AAOS Bulletin - February, 2006

Scholars bring global perspective to OLC courses

International orthopaedists update surgical skills, compare health care systems

By Carolyn Rogers

More international surgeons than ever are taking part in AAOS hands-on surgical skills courses, thanks to ongoing scholarship programs. One spine surgery course this past November, “Spine Surgery: Evolving Applications and Techniques,” attracted one scholar from Spain and two scholarship recipients from Eastern Europe.

The AAOS/Corporate Advisory Council (CAC) international scholarship program enabled Dr. Muharrem Yazici, of Ankara, Turkey, and Dr. Radu Prejbeanu, of Timisoara, Romania, to travel to Chicago to participate in the Nov. 10-12, 2005, surgical skills course held at the Orthopaedic Learning Center (OLC). The CAC program presents orthopaedists from economically diverse regions of the world with a $3,000 scholarship to travel to the United States and attend a surgical skills course.

At the conclusion of the OLC course—led by course directors Alexander J. Ghanayem, MD, and K. Daniel Riew, MD—Drs. Yazici and Prejbeanu traveled to Iowa City for brief observerships at the University of Iowa Hospitals and Clinics.

Goals: Observe, learn, network

The orthopaedists made the long trek from Eastern Europe for similar reasons.

Dr. Yazici wanted to improve his knowledge of complex spine problems, meet young surgeons from different countries and see the OLC. Dr. Yazici is a clinical professor of orthopaedics at Hacettepe University in Ankara, Turkey, which is one of the largest universities in the country. Its children’s hospital—with 600 beds—is the largest in the entire region.

One of Dr. Yazici’s goals in attending the AAOS spine course was to view the AAOS facilities and learn how a surgical skills course is organized.

“The Turkish Society of Orthopaedic Surgery and Traumatology organizes many courses for orthopaedic surgeons in Ankara, both lectures and hands-on courses,” explained Dr. Yazici, who recently served as the society’s treasurer. “We’re planning to organize courses using cadavers in the future, so I wanted to see the OLC, how the course was organized and the quality of your specimens. Hopefully we can emulate some of these features in our future courses.”

Dr. Prejbeanu was also eager to learn new techniques and improve his knowledge of spine surgery, as well as learn more about the practice of orthopaedics in the United States.

Romania’s medical system

Following the fall of Communism in 1989, the bleak economic situation in Romania restricted the practice of orthopaedics in that country. For more than a decade, Romanian orthopaedists were able to do little more than treat fractures or perform a few knee replacements, according to Dr. Prejbeanu.

“As recently as five years ago, orthopaedists in my country weren’t doing any spine procedures, other than treating scoliosis,” he said.

Romania’s health care system is entirely state-run; there is currently no private insurance system in place.

“For each person in Romania, the government pays less than $100 per year,” Dr. Prejbeanu said.

The health care situation in Romania has improved somewhat in the past few years, however, with some of the country’s 500 orthopaedic surgeons performing spine surgery again, as well as hip and knee arthroplasty.

Since attending an AAOS spine surgery course in Florida two years ago, Dr. Prejbeanu has performed 40 spinal surgeries. “Things are improving in my country, but the progress is very slow,” he said.

Romania and Turkey; worlds apart

Turkey is close to Romania geographically, Dr. Yazici said, “but our experience is totally different.”

Although Turkey’s medical system is more stable than the Romanian system, Dr. Yazici said that Ankara Hospital is not representative of other hospitals in Turkey.

“It’s better,” he said. “Here we have access to the Internet in every part of the hospital, with a fast connection.”

This access comes in handy, because “books are still too expensive,” he said. “We often use the free [online pages] at Orthopaedic Hyperguide, but it’s not the best, because the distribution is commercial.”

AAOS textbooks are much more respected.

“Turkish orthopaedic residents often use AAOS textbooks,” he said. “Many students can read the English version, but we would like to have it translated into Turkish so it would be easy for all young residents to read.”

The field of orthopaedics is a popular choice among doctors in Turkey, which is home to 2,500 orthopaedic surgeons, according to Dr. Yazici. “Plastic surgery is the most popular specialty, but orthopaedic surgery ranks third or fourth.”

In 1996, Dr. Yazici completed a spine research fellowship with Marc A. Asher, MD, at the University of Kansas Medical Center in Kansas City. He now specializes in pediatric orthopaedics; his practice is approximately 60 percent pediatric spine and 40 percent hip, knee and foot.

Unlike in the United States, subspecialists are not well organized in Turkey, he said. “Older surgeons are all general orthopaedists—they do everything.”

Orthopaedics in medical school

One thing Romanian and Turkish medical school systems have in common is that both place more emphasis on musculoskeletal medicine than their counterparts in the United States.

Students in both Turkey and Romania go directly from high school into a six-year medical school program. In Turkey, medical students receive 12 lectures on orthopaedics; in their fifth year they spend a full month on orthopaedics. Romanian medical schools also devote a significant amount of time to the study of musculoskeletal conditions and diseases.

Top Romanian students reject medical careers

Unfortunately, the fall of Communism also brought about a slow deterioration in Romania’s medical education system, Dr. Prejbeanu says.

“When I applied for medical school [in 1989], each applicant had to beat eight other candidates to get in,” he said. “Now the ratio is much lower. The best students are choosing other opportunities—they’re becoming lawyers or computer specialists.”

In addition, many Romanian doctors are seeking jobs as medical representatives for pharmaceutical companies or pursuing other medical-related positions, he said.

Young medical residents in Romania have few opportunities to access American or Western European orthopaedic education. “Very few younger doctors are able to travel, and residents learn primarily from Romanian textbooks,” Dr. Prejbeanu explained. “AAOS textbooks are not commonly used, and the only video education programs we have are provided by manufacturers who are trying to sell something.”

“The best medical system”

Dr. Prejbeanu believes it’s beneficial for American doctors to visit Romania and see the medical system for themselves.

“To us, everything seems so normal, but to Americans it’s shocking,” he said.

In recent years, Dr. Prejbeanu has traveled across Europe to observe the different hospital systems.

“I think the United States has the best medical system for both the patient and the medical staff,” he said. “Patients pay more for health care here, but I feel the care is better than in Europe.”

On to Iowa City

Both Drs. Prejbeanu and Yazici were enthusiastic about the spine course, as well as their upcoming observerships. While in Iowa City, AAOS President Stuart L. Weinstein, MD, hosted Dr. Yazici for his stay, and Sergio A. Mendoza, MD, served as Dr. Prejbeanu’s American host.

Medical liability lawsuits: A U.S. export?

In Romania, medical liability lawsuits were unheard of, according to Dr. Prejbeanu.

“With all the new lawyers, though, the number of lawsuits is growing year after year,” he said.

In terms of medical liability concerns, “Turkish doctors were living in heaven—until two years ago,” Dr. Yazici said.

Turkey lost its status as a medical liability “paradise” when it became a candidate member of the European Union (EU), he explained. The country recently changed its laws relating to medical liability as part of negotiations with the EU.

“Soon, our system will be similar to the U.S. system,” Dr. Yazici said. “Turkish doctors are very anxious about this. We’re preparing to protect ourselves.”

Despite his concerns about the effect these new laws will have on the practice of medicine in Turkey, Dr. Yazici managed to find a bit of humor in the situation.

“Turkish doctors have come to the United States to train for many years,” he said. “Now, I think our lawyers are coming here to study, too. Turkish lawyers are starting to advertise on television: ‘If you think you’ve been the victim of medical malpractice, call us!’”

2005 scholarship recipients

The AAOS Corporate Advisory Council (CAC) International Scholarship program—which enables orthopaedic surgeons from economically diverse regions of the world to participate in an AAOS surgical skills course—just concluded its fourth year.

Under this program, four scholars each year are selected to receive a $3,000 scholarship to attend a hands-on clinical skills course at the Orthopaedic Learning Center (OLC) in Rosemont, Ill. In 2005, the program authorized a fifth scholarship that enabled an Iraqi orthopaedist to attend the Feb. 23 to 27, 2005 AAOS Annual Meeting in Washington, D.C.

CAC scholarship candidates must be 45 years of age or younger and have completed their basic and specialty orthopaedic training. Candidates also are required to demonstrate strong leadership potential and possess good English-language speaking and reading skills.
In addition to their participation in the course, each scholar is matched with an American physician-host for a brief hospital observership and private practice tour.

2005 CAC International scholars/AAOS hosts:



Course Date

Course name


Dr. Thamer Hamdan

Basrah, Iraq

Feb. 23-27, 2005

2005 Annual Meeting

Washington, D.C.

Col. Timothy Kuklo, MD

Walter Reed Army

Medical Center

Washington, D.C.

Dr. Cristian Fontbote



April 1-3, 2005

“Open and Arthroscopic Techniques in Shoulder Surgery”

Pietro M. Tonino, MD

Loyola University Medical Center

Maywood, Ill.

Dr Hyzan M. Yusof


May 13-15, 2005

“Surgical Treatment Methods for Knee Injuries and Disorders”


Dr. Muharrem Yazici

Ankara, Turkey

Nov. 10-12, 2005

“Spine Surgery: Advanced Applications and Techniques”

Stuart L Weinstein, MD

Univ. of Iowa Hospitals and Clinics

Iowa City, Iowa

Dr. Radu Prejbeanu

Timisoara, Romania

Nov. 10-12, 2005

“Spine Surgery: Advanced Applications and Techniques”

Sergio A. Mendoza, MD

Univ. of Iowa Hospitals and Clinics

Iowa City, Iowa

The Spanish Society of Orthopaedics and Traumatology (SECOT) began offering OLC scholarships in 2002. Each year, SECOT awards two or three of its member surgeons with scholarships to attend a preselected AAOS surgical skills course. The scholarships are funded through pharmaceutical companies and private foundations in Spain.

2005 SECOT Scholarship recipients/AAOS Hosts:





Dr. Jose Paz-Aparicio

Nov. 10-12, 2005

“Spine Surgery: Advanced Applications and Techniques”

Howard S. An, MD

Rush University Medical Center

Chicago, Ill.

Dr. Oliver Marin Pena

Nov. 17-19, 2005

“Revision and Complex Primary Total Hip Replacement”

Aaron G. Rosenberg, MD

Rush University Medical Center

Chicago, Ill.

Dr. Luis Agueilella

Jan. 20-22, 2006

“Open and Arthroscopic Techniques in Shoulder Surgery”

Gregory P. Nicholson, MD

Rush University Medical Center

Chicago, Ill.

Dr. Juan M. De la Cerda

April 6-9, 2006

“Shoulder and Elbow: Current Techniques and Controversies”


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