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AAOS Now

Published 3/1/2017
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Megan Lusk

Resident Education in the Digital Age

Residents reflect on how technology affects their learning experiences
Today’s orthopaedic residents are connected to more technology than ever before. Smart phones have replaced pagers, information can be accessed instantly, and learning can occur anywhere. How orthopaedic residents learn in the current age of technology was one of the topics covered during the 2016 AAOS Fall Meeting symposium on “The Paradigm Shift in Resident Education” presented by members of the AAOS Resident Assembly Executive Committee.

Afterward, I sat down with committee members Andrew Jensen, MD (University of California, Los Angeles [UCLA]); Philip K. Louie, MD (Rush University Medical Center, Chicago); and Patrick Marinello, MD, (Cleveland Clinic) to discuss how they incorporate technology into their learning and what this new landscape of medical education means to them.

Ms. Lusk: How do you think resident education has changed in today’s digital age?
Dr. Marinello:
I think that there are new challenges for residents with how we are going to learn. We have more resources than ever, even more technology, but we need to pick and go through what the options are.

Dr. Jensen: I agree. It’s both a blessing and a curse. We have all of these extra resources and technology. The downside is that it’s tough to wade through it all. The benefit is that if you find something that works really well for you, you can be more efficient in your learning and ultimately a better surgeon.

Dr. Louie: It’s nice to have so many resources available at any moment. You can be walking in the hospital and pull out your phone or sign on to a computer. The information is often just one click away. If we need information, we know where to find it and how to get it.

Ms. Lusk: Is your practice supportive of the technology that’s available to you, even if that means using your phone in an ­operating room [OR]?
Dr. Marinello:
Very much so. We are transitioning to hospital-based smart phones that will eventually replace our pagers and have education resources available from the hospital. These resources go beyond resident education. Apps have been developed for patient care as well. I have all my patient information on my smart phone, including radiographs and vital signs.

Dr. Louie: We are also given electronic tablets once we start residency, along with recommendations on mobile apps that we can access. For patient care, all dictations and outpatient charts are on an app that is available to us at all times if we need the information. I think hospitals are embracing the technology that’s available.

Dr. Jensen: Same at UCLA. There is very little pushback. They are very supportive; we too were given electronic tablets when we started.

Ms. Lusk: How has this technology affected residency for you personally?
Dr. Marinello: We’ve only been residents during the time of new technology. I think for us it’s more about educating our attending physicians as to what resources we want. It’s like when text messaging first came out. I remember our first family cell phone bill with text messages. My parents didn’t understand why I would text someone instead of calling.

I think that’s the same thing here. Our attending physicians say, “Why can’t you just have a book?” “Why can’t you do it the way we did it?”

That’s the challenge. The current generation of attending physicians and senior mentors definitely embrace technology and they know it’s changing. But we need to work together to figure out how to best implement it.

Dr. Jensen: For example, when many AAOS members were residents, they might have had to get a key at 3:00 a.m., just so they could visit the library to find a journal article. Now, the thought of doing that is just crazy.

Dr. Marinello: With the availability of Wi-Fi, we can access our hospital’s library virtually from just about anywhere, including on a plane. You just need the password.

Dr. Louie: That’s all I know in residency. I still print out a lot of articles. I feel like I learn better, but I don’t know how else to study. In medical school and 3 years in residency, they talk about how technology has affected your training. I really don’t know any other way to do it. This is what we have been accustomed to over the last few years.

That said, I think initially there was a lot of mockery from senior attending physicians. But once you accept that this technology is here to stay, you realize it has a lot of benefits if you are willing to be open to it. We’re starting to see a global change and acceptance of the tools available and the fact that if we all work together on the same tools, we may actually develop a better process and improve outcomes over time.

Ms. Lusk: Do you see a shift in resident education to where you are now teaching your attending physicians on incorporating technology into their practice?
Dr. Louie: Every day. You have to appreciate the fact that they are willing to learn from us. Because it’s not fun for them to admit, “I can’t figure this out,” or, “show me this.” 

Dr. Marinello: You’ll see them sitting there struggling and ask, “What are you trying to do there?” Residents have embraced electronics as a means to get their work done. Writing notes used to be an arduous task, like looking up vital signs. That’s done on a computer in a quarter of the time that people spent in years past. We talk about the challenges in education and working within the hospital work-hour restrictions. But we’re able to get some of that time back by increasing our efficiency with the use of technology.

Ms. Lusk: Do you ever feel that technology is hindering you during residency?
Dr. Louie:
It’s important to remember that technology advances don’t replace education. The technology is just a supplement to education that we need in residency. We’re in the OR, we need the reps, we need the discussions, we need to know about the failures. The didactics are almost more important now than ever before, because we start with a better baseline foundation. We can access information that gives an opportunity to build complexes, and situational sections of what we are learning. Technology is great, but it is just a supplement to the big picture. Everything else in that picture is just as important.

Dr. Jensen: I think it would be really hard to find a resident who would rather do a simulation or bio skills lab than to be in the OR doing a real procedure. Technology just augments the fundamental principles of orthopaedic education, such as anatomy and being in the OR.

Dr. Louie: At the end of the day we want to be good surgeons. Technology won’t make us good surgeons. But it provides us with steps that will help us get there.            

Megan Lusk is social media channel specialist in the AAOS Marketing Department. She can be reached at lusk@aaos.org