February 2004 Bulletin

International scholars seek knowledge, open discourse at OLC courses

Scholarships make OLC course participation possible for doctors from around the world

By Carolyn Rogers

The Academy’s hands-on surgical skills courses are taking on an “international” flavor these days, thanks to two relatively new international scholarship programs. Over the past two years, nearly a dozen young orthopaedic surgeons from Spain, Russia, Cambodia, Nepal, Thailand, Nigeria and elsewhere have received scholarships to attend an AAOS clinical skills course in the United States.

At the SECOT 2003 scholarship presentation in Tenerife, Spain, are (from left) Cesar G. Garcia-Fontecha, MD; Marisa McCarren, of the AAOS international department; Leonardo Santarelli, commercial director of MSD; and Santiago Suso-Vergara, MD, president of the SECOT Education Committee.

One scholarship program, through the Spanish Society of Orthopaedics and Traumatology (SECOT), began offering Orthopaedic Learning Center (OLC) scholarships in 2002. Each year, SECOT awards two or three of its member surgeons with scholarships to attend a pre-selected AAOS OLC training course. The scholarships are funded through pharmaceutical companies and private foundations in Spain.

Spanish scholar enjoys “open discussion”
Merck Worldwide (also known as MSD) funded the 2003 SECOT scholarship that was awarded to Cesar G. Garcia-Fontecha, MD, orthopaedic surgeon from Barcelona, Spain, who attended the Nov. 14-16, 2003, “Spine Surgery: Advanced Applications and Techniques” course in Rosemont, Ill.

Dr. Garcia-Fontecha works at Hospital Vall d’Hebron, one of only two hospitals in Barcelona where spinal conditions are treated. “I’m the only person who specializes in spine for children in my hospital, so I saw this scholarship as an excellent opportunity to improve my knowledge,” he said.
He also wished “to learn the point of view of American spine surgery, discuss my daily activities with other spine surgeons, and meet the important people whose articles and publications I read.”

In a videotaped interview, Tadesse Alemayehu, MD, of Ethiopia, (second from right) discusses his experience with (from left) Howard Mevis, director of electronic media, evaluation and course operations; Lynne Dowling, director of the international department; and Mark Wieting, chief education officer.

Dr. Garcia-Fontecha quickly learned that American orthopaedic surgeons take a different perspective on spine procedures than their counterparts in Europe.

“It is interesting because in Europe we are used to using the same procedures often,” he said. “In the States, there’s more discretion. People have different points of view because there’s a lot of discussion here, and not just by the professors. That’s new for me.”

He appreciates that difference. “When people have a lot of experience and you hear them explain their point of view on a technique or procedure, you learn a lot…One person says, ‘I think he needs a brace,’ and someone else says, ‘No, he needs a procedure.’ There’s a lot of open discussion, and that’s important in choosing a treatment.”

Dr. Garcia-Fontecha not only enjoyed the collegial atmosphere at the course, but also the ratio of professors to participants. “In Europe, we have more students per professor and per specimen,” he said. “Here, you have one professor and two students for every specimen. That’s a good thing.”
Prior to leaving Spain, Dr. Fontecha spoke to Jose Rapariz, MD, a 2002 SECOT OLC scholarship winner, about what to expect from the program. Since his visit in November 2002, Dr. Rapariz has already returned to the United States to attend another AAOS surgical skills course on his own.
“He [Dr. Rapariz] told me how well organized the visit was, how the hotel was right next to the course site, and that the atmosphere was very dynamic,” he said. “He was right. Everything he told me is true.”

After returning to Barcelona, Dr. Garcia-Fontecha planned to share his new knowledge with his colleagues. “I will arrange for a session, or sessions, to explain the new techniques to my team,” he said.

SECOT scholar Cesar G. Garcia-Fontechea, MD, in the OLC.

At the conclusion of the course, Dr. Garcia-Fontecha planned to travel to the University of Iowa Hospitals in Iowa City, Iowa, to participate in a one-week observership with pediatric orthopaedic surgeon Ignacio V. Ponseti, MD. Dr. Fontecha made his own arrangements for this observership.

Dr. Ponseti, a native of Spain, developed the nonsurgical “Ponseti Method” of treatment for clubfoot 50 years ago. Dr. Garcia-Fontecha met Dr. Ponseti previously in Italy through a mutual friend.

“This friend and I are doing a study about club feet, so I have been e-mailing with Dr. Ponseti for a while now,” he explained. “This should be a great experience as well.”

CAC scholarship program
The other OLC international scholarship program, sponsored by the AAOS Corporate Advisory Council (CAC), awards four $3,000 OLC scholarships to international surgeons each year. The CAC serves as a forum for the exchange of information of mutual concern to the AAOS, the Orthopaedic Research and Education Foundation and members of orthopaedic industry.
The CAC scholarship program provides surgeons from less economically stable countries the opportunity to attend an AAOS hands-on clinical skills course. In addition, the visiting scholars are paired with American physician mentors for one- to two-day observerships at local hospitals.

CAC scholarship candidates must be 45 years of age or younger and must have completed their basic and specialty orthopaedic training. Candidates are also required to demonstrate strong leadership potential and possess good English speaking and reading skills.

“Many of the CAC scholars come from countries where only a handful of orthopaedic surgeons must address the orthopaedic problems and needs of an entire nation,” explains Lynne Dowling, director of the AAOS international department. “In these countries, patients must rely on non-orthopaedic surgeons for a great deal of the musculoskeletal care. As orthopaedic surgeons, these scholars are often the primary orthopaedic educator for general surgeons and allied health providers in their country.”

Exceeded expectations
Kirill Redko, MD, an orthopaedic surgeon from St. Petersburg, Russia, was the first 2003 CAC international scholar to attend an OLC course. He participated in the June 20-22, 2003, “Surgical Alternatives to Total Knee Arthroplasty” course in Rosemont, Ill.

Prior to his arrival, Dr. Redko assumed the program would be similar to orthopaedic courses he’d attended in Russia and elsewhere.
“I expected to see senior professors giving lectures and demonstrating the techniques—maybe doing one part of this on cadavers,” he said. Then, at the end of the formal lectures, he thought that the professors would answer questions from the audience.

The reality was quite different.

“Instead, I found young, active people doing the presentations,” he said. “They did a great job of presenting very in-depth information, with good background from journals and from their personal experience. They’d done hundreds of the operations that they talked about.”

Dr. Redko appreciated the opportunity to ask “whatever questions” he wanted. “People are very friendly and open,” he said. “And they are willing to show you their ‘tricks.’”

Another aspect of the course he found surprising was the widespread use of cadavers. “After the presentations, you can try to do the same procedure or technique they just showed you — on cadavers,” he said. “It’s fantastic!”
Cadavers are expensive and therefore used sparingly in Russia.
“You always have some questions after theoretical presentations, so being able to work on the cadavers saves you from making a mistake on the patient,” he said. “Also these specimens were prepared very well for the specific purpose of the course, so it was very convenient.”

Local observership
After the course wrapped up, Dr. Redko was paired with local orthopaedic surgeon Terry Younger, MD, for an observership. The visit began with a tour of Dr. Younger’s orthopaedic group practice—Barrington Orthopedic Specialists and Sports Medicine— in Hoffman Estates, Ill.

“We switched to an insurance system two years ago, so we’re supposed to have private medical practices in Russia now, but we really don’t,” Dr. Redko explained. “So it was very interesting for me to see how people manage their practices. I’m curious how they make decisions on things like how many nurses to hire, the type of equipment to buy, how they handle insurance…That’s all very interesting to me.”

Dr. Redko also sat in on several of Dr. Younger’s pre-op visits and joined him in the O.R. “That first-hand experience is important,” he said. “You can learn about a technique, but you need to see how it looks in reality.”

The staff was “very friendly,” he added. One doctor pointed out how many Russian-speaking patients they have, and encouraged him to come to work with them.

“It’s not so easy as he thinks!” Dr. Redko said with a laugh, “But it was nice to be treated with such friendliness and respect.”

When asked what advice he would give his Russian colleagues about Academy courses, he said he would tell them, “Come on guys, save away!”

“A tremendous experience”
In the fall, CAC scholarship winner Chakra Raj Pandey, MD, of Kathmandu, Nepal, made the trip to Rosemont to attend the Oct 10-12 OLC course, “Techniques in Knee Arthroplasty: Unicondylar, Primary and Revision.”
Dr. Pandey was effusive in his praise of both the CAC scholarship program and his experience at the Academy course.

“I’m extremely happy about being selected for the scholarship,” he said. “The AAOS is an excellent place to update your orthopaedic knowledge, and the faculty is renowned. It’s been a tremendous experience.”

Dr. Pandey received his orthopaedic training at Hacettepe University in Ankara, Turkey. “I was trained there according to the principles set out by the American Academy of Orthopaedic Surgeons,” he said. “I am now practicing in Nepal, and I continue to use the principles established by the Academy.”

Like Dr. Redko, Dr. Pandey was impressed by the use of cadavers in the course. “In my country, we have to read a lot and do studies on the model before you touch your patient,” he said. “By using cadavers, we can benefit much more without harming our patients.”

Dr. Pandey is always seeking to broaden his base of knowledge, he said. “Learning is a continuous process, so this course should act as a stimulant for me to search for more knowledge, and to continue to bring my level of practice to a higher standard.”

He looked forward to sharing his new knowledge with his colleagues in Nepal. “I will arrange a little workshop and try to teach my team what I’ve learned—especially the residents,” he said.

“This will change my life”
Christian Chukwu, MD, of Abakaliki, Nigeria, was the third CAC scholar to attend an Academy surgical skills course. He traveled to Scottsdale, Ariz., to participate in the Oct. 17-19 course, “Pediatric Orthopaedics: Current Perspectives and Techniques.”

The last of the four 2003 CAC scholars—Tadesse Alemayehu, MD, of Addis Ababa, Ethiopia—made the trip to the States to attend the Dec. 5-7, 2003, “Practical Techniques for Improved Fracture Management” course.
“The lectures were really outstanding,” Dr. Alemayehu said. “The atmosphere was very collegial—many of the doctors have more experience than me and I learned a lot from them.”

The American doctors learned from the exchange, as well. Many were surprised to learn that Ethiopia, with a population of more than 65 million, is home to just 19 orthopaedic surgeons. “In a typical day in clinic, I will see 40 to 50 patients,” Dr. Alemayehu said.

Because of the scarcity of orthopaedic surgeons, general practitioners in Ethiopia are trained in all aspects of orthopaedics for six months of their four years of medical training.

Due to poor roads and crowding, Ethiopia has the most road traffic injuries per vehicle in the world, so many of their cases involve trauma, he said. Sports injuries are also common. “We see a lot of football [soccer] injuries and injuries due to running.”

Nearly all of the country’s orthopaedic surgeons work for the government, with just a couple working in private practice, Dr. Alemayehu reports. Orthopaedists in Ethiopia only recently established a national association.
Upon his return to Ethiopia, Dr. Alemayehu planned to share his new knowledge with his fellow orthopaedic surgeons. He was particularly impressed with the course syllabus and planned to share it with his colleagues, as well.

His observership took place Dec. 8-10 at Children’s Memorial Hospital in Chicago. Orthopaedic surgeons David F. Beigler, MD, and Prasad V. Gourineni, MD, served as his American “mentors.”

“I’m so grateful to everyone for sharing their lives so generously and kindly,” Dr. Alemayehu said on his departure. “All of my experiences here have been so good. This will change my life.”

Only the beginning
Each of the scholars expressed a sincere desire for the educational exchange to continue well beyond their brief visit.

Dr. Redko emphasized the importance of making AAOS books and manuals readily available for purchase by Russian doctors, encouraging the Academy to provide Russian surgeons with a “wider opportunity” to purchase the publications.

As the author of several major orthopaedic texts in Russia, “I know what it means to publish a good book—it’s a huge amount of work,” he said. “The Academy’s manuals and books are excellent, and it’s very good that the Academy presents non-commercial information.”

Obtaining access to the Academy’s Orthopaedic Knowledge Online for his team in St. Petersburg is also a priority.

Dr. Alemayehu said he plans to stay in touch with the Academy via e-mail regarding developments in his country and also to share how he’s incorporating his newly obtained knowledge into his practice.

Dr. Pandey expressed hope that more orthopedic surgeons from developing countries will be able to attend AAOS surgical skills courses in the future.
“I wish that this opportunity will be offered to more and more people in the developing world,” he said. “Then, perhaps we can build an extensive network and work together—like an orthopaedic association of the Third World.”

Call for Midwest volunteers: Host an international scholar

As part of the AAOS CAC international scholarship experience, the Academy tries to arrange half or full-day hospital and private practice tours for visiting guests. The Academy is looking for AAOS members, living in the Midwest region, who would be willing to host a scholarship recipient. Activities that could be planned include:

If you are interested in hosting an international scholar, please contact Anna Gurevich of the AAOS international department by phone at (847) 384-4166; fax at (847)-823-0668, or e-mail at gurevich@aaos.org.

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