Letter to the Editor

Branding Osteopathic Orthopedic Education

As you are all well aware, we are in a crisis of sorts with the Single Accreditation System agreed to by the ACGME, AOA and AACOM. This Single Accreditation System is essentially mandating that DO ortho programs are structured the same as MD ortho programs. I say that we need to identify our brand as osteopathic orthopedic educators and work towards that goal.

These are my thoughts on the subject. I believe that our brand is that we produce a very well rounded general orthopedic surgeon who is ready to go into the community and practice general orthopedics. This is contra distinction to the MD model in which most residents do a fellowship whether it’s due to the need for increased operative exposure or because their brand requires sub-specialization. This paradigm difference does not mean one program is superior to the other, it just means that goals of education are different (not better or worse).

I would really like to see our leaders continue to express this sentiment when dealing with the ACGME. This idea of general orthopedics allows our residents early operative exposure, confidence in their clinical decision making and judgment, and backed up by good evidence based didactics as required by all AOAO programs.

As to the 800-pound gorilla in the room…research. Here are my thoughts. Research is a valuable tool but not the hill to die on in my opinion.  Basic science research is very hard to perform when one is in a community hospital setting or is not paid a stipend for research time or administrative time. This is just a reality of how our programs are structured. Research however is important to the resident because it teaches them to think through a complex problem and articulate their possible solution through an organized research algorithm; it also helps them to become familiar with other research as related to that topic when they formulate their bibliography.

And finally, the brass ring is a published article with a PMID that is so important nowadays to the RC and to fellowship applications. Having said all this, most DO orthopedic surgeons are not going to pursue a career in research or high level academic medicine (where there is a publish or perish mentality). This is not a bad thing; it is just the state of who we are. Residents that are so inclined to academics usually can find venues to help them garner high level research and to my knowledge most DO residents that want a fellowship usually end up matching. So, other than the technical exercise of research I am not sure how vitally important it is to the day to day functioning of a community orthopedic surgeon.

Finally, one of the other major issues with the ACGME evaluation with our program is “proper paperwork” and “policy and procedures”. To generate the volume of paperwork needed program directors need dedicated academic time free of clinical responsibility. In addition, dedicated office staff such as a full-time program coordinator is vital to this process as well. It is incumbent upon the sponsoring institutions to supply program directors with a salary to offset loss of clinical revenue and supplement the FTE’s needed to run a program. This requires money and commitment and should be spelled out in the orthopedic budget that is reviewed yearly with administration and the program director.

While research may be the “BIG” stumbling block currently, I worry that monetary commitment and institutional support may be our biggest hurdle to clear in the future.

Marc Trzeciak, DO
Program Director
Valley Orthopedic Surgery Residency of Modesto

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