C. Howard Hatcher, MD, FAOA

C. Howard Hatcher, MD, FAOA
Honored as an AOA Pillar of the Orthopaedic Profession

C. Howard Hatcher, MD, FAOA is being recognized as an AOA Pillar of the Orthopaedic Profession for his leadership, mentoring, and lifelong contributions to orthopaedic surgery during his distinguished career. The champion for this effort on his behalf is Michael A. Simon, MD, FAOA.

Bio

Cly Howard Hatcher’s life began and ended on the West Coast. He was born in Porterville, California, on January 13th, 1900. He served as a medical corpsman in World War I from 1918 to 1919, and attended the University of California, Berkeley from 1920 to 1924. As part of his medical school education, he completed internships at the US Naval Hospital in San Diego and at the Southern Pacific Hospital in San Francisco, graduating with an MD degree from the University of California, San Francisco, in 1929. During medical school, he married Annabel Clark, a lifelong companion with whom he would have three children. After a long and illustrious career at the University of Chicago (1930-61) and Stanford University (1961-80), Hatcher died in California in 1982.

In 1930, Hatcher began his journey as a teacher of orthopaedic surgery: he accepted a position as the first resident in the new Surgery residency program at the University of Chicago. Hatcher found a remarkable mentor in Dallas B. Phemister (1882-1951), the University’s first Chair of Surgery.

In 1933, Hatcher completed his residency. Following in Phemister’s footsteps a quarter of a century earlier, Hatcher travelled to Vienna to embark on postgraduate work in pathology under Jakob Erdheim. As the head of the Institute of Pathology at Vienna’s Municipal Hospital, Erdheim was a prolific researcher and educator who trained future surgeons from around the world. At that time, Vienna’s public hospital system treated patients from an ethnically and socioeconomically diverse populace, and, in exchange for free healthcare, the numerous bodies of deceased poor patients were given to doctors like Erdheim, who would perform autopsies for the purposes of teaching and research in medicine. Such access to cadavers were unparalleled elsewhere in the early 20th century, and Vienna became a global center for medical training, particularly in pathological anatomy.

When Hatcher returned to Chicago as an Instructor in 1933, he carried with him a legacy of Erdheim’s teaching: Hatcher held a firm belief in the fundamental relevance of pathology to orthopedics. These convictions are not as firmly held among modem-day orthopaedic surgeons, but they were prevalent in Hatcher’s time. In the 1930s through the 1950s, surgeons did their own pathology: unlike modem-day surgeons, surgeons at that time did not regularly send tissue samples for separate analysis by a pathologist. During this time, while physiology was prominent in the medical education of non-surgeons, surgical pathology played a major role in the education of future surgeons. Under Hatcher, for instance, orthopaedic surgery residents regularly attended autopsies that allowed them to collect tissue samples for pathological analysis.

With these resources at his command, Hatcher was able to provide his residents with a depth of exposure to musculoskeletal pathology at the histologic and organ level that was rivaled by very few, if any, other programs in the country. In particular, Hatcher’s research and education enabled advances in the field of musculoskeletal oncology, which continues to be a research focus among orthopaedic surgeons at the University of Chicago.

An important part of Hatcher’s legacy is his pedagogy. In teaching his residents, Hatcher disliked any form of formal lecturing, which was predominant in medical education until the 1970s. Hatcher did not practice such a didactic method of teaching, and he did not narrate the entirety of a problem as a pre-packaged lecture. Instead, Hatcher encouraged residents to become independent and active learners. On a regular basis, he asked residents to articulate their visual observations by correlating what they see under a microscope, what they see on an X-ray, and what they see a on a macro-section, which is a large slide made from a whole bone sample. Before the advent of CT scans and MRIs, these visual aids are indispensable to those who study bone pathology. These large slides, in particular, allowed them to see what is inside a human bone, which, particularly at that time, is no small feat. On Friday afternoons, Hatcher would gather his residents in his office, and encouraged them to learn for themselves by correlating what they see on these visual materials.

During these Friday afternoon sessions, Hatcher himself would bring some paperwork to work on. He would ask residents to describe what they see on a macro section, which is projected onto a wall next to an X-Ray. Instead of giving ready-made answers, however, he would allow residents to talk and collaborate among themselves. The setting was informal, with long silences as residents studied the slides and contemplated what to say.

Afterwards, as they drank bourbon and other spirits together, Hatcher and his residents gradually overcame an initially overpowering silence. With the help of these slides and the conversations that followed, they began to know each other as fellow learners of orthopedic medicine. Through Hatcher’s unique pedagogy, residents became researchers, and later on, teachers of other residents too.

Following Hatcher’s teaching philosophy, many of his residents became educators as well. Out of 31 residents who worked under Hatcher between 1933 and 1961 at the University of Chicago, 16 became academic surgeons and 9 became department chairs. (See chart)

Thus, Hatcher’s time was marked by the establishment of a rigorous pedagogy that became successful in teaching teachers of orthopaedic surgeons.

Hatcher’s time at the University of Chicago, nevertheless, came with some personal sacrifices. Because of the University’s budgetary priorities at that time, Hatcher and other faculty members were not well-paid, and his residents remarked that his lifestyle was remarkably frugal. At one point, his residents even bought him a car. These factors are likely to have influenced his decision to move to Stanford University, where he became the first chair of the Department of Orthopaedic Surgery.

Hatcher, like many other faculty members, chose to embark on a teaching career – a pathway that often did not result in financial returns, but one that created a legacy of dedication towards orthopaedic medicine as a practice of both healing and scientific learning.

He developed his signature pedagogy in basic science education, which educated residents to rigorously analyze clinical, radiological, and pathological correlations in each case. Through this pedagogy, Hatcher taught four residents who later became co-founders of the Musculoskeletal Tumor Society (MSTS): William Enneking, Crawford J. Campbell, Eugene R. Mindell, and Michael Bonfiglio. Owing to Hatcher’s strong emphasis in basic science education, these four figures developed a collective expertise in the bone pathology of tumors as well as in non-tumor conditions of the bone. Although almost four decades have passed since Hatcher’s death in 1982, the MSTS continues to preserve his educational legacy through an academic fellowship. In 1986, the Howard Hatcher Travelling Fellowship was initiated under the auspices of the American Orthopaedic Association (AOA) by William Enneking, Michael Bonfiglio, and Eugene Mindell – all of whom were accomplished academics who completed their residency under Hatcher. Beginning in 2007, the AOA transferred the administration of the Hatcher fellowship to the MSTS. Through its financial endowment and its global scope, the Howard Hatcher Fellowship continues to enrich the educational experiences of aspiring leaders in the field of orthopaedic oncology.

In summary, Hatcher was the architect of the pedagogical lineage (William Enneking, Michael Simon, Terrance Peabody, and Rex Haydon) in graduate medical education and academic leadership that has spanned almost one hundred years.

The AOA gratefully acknowledges Dr. Hatcher’s extensive and comprehensive impact on the orthopaedic community and recognizes him as an AOA Pillar of the Orthopaedic Profession. 

For a list of those who contributed to this Pillar honor, please click here.

If you are interested in becoming a Champion for an AOA Pillar of the Orthopaedic Profession, you can find more information here.

Entire listing of AOA Pillars of the Orthopaedic Profession can be found here.