The education of an orthopaedic surgeon occurs in three stages: first as a medical student, next as a resident/fellow trainee, and finally as a lifelong learner through continuing education. Although the three phases are well known to orthopaedic surgeons and their trainees, no comprehensive analysis of published literature about the quality and effectiveness of orthopaedic education exists. Few objective data can be found that identify the best educational practices for preparing orthopaedists and sustaining their expertise during each formative stage of their career.

As the leader in lifelong orthopaedic education, the AAOS, through its Council on Education, is committed to identifying and supporting educational practices that enable orthopaedists to provide the highest quality musculoskeletal care. In 2012, the Council formed a study group, led by Edward Akelman, MD, to perform a comprehensive review of the published literature in orthopaedic educational research.

“The purpose of this group was to discover what information has been published in peer-reviewed journals about orthopaedic education that evaluates current education practices and/or suggests future worthwhile orthopaedic education research studies,” said Dr. Akelman. In a comprehensive search of all published literature, the group identified 2,047 citations, which yielded 233 relevant articles. The articles were divided into 3 groups, focusing on medical students, residents/fellows, and practicing orthopaedic surgeons (Fig. 1).

Medical school education
Dawn LaPorte, MD, Veronica Wadey, MD, and I reviewed the articles on medical student education, which covered new and innovative curricular reforms occurring both in the United States and abroad. New methods, such as structured clinical examinations, patient partners, simulators, and online learning are all being used to improve medical student exposure to musculoskeletal medicine.

“Successful undergraduate musculoskeletal medical education necessitates collaboration with colleagues in other departments such as rheumatology, anatomy, and physical medicine and rehabilitation,” said Dr. LaPorte. “By working together, orthopaedic surgeons can teach all medical students the knowledge and skills they need to be proficient in musculoskeletal medicine, regardless of which specialty they choose.”

Resident/fellow training
Julie Balch Samora, MD, PhD, led the charge on examining research on resident and fellow trainees. She and her coauthors reviewed many excellent articles that were published on accreditation training, resident research, surgical skills, orthopaedic in-training examination (OITE) preparation, and simulation.

“Educational research involving residents and fellows is starting to reflect the changing and evolving training environment,” Dr. Samora said. “The Orthopaedic Surgery Milestone Project will provide an enhanced framework for assessing residents’ medical knowledge and surgical skill. Although the number of published articles focusing on how best to educate the next generation of orthopaedic surgeons is increasing, more research is needed to determine best practices of instruction and assessment.”

Lifelong learning
Although the section on practicing orthopaedic surgeons yielded the fewest number of articles, Alfonso Mejia, MD, found several excellent studies. A few examples were on surgeon decision making regarding blood transfusions, surgeon proficiency with anterior cruciate ligament repair, and the effectiveness of the AAOS Leadership Fellows program.

Dr Mejia noted that a great opportunity exists for research regarding practicing surgeons. “Lifelong learning through continuing medical education is an instrumental part of ongoing surgeon education,” he stated. “Identifying techniques and training tools to optimize learning for busy surgeons in this hectic practice environment is an excellent avenue for potential research ventures.”

By reviewing the literature on education research, this workgroup was able to identify gaps in training and conduct needs assessment based on the phase of the learner. The workgroup believes that the AAOS is uniquely positioned to provide educational opportunities to all learners of musculoskeletal medicine. It is the hope of the Council on Education that the work conducted here can serve as a basis for designing new, exciting, and dynamic educational opportunities in orthopaedics and musculoskeletal medicine.

Robert F. Murphy, MD, is a member of the AAOS Council on Education.

References

1. Murphy RF, LaPorte DM, Wadey VM; on behalf of the American Academy of Orthopaedic Surgeons Orthopaedic Education Study Group. Musculoskeletal Education in Medical School: Deficits in Knowledge and Strategies for Improvement. J Bone Joint Surg Am. 2014 Dec 3;96(23):2009-2014.
2. Julie Balch Samora, MD, PhD, MPH; Philip Bashook, EdD; Andrew Jones, MD, PhD; Todd Milbrandt, MD, MS; Augustus D. Mazzocca, MD, MS; Robert H. Quinn, MD. Orthopaedic Graduate Medical Education: A Changing Paradigm. JBJS Reviews, 2014 Nov;2(11):e1.