Why change? This question comes up every time we consider a change in our department. Imagine what our department would be like without change. Fifty years ago, in 1967, J. Leonard Goldner became chief of the Division of Orthopaedic Surgery; let’s imagine what he would think if he traveled ahead in time 50 years to 2017. Today’s Duke would look to him like science fiction.
Care is very different than it was in 1967: there is a computer in every care environment and we communicate with smart phones, MRI and CT scans provide three-dimensional imaging in ways that could only be imagined 50 years ago, bone cement and modern arthroplasty were not yet available in most institutions, and there was no arthroscopic or segmental spine instrumentation. Patients were treated for many of the orthopaedic manifestations of polio, Duchene muscular dystrophy, and rheumatoid arthritis that are now rare in an era of improved drug therapies. Our patients receive more effective therapies and spend substantially less time in the hospital. These advances only happened by changing the way we do things; taking advantage of new technologies, having a better understanding of pathophysiology, using new drugs and instrumentation, and modifying care to meet the needs of patients in today's world.
Today, Duke Orthopaedics has ten times more faculty than it did in 1967. In addition, we have a much more diverse representation of orthopaedic residents and faculty. Residents participate in a match and are not on call every other night, faculty supervise trainees more closely, and we have fellows in multiple subspecialties. Further, residents start their orthopaedic training directly out of medical school instead of spending time in a surgery residency.
The world seems to be changing faster and faster in all aspects of our lives. Institutions that are nimble and can keep ahead of changes in the environment flourish in changing times, while those that are slow to change do not. It is no different in health care, where a better understanding of pathophysiology, new drugs, new technology, changes in patient desires, and changes in healthcare financing are all driving rapid change.
Duke Orthopaedics is well poised to anticipate and meet the changes in our environment; to position ourselves as leaders in charting the future of orthopaedics. Under the leadership of Chad Mather, our newly appointed Vice Chair of Practice Innovation, and Janet Prvu Bettger, our Director of Health Policy and Implementation Research, we are starting several new practice pilots, including developing a Practice Innovation Unit to pilot new care delivery methods. These initiatives will allow us to rapidly pilot new care delivery models, and to export those that are improvements to become standards of care.
In a similar way, our educational programs are changing to meet challenges in the current environment. Limited work hours, increased time spent on the electronic medical record, and decreased opportunities for independent practice are changing the way we can educate the next generation of orthopaedic surgeons. Under the leadership of Brian Brigman, our Program Director, and Fraser Leversedge, our Vice Chair of Education, our residency curriculum is changing so that we can maintain the critical educational aspects and camaraderie that is the hallmark of the Duke Orthopaedic residency.
Research is the foundation from which changes in care develop. To meet the rapidly changing basic and clinical science environments, we organized our research into five themes, ranging from cell biology to implementation research. Each theme was developed in collaboration with a fundamental research program, providing access to the vast expertise at Duke.
Why change? Because change is part of the evolution of care, education, and research; ultimately resulting in improving outcomes for our patients. By leading the way in change, Duke is well-positioned to lead the way in plotting the future course for orthopaedics. Just as Dr. Goldner would have thought of the Duke Orthopaedics of today as science fiction 50 years ago, one can only imagine what Duke Orthopaedics will look like 50 years from now.