Journal Clubs

The Emerging Case for Shared Decision Making in Orthopaedics
Youm, Jiwon MS; Chenok, Kate MBA; Belkora, Jeff PhD; Chan, Vanessa MPH; Bozic, Kevin MD, MBA

Discussion points:

• The authors examine the concept of shared decision making as it applies to orthopaedic practice. Despite the established utility of this philosophy, as well as its relevance to orthopaedics, it has not been commonly adopted among orthopaedic surgeons. The idea of shared decision making has been refined since its inception in 1982, and is supported by decades of evidence suggesting improved outcomes and benefits.
• The authors of this 2013 Instructional Course Lecture discuss these potential benefits, as well as barriers to implementation of this ideology and methods of promoting its widespread adoption. The latter portion of the article details recent federal and statewide legislative initiatives incentivizing the adoption of shared decision making strategies in clinical practice.
• The article ends with a call-to-action for orthopaedic surgeons to lead this shift in clinical paradigm. This paper provides a comprehensive overview of a contemporary topic pertinent to all physicians, and particularly those in orthopaedics who may have been slower to adopt this important philosophy.

An Observational Study of Orthopaedic Abstracts and Subsequent Full-Text Publications
Bhandari, Mohit MD, MSc; Devereaux, P. J. MD; Guyatt, Gordon H. MD, MSc; Cook, Deborah J. MD, MSc; Swiontkowski, Marc F. MD; Sprague, Sheila BSc; Schemitsch, Emil H. MD

Discussion points:

• The authors investigate the quality and validity of information presented in orthopaedic research abstracts, which are commonly used as sources in major orthopaedic textbooks. By examining the quality and completeness of abstracts presented at the 1996 Annual Meeting of the American Academy of Orthopaedic Surgeons, Bhandari et al. identified factors predictive of the ultimate publication of a complete manuscript following abstract presentation.
• This study revealed that only one-third of abstracts were followed by publication of a full-text article. The authors go on to describe the many inconsistencies in primary outcome measures and results between the original abstracts and final publications.
• Methods that could be implemented to prevent these discrepancies are discussed in the latter portion of the article. By critically assessing the quality and validity of information published in major orthopaedic textbooks and used to guide orthopaedic practice, this article brings to light an issue highly relevant to all orthopaedic surgeons, and particularly those closely involved with research and education.

Measuring Patient Satisfaction in Orthopaedic Surgery
Graham, Brent MD, FRCSC; Green, Andrew MD; James, Michelle MD; Katz, Jeffrey MD; Swiontkowski, Marc MD

Discussion points:

• Clinical researchers have increasingly acknowledged the importance of understanding and documenting patient reported outcomes. Patient satisfaction has been identified as a component when reporting these outcomes. On the surface, this seems an easy task. The reality is that patient satisfaction is very complex. Patient satisfaction is dependent not only on the outcome of care, but on the process of the care. Multiple factors can influence whether patients are satisfied with their care.
• The authors go on to discuss some of the difficulties and discussions of whether patient satisfaction can be measured and if it is a valid measure of overall quality of care. Several examples of patient satisfaction measures are then discussed. The characteristics that make each of these examples reliable and valid are explored in detail.
• The last portion of the article discusses how and when patient satisfaction is important to be reported. The article provides a detailed and concise discussion of a topic most orthopaedic surgeons feel is relatively simple to understand, but when you truly dig deeper, the topic is complicated and often confusing.

Orthopaedic Surgeon Burnout: Diagnosis, Treatment, and Prevention
Daniels, Alan H. MD; DePasse, J. Mason MD; Kamal, Robin N. MD

Discussion points:

• Are you feeling emotionally exhausted? Do you have a cynical view around the workplace? Do you have a perceived lack of personal accomplishment? If so, you may be experiencing occupational burnout. But you aren’t alone. The rate of burnout symptoms in practicing surgeons, academic leaders, and trainees has been reported to be as high as 40% to 60%.
• Burnout can lead to adverse outcomes for surgeons and residents. Symptoms of burnout can lead to a reduced quality of life and interfere with personal relationships at home and at work. The emotional toll can lead to physical exhaustion and affect judgement and decision making skills. Ultimately, it may lead to depression, substance abuse, and physical illness. All these can lead to poor performance and medical error.
• Prevention and treatment of burnout is a challenge with minimal interventions described. Some interventions include didactic sessions and mindfulness based training programs. Prevention programs that include meditation, making time for exercise, and spending quality time with a spouse can also decrease burnout.

Mentorship in Orthopaedic Surgery—Road Map to Success for the Mentor and the Mentee
Levine, William N. MD; Braman, Jonathan P. MD; Gelberman, Richard H. MD; Black, Kevin P. MD

Discussion points:

• One factor shown to decrease the risk of burnout, particularly in academic surgeons, is simply having a mentor.
• The relationship of the mentor and mentee differs based on the level of the mentee’s responsibilities as a resident, fellow, or attending physician.
• This article describes the conditions and responsibilities of each of the participants in the mentor/mentee relationship.