AAOS Through the Eyes of Residents: Part I

Much as the flashing neon lights and one-armed bandits of Las Vegas had their siren songs, so did the 2009 Las Vegas meeting of the American Academy of Orthopaedic Surgeons (AAOS). Adventures in hip arthroscopy, advanced spine techniques, risk management, insurance issues, etc. With so many tempting topics, where to turn? How to organize one’s time? Such questions are particularly challenging for those yet to launch an independent career, namely, orthopedic surgery residents. Not to mention that this array of educational topics, industry offerings, posters, videos and more only mirrors the increasingly complex environment in which orthopedists must practice.

As a seasoned surgeon, you confidently walk into an operating room, having thought through all of the steps and possible curve balls of the surgery the night before. Prior to being the meticulous, skilled surgeon of today, however, you were a trainee…less confident, less experienced, and less knowledgeable. You were a resident, and you needed to gain that confidence, experience and knowledge. Part of the puzzle fell into place when you were allowed to attend your first official trade or society meeting. You met luminaries, heard about new procedures, and learned of controversies in the field. And with each meeting perhaps you became a bit more wedded to your chosen profession…you felt like you belonged.

Such career integration is more likely to happen when organizations award residents with the time and attention that will help them grow into seasoned orthopedists. For a number of years, AAOS has been attempting to do just that. With its residents symposium, as well as educational seminars designed for the budding surgeon, AAOS has increasingly been directing its efforts toward the advancement of the next generation of orthopedists.

And there is much to be done. With the shifting, hot sands of insurance regulations, federal, state and local laws, and industry controversies, residents have more issues than ever competing for their attention. Read on to learn what a sampling of the nearly 1200 resident attendees of the 2009 AAOS meeting had to say about programs, companies, and their surgical elders.

General Impressions

It’s 10AM. The rep is in the waiting room, the patient is on the table, the insurance company is looking for information, and your lead nurse has called out. In a way, this daily juggling act is a mirror of what orthopedists experience when they attend a large society meeting. At any given moment there are multiple things vying for an orthopedist’s attention. The trick is triage.

Dr. Andy Kuntz, a fourth year resident at the Hospital of the University of Pennsylvania in Philadelphia, was one of ten residents interviewed. He was very impressed with the meeting, finding it to be well rounded with a significant amount of helpful information. But, says this first time attendee, it was huge. Dr. Kuntz:

It was a little overwhelming at first. I was actually quite surprised at the vastness of it all.

The enormity also had Dr. Nael Shanti, a fifth year resident at Suny Downstate Medical Center in Brooklyn, shaking his head. “It was a really useful meeting, but sometimes it was a little overwhelming. There were just so many things going on at the same time.”

Dr. Jerry Labson, in his fourth year at the University of California, Davis (UCD), says, “From the mammoth exhibit hall to the sweeping number of lectures, everything was somewhat overwhelming. It was challenging to focus every day and to determine which meeting to attend and what would give me the highest yield.”

A second year resident from UCSD also felt such pressures. Dr. Vid Upasani explains, “I’ve attended two previous AAOS meetings, but this year because the conference was in Las Vegas it was overwhelming. It was hard to stay focused on the event because there were so many distractions. I didn’t get as much from the experience as in the past.”

The perspective of Dr. Wade Van Sice, however, a third year resident at Tulane University in New Orleans, was different. A first-timer to AAOS, Dr. Van Sice notes, “This was an outstanding academic conference. I haven’t seen any organization that has put on such a useful, well organized event. It really opened my eyes as to how much advocacy the Academy does and the political weight they hold.”

Dr. Sean Waldron, in his fourth year at Case Western Reserve University in Cleveland, adds, “I never felt treated any differently because I am a resident. Everyone I interacted with was very helpful and happy to answer my questions.”

A fifth year resident at The University of Texas Southwestern Medical Center at Dallas, Dr. Sara Strebe said, “The event was very well organized, and the programs were pertinent to what I am currently studying.”

Logistics

Perhaps some sort of orthopedic GPS system would have helped. “You are 22.5 yards from the spine symposium. Take the next left at the Venetian Ballroom C and go…” Without such assistance, however, many of the residents interviewed found navigating the 2009 meeting to be somewhat frustrating.

Mir Ali, M.D., Ph.D., a fifth year resident at Mayo Clinic in Rochester, Minnesota, found things to be a bit less smooth than previous years.

While the event was good overall, it was more congested than the last couple of meetings. The booth areas and hallways were tightly packed…and Las Vegas as a setting is not my favorite because there’s just too much going on.

Dr. Van Sice added, “Having the activities in so many buildings made it difficult to get around. And the casinos being set up in such a confusing way didn’t help things.”

On getting the lay of the land, Dr. Kuntz noted, “Because the layout was a bit confusing, I had to spend a fair amount of the first morning figuring out where things were.”

Dr. Upasani found himself in a maze of sameness. “Not only was the layout unclear, but every place looked the same. This meant that when you were coming in from the different hotels into the expo area it was easy to get lost. At times it was even difficult to identify what floor you were on.”

Dr. Krzysztof Siemionow, finishing up his sixth year at the Cleveland Clinic, added, “I have never been to a meeting where people had to stand for talks—despite having plenty of conference space. If you entered even five minutes late you would inevitably interrupt the speaker, as well as those around. They must have underestimated the popularity of the talks.”

It was smooth sailing for Dr. Strebe, however, who said, “I thought the venue contributed to the success of the event because most of the meetings were in close vicinity. I had no problem accessing the events and in fact found it to be easier than the San Francisco meeting because that was too spread out.”

Residency Symposium

Struck by the need to bring future orthopedists into the Academy fold, ten years ago AAOS instituted a residency symposium as part of the annual meeting. The driving force behind the program was and continues to be Kathie Niesen, Education Manager for AAOS. Of the symposium’s origins, Niesen says,

Not only did we want to get more residents involved in the organization, but we also thought that a symposium would be a good chance to provide them with information that they don’t get in medical school or residency.

Having reviewed the positives and negatives of ten years’ worth of feedback, Niesen and her colleagues know that while the symposium can always be improved, it serves a valuable role in preparing the next generation for practice and service to the orthopedic community. Kathy Niesen: “Each year we have had a sponsor for the symposium, however this past year they pulled out. The AAOS leadership recognizes the importance of the event, however, so we decided to cover the costs and keep the event as free of charge to residents.”

The Academy does what it can to ensure that the topics included are on-target. Dr. Philip Wolinsky, who has chaired the Residents Symposium for the past three years, says, “Each year we review the residents’ feedback and make alterations where possible. The 2009 Residents Symposium included presentations on ‘Building a Successful Practice, ’ ‘Marketing Yourself and Your Practice, ’ and the always popular, ‘Avoiding a Lawsuit.’ We also had a very animated attorney on hand to discuss the ins-and-outs of contract negotiation. The residents were curious about things such as how to handle it if a big name entity hands them a contract (how to assess the situation and evaluate it).”

Much of what competes for the residents’ attention is on the home (hospital) front. Many residents were allotted only two or three days away from their programs, and thus were not able to attend the Residents Symposium, held the day before the official start of the meeting. There are few, if any, options for scheduling this event, however, as the remainder of the week is wall-to-wall activities. Among those who did attend were Dr. Labson, who stated, “The Resident Symposium was one of the best things I went to all week. There were a lot of important administrative things on the agenda, such as coding…things that we’ll get hit with sooner or later. The only topic I would have added is that of financial planning, covering things such as taxes and how to employ irrevocable trusts to protect one’s family.”

Dr. Strebe notes, “I found the Residency Symposium to be an improvement over last year’s event because the topics were more relevant. I think it would be great if they could provide a dedicated time for us to talk to the experts who conduct the presentations. Many of us had questions that were individual to us, but there wasn’t enough time for them because the audience was so large. Perhaps discussion groups would be a way to cover more ground.”

Dr. Colin Harris, a fifth year and Chief Resident at the University of Medicine and Dentistry of New Jersey, adds, “Tuesday’s symposium provided a lot of useful pointers and opened my eyes as to the complicated, but important nature of coding. Overall, I found the handouts to be well written and thorough. The only downside was that a couple of the speakers covered the same topics.”

Dr. Wolinsky, who will pass the baton to a new Chair next year, advises, “To best benefit the residents I think we need to ensure that there is little or no overlap between the presentations. It is also important to be aware that there will only be an increasing number of things competing for the residents’ time so we have to keep the program at a reasonable length. We do need to add a bit more Q&A time, however…and always consider the evaluation forms and remain open to change.”

Educational Programs

Perhaps the phrase, “Leave no bone unturned” was in the minds of those who planned the 2009 meeting. With everything from when you should use biologics to pediatric congenital deformities of the foot, there was a surfeit of offerings for all manner of surgeon.

Dr. Van Sice, who is headed for a sports medicine career, found what he was looking for. “The lectures and experts were just incredible. It was particularly helpful to have such thorough handouts that I could take home for future reference. I did find it hard to plan my daily schedule, however, because there were so many overlaps. I’m not sure if anything could be done about that, though.”

Dr. Shanti echoed Van Sice’s thoughts. “Many times I had to miss things I wanted to attend because there were three great events going on at once.”

For Dr. Waldron, whose specialty is pediatric orthopedics, information on the nuts-and-bolts of daily life as a surgeon was the most valuable. “The practice management sessions were the most useful aspects of the meeting for me because I rarely get to hear about such things in my residency. Also informative was the session on taking one’s career from residency to the first job.”

One resident, who asked to remain anonymous, stated, “The only event I found to be lacking was the one on going from residency to your first job. They talked about mentoring in medical school, but since we were beyond that it didn’t apply to us.”

Choosing between anatomical areas was a challenge for Dr. Labson, a general orthopedist who is in the U.S. Air Force. He says, “It was easy to miss out on things. For example, if an ankle talk conflicted with a shoulder talk and you chose the ankle talk, but it wasn’t of the best quality, you lost on both the ankle and shoulder fronts. On the upside, however, because we residents are routinely exposed to the opinions and routines of our own attendings, the educational sessions were a great chance to see how other surgeons do things.”

For Dr. Upasani as well, the value was in the variety of viewpoints.

The panel format where speakers were assigned different topics and debated amongst each other was exciting and informative. It really drove home the point that there is no clear way to do some procedures.  I was also pleased to see that my area of interest, pediatrics, was given so much attention this year.

Dr. Ali, however, needed a bit more variety. “The quality of the seminars was terrific, as was the pace. I did find, however, that the sessions were very similar to the year before. On the whole that’s fine, but I think it would be an improvement to change presenters and topics around somewhat. Specifically, I would like to see a seminar on how to avoid pitfalls early in one’s spine career, as well as one on how to navigate through your first practice.”

Also chanting “spine, spine” was Dr. Siemionow. “I know it’s not fair, but I would love to see more spine seminars. I did find the ones offered to be truly interesting with very relevant material. I would like to see the new technology section expanded somewhat, however.”

Next week: AAOS Through the Eyes of Residents: Part II