April 1999 Bulletin

ICOE helps many advance skills

Whether it's a four-week stint in Toulouse, France, a year-long fellowship in Melbourne, Australia, or three months in a remote area of Thailand, orthopaedic surgeons around the world are taking the opportunity to advance their skills, share their knowledge and broaden their horizons by utilizing the services of the International Center for Orthopaedic Education (ICOE)

"My colleagues in other medical specialties can hardly hide their envy at the benefits of having an organization like the ICOE working for us," says Ashok Acharya, MS, of Karmatka, India.

Enthusiastic comments such as Dr. Acharya's are common among doctors who have taken advantage of ICOE's services. In just its fourth year of operation, ICOE , a project of the American Orthopaedic Association, appears to be an overwhelming success. ICOE's primary purpose is to provide a central facility to coordinate and facilitate international exchange in postgraduate orthopaedic education, and to coordinate postgraduate educational, teaching and service experiences between countries. These exchanges are truly worldwide, not just between North America and the rest of the world.

The ICOE database currently has 2,300 offerings from nearly 1,000 institutions and individuals from 72 countries; some type of financial support is attached to more than one-fourth of these offerings. To date, ICOE has processed more than 2,700 application requests from orthopaedic surgeons in 84 countries. The ICOE is currently in the process of enhancing its web site (www.aoassn.org/icoe.htm) to make it more accessible and user-friendly.

"After extensively accessing the ICOE data base," Dr. Archarya says, "I have been offered a year-long clinical fellowship in pediatric orthopaedics at the Institut Calot, Berck-Su-Mer, France. I also have volunteered my services to the Physicians for Peace organization based in Norfolk, Va., and I have received numerous invitations for observer's posts. All this would have been impossible without ICOE."

Before the ICOE database was established, most of these postgraduate opportunities were arranged in a haphazard manner. The majority of the experiences-such as observerships, clinical clerkships, research or service experiences-were arranged on a "word-of-mouth" basis or by personal contacts, journal advertisements, chance meetings, or prearranged relationships between institutions, countries or individuals. Doctors seeking an educational, teaching or service experience, therefore, lacked complete information on what was available. In the same way, the institutions or individuals offering the experiences may have heard from a limited number of qualified applicants due to a lack of awareness.

The ICOE "offering unit" data base posts the educational (clinical and basic research), service and teaching experiences available through orthopaedic departments, individual ortho- paedic surgeons, hospitals, orthopaedic associations, countries, organizations, orthopaedic-related companies, etc. Basic demographics of the experience are included, such as the duration of the experience, whether housing or financial support is provided, special requirements (licensure, examinations and visas), as well as the contact name, fax number, etc.

The applicant data base contains parallel information. Applicants may complete an application form and indicate the type of opportunity they're seeking. The ICOE then provides them with a list of places that best fit their needs. The computer reports contain detailed information regarding whom to contact, such as names, addresses, telephone and fax numbers. The ICOE, however, does not get involved with making arrangements between the applicant and offering unit.

With the coordination of ICOE, Nusret Kose, MD, an orthopaedic surgeon from Eskisehir, Turkey, was offered a one-month fellowship on bone banking and arthroplasty with the Musculoskeletal Transplant Foundation of Edison, N.J.

"I had the opportunity to learn every aspect of bone banking and its clinical applications," Dr. Kose says. "Since having this experience, I was subsequently accepted for a six-month international pediatric fellowship at the University of Texas Health Science Center in San Antonio. Without the help of ICOE, I would not have been aware of these opportunities."

Royce A. Haas, MD, an orthopaedic surgeon from Pacific Grove, Calif., recently completed a four-week observership at the Prince of Songkla Hospital in Songkla, Thailand.

"They treat a variety of conditions in Thailand that we do not see in the United States, such as particular infections and advanced deformities," Dr. Haas says. "Many patients present in various stages of delayed or malunion, due to a lack of emergent fracture care in remote areas. This type of treatment can be unusually challenging."

Dr. Haas' trip to Thailand was actually a return visit. In 1995, he visited Chiang Mai, Thailand, for a four-week spine observership at Mahraj Nakorn Chiang Mai University Hospital, also arranged through ICOE.

"The staff and residents are invariably quite knowledgeable, friendly, and accommodating, and eager for educational interchange," Dr. Haas says. "I would highly recommend an overseas fellowship to my American colleagues; it's an opportunity to both learn and provide service without the encumbrance of third party payers."

A three-month observership with W.R. Niedermeier, MD, during the summer of 1998 at Sauk Prairie Memorial Hospital in Prairie du Sac, Wis., allowed Linas Vaicekavicius, MD, an orthopaedic surgeon from Lithuania, to expand his knowledge in major joint prosthetic surgery, arthroscopic surgery, and spine surgery.

The opportunity to attend a continuing medical education course, "The Complex Painful Knee: Current Decision Making and Treatment Options" in the Academy's Orthopaedic Learning Center in Rosemont, Ill., was another highlight of Dr. Vaicekavicius' overseas experience.

"As my country continues to develop its medical care system, we are in dire need of learning the latest orthopaedic techniques," Dr. Kaicekavicius says. "It was through the ICOE that I gained the knowledge of modern orthopaedic techniques."

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