISSP with helping to prepare him for that role.

“It was an unprecedented experience that opened the doors to a world of new ideas and achievements,” he said. “The scholarship allowed me to learn from the best faculty I have ever met. My mentors had great expertise in performing trauma surgery, coordinating orthopaedic residency programs, and training in the most modern orthopaedic techniques. I was taught the state-of-the-art in trauma surgery.”

As soon as he returned to Brazil, he asked to be allowed to implement some of the methods of teaching, learning, and assessing residents that he had learned in the United States. “In the beginning, some conservative colleagues resisted,” he said. “However, some months later and especially with the excellent results achieved, we had completely renewed the residency program of my institution.”

Although Brazil has grown as an economic power in recent years, the nation still faces several social challenges, many related to health and health care. “Just as in other countries, high-energy traumas, mainly caused by automobile accidents, are responsible for more than 70 percent of our urgent and emergency care,” said Dr. Palacio.

“Frequently, serious sequelae may develop, including critical soft-tissue injuries and chronic infections, which require not only very high financial support for treatment, but also trained personnel,” he continued. “Both the Flap course and the observership with IGOT should provide me with new horizons and methods for treating patients.”

Dr. Palacio also hopes that his upcoming experience will help ensure that residents at his hospital are afforded a rich, advanced educational exposure as they balance patient care with training. “The benefit of learning from colleagues at other institutions around the world how to multiply knowledge and background among our residents is immeasurable,” he said.

Evandro P. Palacio, MD
Domagoj Delimar, MD, PhD

Practical lessons
Dr. Delimar agreed that participation in the ISSP “significantly contributed to my training and advancement at the most appropriate time.” At the time of his scholarship visit, he had been a fully trained orthopaedic surgeon for 4 years. “Upon return I could immediately start implementing the know-how and the skills I had acquired, with appropriate adjustments to the local conditions.”

His main goal with the IEL program is “to bring home logistical and medical experiences. With small adjustments with regard to local practice and traditions, I hope I will be able to begin applying in daily practice most of the things I will learn.”

Shadowing Dr. Rubash, he said, will provide “the perfect opportunity to learn firsthand how Mass General operates. It will be valuable for me to see how such a great institution is organized and operates on a daily basis.” He also hopes to learn “lessons to be applied to volunteerism and public service, significantly contributing to their advancement and benefiting patients and the community.”

The IEL shadowing track at Mass General was originally conceived with a primary emphasis on administrative affairs. In planning for the inaugural program, Dr. Rubash expanded the scope. “I thought we should tailor it not just to administrative activities but to the clinical component as well, to give participants an opportunity to attend academic conferences and grand rounds. We are all clinicians, and I would want also to be exposed to the academic and clinical side of medicine.”

Thus, Dr. Delimar will observe surgeries and will meet with staff in the services for their subspecialties. Overall, Dr. Rubash said he sought to craft an experience that “would be a meaningful program to me if I were a young leader.”

Dr. Rubash expects Dr. Delimar’s visit to be a learning experience for himself as well. “Croatia has a hybrid socialized and private system,” he said. “I am going to be learning too, because I don’t understand his system.”

Dr. Rubash said the human component is also important in a program such as the IEL. “Like anything else, it is the relationships and friendships that you make,” he said. “It gives you a community of people that you can talk to about problems that we all face. I learn from them just as they learn from me. I’m looking forward not only to imparting some wisdom but gaining some wisdom and hopefully making a friend. I’m excited about it.”

“The ISSP and the IEL scholarships can be considered milestones in the life of fellow surgeons all over the world,” said Dr. Palacio. “The AAOS is doing what no other institution has done. Directly and indirectly, the Academy has transformed the lives of thousands of patients in Brazil.

“I have met colleagues from other countries who say they would never have the opportunity of being trained in such specialized courses without the support of the AAOS,” he continued. I declare myself an AAOS representative wherever I go.”

To support or learn more about the AAOS International Scholarships, contact Anna Gurevich, coordinator, international outreach and scholarships, at gurevich@aaos.org

Terry Stanton is senior science writer for AAOS Now. He can be reached at tstanton@aaos.now

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