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A new era of orthopaedic medical education

Chair's Corner

Welcome to the first “Chair’s Corner” at Duke Orthopaedics. In this column, I will periodically update you on issues facing our department, orthopaedics, medicine, and/or Duke. This will include topics from all areas of our department, including the research, education, and clinical realms. For this inaugural column, I am excited to introduce you to the new educational programs we are developing in our department. Over the coming months, I’ll be providing more detailed commentary on this topic.

This month, after several years of planning, we entered into a new era of competency-based orthopaedic education curriculum at Duke, along with the inaugural combined medical school – orthopaedic residency program.

Abraham Flexner’s report on Medical Education and the Halstead residency model established the architecture of our current medical training system. Over the past century, undergraduate science and clinical content have evolved, post-graduate training was formalized, and medical licensure requirements standardized, but the lock step continuum of medical education has not changed. For most students, medical education follows a linear sequence of educational steps that may last fourteen or more years. Most educators and trainees agree that the process is inflexible, long, and expensive. More worrisome is that despite the years of training, there is little evidence that the process produces competent physicians.  Indeed, the proliferation of fellowships in orthopaedics is evidence that many trainees feel they require additional training after completing residency to become a competent orthopedist.

We are taking on these challenges; developing new paradigms in medical training. Our new residency curriculum is designed to maximize residency educational opportunities and learning efficiencies, leveraging the extensive and diverse clinical practice of the faculty and the advanced learning resources at Duke University. It is enhanced by the integration of advanced strategies for adult learning including surgical simulation, self-directed learning, and improved methods of evaluation and providing feedback to the resident.

The goals of our new competency-based educational curriculum include ensuring the mastery of general orthopaedic core competencies and providing opportunities for advanced training through a selective curriculum tailored to individual interests during the final two years of residency. A structured program to ensure skills in patient safety, ethics, professionalism, research, leadership, and diversity, are critical factors in producing top-notch orthopedists.

To make the medical school-residency continuum more efficient and effective, we also welcomed Tim Kreulen and Elshaday Belay, who will spend their third year of medical school focused on orthopaedics; with the ultimate goal of immediately entering orthopaedic residency training upon completion of their third year. This program follows a growing belief that the length of training can be reduced without compromising quality of care; reducing the debt students’ face by eliminating a year of medical tuition and allowing doctors to begin their careers earlier. This program is designed to provide a more comprehensive pathway to produce exceptional orthopaedic surgeons. Indeed, based in part on our pilot, several other intuitions are developing similar programs. Along with Duke, many of these programs presented their educational models at a symposium highlighted at this past AOA meeting. Furthermore, the Macey foundation has funded work into reinventing medical education, at which our program was highlighted. Thus, we are paving the way to develop the future of orthopaedic training.

As the first residency program to adopt both a competency-based curriculum and a combined medical school – orthopaedic residency program, we look forward to providing program updates on how we are progressing towards achieving our goal of developing a more focused training curriculum that is beneficial to both trainees and our patients.

-Ben