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Reshaping Orthopaedic Resident Education in Systems-Based Practice
Susanne M. Roberts, MD1; Sandra Jarvis-Selinger, PhD2; Daniel D. Pratt, PhD3; Andrea Polonijo, MPH4; Elizabeth Stacy, MA5; Katherine Wisener, MA5; Kevin P. Black, MD6
1 Massachusetts General Hospital, 55 Fruit Street, WHT 535, Boston, MA 02114
2 Department of Surgery, Vancouver Hospital and Health Sciences Center, 2775 Laurel Street, 11th Floor, Room 11233, Vancouver, BC V5A 1M9, Canada
3 Department of Educational Studies, Faculty of Education, University of British Columbia, 2125 Main Mall, Vancouver, BC V6T 1Z4, Canada
4 Department of Sociology, 6303 N.W. Marine Drive, University of British Columbia, Vancouver, BC V6T 1Z1, Canada
5 eHealth Strategy Office, Faculty of Medicine, University of British Columbia, 855 West 10th Avenue, Vancouver, BC V5Z 1L7, Canada
6 Bone and Joint Institute, EC089 Milton S. Hershey Medical Center, Pennsylvania State College of Medicine, 30 Hope Drive, Building A, Hershey, PA 17033. E-mail address: kblack@hmc.psu.edu
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Disclosure: One or more of the authors received payments or services, either directly or indirectly (i.e., via his or her institution), from a third party in support of an aspect of this work. None of the authors, or their institution(s), have had any financial relationship, in the thirty-six months prior to submission of this work, with any entity in the biomedical arena that could be perceived to influence or have the potential to influence what is written in this work. Also, no author has had any other relationships, or has engaged in any other activities, that could be perceived to influence or have the potential to influence what is written in this work. The complete Disclosures of Potential Conflicts of Interest submitted by authors are always provided with the online version of the article.

Copyright © 2012 by The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2012 Aug 01;94(15):e113 1-7. doi: 10.2106/JBJS.K.00638
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This article was updated on September 5, 2012, because of a previous error. On page e113(1), the text had listed one of the authors as “Andrea Polinijo.” The text now reads .“Andrea Polonijo.”

An erratum has been published: J Bone Joint Surg Am. 2012;94(18):e141.


Despite advances in understanding the “systems-based practice” competency in resident education, this topic has remained difficult to teach, assess, and document. The goal of this study was to perform a needs assessment and an analysis of the current state of systems-based practice education in orthopaedic residency programs across the U.S. and within our own institution.


A sample of orthopaedic educators and residents from across the U.S. who were attending the 2010 American Orthopaedic Association (AOA) Effective Orthopaedic Educator Course, AOA Resident Leadership Forum, and AOA Council of Residency Directors meeting were surveyed to determine (1) which aspects of systems-based practice, if any, were being taught; (2) how systems-based practice is being taught; and (3) how residency programs are assessing systems-based practice. In addition, an in-depth case study of these issues was performed by means of seven semi-structured focus group sessions with diverse stakeholders who participated in the care of musculoskeletal patients at the authors’ institution. A quantitative approach was used to analyze the survey data. The focus group data were analyzed with procedures associated with grounded theory, relying on a constant comparative method to develop salient themes arising from the discussion.


“Clinical observation” (33%) and “didactic case-based learning” (23%) were reported by the survey respondents as the most commonly used teaching methods, but specific topics were taught inconsistently. Competency assessment was reported to occur infrequently, and 36% of respondents reported that systems-based practice areas were not being assessed by any methods. The focus group discussions emphasized the need for standardized experiential learning that was closely linked to the patient’s perspective. Orthopaedic faculty members were uncomfortable with their knowledge of this competency and their ability to teach and assess it.


Teaching the systems-based practice competency occurs inconsistently, and formal assessment occurs infrequently. In addition to formal teaching, learning systems-based practice will be best achieved experientially and from the patient’s perspective.

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    Accreditation Statement
    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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