It’s 9 o’clock at night…you’ve already missed your child’s basketball game and your spouse is not exactly pleased to be turning out the light without you—again. But alas, you are struggling with an uncooperative/troubled resident, in addition to trying to establish an appropriate method for assessing surgical competence. Then you discover CORD, the Council of Orthopaedic Residency Directors, a new resource that can, among other things, assist orthopedic leaders with best practices. Eureka.
Dr. Keith Kenter, the Chair of CORD who was on the task force that created the organization, describes this unique and uniquely valuable resource, “Along with several colleagues, I worked with the American Orthopaedic Association (AOA) to launch the Council of Orthopaedic Residency Directors. We meet twice a year, hold educational sessions, examine best practices, and exchange ideas about programmatic problems.”
It is easy for program directors, especially those who are inexperienced, to reach the point of feeling overwhelmed and helpless because they have ‘hit a wall’ and have no idea how to deal with a problem. CORD is a valuable resource that, with our online blog feature, is available 24 hours a day.
Dr. Terrance Peabody, Second President Elect of the American Orthopaedics Association and former Chair of the AOA Academic Leadership Committee adds, “We held the first CORD meeting nearly two years ago although planning had being going on for several years prior. The AOA was aiming to be a hub for academic orthopedists and a ‘home’ for those people who run residencies and fellowships. At the same time we weren’t connecting with some of the other orthopedic organizations; we had association with ARCOS (The Association of Residency Coordinators in Orthopaedic Surgery), but we did not have a formal way of interacting with them. It was obvious that we program directors were inventing our responses to some critical issues on our own, and had limited interaction with people making the decisions—such as the Residency Review Committee (RRC) and ARCOS. It was time to streamline our efforts.”
Take some thin air, add some ideas and sweat equity, and you have the seeds of a new group focused on academic leadership, all within the AOA. Dr. Peabody: “We had no infrastructure and in essence we had to decide under what umbrella CORD should reside. We concluded that the best way forward was to put the new organization under the AOA Academic Leadership Committee governance. After clearing that hurdle, we then had to deal with financing issues. Since it is usually easier for programs to locate funds, we decided to extend membership to programs as opposed to individuals. The other significant challenge of our startup phase was to create a taskforce of members and nonmembers that could identify the benefits of being a member.”
Providing specifics, Dr. Kenter states, “One issue that has emerged from our discussions was that of how a program purchases surgical loupes. A member needed to know—and posed the question on our bulletin board—if programs allowed loupes to be a departmental expense or if the residents themselves would have to pay for them. Another, broader, example of an early issue involved research. Academic programs need concrete information on how to develop and fund their research programs. There have also been a number of questions on the bulletin board lately about the match process—for example, ‘How important are letters of recommendation? Should we dispense with them? Etc.’”
Also, says Dr. Kenter, the age-old issue of fear might be getting in the way. “We are finding that the same people are participating in the bulletin board. We would like it if more surgeons used this as a forum to seek support and advice—and if more than the ‘usual suspects’ would respond to questions. I am not sure what to make of this limited participation, but perhaps people are intimidated. The bulletin board is in its infancy, so we will see what happens in the future.”
Photography by Andrew HuthNow “sitting atop” 128 member programs, CORD could well grow into the “go-to” organization for program directors who need a place to turn for advice and networking. But first there are the occasional growing pains…Dr. Peabody explains, “While we are experiencing a great deal of success, there is the ongoing issue of the need to prove membership benefits. Why? Because people have differing opinions about what this organization should do for them. For example, when we talk about establishing the most useful goals and objectives we sometimes can’t agree on what we would consider essential knowledge and skills.”
Some of the good news, however, is that CORD is indeed interacting regularly with other orthopedic entities in order to smooth the way for residents and program directors alike. “CORD has the same fundamental goals as the RRC, so they have been very supportive. Also, we have formalized a liaison membership with ARCOS and we often present at their meetings.”
In the trenches of CORD is Jim Weiss, Education and Member Services Manager at the AOA. He says, “I’ve been in association management for nearly 20 years and have rarely come across such a group of dedicated individuals. They are tireless in their pursuit of excellence and keep me hopping.”
Weiss, the staff liaison to the AOA governing committee, is working to help shape the future of orthopedic education. “One of our projects is to define learning objectives for the residents/directors, and to provide them with a reference manual for their programs. We are also working on skills assessments for residents, something that is in great demand by our members. At this point the assessment committee has tested the skills assessment tools that we have developed and they are now ready to be distributed to the general membership so that they can adapt them to their programs.”
Elaborating, Weiss says, “Take the process of defining learning objectives. For each subspecialty we had to define the specific learning objectives, i.e., upon graduation a resident in spine should know XYZ. Program directors can then take that basic list and craft a curriculum. Within each subspecialty learning objectives were defined for both junior and senior residents. For a junior resident in foot and ankle a learning objective in patient care is, ‘The resident will be able to effectively deliver patient care and use his or her clinical skills to facilitate the evaluation of foot and ankle conditions in adolescents and adults.’ Then we list the particular skills that the residents should demonstrate. Other areas where learning objectives have been established are practice based learning and improvement, interpersonal and communication skills, professionalism, and system based practice. The good news for program directors is that they can go to the CORD website, take our template, and modify these things as they see fit.”
Fundamentally, these efforts should mean that Hip Specialist X in Tucson is learning the same things as Hip Specialist Y in Manhattan. Dr. Kenter:
One of the first things that we did was to emphasize learning objectives so that what I teach sports medicine residents in Cincinnati is no different than what someone teaches in Miami or Seattle. The next ‘streamlining’ project is to compile a list of procedures that we feel are core competencies.
“The sticking point here is that one camp feels there should be a set curriculum and the other camp thinks it should be based on the number of cases. Let’s say that a resident comes into our program and within two weeks I feel that he is competent in basic sports medicine procedures. Why should this person have to spend another five months with me if they are competent in that arena? I think it makes more sense to say, for example, ‘This person needs work in trauma, so let’s give them extra time on that rotation.’ This is just one of a number of ‘minor’ points that can have a major effect on training…and that remains to be worked out.”
Not content to leave fellows and fellowship directors in the lurch, Dr. Kenter and his cohorts are looking to bring them into the CORD family as well. “While we endeavor to have fellowship programs as members, working out the details for this particular group is, as they say, ‘a whole other animal.’ At Cincinnati, for example, we have the hand, sports medicine, and spine fellowships under the University umbrella; then there are fellowships that aren’t part of any residency institution. Since paying an annual fee allows one person to come to a meeting this can all get a bit confusing. We have gained much experience with the development of the program for residents, however, something that should help lay the foundation for working with fellowships.”
Dr. Kenter concludes, “We are thrilled to be bringing quality tools and products to the program directors around the country. There are so many smart people out there directing programs…by putting our heads together we can derive concrete solutions to real problems.”
