AAOS Now: How did this program come to be? What motivated AAOS’ commitment to develop a residency curriculum?
Dr. Tornetta: The need for a unified curriculum has been apparent to program directors for decades. Both program directors and residents have clearly communicated the need for a unified system of learning. It was this need that drove the development of the program and is the motivation behind the Academy creating this now. To be effective, the curriculum will cover the knowledge that a Board-certified orthopaedic surgeon should know. The profession needs a consistent system of education that residents can count on being accurate and complete. Many societies have done work to provide resident education, but there has been no unified knowledge curriculum at a high standard that programs and residents can count on.
Dr. Morris: I tried to do something similar for tumor training for the Musculoskeletal Tumor Society, where we created a standardized online platform for residency programs around the country. The premise was that there needed to be a standardized set of learning goals and a single source that allowed a basis of comparison across residency programs around the country and aligns with our way of testing for that, which is the Orthopaedic In-Training Examination® and the Boards. There was a need to come up with a resource that allowed for an integration of those concepts that was dynamic, important for residents to know, and also valuable for program directors to have a basis of something measurable.
Dr. Tornetta: Resident education is really within the wheelhouse and competencies of the Academy. AAOS recognized that devoting resources and energy to the residents is something that is necessary for the health of the specialty and will make us stronger as a group. Every residency program is strong in different areas. The idea for this curriculum is that it brings together high-value content organized by the trusted leaders in each subspecialty to develop accurate educational materials and will allow residents to dig as deep as they want to in a given area, leveraging the vast educational resources of AAOS.
What has been your role in this project, and why are you personally motivated to spend time on this?
Dr. Tornetta: Dr. Morris and I are the overall editors, and then each subspecialty has incredibly high-quality, devoted, and knowledgeable editors leading those areas. The subspecialty leaders have each selected section editors and authors to write and organize the chapters, then everything is secondarily reviewed with the support of the content committees, which are the structure of the Academy’s educational council.
Having a curriculum like this has been a goal of mine for more than 20 years. By nature, I’m primarily a patient and resident advocate. The thing I’m most passionate about is resident education, and I want resident education everywhere to be better.
Dr. Morris: Resident education across several different demographics has remained important to me. It’s a lasting contribution that we can make to the field in the area of education, creating a national curriculum to guide the field going forward that will last. The overarching goal of this project very much resonates with my core as far as what is important to me in being an orthopaedic surgeon and passing that on to the next generation of orthopaedic surgeons. It’s also to preserve the fidelity of education in our field. There has to be leadership and stewardship in ensuring high-quality education going forward. This program is an opportunity to do that.
What do you find to be the greatest value of this program for both residents and program directors?
Dr. Tornetta: What it brings to the residents is a current, unified platform and an evolving knowledge base. It is very different than anything that is out there because it can incorporate ancillary educational activities. For instance, the curriculum will include videos of symposia and Instructional Course Lectures presented at the AAOS Annual Meeting and videos from various books and other sources. It will include full chapters from AAOS titles as well as primary literature, with Journal of the AAOS ® articles, podcasts, and PDFs from major journals. It’s not a typical review book. This is really an in-depth, robust educational platform. The residents will be able to dive as deep as they want to.
The hope is that they use the knowledge curriculum as a resource and get as much as they need from each chapter. Each topic (chapter) is set up to have mandatory elements that should take about an hour per chapter and covers a reasonable amount of information at both the junior and senior level. Programs will be able to track residents’ progress through the chapters in this way. More importantly, each chapter will contain many other “assets” or resources that allow the resident to have a richer experience in the material. We can envision a resident spending six hours on some of these topics, really digging deep into all of the available resources, because we’re making a breadth of Academy resources available on the platform.
This is really a resident knowledge-based curriculum. It’s not designed to meet all the requirements of the Residency Review Committee. It is directed toward the knowledge that needs to be acquired to pass the Boards. Although we will have topics of professionalism and ethics in the curriculum, our primary goal is to fill in the knowledge gaps and provide those resources.
What the residents also get is a platform of education that will grow and evolve as they do, optimize their learning, and serve their needs the way they want them to be served. The Academy has absolutely committed to making this free for residents.
The residents had a large part in how this has been developed. We have gone to the Resident Assembly multiple times, surveyed residents, and had focus groups to understand not just what they need but how they want the information to be delivered. Similarly, we have worked with volunteers from the Council of Residency Directors. The idea right from inception was to give the residents and program directors what they wanted so both sides of the platform are generated by what users want, not by what we think it should be. The assets and resources can change over time; as we get more information, the chapters and topics will be rebuilt. We plan to update the chapters every other year on a rotating basis. One of the most exciting features of the curriculum is that it will be a living document that will keep pace with the rapid changes in our field.
Dr. Morris: There’s tremendous variability in how education is delivered in the various residency programs, including variability in quality. To help streamline that process and allow for a validated framework of knowledge that is required to be a competent orthopaedic resident, I would imagine that residency program directors would find that helpful. The curriculum allows program directors to monitor resident engagement and progress and support residents who might be struggling so they can redirect them toward success.
Dr. Tornetta: As a program director, I have struggled with understanding how much work my residents are putting into their independent learning. The curriculum will provide residency directors with objective data—which we’ve never had—and this will enable us to coach the residents better. We will be able to show residents how much time they are spending compared to their peers as well as their progress based on the questions each chapter will have.
The curriculum is set up in modules by subspecialty. Different residency programs may employ the curriculum in different ways. Some residency programs may have the residents work through it in the order that they’re doing their rotation. Others may already have a wonderful educational program for half of the topics and will continue to use that, filling in the deficit areas with the new curriculum for the areas in which they don’t have the same quality of materials. The idea is to provide the program directors with high-quality tools that can be incorporated at the depth, breadth, and timing appropriate to achieve their programs’ goals.
Dr. Morris: It’s very dynamic and smooth. The best part is it’s all there. Everything a resident needs to be an orthopaedic surgeon and to pass the Boards is all in the curriculum.
It’s not just good for struggling residents. It’s also great for residents who are on the other side of that spectrum—those who are excelling so much that maybe their residency programs can’t even keep up with them. There is an opportunity to dive really deep on every single topic within the curriculum and become a resident expert on it.
Can you talk about the contributors to this program?
Dr. Tornetta: Dr. Morris and I, along with the residents and program directors, have developed the general concepts of the curriculum along with its goals. Once the overall goals were determined, the Academy staff has been absolutely phenomenal working with us to create this new type of educational resource. The staff has also worked with the subspecialty editors, section editors, and authors individually. This initiative has been one of the largest undertakings we have ever embarked upon.
The volunteer editorial staff and authors have had to learn a completely new way to write, as this is not a typical textbook. We asked these dedicated volunteers to include as many assets as they could for each chapter and to provide the knowledge in bulleted and expanded formats. There was a difficult learning curve. It required a lot of conversation among Dr. Morris and I and the subspecialty editors to explain what we’re looking for, and they have been extraordinary in their response. Personally, I have never worked with a better group of people on a project so important. The concept of a blended program is so different than a standard textbook chapter, and the authors have really come through.
The authors, section editors, and subspecialty editors, along with our staff, deserve the majority of the credit for working hard in a completely new arena to make a different kind of product. Going forward, we’re going to be leaning on the content committees and the editors and authors to update the information cyclically. The plan is to routinely incorporate new symposia, webinars, chapters, and articles so that the curriculum becomes more complete and remains current over time.
Dr. Morris: I think the curriculum is going to be the template going forward for how the Academy will bring subspecialty societies together for common goals. This project brings everybody together into the single house of orthopaedics. It’s really easy to rally around resident education, because people feel very strongly about it.
How do you see the residency curriculum program evolving over the next five years?
Dr. Morris: I think it will be the go-to education platform for all residency programs. Because it is a living course of study, it will just get better each year. I think five years from now it’s going to be an even better program.
Dr. Tornetta: I’m truly looking forward to what it looks like in five years. The entire goal here is to provide something that works for everyone. I can envision myriad changes in the way it’s delivered, the content that is included, and the way that the program directors use it.
The Academy and the staff have been truly open to what people want. This is a passion project for everybody involved. The only goal is to have it be a wonderful educational platform and tool for program directors and residents. I think five years from now, it will look different than what it looks like now.