AAOS Bulletin - October, 2006

Instructional Course Committee

By Carolyn Rogers

Orthopaedic surgeons across the globe regard the AAOS Annual Meeting as the world’s premier educational event in orthopaedics. This reputation is due in large part to the high quality of the 180 instructional courses presented at each meeting.

Making sure the courses maintain that level of excellence is the responsibility of the AAOS Instructional Course Committee (ICC).

The ICC’s mission is to plan, conduct and evaluate a program of instructional course lectures for the AAOS Annual Meeting. It ensures that the courses are consistent with the educational needs of AAOS fellows and in accordance with the essential policies and standards of the Accreditation Council for Continuing Medical Education.

“We recognize how precious time is for orthopaedic surgeons and how important focused CME courses such as these instructional courses are to our members,” says Paul J. Duwelius, MD, 2007 ICC chair.

Dempsey S. Springfield, MD, (far left), Frederick M. Azar, MD; Paul J. Duwelius, MD; J. Lawrence Marsh, MD; and James D. Heckman, MD, all serve on the AAOS Instructional Course Committee. Members Terry R. Light, MD, and Mary I. O’Connor, MD, are not pictured.

With input and direction from the Council on Education and the Annual Meeting Committee, the ICC strives to provide the maximum educational value for the time invested by the members and guests of the Academy. Courses are added, expanded, revised or dropped on the basis of evaluations completed by course registrants.

“We’re always asking, ‘how can we do a better job?’” says Dr. Duwelius.

Committee structure
The ICC, which reports to the Annual Meeting Committee, is composed of Dr. Duwelius, 2007 chair; Frederick M. Azar, MD, 2008 chair; Terry R. Light, MD; J. Lawrence Marsh, MD; and Mary I. O’Connor, MD. Ex-officio members are James D. Heckman, MD, editor of The Journal of Bone & Joint Surgery American (JBJS-A); and Dempsey S. Springfield, MD, JBJS-A deputy editor for Instructional Course Lectures.

As 2007 and 2008 ICC chairmen, Drs. Duwelius and Azar are also members of the Annual Meeting Committee.

Getting down to work
The committee begins by reviewing the evaluation results from all instructional courses presented at the previous Annual Meeting. The quality of the evaluations determines whether or not a course is repeated.

Since 2005, most instructional courses have a three-year life cycle.

“If attendee and reviewer evaluations are very positive and attendance numbers remain strong in the final year, however, we often renew the course with a new moderator and new faculty,” Dr. Duwelius says.

Courses that have not reached the three-year limit are automatically considered for the following year’s meeting. If a course receives an overall rating well below the mean for all courses presented that year, the committee may recommend revising the faculty or content to address the concerns of course attendees, or the course may be eliminated.

With this approach, up to 20 percent of the 180 courses rotate off the schedule in a given year, leaving as many as 35 slots open for new courses.

“This year, the vast majority of the courses in rotation received positive ratings,” Dr. Duwelius explains. “That enables us to focus on ensuring a good selection of new courses for next year.”

Selecting new courses
Each year the ICC considers 100 applications for new courses. In making their selections, committee members solicit as much assistance as possible from the various specialty societies.

“Their involvement in the course selection process is extremely helpful,” Dr. Duwelius says. “We really appreciate their input.”

To ensure a well-balanced program without duplication, the ICC looks closely at the number of courses in each specialty area. Other factors include thoroughness of the proposal, choice of faculty, similarity to current courses, and relevance of the content.

A two-hour course must incorporate a maximum of 90 minutes for didactic lectures and a minimum of 30 minutes for a question-and-answer (Q&A) session, with a limit of four speakers. Three-hour courses allow a maximum of 135 minutes for didactic lectures and a minimum of 45 minutes for Q&A, with a five-speaker limit.

Instructional courses must include at least one faculty member and a moderator. All courses must be designed to stand alone and not require attendance at a previous or future course.

For the 2006 meeting, five hands-on surgical skills courses were added to the program for the first time. The courses were three hours long, with an initial didactic and surgical technique video session followed by a two-hour, hands-on lab session. The courses concluded with discussion, debate, or illustrative case presentations. Each course accommodated 50 participants, and all five sold out prior to the Annual Meeting. Due to the success of the hands-on courses, the ICC is considering ways to expand the surgical skills program in 2007.

Courses vs. Symposia
Instructional courses differ from symposia in a number of ways. Symposia are two hours long and cover cutting edge, controversial, new or innovative topics. The information presented in the two- or three-hour instructional courses reflects accepted principles and techniques as well as new evidence-based practices. ‘Pearls and pitfalls’ of procedures are often discussed, and most instructional courses include video that demonstrates surgical techniques.

“One of the key differences is that the instructional course provides much more interaction and discussion between the faculty and participants,” says Dr. Duwelius. The 2006 instructional course program consisted of 180 freestanding courses, 11 of which featured an audience response system. The technology allows attendees to answer a variety of clinical and demographic questions during the session, with results provided instantaneously.

The response system continues to be popular among attendees and faculty as a way to measure understanding of the information presented.

“Some instructors use the system better than others, but the audience loves it,” says Dr. Duwelius.

The ICC is also responsible for the Orthopaedic Review Course. The eight-hour course reviews current knowledge on diagnosis and management of clinical problems from a nationally accepted orthopaedic practice perspective.

Moderators run the show
“The Committee is very discriminating in its selection of course moderators because they play such a key role in the course,” says Dr. Duwelius.

Moderators have several responsibilities, including collecting faculty members’ handout materials and reviewing them for compatibility with course material and for commercial bias.

All faculty members are required to provide an extensive written outline for the course. Handouts are limited to 10 pages per instructor per course and must not contain the name of a commercial company or endorse a specific product.

“During the course, the moderator is responsible for introducing the faculty members, enforcing speakers’ time limits and engaging the audience in the Q&A,” says Dr. Duwelius.

“More Q&A time, please!”
At the end of the course, registrants complete an evaluation form, which includes space for written comments. The evaluation results are mailed to all faculty members approximately one month after the Annual Meeting.

“One of the most frequent comments on the 2006 evaluations was the request for more Q & A time,” Dr. Duwelius says.

Thanks to this feedback, the ICC is strongly advising 2007 moderators and faculty to leave ample time for questions and discussion at the end of every course.

“We’ve never seen ‘too much Q&A!’ listed as a complaint,” Dr. Duwelius adds.

In addition to participant feedback, certain courses are also evaluated by ICC members, specialty society representatives, or special evaluators appointed by the Committee. Results of these blinded evaluations are available only to the ICC—not to course faculty.

Faculty requirements
All course instructors must complete a Mandatory Financial Disclosure (MFD) form as well as a Food and Drug Administration (FDA) form. The MFD form requires instructors to disclose if they or anyone in their immediate family has received compensation from any company associated with their presentation.

The FDA form requires that instructors disclose the FDA status of all instruments, implants and devices discussed in the course. The disclosures are also included in the final program. Faculty members who do not complete either form may be replaced.

Beginning in 2007, each speaker also will be required to declare/disclose any potential conflicts of interest prior to the presentation. In addition, the evaluation forms will also ask: “Was the educational value/content of this course affected or compromised by the bias of any speaker?”

Instructional Course Lectures text
As the 2007 ICC chair, Dr. Duwelius will serve as editor of the 2008 Instructional Course Lectures volume. The chair/editor invites select lecturers to contribute a manuscript based on their instructional course presentation at the Annual Meeting.

As the incoming chair, Dr. Azar will serve as assistant editor of the volume and edit chapters in his specialty. The 2006 Instructional Course Lectures, Volume 55—edited by Dr. Light based on lectures presented at the 2005 Annual Meeting—is currently available online or by calling AAOS customer service at (800) 626-6726. The 2007 ICL volume will be published next spring.


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