On-Demand Symposia

Symposium: Medical Student Musculoskeletal Education - Addressing the Long-Standing Deficit

Moderator: Tessa Balach, MD, FAOA: The University of Chicago

Panelists: 

  • Peter V. Scoles, MD, FAOA: Thomas Jefferson University
  • Adam S. Levin, MD, FAOA: Johns Hopkins University
  • Brian P. Scannell, MD, FAOA: Carolinas Medical Center – Atrium Health
  • Shepard R. Hurwitz, MD, FAOA: University of North Carolina

Objectives: 

  1. Understand the critical need for medical student educational resources including basic information for students entering Orthopaedic residency
  2. Explain how the OrthoACCESS Curriculum framework meets this educational need
  3. Describe the development of a medical student musculoskeletal education platform patterned after JBJS Clinical Classroom for knowledge acquisition and assessment
  4. Understand the medical student competencies that allow for a smooth transition to residency.

Summary: Students spend a significant portion of their fourth year of medical school engaged in orthopaedic clinical rotations both at and away from their home institution. Often, during three to four months on these rotations, there are little to no didactic or skills sessions formally directed toward medical students which has revealed an opportunity to teach the foundations of orthopaedic surgery to these medical students.

Program directors and faculty want students entering orthopaedic residencies to have an understanding of the fundamentals of orthopaedic surgery; we expect them to be able to achieve Level 1 on all ACGME milestones. Whether or not our students achieve these milestones is unknown. OrthoACCESS has set out to begin to address this educational deficiency with a standardized curriculum for all fourth-year medical students interested in orthopaedic surgery. Tying this to the JBJS Clinical Classroom medical student section will further help students achieve their educational goals and improve their preparedness for residency.

Looking beyond medical students, there is an opportunity to extend these educational opportunities, tools and experiences to advance practice providers such as physician’s assistants to ensure access to high-quality foundational educational materials in orthopaedic surgery.

We will take time during this symposium to identify opportunities to improve the musculoskeletal education our students receive during their fourth year of medical school, understand how improvements in these opportunities improve preparedness for residency and look at the expansion of these resources beyond medical students.

Symposium: A Departmental Approach To Addressing Racism

Moderator: Michael T. Archdeacon, MD, MSE, FAOA: University of Cincinnati

Panelists: 

  • Jaysson T. Brooks, MD: University of Mississippi
  • Tonya L. Dixon, MD: University of Cincinnati Medical Center
  • Bonnie Simpson Mason, MD: Nth Dimensions & ACGME

Objectives: 

  1. Acknowledge the existence of systemic racism in orthopaedic surgery
  2. Develop and apply a proactive plan for combating racism in your department /practice
  3. Understand the value and success of pipeline programs

Summary: This AOA socioeconomic symposium highlights a systemic problem in medicine and more specifically orthopaedic surgery—racism. Although an uncomfortable topic, the panel will make the compelling argument that an organized approach to both acknowledging and addressing racism in orthopaedic surgery has the highest potential to counteract its negative impact on patient care, education, and recruiting/retention of diverse students, residents, and faculty.

Orthopaedic surgery continues to be one of the least diverse specialties in medicine. In order to eradicate racism in orthopaedic surgery, the panel strongly supports an approach that focuses on acknowledging the existence of systemic racism in orthopaedic surgery, implementing a proactive plan to combat racism, and developing proven “pipeline” programs. Given that the majority of orthopaedic surgeons are white males, it is imperative that the “majority” be willing to listen and learn from peers and colleagues of color.

Symposium: Providing Orthopaedic Care to Vulnerably Underserved Patients

Moderator: Fred G. Corley, MD, FAOA: University of Texas HSC

Panelists: 

  • James M. Saucedo, MD, MBA: Houston Methodist Hospital
  • Christina Brady, MD: University of Texas Health –  San Antonio
  • Ryan Rose, MD: University of Texas Health –  San Antonio

Objectives: 

  1. Understand social determinants of health and how it can affect our patient population
  2. Understand policy surrounding care for patients, including how the Affordable Care Act (ACA) impacted care for underserved patients, the importance of safety net hospitals, and discuss future directions within orthopaedic health care policy
  3. Discuss initiatives and strategies to incorporate caring for the underserved patient, while still growing your practice

Summary:

The vulnerable patient is defined by an increased risk of poor health secondary to poor social determinants of health and includes uninsured as well as under-insured patient populations. When addressing the disparities and barriers these patients encounter, we need to consider the associated burdens of cost, access to care, and quality of care. Although the ACA has expanded the number of insured patients through Medicaid, a significant number of patients remain outside its reach; undocumented immigrants remain a particularly vulnerable population.

Safety net hospitals have been—and will continue to be—the main source of care for our indigent population. Efforts to improve their sustainability will be paramount, especially as funding becomes more restricted. In addition to governmental funding, private organizations and charity organizations continue to care for a large portion of at-risk patients. They can also provide a successful model for other institutions to follow. Surgeons can incorporate best practices to help care for indigent patients, and an effective place to start is by focusing on lowering costs and in effect, “passing” some of those cost-savings to the patient, such as through in-office procedures. Other strategies include improving patient communication (especially those with limited health literacy) to help identify and overcome certain barriers to care, as well as an awareness of the available resources through charity, safety net institutions, and local networks of providers who share a desire to share the care of this population.

Finally, we have learned that mission-driven organizations tend to be most successful in serving their constituents. Articulating a clear mission and committing to finding ways to accomplish it often lead to better results—even when the challenges seem insurmountable, and the funding seems to dry up. Caring for the indigent, then, requires first that we commit to it. Once we have done that, we can each find ways to play our part, which may take on a variety of forms depending on each of our situations.

Symposium: How to Advance Your Leadership and Career Trajectory in Orthopaedics

Moderator: Julie Samora, MD, PhD, MPH, FAOA: Nationwide Children’s Hospital The Ohio State University College of Medicine
Panelists:
  • Gregory A. Brown, MD, PhD, FAOA: CHI St. Alexius Health Williston ND
  • Kristy L. Weber, MD, FAOA: University of Pennsylvania
  • Denis R. Clohisy, MD, FAOA: University of Minnesota Hospital
Objectives:
  1. Participants will be able to distinguish between coaching and mentoring.
  2. Attendees will acquire an understanding of the role of coaching to develop leadership skills, enhance competencies in negotiation and conflict management, and determine individual strengths and opportunities.
  3. Participants will learn skills to drive performance and interpersonal communication, which they can incorporate into their careers.
Summary:

Coaching can improve career satisfaction, foster resilience, enhance leadership potential, combat threats to success, and has the potential to transform a leader from good to great.

A brief coaching role play related to a common negotiation or conflict management scenario will begin the symposium. An introduction of the presenters and respective topics will highlight coaching  styles, uses, and potential outcomes.

Symposium: Does Value Based Care Threaten Access for Vulnerable Patient Populations?

Moderator: Charles L. Nelson MD, FAOA: Penn Orthopaedics
Panelists:
  • Mary I. O’Connor, MD, FAOA: Vori Health
  • Kevin J. Bozic, MD, MBA FAOA: The University of Texas At Austin Dell Medical School
  • Said Ibrahim, MD – Senior Associate Dean of Diversity and Inclusion: Weill Cornell Medicine
Objectives:
  1. Discuss the current and developing value-based care initiatives relevant to orthopaedic surgery, as well as documented successes in promoting improved value (quality/cost)
  2. Review potential unintended consequences related to various forms of value-based health care initiatives and the threats to access for vulnerable patient populations (minorities, rural communities, patients with lower socioeconomic status, less social support or challenging living situations, etc)
  3. What strategies can we implement now to assure that access is not only maintained, but improved with value-based care changes?
Summary:

The growing movement towards value-based care (VBC) has significant implications for all health systems. This symposium offers an overview on the current state of VBC, focusing on programs relevant to orthopaedic surgeons—voluntary- and mandatory-bundled care programs (BPCI), Medicare Hospital Readmissions Reduction Program (HRRP), etc—as well as recent changes in health care reform (removal of TKA and THA from the inpatient only list), and its impacts on patient access.

In 2020, the AOA presented a symposium on how VBC will impact large academic hospital systems and training of orthopaedic residents and fellows; this 2021 symposium will continue the discussion.  How can VBC lead to an erosion of patient access due to some of the proposed changes in care? How will VBC need to be adjusted for more video/virtual care approaches with the recent effects of the COVID-19 pandemic?

Symposium: Diversity and Inclusion in Orthopaedic Surgery from Medical School to Practice

Co-Moderators:
  • Antonia F. Chen, MD, MBA, FAOA: Massachusetts General Hospital/Brigham and Women’s Hospital/Harvard Medical School
  • Colm J. McCarthy, MD: Brigham and Women’s Hospital
Panelists: 
  • George Dyer, MD, FAOA: Massachusetts General Hospital/Brigham and Women’s Hospital/Harvard Medical School
  • Anthony E. Johnson, MD, FACS, FAOA, The University of Texas At Austin Dell Medical School
Objectives: 
  1. Provide participants with a better understanding of how to start recruitment, advocacy, and wellness in a practical way regarding diversity within orthopaedic departments.
  2. Provide experiences with pitfalls and successes in implementing increased diversity and inclusion within orthopaedic departments.
  3. Provide participants with information on how to maintain and grow diversity and inclusion within their orthopaedic departments.
Specific Learning Objectives:
  1. Discuss and introduce approaches and methods for grassroot early pipeline recruitment of diverse individuals.
  2. Provide participants with insight into how to best serve as an ally to provide support to diverse candidates in a meaningful way.
  3. Understand and appreciate the hurdles to recruitment as well as retention for these excellent candidates.
  4. Discuss and educate individuals on the role of allyship and how to make room for others to succeed.
Summary:

Orthopaedic surgery remains one of the least diverse fields in medicine. This is additionally impressive given the dramatic increases in diversity within medical schools. While it has become generally accepted that increased diversity benefits the field, this change cannot occur overnight. The road to diversity within orthopaedics must start with early recruitment and inclusion. Residency has become the gatekeeper of diversity within our field, as there are only 6.5% female membership of the AAOS and 12.6% of AAOS membership not identifying as Caucasian. In order to meaningfully increase diversity, a ten-year plan must be implemented to engage in medical student, resident, and faculty recruitment. This symposium will discuss how to improve diversity within orthopaedics from early undergraduate and medical student recruitment to faculty positions as well as allyship in a meaningful way.

Changes within orthopaedic surgery regarding diversity and inclusion are, by definition, slow moving. Cultural change is limited by acceptance of these changes by those in decision-making positions, as well as the 5-year delay of changing residency populations.

In order to change diversity in a meaningful way, we should strive to emulate institutions and individuals who have successfully managed to diversify their residency and faculty and identify groups of individuals who need greater representation in our field. Allyship is only useful if those we are trying to advocate for are helped by it.

In this symposium, we look to several surgeons who have helped build a more diverse faculty and residency program and hear firsthand from them how to build such a program, how to support our colleagues, and how to be better allies.

Symposium: Effectiveness of Deficit Recovery Strategies for the Orthopaedic Service Line

Moderator: Charles S. Day, MD, MBA, FAOA: Henry Ford Health System
Panelists:
  • Lisa L. Lattanza, MD, FAOA: Yale School of Medicine
  • Charles A. Goldfarb, MD, FAOA: Washington University School of Medicine
  • L. Scott Levin, MD, FACS, FAOA: Penn Medicine
Objectives: 
  1. Understanding the overall financial impact of the COVID-19 pandemic at 4 different orthopaedic surgery departments.
  2. Understanding at least 4 different strategies for deficit recovery for an orthopaedic service line.
  3. Acknowledging specific barriers to deficit recovery in the health care system.
Summary:

Orthopaedic service lines and departments were greatly affected financially by the COVID-19 pandemic as many of their clinical operations were deemed nonessential. Thus, departmental leadership were left to devise strategies to recover as much of its deficit for the remainder of the year.

Four orthopaedic surgery leaders from four different health centers (Yale School of Medicine in Connecticut, Henry Ford Health System in Michigan, Penn Medicine in Pennsylvania, and Washington University School of Medicine in St. Louis) implemented unique strategies in order to recoup their accrued 2020 fiscal year deficit in orthopaedic surgery. While financial recovery strategies may be more pertinent presently due to the pandemic and ensuing lockdown, these general deficit reduction strategies may apply to any orthopaedic service line aiming to increase revenue and engage patients. The panelists will share their accrued deficit from the elective surgery shutdown, their strategies for financial recovery, the barriers that made recovery difficult, and ultimately how effective their strategies were at reducing their deficits through the end of 2020.

Symposium: Patient Reported Outcome Measures - Why Every Orthopaedic Department Should be Collecting Them

Moderator: Kurt P. Spindler, MD, FAOA: Cleveland Clinic 
Panelists: 
  • Eric Makhni, MD, MBA (Emerging Leader): Henry Ford Hospital/Wayne State University
  • Stephanie J. Muh, MD, FAOA: Henry Ford Health Systems
  • Judith F. Baumhauer, MS, MD, MPH, FAOA: University of Rochester 
Objectives: 
  1. How to successfully integrate PROM collection into daily clinical workflow, regardless of institutional or logistic barriers. 
  2. How PROMs can be incorporated into quality efforts across an orthopedic department or service line 
  3. Tips for successful collection and integration of PROMs for clinical research applications 
Summary:

Patient-reported outcome measures (PROMs) are validated questionnaires that quantitatively report health states from the patient’s perspective. These instruments are critical in not only measuring clinical outcomes, but also for conducting high-impact clinical research, assessing quality, and facilitating value-based healthcare. Despite this importance, most institutions and orthopedic departments struggle to integrate PROM collection into routine clinical care.

The purpose of this symposium is to highlight how orthopedic leaders can not only integrate PROM collection into clinical operations, but also how to leverage this collection for valuable healthcare initiatives. The panel will relate institutional examples of high-fidelity PROM collection and application towards research, quality, and value-based initiatives. The panel will also share operational tips on how to overcome roadblocks and barriers to successful workflow integration.

Department Leadership Forum: Building Tomorrow's Leaders

Panelists

  • Paul Dougherty, MD, FAOA
  • Jeffrey S. Fischgrund, MD
  • Mitchel B. Harris, MD, FAOA
  • Mary I. O’Connor, MD, FAOA

Department Chairs representing one of three types of organizations, institution, traditional academic department, and large health care group, fostered dialogue from the perspective of their department.

Discussion Points of Interest:

What is changing for musculoskeletal healthcare organizations?

  • How will the organizational structure differ for the future?
  • Will the traditional departments go to the “service line” or institute model, which incorporates a larger number of midlevels, physical therapy, physical medicine, and nonoperative orthopaedic surgeons

What is changing for education?

  • Use of simulation
  • More assessments

After completion of the session, participants will be familiar with:

  • Trends in the delivery of orthopaedics in different healthcare organizations
  • Changes in how future surgical education might be conducted for residents, fellows, and post-graduation

Sessions

AOA Opening Ceremony & Steele Lecturer

AOA Opening Ceremony & Howard Steele Keynote Lecture

Paul Barker, Director of Development and Community Activation, Motown Museum gives a presentation, entitled, “Motown Museum: The Inspirational Story Behind The Music and The Legacy.”

Presidential Address of Serena S. Hu, MD, FAOA: Leadership in Uncertain Times

Serena S. Hu, MD, FAOA installed as the 2021-2022 AOA President. She gives her address, entitled “Leadership in Uncertain Times.”

Presidential Keynote Speaker: Shannon Huffman Polson

Shannon Huffman Polson gave a talk called “The Grit Factor: Going for Grit in Times of Change” followed by a dynamic Q&A moderated by AOA First Past President, Theodore W. Parsons, III, MD, FACS, FAOA.