Chairman's Corner
Introduction
I am pleased to welcome you to the fifth issue of the
Orthopaedic Journal 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, Don Bae, MD. They have worked very
hard to produce this publication and deserve everyone's gratitude.
Please make sure to let them know this the next time you
see them or send an email. I would also like to acknowledge
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.
This year, as many of you know. I have the privilege of
serving as President of the American Academy of Orthopaedic
Surgeons. The position brings a great responsibility in these
difficult times for medicine in general and our specialty in
particular, but it also brings great joy and satisfaction to me at
the same time. Patient safety will be the major thrust of my
efforts this year. Our Board of Directors will be devoting their
entire Spring Workshop to this issue. I address the problem at
each local, state and regional meeting I attend, along with other
important issues facing orthopaedic surgeons. Number one of
this list is professional liability reform, followed by declining
Medicare reimbursements and regulatory issues – HIPAA,
EMTALA and many others.
I am happy to hear from any of you about your concerns
and any issues that you feel are important. If you have suggestions
for improvement or change please let me know. I am
available as President of the AAOS to every member.
First, I would like to recognize two special award winners
from last year's Graduation Dinner. Dr. Don Bae received both
the Leonard Marmor Award for academic excellence in the OITE
examinations, and the William Thomas Award. This double
recognition is a fitting acknowledgement of Dr. Bae's accomplishments
as a resident and potential as a practicing surgeon.
I would also like to acknowledge Dr. Mark Vrahas as the winner
of the Golden Apple Award for outstanding teaching in our
program, chosen by our residents. I applaud Dr. Vrahas for his
outstanding teaching and contributions to our program.
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.
Information about the new HIPAA regulations and patient
safety has been added to the Core Curriculum. A new session
on physician/patient communication has also been added.
This year's speaker will be Dr. Gary Friedlander, Chair of the
Department of Orthopaedic Surgery at Yale.
The Journal Club continues to be an important conference
for resident education. Drs. James Heckman and Robert Poss
continue to be tremendous mentors to the Club and its participants.
Plans are currently underway to use the OREF award
received last year to bring in guest speakers and to provide
resources for residents in the areas of study design, biostatistics
and clinical epidemiology. I would to thank Jim O'Holleran,
MD, for his leadership of Journal Club earlier this year and the
current leadership of Pearce McCarty, MD. Their time commitment
to this activity is much appreciated.
With regard to resident recruitment, I am pleased to
announce that we had our most successful match to date this
past March. Our incoming PGY-1 residents are listed in the
adjacent box. I want to thank the residents for their efforts in
making this a successful recruiting year. In particular, I would
like to thank Renn Crichlow, MD, for his special efforts in this
regard. As part of our ongoing efforts to showcase the residency
program and improve information for prospective applicants,
an impressive new website has been developed. The site is
based on the Harvard server and linked to each of the participating
hospitals. In this way the program can be found by
those searching on the HMS web site, as well as those searching
the Hospital web sites. The address is www.hms.harvard.edu/
ortho. I would like to thank Robert O'Toole, MD, for his leadership
of this effort and all who helped make this possible. I
encourage each of you to visit the site. Please feel free to forward
any suggestions or comments for improvement.
Certainly one of our greatest challenges over the past
year has been the development of goals and objectives by
service that incorporate the general competency requirements
endorsed by the Accreditation Council for Graduate Medical
Education (ACGME) in 2001. The general competencies are in
the following areas:
- Patient Care
- Medical knowledge
- Practice-based learning and improvement
- Interpersonal and communication skills
- Professionalism
- 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."
Over the past year the chiefs and faculty of each service
have worked hard to develop curricula that provide clear goals
and objectives for each level of resident rotating on their service.
These curricula also include schedules for each resident
on the service, as well as clear statements about the lines of
responsibility between residents, fellows and attendings. With
few exceptions, we now have written a curriculum for each of
the subspecialty services at the BWH and MGH, as well as a
curriculum for the six-month pediatric orthopaedic rotation at
Children's Hospital. Over the coming year we will be getting
feedback from residents and working to refine these curricula
in advance of our RRC site visit in 2004.
An important part of the ACGME Outcome Project is the
requirement that programs develop evaluation tools that will
provide objective measure of residents' performance on the
general competencies. Toward this end, we have revised our
existing rotation evaluation forms and added several new forms
and approaches. One of the new approaches is a resident selfassessment,
asking residents to describe particular situations
they have faced in the past six-months. The types of situations
queried include shared decision-making, surgical decision-
making, end-of-life discussions, ethics and dealing with
personal limitations. Residents are being asked to respond
in writing to one of four questions and to come prepared to
discuss their response with me as part of their individual,
semi-annual evaluation meetings. I am pleased to report that
these discussions have been excellent, raising issues that before
now have not been addressed. A second new approach that
is being initiated is a 360-degree evaluation of each resident.
As a start, information will be gathered from nursing staff on
the floors and in the OR, as well as patients. The scope of this
evaluation will be expanded as the process proceeds. In addition,
each subspecialty service has been encouraged to include
evaluation strategies specific to their rotations. In particular,
each subspecialty service has been asked to develop a test
based on questions from the Orthopaedic In-Service Exam and
self-assessment exams. Residents will also be encouraged to
utilize self-assessment tools, e.g. JAAOS, OKO and OKUs made
available through the Academy of Orthopaedic Surgeons. Each
resident in the United States now receives a free subscription to
the JAAOS and OKO from the AAOS.
In addition to work on the curriculum, we are also in the
midst of dealing with the resident work hour issue at each of
the hospitals. As endorsed by the ACGME, residents can no
longer be involved in patient care the day after being on call in
the Hospital. The specific work hour requirements include:
- No more than 24 hours on duty.
- No more than 80 duty hours per week
- One day off each week.
- No more than every third night on call.
It is important to note that adherence to this rule is not at
the discretion of individual residents who might prefer to work
the next day. Our initial plan for dealing with this requirement
is to have a PGY-2 night float for in-house patient coverage and
the OR at the MGH and BWH; increase the number of physician
extenders and RNs; request to increase residents from the
RRC to 12 per year (our previous size). Children's has already
implemented a PGY-3 night float position. In addition, many
services will need to re-deploy the efforts of fellows and physician
extenders, where available. While we are hopeful that these
arrangements will be sufficient, we will be monitoring this situation
closely over the coming year.
Beginning in July 2003, the Harvard Orthopaedic residency
will no longer include a six-month chief residency. The
decision to eliminate the chief residency requirement from our
program reflects the strong preference of the younger residents
coming up who are anxious to start their fellowship programs
or pursue other educational opportunities. I want to commend
the Executive Committee for making this difficult decision.
Residency training is definitely long and almost all of our residents
take fellowships. This change will also allow us to provide
trauma care by specialists and not trainees.
I would like to provide you with a brief update on the search
that is underway at the Beth Israel Deaconess Medical Center
for a full-time Chief of Orthopaedic Surgery. Dr. Joseph Fisher,
Chief of the Department of Surgery at the BIDMC, is directing
the search. Drs. Kasser, Thornhill and I serve on the Search
Committee. As part of the search, the Hospital has committed
to re-establishing a Department of full-time faculty who are
committed to the educational mission, as well as research and
service. It is also clear that the new chief must move quickly
to recruit a chief of orthopaedic trauma. Because this process
is well underway with a clear commitment to establishing an
academic department of orthopaedic surgery, the Executive
Committee will be requesting an increase in residents.
Promotions and appointments across Harvard
Orthopaedics over the past year include:
Professor: Julie Glowacki, PhD, and Mark Gebhardt, MD
Assistant Professor: Tamara Martin, MD, Scott Martin, MD,
Phil Blazar, MD
In my role as Chairman of the Partners Department of
Orthopaedic Surgery, I would like to commend Tom Thornhill
and Harry Rubash on their leadership of orthopaedic surgery
at the Brigham and Women's and Massachusetts General
Hospitals. I direct you to their respective "Chief's Corners" for
an overview of the accomplishments of their Departments over
the past year. Both Departments underwent an external review
in February/March, organized by Harvard Medical School on
behalf of the Dean and the Hospital Presidents. The purpose
of the review was to assess the quality and vitality of the
Departments' programs with particular emphasis on the status
and accomplishments of their academic programs. The Medical
School invited six leaders in orthopaedic surgery from across
the country to participate in this process, three at each institution.
In addition to their review of an extensive written report
prepared by each Department, the reviewers met with the
Hospital leadership, the chiefs and a cross section of faculty and
residents. The reviewers' final reports are shared with the Dean
Martin and the hospital presidents. Insights and recommendations
will then be shared with each Chief. The initial results
from the reviewers were quite positive and complimentary.
In closing, I want to share with you my plans for the
coming year. As many of you may know, I will be stepping
down as Chairman of the Partners Department of Orthopaedic
Surgery effective at the end of 2003. However, I am pleased
to announce that I will continue as Program Director for the
Harvard Combined Orthopaedic Residency Program. Given our
need to fully comply with the ACGME requirements, request
additional residents and prepare for an RRC review next year,
I expect this to be a very challenging but productive year for
our Program. I look forward to continuing to work with our
Executive Committee, faculty and residents on resident education.
Congratulations and best wishes to our graduating residents
as they leave for fellowship training and practice. I would
also like to thank the chief residents 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.
Links of interest:
|
