Lessons in Orthopaedic Leadership: An AOA Podcast

Curious about how the future of orthopaedic surgery scholarly publications is shaping up? This episode features a deep dive with Marc F. Swiontkowski, MD, FAOA who provides an authoritative look at the challenges and opportunities facing the field. From the unintended consequences of open access mandates leading to a surge in subpar journals and paper mills, to the crucial rise in retracted manuscripts due to poor peer review, Dr. Swiontkowski explores every avenue. Also covered is the role of hybrid open access models and the complexities surrounding preprint servers, especially in the wake of the COVID-19 pandemic. This is an unmissable conversation that underscores the need for rigorous peer review and global cooperation to maintain the integrity of orthopaedic research.
 
In another compelling segment, the pitfalls and limitations of using large clinical databases and registries in medical research is assessed. Learn how missing data and skewed populations can skew your conclusions and why it’s crucial to approach these resources with a critical eye. The misuse of statistical methods by some researchers to chase positive associations without a clear research question, and how this can dilute scientific rigor is also discussed. Finally, how academic journals may inflate their impact factors and the transformative—and sometimes troubling—role of AI in academic publishing is explored. This episode is packed with invaluable insights for anyone vested in the future of orthopaedic surgery research and publications.

Unlock the future of orthopaedic residency training as Dr. Douglas W. Lundy sits down with Dr. J. Lawrence Marsh, a leading voice in the field and chair of the Department of Orthopedic Surgery at the University of Iowa Hospitals and Clinics. Dr. Marsh shares a treasure trove of insights on the paradigm shift from a time-based to a competency-based education system, already gaining momentum in countries like Canada, Australia, and the UK. Listen to Dr. Marsh's firsthand experience and wisdom on what these changes mean for the next generation of orthopaedic residents in the US and how they are set to revolutionize medical training.

Discover the intriguing challenges of granting more independence to exceptionally skilled surgical residents and how this can widen the competency gap between them and their peers. We explore the logistical and operational hurdles in transitioning to a competency-based training system and why a well-defined curriculum is critical. Organizations like the ACGME and orthopaedic boards are taking significant steps to implement this new framework, and we discuss the delicate balance needed to integrate competency-based attributes within the traditional time-based structure.

Stay ahead of the curve with the latest advancements in residency training, particularly through practice-based assessments and real-time evaluations using mobile technology. These innovations promise to significantly enhance skill acquisition and feedback, generating vast amounts of data to improve training standards. From basic models to cutting-edge VR simulations, we delve into the essential role of technology in preparing residents for complex surgical tasks. Finally, we contemplate the external forces driving rapid transformation in medical education, emphasizing the urgency for change within the next three years. Join us for an enlightening conversation that promises to reshape the future of orthopaedic education.

How is artificial intelligence revolutionizing orthopaedic surgery, and what can big data teach us about improving patient outcomes across different healthcare systems? In our latest episode, we feature insights from Dr. Wayne Sebastianelli, a leading expert in orthopaedics, as he discusses the transformative role of AI and big data in advancing orthopaedic care. Dr. Sebastianelli provides a comparative analysis of international big data registries, highlighting the differences between systems in the United Kingdom, New Zealand, and the United States, and the impact these systems have on patient care. We also explore the challenges of managing extensive data and the implications of different healthcare models on orthopaedic practices.
 
Leadership development and emotional intelligence are pivotal in ensuring the future success of orthopaedists. Listen as Dr. Sebastianelli shares his vision on balancing manpower and honing leadership skills within the field of orthopaedics. We dive into the collaborative efforts of the AOA, AAOS, and ABOS in addressing key issues like compensation and advocacy while emphasizing the critical role of AI in reducing administrative burdens. Dr. Sebastianelli's rich experiences and leadership roles offer valuable perspectives on preparing the next generation of practitioners. Join us for an enlightening conversation that celebrates Dr. Sebastianelli's contributions and looks ahead to the evolving landscape of orthopedic surgery.

Douglas W. Lundy, MD, MBA, FAOA, interviewed Jim Barber, MD who is an accomplished orthopaedic surgeon who practices in Douglas, Georgia. Dr. Barber shares his compelling journey, the various leadership roles he has embraced, and his experiences enriching a close-knit community despite the geographical limitations of a small town. His story illuminates the challenges and rewards of rural healthcare, showing how one dedicated individual can make a significant impact both locally and nationally.
 
Drs. Lundy and Barber tackle the evolving landscape of rural solo private practice, touching on the mounting pressures from insurance companies, the complexities of electronic medical records, and the growing need for larger teams. Dr. Barber offers his thoughts on state support programs, value-based care, and the pressures of consolidation, while reflecting on the changing dynamics of physician collegiality and scope of practice. Through innovative collaboration with local hospitals and Medicare shared savings programs, various pathways are explored for sustainability and the importance of staying positive and proactive in this challenging environment.

Aaron Brandt, MD, spoke with Anthony Catanzano, MD, a Pediatric Spine and Neuromuscular Surgeon at Duke University, and Erin Honcharuk, MD, a Pediatric Deformity Surgeon at Johns Hopkins University, to discuss the Board Certification Process and their methods for preparation.

While the boards can be a stressful process, all three orthopaedic surgeons emphasized that the examiners want to make sure that you are practicing safe medicine. Drs. Brandt, Honcharuk, and Catanzano highlighted the importance of using proper documentation, redacting all identifying data, and thoroughly reviewing the ABOS guidelines. Using proper documentation will set you and your patient up for future success. Throughout the conversation, they share valuable insights and personal stories about how mentors and colleagues played pivotal roles in their board preparation. Tune in for essential tips and advice to help you navigate this challenging process with confidence. 

Douglas W. Lundy, MD, MBA, FAOA, interviewed Karl Koenig, MD, FAOA, Executive Director and Adult Reconstruction Surgeon at Musculoskeletal Institute for the University of Texas at Austin, to discuss Shifts in Medicare. 

Dr. Koenig touched on the different views for Medicare shifting payment systems and managing budget issues. While America has spent large amounts of money on healthcare, Dr. Koenig believes the payment system needs to be adjusted to improve patient outcomes. It is discussed how Medicare is trying to move in a different direction by creating relationships between the specialists and Accountable Care Organizations (ACOs), so they can work together and achieve the same goals. Drs. Lundy and Koenig transitioned to a discussion on bundle payments; and explained the pros and cons for both physicians and patients. Overall, Dr. Koenig stated there are different views on Medicare, but the goal is to have the surgeons’ incentives be more aligned with the patients, to give them the best care possible.  

Alexander Aleem, MD, FAOA, interviewed Dr. Danny P. Goel, CEO of PrecisionOS, who currently practices in Vancouver, B.C. and is a Clinical Professor in the Department of Orthopedic Surgery at the University of British Columbia, to discuss the role of virtual reality training and surgical simulation in orthopaedics.

Virtual Reality (VR) training is impacting orthopaedics for both residents and educators. The ease of access and affordability of virtual reality education allows residents to practice and be better prepared in the OR, while also allowing the educators to assess the resident’s performance and teach them the best habits and actions to operate at the highest level. While typical training methods give haptic feedback to residents, virtual reality allows both haptic and real data feedback to assess competency. In addition to the different types of feedback that VR provides, it also can help foster mentorship both live or on demand, which helps promote a synchronous learning experience for the mentor and mentee. Dr. Goel expresses his excitement and optimism about the future role that VR and AI will play in the world of orthopaedics to provide the best training to future orthopaedic surgeons.

Dr. Aaron Brandt sat down with James R. Ficke, MD, FACS, FAOA, Department Chair of Johns Hopkins, and Joseph R. Hsu, MD, FAOA, Trauma and Deformity Surgeon at Carolinas Medical Center in Atrium Health in Charlotte, to discuss meaningful mentorship during early career. 

This conversation focuses on what they believe led them on a path to success, and how they have gotten the most out of both experiences – being a mentor and as a mentee. Their discussion communicates the importance of honesty and vulnerability when making relationships, and how this gives both parties the ability to trust one another. Throughout their chat, Drs. Brandt, Ficke, and Hsu, share numerous stories on how their relationships began, and the ways they were able to capitalize on being their genuine selves.  

Douglas W. Lundy, MD, MBA, FAOA, discussed generational shifts and worldview changes in orthopaedics with Lisa Lattanza, MD, FAOA, Chair of Department of Orthopaedics and Rehabilitation at Yale School of Medicine. 

Dr. Lattanza sees a lot of similarities between the residents of today, and those during her time of residency. Although there are generational differences in technology and practices, there are many positive changes that allow orthopaedic surgeons to become competent and successful in their practice. Young faculty prefers to have a culture that supports their professional and personal lives, allowing them to develop their leadership skills and become a working member of society. 

Some of the major differences between generations are the faster adaptation to technology and the increased effort to support diversity amongst the orthopaedic profession. Both factors allow for orthopaedic surgeons to become better poised to solve issues in medicine, use more forward thinking, and expand their leadership to a more inclusive culture. 

Douglas W. Lundy, MD, MBA, FAOA, spoke with Scott Porter, MD, FAOA, Orthopaedic Oncologist and Vice Chair of Operations in the Department of Orthopaedics at Prisma Health, Greenville, South Carolina, to discuss how changes in compensation will affect access to patient care in the future. 

Throughout the discussion, the concepts of rationing healthcare, bundling, and the future of compensation models are evaluated. Dr. Porter explains that compensation affects physician behavior which directly impacts access to patient care. The limitation or creation of access to patient care is created by the physician, while rationing healthcare is only due to overconsumption.

Dr. Porter describes his ideal situation for future patient care, which involves a way to fund a healthcare account owned by the patient. This can be used as a means to pay for healthcare in the future, which can also be gifted and transferred to others. 

In conclusion, Dr. Porter states that it is not a matter of whether changes in compensation will affect access to patient care, but how it will influence access.