Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Douglas Lundy, MD, MBA, (00:24):
Welcome
to the AOA Future in
Orthopaedic Surgery podcastseries.
This AOA podcast series willfocus on the future in
orthopaedic surgery and theimpact on leaders in our
profession.
These podcasts will focus onthe vast spectrum of change that
will occur as the futurereveals itself, reveals itself.
We will consider changes asthey occur in the domains of
(00:44):
culture, employment, technology,scope of practice,
compensation, and other areas.
My name is Doug Lundy, host forthis podcast series.
Joining us today, we have twodistinguished guests.
First is Dr.
Tessa Balach is Professor andVice Chair of Education of the
(01:04):
Department of OrthopaedicSurgery and Rehabilitative
Medicine at the University ofChicago, specializing in
musculoskeletal oncology.
She is the Associate ChiefMedical Officer of the clinical
learning environment.
She went to college at theUniversity of Chicago, went to
medical school at the New YorkMedical College and returned to
do her residency and fellowshipat the University of Chicago.
She was a Leadership Fellow ofthe AAOS from 2018 to 2019, a
(01:33):
practice enhancement travelingfellow with the Ruth Jackson
Orthopaedic Society in 2014, andis the past chair of the
American OrthopaedicAssociation's Council of
Orthopaedic Residency Directors(CORD).
Also joining us today is Dr.
Trent Guthrie.
Dr.
Guthrie is Assistant Professorof Orthopaedic Surgery at Henry
Ford Health in Detroit, Michigan, where he serves as the Program
Director of the OrthopaedicSurgery Residency Program.
He went to medical school atthe University of Texas
(01:55):
Southwestern, did residency atWayne State University and his
fellowship in orthopaedic traumaat the Combined Twin Cities
Orthopaedic Trauma Fellowship inMinneapolis, Minnesota.
Dr.
Guthrie is the current chair ofthe Council of Orthopaedic
Residency Directors and I'mhappy to have another trauma
surgeon on the podcast with meas well.
So, Tessa and Trent, welcome tothe podcast.
(02:37):
Thank you.
Thanks for having us.
Trent, you're currently runningthe show and Tessa, you were
doing it right before Trent, soboth of you guys have a
tremendous amount of insightinto this.
But first we have a CORDConference coming up right.
Trent Guthrie, MD, FAOA (02:51):
Right.
So we have worked over the pastyear to create a freestanding
CORD Conference.
You may recall, in the past wewere at the AAOS meeting for a
couple hours in a basementsomewhere, but now we have moved
separate from the Academy andthat has allowed us to have a
little bit more of aneducational program to provide
(03:15):
for our members and also hasallowed us to collaborate more
with ARCOS, which is theassociation of program
coordinators.
S o we had some greatconversation last year, some
great collaboration between thecoordinators and the program
directors and had a fantasticmeeting in Nashville in February
.
This year coming up, which willbe 26 in February, we'll be
(03:38):
down in Jacksonville, Florida,which will be hopefully a little
bit nicer weather thanNashville in February, and we're
really looking forward to againcollaborating with ARCOS and
having a great meeting there.
Douglas Lundy, MD, MBA, FAOA (03:49):
I
did my fellowship in Nashville
but I'm not sure I ever steppedoutside because, like you, in a
trauma fellowship you don'treally get to go out.
I'm sure oncology is the sameright, Tessa?
Tessa Balach, MD, FAOA (03:59):
Pretty
similar.
Douglas Lundy, MD, MBA, FAOA (04:01):
So
we, kind of the three of us,
are kind of assuming everybodyknows what CORD is about.
Tessa, can you tell us whatCORD is to the folks that may
not know what CORD is?
Tessa Balach, MD, FAOA (04:26):
It is a
group comprised of, obviously,
residency program directors,associate program directors.
We have been welcoming ourmedical student, clerkship or
rotation directors, as well asfellowship directors in all
specialties.
The goal of the group is notonly to provide some education
for people who are leadingeducational programs in
orthopaedic surgery, but tobring us together to talk about
new ideas, best practices,what's up and coming and build
(04:49):
some camaraderie and build anetwork of support as we and our
individual programs arenavigating this.
And, I think, one of my mostfavorite things about CORD is
our meetings, both at the annualmeeting with the AOA and our
winter meeting.
And, as Trent mentioned, thereally nice thing about the new
format for the winter meeting iswe have more time to spend
(05:09):
together, to talk, to dive intowhat we as educators are all
really passionate about.
So there are subgroups andsubcommittees within CORD.
So if you are a CORD memberitching to get involved, there's
opportunities to do that on abigger level.
Douglas Lundy, MD, MBA, FAO (05:25):
And
Trent, do you have any specific
agenda items or anything thatis going to come up in this
court conference that couldtickle somebody's fancy on that?
Trent Guthrie, MD, FAOA (05:30):
Well, I
think that we are always trying
to create an agenda thatappeals to everyone throughout
the audience.
I think we have some seasonedprogram directors who have a
pretty good understanding ofwhat it's all about, but they
need some updates on some of thenew best practices.
What's new in education, andparticularly competency-based
(05:51):
education and that's a biggertheme that we may get into a
little bit later is we're seeinga transition from more
time-based education to morecompetency-based education as we
move forward over the next fewyears, or few decades even, and
we're really trying to weavethat into all of our sessions.
In addition, we're also tryingto appeal to new program
(06:14):
directors, associate programdirectors, who are aspiring to
move up in the ranks, and reallyteach them some kind of nuts
and bolts of how to run aresidency program.
The administration of medicaleducation is its own language in
and of itself.
There are a lot ofadministrative details through
the ACGME and through our ABOSand other organizations that you
(06:39):
really need to try and get ontothat learning curve early so
that by the time you become afull program director you can
really hit the ground running.
So our meeting coming up inFebruary Dr.
Milo Sewards is our programchair for the meeting.
He has a great agenda puttogether.
In addition to some of thosenuts and bolts talks, he's
working through an agenda ofwhat happens when things don't
(07:02):
go according to plan.
So we're trying to weave inkind of some topics like that
into all of our meetings so thatagain we can appeal to the
entire audience.
Douglas Lundy, MD, MB (07:13):
Beautiful
.
Yeah, I'd love to get into somecompetency-based discussion in
a minute, but first let's talkabout the future of CORD.
So, Tessa, let me have youstart off with before you became
CORD Chair.
Where did you see the changesand the direction of CORD before
you became Chair, and thenthrough your time, and then
(07:34):
Trent, can you take it fromthere, launching into the future
, and both you guys, whateveryour thoughts are on that.
So, Tessa, if you want to startoff and then Trent will pick it
up from there, so, Tessa, ifyou want to start off, and then
Trent, I'll pick it up fromthere.
Tessa Balach, MD, FAOA (07:47):
Sure, I
started my tenure as the CORD
Chair in 2021.
(08:35):
We started to make someconnections during my time in
the leadership space with ourmedical student directors.
We thought really pointedlyabout sort of that transition
from undergraduate to graduatemedical education in regard to
the application process, theadvising we're doing for
students and leading themthrough that, and then, as I
(08:57):
finished my time in the role andpassed things to Trent, we
wanted to think even morepurposefully about how we are
engaging fellowship directors.
I think there's a tremendousopportunity to support the work
that they are doing in that lastpiece of graduate medical
education before those traineesstep into practice.
There's a lot changing in theaccreditation space in the as
(09:20):
Trent alluded to earlier, thecompetency-based medical
education space that you know,when you're a fellowship
director for one fellow a yearor two fellows a year, you might
feel like you're on an island,and so I think creating a space
where we can support fellowshipdirectors across the specialties
has been the newest addition tokind of the scope of offerings
(09:43):
that CORD brings to theorthopaedic education community.
And I'll let Trent take off onthat, because we launched a new
Fellowship Directors Forum thisyear that I'll let him share a
little bit more about.
Trent Guthrie, MD, FAOA (09:58):
I would
agree that I think it's been a
little bit myopic, if you takethe 30,000-foot view of
residency education and justeducation in general.
I think our goal as educatorsis to train the next generation
of orthopaedic surgeons right,and again, it's a little bit
myopic to say that five yearswhen they're in their residency
(10:18):
is all that we should befocusing on.
And so I think that, rightly so, over Tessa's tenure, and
hopefully through mine andbeyond, we're going to start to
reach out into medical schoolsand beyond, into fellowships and
even perhaps beyond that.
But I think that we really needto be focused more on that
(10:41):
whole continuity, the wholespectrum from early learner
through resident and topracticing surgeon.
And so, yes, we had a fantasticFellowship Director's Forum this
year.
Dr.
Felicity Fishman helped tospearhead that.
We had some great sessions onkind of remediating fellows as
(11:01):
they're in there just one yearof fellowship, what does that
look like?
And also trying to have someconversation with program
directors.
The residency level how do webetter prepare our residents to
be successful fellows movingforward, and then fellowship
directors how can they preparetheir fellows to be successful
surgeons beyond that?
So I think the theme thathopefully you're hearing is that
(11:22):
, yes, we all wear programdirector hats, but we all are
looking beyond those walls andtrying to affect change
throughout the years ofeducation for our future
surgeons.
Douglas Lundy, MD, MBA, (11:34):
That's
fantastic.
The AOA is all about thedevelopment of leadership in
orthopaedic surgeons.
Trent Guthrie, MD, FAOA (11:58):
Could
both of y'all, Trent let's start
off with you this time kind ofgive your personal gleanings of
what your involvement in CORDearly on as an Associate Program
Director and sitting at thetable with some icons in
education.
I remember my very first CORDmeeting, I was at a small group
session sitting next to Anne VanHeest and she just welcomed me
right into that table as acomplete peer and we had some
(12:20):
great conversations aboutleadership and residency
education and I'll alwaysremember that one.
But I think getting moreinvolved in CORD over the years
I think has also been a greatleadership journey, I think you
know I give great credit toTessa for the work that she did,
putting together severalworking groups during her time
(12:40):
to try and solve some of thereal crucial problems that we
were seeing in residencyeducation.
At the time I had the greathonor to chair a working group
on preference signaling and wedid some work there to affect
some change in orthopaedics andreally be leaders in that space
nationally.
With regards to the otherspecialties out there and that's
(13:03):
another podcast in and ofitself to dive into that.
But you know, being able tolead a small working group as
someone who was just aninterested member in CORD and to
be selected and to be able toaffect some change there.
I think was a tremendousopportunity and I think that's
just one small example of theopportunities that are available
(13:23):
for anyone who's interested andwilling to put in the time and
effort to lead.
Tessa Balach, MD, FAOA (13:30):
I think
one of the things I've loved the
most about my time in the AOAand court is that it hits on two
things I love a lot, which iseducation.
I share this with a lot ofpeople.
I come from educators, notphysicians being able to take
advantages of opportunities tofoster my own sort of leadership
journey but also, as I've movedforward on mine right, bring
(14:04):
others along onto that path andhelp them develop those skills
to be leaders in theirinstitutions, in the AOA, in
court, etc.
And so court and the AOA hasbeen a great opportunity for me
to do a lot of that.
I've been given opportunitiesto serve on national committees.
I was on the Milestones 2.0committee thanks to being in
(14:27):
CORD.
I've sat at the ABOS rightthanks to my role in CORD and in
.
As Trent mentioned, when I wasthe CORD chair, I did put these
working groups together.
I knew that the ambitions I hadto examine all the pieces of
the residency recruitmentprocess was going to be
impossible for me to tackle onmy own, but a great opportunity
(14:48):
to increase member engagement,and we created nine working
groups.
Each one had a chair.
Trent was one of them.
There are lots of others whohave been able to step into that
and then that has boosted theirengagement in the group and on
the committee.
So that was really fun for menot only to you know, in the
years I've been a member notonly of CORD but of the AOA to
foster my own leadership butthat of others, and that's
(15:10):
probably the educator in meright that thinks about helping
others succeed and realize allof their potential.
So it's really one of myfavorite places to be.
Douglas Lundy, MD, MBA, FAO (15:56):
The
big thing in the room is the
competency-based education.
I heard Larry Marsh and AnneVan Heest and folks talk about
this extensively at the ABOSmeeting you see the other
members of the carousel thereand at the symposium that we did
year before last it spoke up onthe resident unions.
They were talking extensivelyof how residencies are run in
these other countries.
So we're not the first ones tofigure out this competency-based
stuff.
So can y'all define whatcompetency-based training is
about, where it's going and whatare the pitfalls and the
(16:18):
benefits of that as we moveforward?
Tessa Balach, MD, FAOA (16:36):
is
focused on getting our learner
to the point of competency right, and hopefully even a little
bit beyond that, and using thoseas markers for completion of a
program, as opposed to simplytime.
Those of us who cook and bakeknow that sometimes that steak
needs a little more time on thegrill to be the perfect
temperature, and I think thesame goes for learners, and for
those of us who have spent timein education whether it's a year
(16:59):
or two year or decades knowthat people learn at different
rates, have different skill sets, have different strengths, have
different areas that they needa little more attention on, and
competency-based medicaleducation helps to do that on a
more individualized, thoughtfulbasis, as opposed to if you stay
here for five years, you'regoing to be, you're going to be
ready to go and that stake isgoing to be perfect.
(17:20):
But we know that that's not,that's not the case, and and so
the.
That is it, I think, in its, inits, at its core.
And so what's been?
What we've been seeing, notonly in orthopaedics but across
graduate medical education andall of the specialties, is this
move towards competency basededucation and development of
(17:41):
tools and processes to help usbe successful in implementing
that, because it's a huge shiftin how we sort of assess,
measure, write and moveresidents along in our current
world as opposed to that of acompetency-based medical
education world.
Trent Guthrie, MD, FAOA (17:57):
Yeah, I
agree.
I think that this is such abroad topic and becomes a little
bit nebulous and people starthaving conversations and realize
that they're not even in thesame space.
And I think if you take a stepback and realize what our
ultimate goal is, we're tryingto create orthopaedic surgeons
who are competent to move intoindependent practice.
(18:20):
If you have your ABOS hat on oryou have your program director
hat on or you're a consumer inthe real world trying to figure
out, is this surgeon able to dowhat they say they can, you know
we're all trying to hit at thesame thing and that's competency
.
And there are a number ofdifferent ways to measure
(18:43):
competency and we've seen thatacross a number of different
specialties and, more broadly, anumber of different countries.
You said that before, Doug thata lot of different countries
Canada, Australia, UK, a lot ofplaces are ahead of us on this.
I would say they're just in adifferent place and you know, if
you talk to a lot of the peopleyou know, particularly in
(19:06):
Canada, Toronto did a fantasticjob.
They had a huge pilot in themid-2000s trying to create a
competency-based curriculum andtraining program and it worked
fairly well.
But at the end of the day, theycame to some of the same
decisions that, yes, some peopleare ready a little bit earlier,
some take a little bit moretime years to kind of get
(19:34):
through what we need to getthrough in order to learn what
we need to learn from a medicalknowledge standpoint, from a
surgical skills standpoint and aclinical decision-making.
There just is a certainexperiential component to all of
it.
So, yes, we can break it downinto very discrete can you do a
carpal tunnel release on cadaver?
Can you do a carpal tunnelrelease on cadaver?
And we can come up with somecheck boxes and make sure that
(19:57):
people can check all those boxes, but does that mean that
they're ready to care forpatients with carpal tunnel
syndrome out in the real world?
I'm not sure, and that's wherethe complexity comes in of being
able to create curriculum andassessment scheme and then
ultimately, a determination ofcompetency.
So it's a monumental task and Icredit everybody who's come
(20:24):
before us and done a tremendousamount of work to get us where
we are In terms of leadership.
I think that, looking at otherspecialties, I feel very
fortunate with all the work thathas been done in our specialty
before, that we're in a prettygood place.
Compared to other specialties.
I feel like we're fairly welladvanced just in terms of having
assessment tools and having afairly discrete curriculum
(20:47):
that's been developed over theyears.
So I think that you know we'llcontinue to grow and we'll
continue to work towards that.
I think ultimately it's betterfor our surgeons in the future,
it's better for the public andyou know it's.
There's a lot that goes into itclearly.
Douglas Lundy, MD, MBA, FAOA (21:02):
I
appreciate that and I was
thinking when I was thinking ofthe Canadian experience that I
had with it.
It was because just recently Iwas in the airport with Emil
Schemitsch for probably aboutthree hours and we were chatting
through this stuff the airportwith Emil Schemitsch for
probably about three hours, whenwe were chatting through this
stuff.
And one thing that came up as Iwas talking with Emil is I'm
like how do you so you cutsomebody short six months, so
they're done in four months,four years and six months, or
(21:23):
you run them longer.
Now it's five years and sixmonths.
How does that work withfellowships?
Does that mess everything up?
And I don't want to quote mealout of context, but he was
suggesting that you would eithercut a year off or add a year on
to your residency.
What are your thoughts on that?
Because I'm going to togglesome bumps in the road.
Tessa Balach, MD, FAOA (21:42):
And that
, as Trent mentioned, how
monumental this all is.
Those are the pieces that Ithink we as an orthopaedic
education community are stilltrying to figure out.
(22:03):
I think about that in my ownresidency as I use some of the
assessment tools that have beenprovided to us by the board.
You know, how do we manage thisgoing forward if someone needs
to change the pace in thesetting of 20 other residents
who might be on a morepredictable schedule.
I don't have an answer for thatyet, but I think you've nicely
(22:26):
pointed out one of thechallenges.
But I think the benefit ofunderstanding who needs help,
where they need help and how wecan get them to that finish line
successfully in someone whomight be struggling is really
important for me, because Ithink we lacked some of that
ability with clarity and as muchobjectivity as possible, which
(22:50):
is always a hard thing.
But I feel like I have a bettersense of where my residents are
on their path towardsgraduation with some of these
assessment tools than I did fiveand 10 years ago.
Trent Guthrie, MD, FAOA (23:01):
Yeah, I
think that's a great point In
my mind, if I look into thefuture as best I can and see
where we're headed, I think thatwe're headed to a place, just
like Tessa said, where we canmore accurately and earlier
diagnose someone who may befalling off of that curve and be
(23:22):
able to intervene earlier andget them to where they need to
be with the right resources, asopposed to somebody else who may
finish early, quote, unquote.
I think that you know wherethey're going to end up is
they're going to be a fantasticsurgeon at the end of their
training, right?
They're going to be competentmaybe a few months early, but
they're going to use that extrafew months to be an even better
(23:44):
surgeon in the long run, ormaybe become a clinician
educator or clinician scientist,and I think that there should
(24:21):
be room for all of that.
I think another big issue to mewith the rollout or and not all
of them are going to be able toscale to do something like
Toronto did I remember talkingto one of the surgeons in
Toronto about, well, whathappens if somebody finishes a
rotation early?
Well then, that blows up theircall schedule.
They have to float fellows intocover and that isn't a problem
(24:46):
at Toronto, where they have 50or 60 fellows and can do
something like that.
But if you do that to a two orthree resident a year community
program, I think that that'scertainly going to cause some
disruption and above and beyondthat, I think, have to have some
significant changes in how wefund and how we manage graduate
medical education education.
Douglas Lundy, MD, MBA, FAO (25:35):
Now
, at the AOA meeting this year
we had a symposium on earlysubspecialization in residence.
So, for instance, if I know Iwant to do trauma surgery, then
I can finish all my core things,make sure I have my minimums,
but I'm never going to do carpaltunnels, never going to scope
knees again, so why don't I justgo into the trauma suite and
work with the trauma surgeonsthe rest of my residency?
Is that another way of doingcompetency-based, where you're
(25:59):
clearly checked out on theminimums and the competency and
everything outside of yourchosen area of specialty.
So for the remainder of yourresidency you can just knock in
total choice or do tumors orfractures or sports or whatever.
How about that?
Trent Guthrie, MD, FAOA (26:16):
I have
some very strong feelings about
this and I may show my gray hairhere, but I think that
residency education should be.
Your residency year should beto learn to be a general
orthopaedic surgeon, traumasurgeon, on a tumor service.
(26:42):
I am working all over the bodyand I'm seeing approaches that
I've never seen before and I'mjust getting a much better sense
of my surgical skills and myboundaries as a surgeon when I'm
not doing the thing that I'mgoing to do the rest of my
career.
You said I don't need to do anymore carpal tunnels.
Well, guess what?
Like two weeks ago, I did acarpal tunnel on a patient that
had a blasted distal radius andhad an acute carpal tunnel
(27:03):
syndrome.
So I mean, you never know whenyou're going to need those
general orthopaedic skills as apracticing surgeon.
So I don't think that you canget enough general orthopaedic
surgery training during thoseresidency years to then be able
to say you know what, I'm good,I'm going to go and just do my
(27:26):
thing.
So I don't know.
I know there was some dissentin the room, but that's where I
fell out.
Tessa Balach, MD, FAOA (27:33):
I'm
similarly on the side of.
I think residency training is tobecome a well-rounded,
competent, general orthopaedicsurgeon.
But balanced and well-rounded, Ithink, is the key to it, and
part of the ACGME minimums andguidelines from the ABOS about
how resident experiences shouldbe shaped guide us towards that
(27:55):
in our programs.
You know, back in the day whenwe had the blue bar graphs and
my residents were doing far toomany spine cases and not enough
sports cases, we knew thatneeded to be rebalanced so that
they could come out and havethat foundational knowledge in
all of the subspecialties oforthopaedic surgery to be a
great spine surgeon or to be agreat tumor surgeon or
(28:18):
traumatologist.
I firmly believe that I am abetter orthopaedic oncologist
because I was first a competent,well-rounded orthopaedic
surgeon.
Because when then people cometo my office, I can understand
whether they have an oncologiccondition or something that's
non-oncologic and still generalorthopaedic, playing into their
(28:40):
pain, their symptoms, whateverthey're struggling with.
And I worry that if we get toosubspecialized too soon we will
lose that and probably not beable to care for our patients as
well as they should be caredfor.
Douglas Lundy, MD, MBA, FAOA (28:53):
If
y'all remember my last slide in
my presentation during thatsymposium should you specialize
or not?
The answer was yes.
Tessa Balach, MD, FAOA (29:03):
I like
that a lot.
I like that last slide.
Douglas Lundy, MD, MBA, FAOA (29:06):
I
remember it kind of decreased a
little of the tension that Trentwas talking about in there.
All right, let's talk aboutanything else that's going to
change in residency education.
So y'all can look out as far asyou can see.
Look all the way to the horizon.
What does it look at now?
Having prefaced that the babyboomers are getting older?
However, I think I read recentlythat the millennials are the
(29:29):
largest generation ever in thehistory of the planet.
Yet simultaneously with that,in the United States, the
graduating the seniors in highschool right now is the largest
class of high school seniorsthat the United States has ever
seen and will ever see, becausethe population is decreasing
(29:53):
after that.
So after this year, we willgraduate less high school
students every year.
I know you guys working atthose big universities focus on
this, because the kids that aregoing to start enrolling in
their bachelor's degrees whenthey come out of high school is
going to go down year after year.
So, with all these demographicshifts out there, what does
(30:14):
residency training and theeducation of orthopaedic
surgeons look as far as you cansee?
Let's start with you, Tessa.
Tessa Balach, MD, FAOA (30:22):
I think
one of the biggest things is
adopting to all of thetechnology that is coming into
the world, coming into medicineand coming into orthopaedics.
We see that medical studentsand residents learn really
differently than we learn.
There are no textbooks anymoreon anyone's shelf.
I mean I had multiplefive-volume textbooks on my
(30:45):
shelves and I would read thebook and highlight and do all
those things, and so people areacquiring knowledge differently.
We look and are able to searchfor information differently.
We can search the literature inways that are faster, easier
than ever before and you know,even on day-to-day things in the
hospital, residents do thingsreally differently than we did.
(31:06):
There are no more paper orders,you're not handwriting things,
you don't have to memorize dosesof medications.
Make sure that we are stillsupporting the acquisition of
foundational knowledge andskills while adapting to living
in this faster-paced space wherethere's more technology and
more knowledge.
(31:27):
I think is going to be reallyinteresting.
The CORD meetings for the lastyear had a focus on AI.
Certainly our summer meeting wetalked a lot about that.
I think understanding how thatcan be helpful to us from an
assessment tool, from creatingdashboards to helping us
understand where our learnersare in the trajectory of their
(31:49):
path towards residencygraduation, how we can safely
use AI to support learning,right, I mean, there are good
ways to use it to find and haveinformation at your fingertips.
So I think that's the thing Ithink about a lot as I look
towards the future.
The foundations of you stillhave to learn how to hold the
(32:12):
knife and retract and doneurovascular dissections, and
put a plate and screws on and doa nail.
That stuff is going to lookpretty similar.
Sure, technology in theoperating room is changing, but
I think at a slightly differentpace than what's happening
outside of the operating room.
Trent Guthrie, MD, FAOA (32:28):
Yeah, I
think one of the big take-home
points that I got from all theAI sessions that we had at the
past few meetings was thatsurgeons are not going to be
replaced by AI.
Surgeons are going to bereplaced by surgeons who are
able to use AI and othertechnologies, and I think that
that's something we see ineducation too.
There's a really interestingtalk by Dr.
(32:49):
Moore at this summer meetingabout using artificial
intelligence to help withresident education.
To really be able to take adeep dive and give a resident
some learning assignments, havethem work through learning
assignments, take an assessmentat the end, based off of that
assessment, then that can helpto drive okay what's the next
(33:10):
learning module that thistrainee needs and that is
adaptable, based on whatrotation you're on, what PGY
year you're currently in, andyou know.
That can, I think, create amuch more efficient landscape
for us in residency educationmoving forward.
But I don't want to step too faraway from it because I do think
(33:30):
that technology is going tocontinue to advance and I might
disagree with Tessa a little bit.
I do think that at some point arobot's going to be able to put
in a plate and screws betterthan I can, but the one thing
that we always need to becompetent in is patient care,
communication, having ethicalphysicians at the bedside.
(33:53):
I think that those are thingsthat are very difficult to AI
away from us, and so I think,more than anything, those are
the skills that we need todouble down on those
professional behaviors and, aswe move forward into more of a
technologically based specialty.
Douglas Lundy, MD, MBA, FAOA (34:13):
We
get a little controversial here
maybe.
How do you see the futurerolling out in the development
of our workforce in terms oflooking more like the
demographics that we serve?
These are not easy lifts.
I mean just we've been able todo that here in our program at
this place.
But how do you see the futureregards in terms of us
developing a workforce moreconsistent with the population
(34:44):
that we care of?
Trent Guthrie, MD, FAOA (34:46):
Well, I
think certainly, the literature
is crystal clear that having aworkforce that closely resembles
your population is able toprovide better care for that
population, and so I think, ifwe always have that as our North
Star, I don't think there's anycontroversy here.
Douglas Lundy, MD, MBA, FAOA (35:02):
So
as we talked about a little bit
earlier, the demographicchanges in the country are such
that this year's high schoolgraduating class is the biggest
class that we'll ever see, andso there'll be less kids going
through high school, less peoplegoing into college and then
medical school and residencyafter that, which are going to
have to take care of theworkforce from here.
So there's a certain amount ofgenerational interest in that.
(35:25):
Now, how we look at thegenerations we train really
varies.
Some people think that, oh mygosh, the millennials and the
alphas are the worst ever.
They don't do anything right,they're always so lazy compared
to us, and all this.
On the other hand, I personallydon't see that when I look at
our residents, they work just ashard, have just as much care,
(35:45):
just as much compassion, just asmuch ethic as I ever remembered
when I was in training.
What are your thoughts on thegenerational issues as we move
forward in terms of residencytraining, Trent, why don't you
start?
Trent Guthrie, MD, FAOA (35:58):
Yeah, I
agree.
I think it's.
Generational issues is always atopic that comes up at symposia
over the years and I've neverreally found a lot of traction
in that.
I think that, yeah, we can tryto stereotype certain people in
certain generations, but at theend of the day we're dealing
with a bunch of individuals.
And to your point, Doug, Ithink that if we go through a
(36:21):
selection process and get highlysuccessful individuals who are
highly motivated to becomeorthopaedic surgeons, I think
that a lot of those generationaldifferences that you read about
on Wikipedia just don't playout.
Tessa Balach, MD, FAOA (36:34):
So you
know, that's obviously one
person's opinion, but I haven'treally seen that bear out over
my years of training theirapproach, their education
(37:02):
approach, the acquisition ofknowledge, I think from a work
ethic, gritty, want to be there,want to stay late, want to get
there early, want to take greatcare of patients.
That doesn't seem to havechanged.
We select for that in ourrecruitment processes.
We want people who share thesame values around hard work and
patient care and ethics that weall have in orthopaedic surgery
(37:23):
, as academic surgeons, ascommunity surgeons.
And so, to agree with Trent, Ithink some of those differences
that we may see in other partsof the world, the generational
differences we may see in otherparts of the world, are blunted
a little bit in orthopaedicsurgery.
They certainly learndifferently and that's something
that I've had to adjust to, butthat is.
(37:45):
That's just technology andtimes, and I'm happy that they
share the again, the work ethicand the values that that I did
as a resident.
Douglas Lundy, MD, MBA, FA (37:54):
This
has been a very interesting
discussion with the past cordchair and the current cord chair
in terms of where the future inorthopaedic surgery is going in
terms of residency, educationand all the complexities and
issues associated with that, aswe continue to build our
workforce and as we, as leaders,are going to lead that next
(38:14):
generation into taking care ofus as we get older.
So, Dr.
Balach and Dr Guthrie, thankyou so much for being on the
podcast.
Tessa Balach, MD, FAOA (38:23):
Thanks
so much for having us.
Trent Guthrie, MD, FAOA (38:24):
Thanks
for having us.
I think that that's a fantasticsegue into our next summer CORD
meeting in 2026, which will bein Albuquerque.
Douglas Lundy, MD, MBA, FAO (38:34):
The
theme there is shaping
tomorrow's orthopaedic workforce, so that dovetails nicely in
our last conversation, so I hopey'all will take advantage of
that and go visit these finefolks at the CORT conference and
continue to develop ourleadership in orthopaedics, and
I look forward to seeing y'allagain on another podcast in this
channel series.
Thank you.