CHAIRMAN’S CORNER
JAMES H. HERNDON, MD, MBA
CHAIRMAN, PARTNERS DEPARTMENT OF ORTHOPAEDIC SURGERY PROGRAM DIRECTOR, HARVARD COMBINED ORTHOPAEDIC RESIDENCY PROGRAM
I can’t believe it, but this is now the fourth issue of the Journal of Orthopaedics at Harvard Medical School. The residents continue to do an outstanding job of producing this high quality Journal and we continue to receive great compliments from our readers and alumni. I again congratulate the editorial staff and this year’s editor, Greg Erens, MD. They have worked very hard to produce this publication and deserve everyone’s gratitude. Please make an effort to let them know your appreciation.

We also owe a debt of gratitude to all our industry colleagues who have generously and continuously supported our journal. Without their advertising commitment, publication of our journal would not be possible. Please join me in thanking each and every one of our corporate sponsors.

Over the past year, the Harvard Combined Orthopaedic Residency Program has continued to improve the quality and content of the Core Curriculum, conferences and Journal Club. In addition to sections devoted to each subspecialty, the Core now included new material on contracts, ethics and practice management issues. Plans are already in place to add a section on physician-patient communication conducted by an educator from the American Academy of Orthopaedic Surgery who trained at the Bayer Institute of Health Care Communication. This section will be one of several added to address the new core competencies required of all residencies by the Accreditation Council for Graduate Medical Education. Thanks to Mark Gebhardt, MD and the Core Curriculum Committee (faculty and residents) for their hard work this past year. Thanks to Scott Martin, MD and the faculty for another superb Anatomy course this past summer.

David Wimberley, MD

The Journal Club has become an important conference for resident education. James Heckman, MD continues to be a tremendous mentor to the Club and its participants. I am also pleased to announce that David Wimberley, MD, the Club’s resident founder, was awarded an OREF grant to support a special program or contribution to the Journal Club. The proposed use of the funds will be determined over the next several months. David has now turned over the reins to Jim O’Holleran, MD who will organize future Journal Club meetings.

With regard to resident recruitment, I am pleased to announce that we had our most successful match to date this past March. While there was a general reduction in applicants to orthopaedic residencies nationally, we were fortunate not to experience a decline in the quality or number of applicants to our program. Apparently, this reduced interest in orthopaedics as a career choice stems from a growing concern among medical students about lifestyle issues. From their perspective, orthopaedic surgeons have no life! Times are changing! Our residency program remains strong as we adjust and change to address issues of importance to all residents.

Core Curriculum

Journal Club

While we continue to improve our program, the Accreditation Council for Graduate Medical Education (ACGME) has released a series of new requirements over the past year that must be incorporated into our program by July 2002 and be fully implemented by our next RRC review in 2004. These requirements are designed to ensure that certain skills and attitudes are being taught to our residents and that our residents have the opportunity to master these skills in the course of their residency training.

The general competencies endorsed by the ACGME are in the following areas: patient care, medical knowledge, practicebased learning and improvement, interpersonal and communication skills, professionalism, and systems-based practice. Specific competencies in these various areas include the expectation that residents “communicate effectively and demonstrate caring and respectful behaviors when interacting with patients and their families; perform competently all medical and invasive procedures considered essential for the area of practice; and work effectively with others as a member or leader of a healthcare team or other professional group.” An important part of this effort is the requirement that programs develop evaluation tools that will provide objective measures of whether residents are developing these competencies. While it is expected that programs will have some form of evaluation in place by July 2002, the ACGME expects that it will take at least two years for programs to have these tools in place.

Arthroscopy Lab

Another important emphasis reflected in these new requirements is the desire to increase residents’ outpatient experience and provide greater opportunity to participate in and practice continuity of care. The goal is to have residents working in the ambulatory setting at least one day per week. Too often in our own program, residents have been kept in the operating room with little exposure to the office practice of orthopaedics, i.e. physical exam and diagnosis, pre-operative education, nonoperative management and post-operative care. While the ACGME requirements may be difficult to integrate into our program, the benefits to the residents of doing so will be enormous.

An area of growing concern nationally within graduate medical education is the issue of work hours. New directives required by law in New York State limiting work hours are likely to be adopted nation-wide, particularly as the country embraces patient safety as a key priority for health care providers and institutions. While our record in this regard is mixed, I am asking the Chiefs of each service to revisit the residents’ responsibilities on their services to make sure we are setting the right standard.

Dr. Philip Blazar Dr. Peter Millett Dr. Andrew Hecht Dr. Malcolm Smith Dr. Brian Grottkau

Lastly, the ACGME has enacted a more stringent accreditation requirement for completion for the Board exams. Currently 75% of the residents must pass Part I of the ABOS exam. The new standard is 75% must pass both Parts I and II. While this should not be an issue for our residents, it may be a concern for others.

In order to fully address and incorporate these new requirements into our program, I have held a series of miniretreats with the faculty in each subspecialty. Every service is being asked to develop goals and objectives for each PGY rotation on their service that incorporate the six areas of general competency; to identify methods for evaluating these goals and objectives, (e.g. case presentations, pre- and posttests); to design a schedule for each rotation that includes one day per week in an ambulatory setting with patients; and to provide a description of levels of responsibility between fellows, residents and faculty in order to maximize teaching, fairly distribute scut work, and clarify responsibility for patient care. I have also asked each service to evaluate the need for a teaching and non-teaching service for resident training. While I doubt that any of our services will elect to implement this model, we are reaching a point where resident education is significantly at risk and such a model will be needed.

In my role as Chairman of the Partners Department of Orthopaedic Surgery, I am pleased to acknowledge the recruitment of new faculty, strengthening of our clinical programs and growth of our research program. I would like to commend Tom Thornhill, MD and Harry Rubash, MD on their leadership of orthopaedic surgery at the Brigham and Women’s and Massachusetts General Hospitals. I would also like to commend Jim Kasser, MD on his leadership of the Department of Orthopaedic Surgery at Children’s Hospital. I direct you to their respective “Chief’s Corners” for an overview of the accomplishments of their programs over the past year.

Of particular importance to the residency program and growth of the Partners Department, I would like to acknowledge the arrival of several outstanding new physicians to our ranks: Philip Blazar, MD in hand surgery; Peter Millett, MD in shoulder surgery, Andy Hecht, MD in spine surgery; Malcolm Smith, MD in trauma and spine surgery; and Brian Grottkau, MD as Chief of Pediatric Orthopaedics at MGH and MassGeneral Hospital for Children. These surgeons represent important additions to our complement of subspecialty services. As we grow, we anticipate additional recruitments in the areas of trauma, sports, foot and ankle, and spine.

Promotions and appointments in the Partners Department over the past year include: William Tomford, MD to Professor, Mark Brezinski, MD to Associate Professor, Orhun Muratoglu, MD to Assistant Professor, and Ariane Gerber, MD, Elvire Gouze, MD, Martha Murray, MD, and Sonya Shortkroff, MD to Instructor. I would also like to acknowledge John Emans, MD promotion to Professor of Orthopaedic Surgery at Children’s Hospital.

I would like to congratulate Harry Rubash, MD for being named the third incumbent of the Edith Ashley Chair at Harvard Medical School. Likewise, I would like to acknowledge that Henry Mankin, MD has become the Distinguished Edith Ashley Professor.

I am also proud to acknowledge the other honors and awards received by our faculty over the past year. Myron Spector, PhD has been awarded the 2002 Clemson Award for career achievement in Applied Biomaterials Research. Congratulations to the entire group. Congratulations also to Andreas Gomoll, MD who received the Marshall R. Urist Residency Research Award from the Association of Bone and Joint Surgeons for his research on nanocomposite bone cement with improved mechanical properties. I am also extremely proud to report that the Partners Orthopaedic Trauma Service, under the leadership of Mark Vrahas, MD, received its second consecutive Partners in Excellence Award for service to the patients and physicians of this community.

Our musculoskeletal research program continues to grow at both the MGH and BWH. I want to commend Mark Brezinski, MD for his success over the past year in securing an important sponsored research agreement with Eli Lilly, as well as obtaining four RO1s and two subcontracts.

I would like to acknowledge Chris Evans’, PhD work in preparing for Phase II of a clinical trial in gene therapy for arthritis. Development of the Phase II protocol is in the advanced stages of planning and the Center is currently negotiating with NIH for a contract to fund this work. I would like to commend Chris on his leadership of the Center, which is now fully functional and generating original publications on the results of their research.

In closing, I want to congratulate the graduating residents and wish them every success as they leave for fellowship training and practice. I would also like to thank the Chief Residents who finished in December and those who will finish in June. On behalf of the Harvard Combined Orthopaedic Residency Program and the institutions we represent, I want each of you to know that we are proud of the role you play in ensuring the continued excellence of Harvard Orthopaedics.

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