James H. Herndon, MD, MBA

Chairman's Corner: Introduction

I began my remarks last year in this Residency Program Director’s Corner with “changes continue in the Harvard Combined Orthopaedic Residency Program”. Well – today, just as last year, changes continue in the Harvard Combined Orthopaedic Residency Program. We had our successful Residency Review Committee’s site visit in April and were approved to expand our Program to 12 residents each year from 10, bringing our total number of residents to 60. The reason necessitating the return to our previous level of twelve residents a year was essentially because of the 80 hour work rule, which has forced us to install a night float rotation at the Massachusetts General Hospital and the Brigham and Women’s Hospital. The night float system obviously removes a resident from a specialty clinical rotation during the time he or she functions as a night float. In addition, Dr. Gebhardt has been very successful in recruiting young and enthusiastic academic faculty at the Beth Israel-Deaconess Medical Center and we, the Executive Committee and residents, developed a plan to return residents to BIDMC. In fact, on Saturday, March 12, the Executive Committee, representatives of each class of residents and junior faculty from each of the main teaching hospitals met to consider the necessary clinical rotations to accommodate these new additional residents as well as return to the BIDMC. Our educational principles and goals were as follows:

  1. Develop a mandatory introduction to research (rotation) within the residency program.
  2. Develop an elective rotation, if possible.
  3. Return residents to the BIDMC (resulting total: one each in PGY 2, 3, 4 and 5, and four PGY 1’s).
  4. Increase our residents’ foot and ankle experience.
  5. Increase our residents’ spine experience
  6. Provide junior and senior resident rotations on all clinical services.
  7. Attempt to provide longer services; that is, 10 weeks, which are more desirable than the 4-5 weeks rotations.
  8. Structure the fifth year to include the clinical services that allow the residents as much surgical independence and patient responsibility as possible.

A two-month introduction to research (rotation) will begin in the PGY 4 year by 2006. The purpose of the research rotation is to provide an introduction to research as well as allow protected time for residents to complete their thesis research project. Each resident is still required to present a thesis at the end of the PGY 5 year before graduation. Some theses are about clinical issues, others involve basic science. Many of our residents have a basic science background, have already worked in some Harvard laboratories and usually complete a project in those laboratories. Others, with an interest in basic science, can start a project early in the residency program with one of our scientists in any of the four major teaching hospitals. Importantly, this two-month research block will ensure that residents receive an introduction to the scientific method, learn how to formulate a hypothesis, introduce them to laboratory methods and types of clinical research as well as the importance of clinical trials and outcomes research. We want them to learn how to determine sample size and understand power analysis to help them with both design and analysis of studies as well as to critically evaluate orthopaedic literature. We have asked our research faculty to develop a series of seminars and lectures during this rotation and supervise an orthopaedic research journal club. Our Executive Committee wants our residents to appreciate basic and clinical research and be able to critically evaluate the orthopaedic literature. Our residents are very excited about having this opportunity free of clinical obligations to devote to their research efforts. The faculty and Executive Committee are looking forward to this rotation to help further educate the residents concerning the critical evaluation of orthopaedic basic and clinical research in orthopaedic literature.

We continue to expand our evaluation of residents regarding the six new core competencies mandated by the ACGME with a 360-degree evaluation of all residents. Residents will begin to evaluate their peers as well. We will continue to ask for, in addition to the faculty, evaluations by nurses and patients themselves about our residents’ performance. In the next few months, the virtual reality arthroscopic knee simulator provided by the American Academy of Orthopaedic Surgeons will be in place (with Dinesh Patel’s oversight) for a pilot project to evaluate our residents’ performance with the simulator. It has obvious important implications not only as an educational tool, but also as an examination device.

Saturday morning breakfast with the Program Director continues. The section entitled the “Business of Orthopaedics” has resumed this year. To date, we have discussed the following issues:

  • Medicare formula and payments
  • Practice management systems
  • Contract negotiations
  • Billing terminology
  • Outsourcing
  • Fraud Issues
  • E/M Guidelines
  • CPT/ICD-9 codes and modifiers

The most recent topic was Financial Planning (provided by the Massachusetts Medical Society.) The session was greatly appreciated by all our residents. It provided insightful information about investing for their future. Chris Chiodo also provided a CORE session on coding and participated in the Saturday Breakfast meetings with a lecture on “alternate rev-enue streams.”

Another change this year: We are combining Graduation and Thesis days. On Friday, June 17, we will honor our gradu-ating residents with our traditional dinner and ceremonies which will also conclude our annual Osgood lecture and Thesis Day. The Executive Committee and I would especially like to welcome any and all alumni to return for this day’s activities. It would be wonderful if, in the future, we could combine this with a Saturday program allowing our alumni to present papers. Of course we would include some sporting activities as well and possibly enjoy a Saturday evening dinner with the faculty, residents and alumni.

This year many of the graduating residents have received awards. Brandon Earp received a resident/fellow research award from the OREF for work entitled “The Correlation of Muscle Imbalance with MRI Imaging in Children with Brachial Plexus Birth Palsy.” Reuben Gobezie received the MGH Physician Scientist Award for “Proteomic Analysis of Osteoarthritic Joints” and a Zimmer Holdings Inc/OREF Orthopaedic Career Development Award for his work: “Determining Biomarkers for Osteoarthritis Using Proteomics Technology.” David Cashen received the AOA/OREF Zimmer Resident Leadership Forum award and will attend the Resident Leadership Forum at the Annual AOA meeting in California. Kevin Bozic, Class of 1999, who is now on the faculty at the University of California in San Francisco has been selected as a North American Traveling Fellow this fall. You may get a chance to see him as he travels around the United States on this fellowship. David Ring (MGH), class of 1998, and Sig Berven (UCSF), class of 1998, have also been selected for this year’s prestigious ABC Traveling Fellowship. This year’s Marmor Award for the overall Outstanding Performance by a Resident on the In Training Exam for four years was won by Chris Forthman. Congratulations to all.

This year is the first time residents who have participated in the “Surgical Loupe Program” have been in practice for a year. As agreed, each resident pledged to pay back the initial cost for his or her loupes. I am asking everyone who has received these loupes and has been in practice for a year to please reimburse the residency program through Diane Sheehan. We need this money to purchase loupes for our new residents. Now that the initial seed funding has been completed the program will be self-sustaining as long as residents who have graduated and in practice return the initial cost for their loupes. The program has been very successful and I thank the Executive Committee for supporting the start up costs.

Conrad Wang will be rejoining the residency in July after a two-year leave of absence to complete his MBA at the Harvard Business School. He now faces the tough decision whether to remain in medicine or pursue a new career in the venture capital world. Either way, we wish him success as we do all our graduates.

Last month one of our recent graduates – Brent Ponce – was deployed to Iraq. We wish him a speedy and safe return home.

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