AAOS Bulletin - April, 2005

Boards approve revised statements, hear progress reports and make volunteer appointments

By Susan A. Nowicki, APR

The Boards of Directors of the American Academy of Orthopaedic Surgeons and the American Association of Ortho- paedic Surgeons (AAOS) met on Feb. 21, 2005, in Washington, D.C. They approved revisions to a position statement on evidence-based guidelines and to an advisory statement on thermography.

In other actions, the Boards also recognized several members retiring from volunteer positions and heard progress reports on several key AAOS activities and projects.

Stuart L. Weinstein, MD (left); Karen L. Hackett, CAE, FACHE, AAOS CEO; and Robert W. Bucholz, MD, 2004-2005 AAOS president, listened to reports during the February Board of Directors meeting

Revised Statements approved

As recommended by the Evidence-Based Practice Committee, the Academy Board approved revisions to the “Position Statement on Evidence-Based Guidelines.” In June 2004, in response to the adoption of American College of Occupational and Environmental Medicine guidelines in California for treatment of workers’ compensation patients, the Board of Directors charged the Evidence-Based Practice Committee with developing a position statement on evidence-based guidelines. The Board approved the position statement in October 2004.

Subsequently, the committee was asked to revise the statement to include a reference to patient preferences. Additionally, the Board requested that a boundary be set on the role of expert opinion in evidence-based medicine.

The new language in the statement can be found in the section on The Evidence-Base: Implications for New Technologies. It states:

“The limitations of evidence-based medicine need to be recognized. There will always be topics that are not amenable to evaluation by an evidence-based approach. Expert consensus may be required to complement an evidenced-based conclusion. Consensus should be reached using a Delphi method or other formal structured methodology.”

Under the Evidence-Based Guidelines and Implementation of Evidence-Based Practice section, new language now states:

“The guideline should represent a reasonable approach to the problem that allows for a wide variance in practice-style based on the practitioner’s clinical expertise and experience, as well as the values and preferences of the patient.”

As recommended by the Council on Health Policy and Practice, the Board of the Association approved the revised “Advisory Statement on Thermography.” The statement reads in part:

“The American Academy of Orthopaedic Surgeons believes that the use of thermography as a clinically useful diagnostic or prognostic test in orthopaedic surgery cannot at this time be scientifically justified.”

OKO report

William A. Grana, MD, MPH, editor of Orthopaedic Knowledge Online (OKO), reported that OKO has just completed its third full year as an online educational resource for AAOS members. He noted that by the end of 2004, more than 11,500 individual orthopaedic surgeons and residents had registered to use the OKO site, with a return rate of 77 percent; monthly visits grew to almost 8,000 individual users. In the 35 months since OKO was launched, there have been more than 220,000 logins to the topic area of the Web site, with almost two million page views.

Dr. Grana outlined several key OKO developments during 2004. He noted that the home page was redesigned and expanded to include three new areas—online continuing medical education (CME), orthopaedic review and virtual bookstore. A new content area on musculoskeletal oncology is now under development for launch in 2005. In OKO’s online CME section, six courses have been developed and an additional six CME modules are planned for 2005.

During 2004, several orthopaedic specialty societies provided content for their respective interest sections of OKO, including topic and author choices, links to society sites, news, education and programs. Societies that have agreed to participate include Pediatric Orthopaedic Society of North America, American Orthopaedic Society for Sports Medicine, the Hip Society and American Association of Hip and Knee Surgeons.

JAAOS Report

Alan M. Levine, MD, editor of the Journal of the American Academy of Orthopaedic Surgeons (JAAOS), reported that the year 2004 was one of planning for the future, and positioning JAAOS for change in 2005. Key among those changes will be a shift in editor. Dr. Levine is stepping down after eight years as editor-in-chief to assume the chairmanship of the Council on Education. William P. Cooney III, MD, has been appointed to serve as the new editor-in-chief of JAAOS. (See related article on page 37.)

Dr. Levine noted that the circulation for the English edition increased from 17,604 in 1993 to almost 30,000 in 2004. In addition, foreign-language translations have dramatically increased the worldwide readership of JAAOS to almost 40,000. In fact, Dr. Levine added, JAAOS is now the most widely read orthopaedic journal.

JAAOS on CD-ROM (1993-2004) has again been produced through an educational grant from sanofi~aventis Group and will be distributed with the March/April issue to all AAOS fellows, and candidate, emeritus and international affiliate members. Hyperlinks from cited references to their abstracts on MEDLINE are included on both the CD-ROM and online version of JAAOS. (See related article on page 38.)

JBJS update

James D. Heckman, MD, editor-in-chief of the Journal of Bone and Joint Surgery (JBJS), and James R. Urbaniak, MD, chairman of the JBJS board of trustees, presented updates on the content aspects of the publication. They noted that more than 1,149 manuscripts were received during 2004, an increase of 89 over the previous year. The overall acceptance rate upon first submission was 18 percent.

Articles that appear in the “Orthopaedic Forum,” “Ethics in Practice,” “Topics in Training” and “What’s New and Evidence-Based Orthopaedics” sections have an overall acceptance rate of 80 percent. The average time from submission to publication for clinical manuscripts was 12.9 months, down from 13.5 months in 2003.

ABOS report

Peter J. Stern, MD, president of the American Board of Orthopaedic Surgery (ABOS), reported on the results of the 2004 written and oral certification exams. He said that 737 candidates (616 first-time takers and 121 repeaters) had taken the exam. The written exam pass rate was 96.3 percent; the pass rate among repeaters was 46 percent. The pass rate for the oral exam was 85 percent, with 698 candidates passing.

Dr. Stern noted that candidates are required to submit CPT codes for the procedures they have performed during the year previous to taking the exam; the top three codes were 29881 (arthroscopy, knee, surgical; with meniscectomy), 64721 (neuroplasty and/or transposition; median nerve at capal tunnel) and 20680 (removal of implant).

Mary Beth Ezaki, MD, and David G. Lewallen, MD, co-chairs of the ABOS/AAOS Task Force on Maintenance of Certification (MOC), presented an update on the ABOS MOC program. Three components of the program have been accepted by the American Board of Medical Specialties: Professional Standing and Evidence; Evidence of Life-Long Learning (120 hours of CME and self-assessment examination); and Evidence of Cognitive Expertise. The fourth component, Evidence of Practice Performance (includes the patient survey) has not been finalized. However, the MOC process, including the life-long learning and self-assessment component, will be phased in as soon as possible.

Dr. Ezaki added that there are provisions being made for an MOC process for non-operative orthopaedists.

Mary Beth Ezaki, MD, co-chair of the ABOS/AAOS Task Force on Maintenance of Certification, presented an update on the process.

75th Anniversary

Dr. Bucholz announced that the Academy’s 75th Anniversary program activities were now fully funded. Commitments totaling $1.869 million have been received from 10 sponsoring organizations, including DePuy; Zimmer; Smith & Nephew; George M. Boswell Jr., MD, Fund for Orthopaedic Surgery; Synthes; sanofi~aventis; GE Healthcare; Canon Medical Systems, and Paragon Medical, Inc.

Committee appointments

Stuart L. Weinstein, MD, reported that the Expert Witness Project Team and the Presidential Line jointly recommended that oversight for the AAOS Expert Witness Program be transferred from the Professional Liability Committee to the Committee on Professionalism. To lead these key new committees, the Committees recommended, and the Board approved, the following appointments: Peter J. Mandell, MD, as the first chairman of the new Committee on Professionalism, and Richard D. Schmidt, MD, as the first chairman of the new Judiciary Committee.

Retiring council, board members

Five individuals retiring from the Boards of Directors were recognized for their service, including Vernon T. Tolo, MD; Laura L. Tosi, MD; Frederick M. Azar, MD; Glenn B. Pfeffer, MD; and Peter J. Mandell, MD. Joseph Zuckerman, MD, was recognized for his service as chair of the Council on Education.

Board member Frances A. Farley, MD, (left) reads a tribute to her Leadership Fellows Program mentor Vernon T. Tolo, MD, (right) upon his retirement from the AAOS Board of Directors. Stuart A. Hirsch, MD, (center) chair of the Communications Council, looks on

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