The orthopaedic surgery residency program is one of the most rigorous training programs in the medical world. Although the hours spent in the clinic, hospital, and operating room (OR) provide an invaluable foundation for residents, it behooves them to take advantage of extra-institutional educational opportunities as well.
Surgical courses for orthopaedic residents supplement learning by providing hands-on laboratory work and educational classroom teaching. Many courses have 1:1 or 2:1 faculty-to-resident ratios, providing the resident with personalized training and extensive teaching that is not always feasible in the OR setting. Additionally, several courses feature cadaver sessions, enabling residents to safely practice new skills or perfect those already acquired through institutional training.
Importantly, these courses have been found to be effective means of improving residents' surgical skill. A recent study of residents who attended the Arthroscopy Association of North America (AANA) Resident Arthroscopy course demonstrated objective improvement in arthroscopy skill after completion of the course. Another study found that resident participation in a formalized surgical skills fracture course significantly improved surgical skills. The article concluded that courses "are a valuable training resource which directly impact resident performance."
AO Basic Principles
One of the preeminent orthopaedic surgical courses is the AO Basic Principles and Techniques of Operative Fracture Management course. It provides a format worthy of imitation for other surgical courses. The multiple brief lecture topics deliver a digestible amount of information, and these lecture principles are then immediately applied in a hands-on lab setting. The skills labs are thoughtfully designed to reinforce classroom principles.
The course enables students to interact with knowledgeable faculty in a supportive environment in which learning is the top priority. In addition to enabling residents to collaborate in surgical techniques with residents from other programs, the course provides opportunities for professionally networking with residents and attending physicians from various programs across the country.
Many surgical courses for orthopaedic residents are held at the Orthopaedic Learning Center (OLC) Education & Conference Center at the AAOS headquarters in Rosemont, Ill. (Fig. 1). The AAOS, the AANA, and the American Orthopaedic Society for Sports Medicine (AOSSM) jointly own the OLC and hold courses specifically for residents, as well as the orthopaedic community at large. This brand-new facility provides a state-of-the-art cadaver lab as well as first-rate educational classrooms and lecture halls. The skills lab contains high-definition broadcasting equipment so that residents are always connected with the teaching that occurs during lab sessions.
So what's the problem?
Three significant obstacles prevent residents from attending surgical courses—clinical scheduling conflicts, funding availability, and awareness of course opportunities. Although granting time to attend surgical courses is a residency program-specific issue, obtaining funding to attend courses and being aware of course opportunities are barriers that residents can often overcome.
Financial constraints are a significant barrier for many residents, but some organizations offer free surgical skills courses. For example, each spring, the AAOS, in conjunction with the American Association of Hip and Knee Surgeons (AAHKS), The Hip Society, and The Knee Society, offers a free skills course for orthopaedic residents. The course provides a unique opportunity for residents to gain hands-on practice with several hip and knee arthroplasty procedures. The Fundamentals of Hip and Knee Arthroplasty for Orthopaedic Residents course is held in 3 locations—on the East Coast, at the OLC, and on the West Coast—so residents can choose the most convenient location. No registration fee is required for any resident from a North American orthopaedic residency program.
In addition, some organizations offer discounted registration costs for orthopaedic residents. The highly regarded AAOS Fundamentals of Knee and Shoulder Arthroscopy for Orthopaedic Residents course has a resident-specific reduced registration rate. During this intensive, hands-on course, residents practice a variety of procedures to improve their arthroscopy skills. The evaluation data from past courses is exceptional; residents attest that their arthroscopic skills and confidence improved due to the course, enabling them to progress more rapidly in arthroscopic training in residency.
Other organizations provide financial aid to residents to help them attend surgical courses. The AAHKS provides residents attending its Annual Resident Course with up to $500 in financial aid for airfare, lodging, and meals. The course is held during the AAHKS annual meeting.
Residents can also obtain grants from industry and educational organizations to help cover the cost of attendance at courses. Some residency programs provide residents with annual stipends to attend surgical courses. Lastly, if no funds are available, residents can claim all course-related expenses as a tax deduction.
The final barrier for residents is awareness of course availability. No well-vetted, comprehensive list of surgical courses for orthopaedic residents is available. Instead, residents are often left to discover these courses through word of mouth, interactions with industry representatives, or incomplete and outdated course lists maintained within a program. This second-hand knowledge of courses limits awareness and may prevent some residents from pursuing these educational opportunities.
Addressing the problem
At the 2016 AAOS Annual Meeting, the Resident Assembly's Education Committee voted to take steps to increase awareness of and access to surgical courses for orthopaedic residents. The first step in this process was to create a comprehensive list of surgical courses and relevant funding sources. This list has been created and will be hosted online on the newly established AAOS Community website. Organizations wishing to add their surgical course to this list can contact the Resident Assembly Education Committee (email@example.com). It is hoped that this surgical course list will increase awareness and improve access to surgical course opportunities for residents.
Patrick J. Smith, MD, is a PGY-4 resident at the University of South Alabama department of orthopaedic surgery; Andrew R. Jensen, MD, MBE, is a PGY-3 resident at the University of California Los Angeles department of orthopaedic surgery and chairs the AAOS Resident Assembly Education Committee.
- Martin MK, Patterson DP, Cameron KL: Arthroscopic training courses improve trainee arthroscopy skills: A simulation-based prospective trial. Arthroscopy 2016; May 24 [Epub ahead of print].
- Egol KA, Phillips D, Vongbandith T, Szyld D, Strauss EJ: Do orthopaedic fracture skills courses improve resident performance? Injury 2015; 46(4):547–551.