The Orthopaedic Forum   |    
Podium Disclosures at the 2012 AAOS Meeting: An Exercise in Going Through the Motions
Adam A. Sassoon, MD, MS1; Robert T. Trousdale, MD1
1 Department of Orthopedic Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905. E-mail address for R.T. Trousdale: Trousdale.robert@mayo.edu
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  • Disclosure statement for author(s): PDF

Disclosure: None 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 any aspect of this work. One or more of the authors, or his or her institution, has had a financial relationship, in the thirty-six months prior to submission of this work, with an entity in the biomedical arena that could be perceived to influence or have the potential to influence what is written in this work. 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 © 2013 by The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2013 Apr 17;95(8):e51 1-4. doi: 10.2106/JBJS.L.00905
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Slide-based disclosure of potential conflicts of interest prior to presentations is practiced at most orthopaedic meetings to help audiences critically evaluate the data presented. These slides are often supplemented with a printed disclosure in program guides and occasionally on Internet sites. The fidelity and usefulness of this format have not been investigated. We report the practice of disclosure of potential conflicts of interest during the 2012 American Academy of Orthopaedic Surgeons (AAOS) Annual Meeting to determine if the process is accomplishing its primary goal.


Orthopaedic residents and fellow volunteers completed questionnaires related to the disclosures presented at symposia and instructional course lectures they attended at the 2012 AAOS Annual Meeting. The attendees were instructed to record the duration of time for which a disclosure slide remained visible to the audience. An attempt to count the words appearing on the disclosure slide, or photograph the disclosure slide so that a subsequent word count could be obtained, was also performed.


One hundred and thirty-nine disclosures were observed across a range of subspecialties including adult reconstruction, hand and wrist, pediatrics, shoulder and elbow, sports medicine, trauma, and oncology. Of these, 125 (90%) included the required disclosure slide and underwent additional analysis. Ninety-five slides had a number of words that were countable, with an average of 19.6 words per slide; thirty slides were not presented long enough to permit an accurate word count or photograph. The average time that disclosure slides were viewable was 3.1 seconds. Only 52% of slides noted whether the author disclosures were related to the data presented; 59% of presenters failed to mention this fact verbally. Only 45% of studies with multiple authors included coauthor disclosures on the slide. Institutional disclosures were absent from slides and discussion in 85% of presentations.


Slides disclosing potential conflicts of interest were included in 90% of the observed presentations. Despite these slides having been shown, they were ineffective in communicating these disclosures because of deficiencies in timing, format, and content. We recommend that the practice of required slide-based disclosure of potential conflicts of interest should be abandoned and be replaced with a standardized and objective practice of disclosure.

Figures in this Article


    exercise ; disclosure
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    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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    Paul Tornetta III MD
    Posted on June 11, 2013
    Comments on AM Disclosures
    Boston University Medical Center; Chair: AAOS Annual Meeting Committee

    The American Academy of Orthopaedic Surgeons (AAOS) appreciates the interest this article has generated and believes in transparency with respect to outside interests and their potential conflicts for all presentations at the annual meeting.  The primary ways in which disclosures are communicated are in the Annual Meeting Final Program and the AAOS online disclosure program.  All authors and co-authors are required to participate in the online disclosure program prior to any abstract to be considered for presentation.  In addition, all speakers are required to disclose prior to speaking in Instructional Course Lectures or Symposia, thus ensuring, as completely as possible, transparency in all presentations.  All outside interests by type (intellectual property, consulting, stock ownership, etc.) are clearly delineated within the program for each paper and speaker as well as within the mobile app.  The AAOS has also asked each speaker to include, as a first slide in their presentation, a disclosure slide to remind the audience whether he/she has any outside interests or if potential conflicts may exist regarding studies or lectures being presented.  The main purpose of this slide is to clearly state whether outside interests exist, rather than to fully explain them.  The full reporting of these relationships may then be reviewed in the Final Program or the online program.

    In addition to this process, at the 2013 Annual Meeting, the AAOS piloted the use of two screens during selected educational events. One screen displayed the primary education material and the other screen showed complete disclosure information for all of the speakers in the session.  This was an attempt to make the information visually available for a longer period of time, again reminding the audience to look in the program or go online if they wished to review the complete disclosures.

    The disclosure pilot at the 2013 Annual Meeting covered 12 symposia, 24 paper sessions, and 6 Instructional Course Lectures (ICLs) in three session rooms. In these educational sessions, faculty continued to disclose their industry relationships in the traditional manner, with a disclosure slide they personally developed at the beginning of their talks.   In the rooms selected for the enhanced disclosure pilot, an additional screen projected a scrolling presentation that included complete disclosure information reported by the faculty members through the AAOS Orthopaedic Disclosure Program. This information was prepared by the AAOS staff.  After each session, attendees and presenters were invited to answer a short survey regarding their views of this disclosure option.  Overall, though this information was available during the entire session, the vast majority of viewers were not in favor of continuing this process, with many noting that the scrolling of the disclosures was distracting and that the disclosure information was difficult to read.  This feedback supports the message that the primary method of reviewing disclosures resides in the Final Program and the website.  The results of the pilot are still being considered and the AAOS is committed to improving it over time.

    It should be noted, however, that some of the beliefs held by the authors of this study, and in fact the metrics used in the study are not shared by the AAOS nor are they ACCME requirements.  AAOS has spent many hours developing and enforcing rules to provide transparency for the audience at the Annual Meeting.  Several policies consistent with ACCME guidelines have been made purposefully that are different than those suggested by the authors of this paper.

    First, the authors believe that the speaker should determine whether an outside interest constitutes a conflict, while the AAOS believes that this determination should not be left to the speaker, but to the audience to determine.  By example, if a surgeon receives income for consulting on a total knee replacement system and is speaking about total hip replacements but happens to use the same company’s product, does he/she have a conflict?  The surgeon may determine that he or she have no conflict, but in reality, if the surgeon is in a position to influence the CME event to his or her perceived benefit, then based on ACCME guidelines, a conflict does exist and further, this conflict needs to be managed.  As many hospitals and hospital systems buy hip and knee implant systems together, if the surgeon promotes the hip system for which they are not compensated, it may drive sales of the knee system for which they are.  While this is unlikely, and the AAOS believes in the integrity of its members, the perception of bias can diminish the value of the presentation or paper.  In fact, the perception of bias is tracked for all speakers  and courses carefully and if reported, reviewed by the moderator and a member of the committee.

    Second, the authors assert that all institutional support should be reported, which is not consistent with ACCME guidelines, and in fact, was not disclosed by the lead author of the paper at the meeting in question.  This question, also, has been carefully vetted by AAOS.  Many complaints were received from speakers in past years when the AAOS did request disclosure of all institutional support in the name of completeness.  Presenters pointed out that it was very difficult to get this information from their institutions or department, as there is often no repository containing the information. Additionally, it was felt that when the presenters had nothing to do with such support and/or were unaware of it, institutional support did not present a conflict as defined by the ACCME.  Finally, for larger institutions, such as that from which this study originates, the disclosure slide would be inflated with outside interests that would potentially take away from the focus on the more salient outside interests that might rise to the level of a conflict.  Based on careful discussion, AAOS in 2009 dropped the requirement of disclosure of all institutional support in favor of reporting only that institutional support for which the speaker had some connection, such as being involved in a supported study or receiving educational grants.

    Despite our differing opinions regarding the verbal disclosure and those outside interests that should appear on the disclosure slide, AAOS agrees with the spirit of transparency promoted in the paper.  We will continue our efforts to make the AAOS educational program and disclosure process helpful to attendees and as effective as possible.  Comments from the orthopaedic profession are welcome, and all feedback will be carefully considered in the development of future educational opportunities.

    Thank you for this opportunity to comment regarding this important issue.

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