"Behind the scenes," start-to-finish look at the creation of a surgical skills program
Note: This article was originally scheduled to appear in the October 2002 issue of the Bulletin. Due to space limitations, it was held over to the December issue.
By Carolyn Rogers
Orthopaedic surgeons from all over the United States and as far away as Trinidad and Dubai registered for the AAOS surgical skills course, "Current Techniques in Knee Arthroplasty: Unicondylar, Primary and Revision." In fact, the two and 1/2 day program reached full capacity96 participantsnearly two months prior to the Oct. 25-27, 2002 course date.
While pleased with this high level of interest, the course chairmen werent surprised. Academy courses such as this one maintain their popularity year in and year out thanks primarily to the faculty who donate their time and expertise and to the members of orthopaedic industry who provide millions of dollars worth of equipment in support of surgical skills education.
This article is the second in a three-part series that looks "behind the scenes" at the "Making of an OLC course." The series follows all the key players throughout the two-year-plus process, from the time the course is first placed on the schedule until all of the post-course feedback is analyzed and planning begins for next years program.
In "Part one" of the series, which appeared in the August 2002 Bulletin, (pp.59-60), readers traced the 25-plus year history of the Academys surgical skills courses, heard from the CME courses committee, the course chair, co-chair and course liaison, and gained a "behind the scenes" look at strategies used to market the course.
For "Part two," we fast-forward to one month prior to the Oct. 25-27, 2002 course. We hear from faculty members as well as the chair of the Council on Education, check in with the course coordinators and even take a moment for a word from a representative of a company providing equipment to support the course.
One month out
"The course reached full capacity nearly a month ago," reports Ann ONeill, AAOS CME course manager. "I think were in pretty good shape at this point." Earlier on in the planning process, ONeill worked closely with the CME course committee, the course chair and co-chairThomas S. Thornhill, MD, and Daniel J. Berry, MDas well as course liaison William P. Barrett, MD, to determine and finalize the programs educational focus and content. Once the content was finalized, two staff coordinators took the lead.
"The course coordinator and the surgical skills coordinator really fine-tune the program with the course chairmen," ONeill says. "We have several seasoned individuals involved with this particular course, so the planning has gone really well."
Fine-tuning the course
One of those "seasoned individuals" is CME course coordinator Jeri Busch, who has been with the Academy for 16 years. In addition to the Oct. 25-27 total knee replacement course, Busch also coordinates the spine, sports medicine, occupational orthopaedics and sports knee courses. Her primary role is to work with the chairmen to add educational value to the course and to manage course logistics.
"At the end of the 2001 total knee course, I met with the chairmen to review the entire program," she says. "We do this with every course to improve the following years presentation. Were always tweaking it and trying to present those things that are hot and up-and-coming. We continuously strive to improve the educational quality of the courses."
For instance, based on registrant feedback and evaluations from the 2001 "Current Techniques in Arthroplasty" course, the participants most common request was to include more information on unicompartmental arthroplasty ("Unis"). "We listened," Busch says. "The 2002 course includes an entire section on Unis."
Greater emphasis also has been placed on the little "nuggets" or "pearls" of advice faculty offer the registrants throughout the course.
"Last year, a number of participants asked for more pearls from the educators," Busch explains. "They always love the pearls, but especially when it comes to total knee replacement. Everybody does totals differently, so the participants are eager to get those little nuggets of knowledge from the leaders in the field."
Faculty chimes in
One of the surgeons who will share some of those pearls of wisdom is Arlen D. Hanssen, MD. He has agreed to teach the total knee course for the fourth year in a row.
"To be honest, this is a really grueling course for faculty," Dr. Hanssen admits. "We start early, go all day long in the cadaver labs and then get up and do it again the next day. Its a pretty big commitment."
So why is he willing to volunteer his time?
"This is a totally different kind of course," he says. "Its something the Academy is uniquely capable of doing. I think the attendees and the faculty all feel that and appreciate it."
The person serving as course chairman was another factor in Dr. Hanssens decision to volunteer his time and expertise.
"The chairman is crucial to getting people to agree to teach a course," he says. "When theyve called and asked if Im willing to do it, thats been a huge factor."
Ultimately, Dr. Hanssen believes the Academy is providing an important service to members by offering this course. "Its a valuable thing for orthopaedists to be able to come and improve their skills, and maybe for some of them to realize their patients requiring knee replacement are more appropriately referred," he says.
"I like teaching orthopaedics"
Aaron G. Rosenberg, MD, agrees that the course is demanding on faculty.
"Its very intensive," he says. "Youre constantly on. If youre not in a session giving a lecture, then youre in a lab. Unlike other courses where theres a lot of free time, its intense for both the faculty as well as the participants."
He compares it to a full day of surgery. "Its exhausting, but at the end of the day you feel good about what youve accomplished," he says.
Dr. Rosenberg says he volunteers to teach because he enjoys talking about orthopaedics with other orthopaedic surgeons.
"An eclectic collection of people come to this course to learn," he says. "Some dont know a lot, and others know as much as the faculty and just want to see if they can pick up something new. Its an opportunity to get together yearly with the best people in the field to find out what we know and dont know about knee replacement."
Bumps in the road
Its one month out, and while Drs. Rosenberg and Hanssen remain firmly committed to their participation in the course, three other faculty members have just canceled, Busch reports.
"A lot of the surgeons are so busy, their plates get too full and they occasionally have to bow out," Busch explains. "In that case, I go to the chairman and we try to work together to arrange for last-minute substitutes."
In addition to securing new faculty members, at one-month-out, Busch is finalizing hotel arrangements and finalizing the syllabus for printing.
"Not all faculty submit their handouts in time, so its not always easy," Busch says. "Unfortunately, thats one of the biggest complaints that show up on the evaluations formsthe participants hate to see a blank page in the syllabus!"
Basic information on the backgrounds and interests of the course participants is being compiled at this point as well.
"Prior to the course, the registrants receive a questionnaire asking what types of problems they hope to see addressed at the course, what kind of practice theyre in and whether theyre a generalist or a specialist, etc.," Busch says. "We compile that information to help the chair make last minute changes, if necessary, and to know more about the participants expectations."
Participants also are sent a selection form so they can indicate which "total knee" system they would prefer to use. "Although were limited to a certain number from each company, we try to give registrants their choice," she says.
This crucial elementobtaining the appropriate equipment for the courseis in the hands of the surgical skills coordinator, Ro Simon.
Securing the equipment
Simon, who has 17 years of O.R. experience as a surgical tech under her belt, began working to secure the appropriate equipment for this course more than six months ago.
"The majority of the equipment is confirmed," shes happy to report.
Simon began the process by compiling a list of the equipment necessary to present the course. After determining which companies might participateand consulting a database of companies that have similar equipmentSimon got to work contacting industry.
"If we have 24 stations and there are eight companies, Ill request three sets from each company," she says. "Sometimes a company will say it cant provide the equipment, for whatever reason. In that case, Ill go back to the remaining companies for additional sets of equipment."
Each company sends personnel along to support their equipment at the course. In addition, the Academy hires two floor managers and a third person to assist faculty with the live demonstrations. Orthopaedic residents also volunteer to serve as staff assistants to help with the lab, specimens, and equipment.
Complying with the Occupational Safety and Health Administration (OSHA) regulations is becoming increasingly difficult, according to Simon, who works closely with OLC Director Pat Cichlar on this issue. "The regulations are strict, especially regarding the protective wear that needs to be worn and when it has to be worn," she says.
In fact, OSHA regulations are one of the primary reasons behind the recent OLC renovation and expansion. "Up until a few weeks ago, we were cleaning instruments and equipment in the same room with contaminated instruments," says Simon. "Now, to be OSHA compliant, we have separate clean, decontamination, and specimen rooms."
At one month out, Simon hasnt run into any major hitches with the Oct. 25-27 course. "Were not anticipating any equipment glitches," she says. Unfortunately, thats not always the case.
"Ive had companies call at the last minute and say they have a conflict so they cant send the equipment," Simon says. "Thats the biggest problem I run into. And occasionally, the faculty will call at this point and say they need additional equipmentwhich at one month out is just about impossible to get."
"Its a big deal"
For this course alone, Simon estimates that orthopaedic industry is providing somewhere between $1 million to $2 million worth of equipment. "Their support is unbelievable," she says.
Joseph Zuckerman, MD, chair of the AAOS Council on Education, agrees.
"I daresay that we would not be successful in our ability to teach surgical skills education without industry," he says. "Academy programs really are a partnership between the AAOS and orthopaedic industry. Every course we present in the Learning Center is supported by five, six or seven representatives of industry. These companies are routinely providing equipment and personnel, and we recognize this is not as easy as it used to be. We recognize the requirement of time, effort and resources. Its a big deal and we dont take it lightly."
Industry participation in surgical skills courses not only makes these courses possible, says Sharon Lamson, education manager for Stryker Instruments in Kalamazoo, Mich., industry involvement also provides registrants with:
"And by providing the products as a donation, the AAOS can keep the registration fees down for its members," Lamson adds.
The challenges companies face in making equipment available for OLC courses come down to three key factors, Lamson says: Money, equipment, and people.
"Every company has a limited number of these resources," she says. "Each company has to determine if it has enough of each of these resources to provide for an optimal experience at the OLC. Some companies have more of all of these items and view education as a very important aspect of their business. Others may have a lesser amount of equipment available but also appreciate the opportunity to participate."
"The right thing to do"
"For the AAOS, this course is an educational opportunity for its membership," Lamson says. "It would be false to assume that companies have the same missionwe are in the business of making money."
Therefore, companies face the challenge of justifying the thousands of dollars spent in providing equipment to these coursesin addition to the cost of travel, the cost of disposables, and the cost of giving up 12 to14 weekends a year, she says.
"Our company is not able to equate any of these dollars spent with resulting sales," Samson concludes. "Most of the time we just think this is the right thing to do."
"Fair and balanced" presentation
As crucial as industry involvement is, however, the AAOS must ensure that industry participation doesnt compromise the integrity of the courses, Dr. Zuckerman adds.
"This means industry never participates in the planning of the courses and has no say in the structure, the topics, or the faculty involved," he says.
AAOS policy states that the Academys CME courses must be developed to ensure that the educational content is presented in a "fair and balanced" manner. In addition, faculty is encouraged to use generic terminology and avoid favoritism toward a specific company in lectures, discussions, laboratory sessions or other educational formats.
Look for the conclusion to the "Making of an OLC Course" series in the February 2003 Bulletin. Highlights include an overview of the 3-day course experience, post-course interviews with participants to see how they are implementing their new skills into their practice, as well as a backstage look at the all-important post-course evaluation where the key players hash out the "good, the bad and the ugly" and decide how to make the program even better in 2003.