Transitions to a portfolio-based model
The AAOS, through the Council on Education, continually strives to support and provide education practices and opportunities that enable its members to provide the highest level of orthopaedic care. To that end, the AAOS Council on Education is currently in the process of revamping its working structure and education strategy to be more responsive to members' learning needs. To find out more, AAOS Now spoke with Evan L. Flatow, MD, chair of the AAOS Council on Education.

AAOS Now: What prompted the AAOS Council on Education to embark on these changes?

Dr. Flatow: The Academy is at a critical juncture in its evolution. Competition in the orthopaedic education market is at an all-time high and the needs and expectations of our members are changing quickly. Although all medical and surgical specialties embrace lifelong learning, it is especially important in orthopaedic surgery because of the pace of innovation in, for example, new types of implants, minimally invasive and arthroscopic approaches, and biologic agents.

The Academy must adapt to the changing education landscape. We believe that the December 2013 AAOS Board-approved Education and Publishing Strategy, which recommends a portfolio-based model for education, will enable the Academy to remain relevant today and in the future.  In many ways we are disrupting ourselves.

AAOS Now: How will this be accomplished? What are some of the major priorities?

Dr. Flatow: The AAOS—in support of the portfolio-based approach—is aligning the governance of the Council on Education to ensure that we are more nimble and responsive to the needs of our members and the global markets served by the Academy. We expect the new governance structure to support our highly engaged and committed volunteers who give their time and talents to plan and build education experiences for the orthopaedic community.

Specifically, we are shifting our current committee structure away from format-centric models of the past, such as courses, books, and periodicals to anatomically based content areas. We refer to these as Content Committees (CCs), of which there will be 10 in total.

In addition, we are inviting the specialty societies to designate a member of their choice to serve as a liaison with the appropriate CC. In this shared planning model we are working together to form plans and meet the needs of our members at every stage of their careers. CC participants also come from other disciplines within the AAOS and include representatives from the Journal of the AAOS, Annual Meeting Committees, Assessment and Exam Committees, and the Resident community.

Importantly, the CCs are responsible for developing a body of knowledge for their content areas and for identifying content gaps that may be supported with future content delivered in a variety of traditional and easily accessible digital formats. The identified gaps will initially come from two areas: evaluating the content within the portfolio and member feedback. Members generally know where their opportunities are for growth, and have indicated they expect to learn new skills or techniques to expand their practice and improve patient care.

This clinical needs assessment in each content area is very important to our planning process and is a high priority. Having this insight will inform the work of our volunteers and staff. A clinical needs assessment initiative is underway to obtain this information. As an example of that initiative, we are employing quantitative methodology to survey our members—at every career stage and specialty level—to self-identify areas in which they need or desire clinical education. This information will help guide CCs in making decisions about our future education planning.

AAOS Now: Orthopaedics applies to all areas of the body—that's a lot of ground to cover. How will the survey be constructed?

Dr. Flatow: The Academy has worked, with significant input from the specialty societies, to complete a taxonomic structure for classifying orthopaedic content. The 10 major domains in the taxonomy align with the 10 major areas of specialized practice by orthopaedic surgeons that make up our CCs. The specialty areas are as follows:

• Hand and Wrist
• Shoulder and Elbow
• Adult Reconstruction (Hip and Knee)
• Foot and Ankle
• Spine
• Musculoskeletal Oncology
• Pediatric Orthopaedics
• Sports Medicine
• Trauma
• Basic Science

Within the survey, each member will be able to self-select the areas of practice in which they need or desire additional education, knowledge, or skills. Their selection will drive subsequent questions. For each topic selected, more detailed lists covering orthopaedic conditions to choose from under that topic will be presented. The topic areas that members identify as areas for further exploration will become the areas that the Academy will investigate as opportunities for new content development to meet members' needs.

We encourage members who receive an invitation to take part in the survey to provide their feedback—it is a small investment of time that will help shape our plan for developing education in the years to come for the entire community of orthopaedics.

AAOS Now: It sounds like a lot of time and effort has gone into this plan.

Dr. Flatow: The AAOS has been preparing for this throughout the nearly 3 years I've served as chair of the Council on Education. My predecessor, Edward Akelman, MD, led an engaged group of volunteer leaders on the Council who invested their time and talents to get us to this point. The AAOS Board of Directors has approved significant investments in technology platforms and tools that will support the digital development and delivery of our content that we are implementing today.

It's important to also mention that the AAOS did not go about this exercise alone. It enlisted the participation and support of the specialty societies, whose members are often Academy members. The Council on Education committees and staff collaborated to create the framework of the taxonomy. It then used an iterative review process to provide the details and specifics for each major domain. The final vetting of each of the major domains was completed by the specialty society for that content area. Every society in the orthopaedic community had an opportunity to contribute to this project and I believe that is why it was a success and will inform and support our plans!

AAOS Now: What is the long-term strategy for this initiative?

Dr. Flatow: This will be an ongoing effort, not a one-and-done event or survey. To be relevant in a changing marketplace, we need to make a commitment to ongoing needs assessment. This data informs our plans with society partners and others including continued expansion of JAAOS with our journal publisher, Wolters Kluwer; strategies with our emergency medical technician (EMT) content and credentialing partner, Jones & Bartlett Learning; as well as our newest partner, Orthobullets. We are very excited about our work with Orthobullets. We've worked with the founder, Derek Moore, MD, and his team to add thousands of the Academy's exam questions to their new website. We know many of our residents, younger members, and residency programs use Orthobullets for review and learning in a more modern way. At the 2017 AAOS Annual Meeting in March, we'll also be introducing new formats for learning and engagement that will help members maintain and track their learning activities.

Our plan is to identify and encourage multiple methods of soliciting, encouraging, listening, and acting on member feedback. We believe "Feedback is the Breakfast of Champions!" The clinical needs assessment study is a major initiative—and one of the first of its kind at the AAOS. We will also continue to hold various focus groups, collect product/program evaluations, conduct market analysis, and explore using more on-the-spot surveys to gather information about our members' education needs and wants.