June 2001 Bulletin

Orthopaedists teach primary care doctors

Limited or nonexistent orthopaedic training in medical schools and primary care residencies has resulted in large numbers of primary care physicians who need continuing education in common office musculoskeletal problems.

The need for further musculoskeletal education for primary care physicians was evidenced most recently by the popularity of the Academy’s Essentials of Musculoskeletal Care (first edition). In response, the AAOS charged its educational programming committee to find a way to assist orthopaedists in educating primary care physicians. After considering the possibility of sponsoring musculoskeletal courses for primary care physicians, it was ultimately decided that this wasn’t the role of the AAOS. The committee instead determined that the need would be better served if orthopaedic surgeons, in cooperation with medical centers, presented such courses locally.

"Not only are people more likely to attend a local course, but the benefits and impetus to teaching such a course are more local and regional," says Mark Bernhardt, MD, member of the educational programming committee. "Referring doctors will attend the course, and it can be used as a source of advertising and marketing for the practice."

The committee developed a suggested outline for an "ideal" course for primary care physicians on office orthopaedics, using the experiences of several orthopaedists around the country who have had success in presenting such programs. This outline is intended to serve as a template for orthopaedic departments or groups to present a regional or local course, in conjunction with their hospital or medical center.

According to the Orthopaedics for Primary Care Physicians program outline, speakers should focus on diagnosis, pathophysiology and treatment of common musculoskeletal problems. The outline recommends that discussion of surgical treatments be avoided, other than specifying which patients can benefit from surgical treatment or who needs referral for surgical treatment. Putting together a comprehensive course syllabus with useful lists of references is strongly recommended; the AAOS’s Clinical Guidelines and Clinical Algorithms are suggested as useful materials to include in the syllabus. In addition to one’s training and clinical experience, the AAOS’s Essentials of Musculoskeletal Care textbook is recommended as a supplement for demonstration.

Dr. Bernhardt, author of the outline, has presented a number of successful orthopaedic seminars for primary care physicians in Kansas City, Mo. He and other members of his orthopaedic group present the course, which typically draws 100 to 150 general internists, pediatricians, nurse practitioners and family physicians. Dr. Bernhardt also takes part in a national course.

"An off-shoot of the Academy’s efforts in this area is an American Academy of Family Physicians’ course on musculoskeletal procedures, which is now in its second straight year," Dr. Bernhardt says. "I served on the faculty as a representative of the Academy. It’s a very hands-on course, and the participants love it."

Sherwin Ho, MD, serves as course chairman for the University of Chicago Primary Care Orthopaedics course, which is now in its eighth year. The four-day course is presented every June and is attended by approximately 220 to 240 primary care physicians, including family practitioners, emergency room doctors, internists and pediatricians from nearly every state in the country. Physical therapists, athletic trainers, and nurse practitioners also attend. Last year, the course was presented in Hawaii, jointly sponsored with the University of Hawaii Department of Orthopaedics, which plans to do so every winter.

"It’s part of our mission at the university to educate, and this a just another extension of that goal," Dr. Ho says. "We’re educating the physicians who initially manage our patients and subsequently refer them. It makes our job much easier if the initial management has been appropriate and thorough. And it also eliminates a lot of unnecessary or inappropriate referrals."

The University of Chicago course covers all of the major fields of orthopaedics, including topics of broad interest to the primary care physicians, such as physical examination and diagnosis, nonsurgical management of orthopaedic problems, what diagnoses not to miss, and which conditions need to be referred and when. The course avoids surgical and technical topics, such as the latest knee implants, or methods.

The response from the participants is "routinely and overwhelmingly positive," Dr. Ho says. "They’re grateful for the course."

However, Dr. Ho encourages orthopaedic surgeons to present such a course only if they are "prepared to devote an awful lot of time, money and energy to do so. Our syllabus is over 300 pages long and took hundreds of hours to write and edit, and it is updated every year…. We do not pay our orthopaedic speakers, because we feel it is part of our mission to teach and educate as full-time academic orthopaedics. And all profits from our course go into a resident research and education fund here at the university."

In addition to filling an educational need for the primary care physicians in an orthopaedist’s locale, organizing an office orthopaedics course can be an effective marketing strategy for your practice, according to Robert Bucholz, MD, chair of the educational programming committee.

By presenting such a course, "an orthopaedic surgeon can develop lines of referral which might increase clinical volume," says Dr. Bucholz, MD. "The quality of the referrals can be improved so that you aren’t called upon to treat a lot of minor musculoskeletal problems that could easily be managed by family physicians. It’s also a service to the community, so the overall quality of musculoskeletal care in the community is improved."

"The more orthopaedic departments that present these courses locally and regionally," Dr. Bernhardt points out, "the better we’ll be able to reach the thousands of primary care physicians who don’t have enough training in diagnosis, treatment, casting, etc. There is just a great need out there."

Since posting in October 2000, more than 250 visitors to the web site have reviewed the outline.

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