At the Annual Meeting of the American Orthopaedic Association (AOA) in June
2003, the Executive Committee of the Academic Orthopaedic Society (AOS) met
and voted to formally dissolve the AOS at the end of this fiscal year. This
decision came at a time when program directors face substantial changes. These
changes, mandated by the Accreditation Council for Graduate Medical Education
(ACGME), specified resident work-hour requirements, as well as resident
evaluations based upon performance in the six core competencies.
Traditionally, these topics would consume much of the Annual Fall Meeting of
the AOS. In the organization's early years, these mandates would have been
subjected to the scrutiny of a midyear Delphi panel. Chairpersons and program
directors would have had an opportunity to carefully review these required
changes, reach a consensus, and, hopefully, come to an agreement with regard
to the best method of implementation. In fact, chairpersons and program
directors in all specialties have felt the need for frequent collaboration
and, as such, virtually every specialty has an association of program
directors and, in turn, a national association of program directors. The
history of this organization in orthopaedics is as follows:
The Association of Orthopaedic Chairmen (AOC) was originally founded in
1971 under the leadership of Kay Clawson, MD, and Fred Reynolds, MD. The
purpose was to discuss issues that were not currently addressed by the AOA,
the American Academy of Orthopaedic Surgeons (AAOS), or the American Board of
Orthopaedic Surgery. These issues included the recruitment of new faculty
members, development of an orthopaedic residency curriculum, and providing
orthopaedic instruction in undergraduate medical education. The founders
recognized the necessity to speak in a unified voice to medical school deans
with regard to the problems confronting academic departments and/or divisions
of orthopaedic surgery. The organization began with fifty-six members and, by
1990, had grown to 179 members. Traditionally, the meetings convened in the
fall, concurrently with the meeting of the Association of American Medical
Colleges (AAMC). Key issues affecting curriculum changes in medical schools
could be communicated in a timely fashion to the orthopaedic chairpersons in
attendance. The AOC could send representatives to the Council of Deans to try
to increase the amount of time allocated to orthopaedics in the medical
student curriculum.
The organization grew by allowing each chairperson to invite a junior
faculty member. Those selected were usually rising stars in academic
orthopaedics. These young academicians were quickly assimilated into the fold,
frequently becoming program directors or department chairpersons at their
sponsoring institution. Some would also move on to other programs in need of
academic leadership.
The AOC meeting usually lasted one and a half days, and programs focused on
issues relevant to medical student and resident education. Topics ranged from
methods of evaluation to the management of the problem resident. Other
subjects that were presented and discussed included the development of an
ideal orthopaedic residency curriculum, starting a research laboratory, and
preparing for a Residency Review Committee visit.
In 1991, with the lofty goal of becoming an even more comprehensive
academic organization, the AOC adopted a new mission and vision statement and
changed its bylaws to become the Academic Orthopaedic Society. The group held
their traditional meeting in conjunction with a concomitant session that was
focused on orthopaedic basic science. While traditional in terms of committee
reports, the AOS used this meeting to address bigger, more controversial
issues, such as the potential role of the nonoperative orthopaedist in
resident education and clinical practice.
Questions that were addressed included "Should we be training young
doctors in orthopaedic medicine, as well as surgery?" At the
basic-science session, invited papers that covered a broad spectrum of
subjects, ranging from osteoporosis to the care and management of patients
with a musculoskeletal tumor, were presented. Many individuals with
educational and research backgrounds in orthopaedics were attracted to the
meeting and eventually became members of the new organization. They included
fellowship program directors and other full-time faculty who were considered
essential to medical student and resident education. While the concomitant
sessions of basic science and clinical issues did not continue,
consensus-building groups, or Delphi panels, were initiated to address such
controversial subjects as the ethics of our relationship with industry,
problems confronting teaching in a managed-care environment, the numbers of
residents and programs necessary in orthopaedic surgery in the United States,
as well as the concept of a separate, extended curriculum to train an
"academic orthopaedist." This goal continues today through the
AAOS and the AOA as these organizations seek funding for selected individuals
to train as clinician-scientists. Many Delphi sessions were convened at a
separate meeting, which usually was held in Chicago in the spring, while the
fall meeting continued to follow the AAMC schedule. The luxury of two meetings
per year and the convening of the Delphi panels represented the golden years
for the organization. This ended abruptly with the advent of managed care. At
most institutions, tighter travel budgets for teaching faculty and the
membership's desire for more focused meetings led to fewer meetings. Since
many AOS members were also AOA members, in the mid-1990s, the leadership of
both groups held meetings to discuss a merger.
Combined programs at the 1998 AOA meeting and the spring AOS meeting were
held in Asheville, North Carolina, and a subsequent AOA meeting was held in
Sun Valley, Idaho. Merger plans continued and, finally, at the Annual Fall
Meeting of the AOS in 2002, a formal plan was presented for a merger of the
two organizations. The plan included the creation of an Academic Issues
Committee within the AOA, with a seat and vote on the Executive Committee. The
following new committees were formed: the Academic Leadership Group, Graduate
and Medical Education Committee, Faculty Development Committee, and Department
Administration Management and Resources Committee, and representatives to the
AAMC and to the AMA were designated (Fig.
1). Each of these groups, committees, and individuals would be
responsible to the Academic Issues Committee.
Merging the AOS and the AOA allowed both to work together to enhance
training, mentoring, and monitoring of academic leadership. Careful review of
the mission statements of both organizations showed that they complemented
each other beautifully. What better organization could there be to energize
and direct the vision for academic orthopaedics than the self-motivated
members of this new organization?
This year, the AOA leadership considered many applications from the AOS and
most were accepted. Standards for membership in the AOA are, and should be,
high with no compromise in values. Still, young program directors and
department chairs who are newly appointed and not yet members will need access
to the annual meetings of the AOA. The Academic Leadership Group and perhaps
the Faculty Development Committee have the responsibility to ensure that young
faculty, program directors, and department chairs are invited to the
meeting.
Locations for the AOA meeting are changing from resorts to larger cities.
The meeting programs are being extended to include more afternoon sessions,
with a focus on academic issues, and consideration is being given to changing
the time of the meeting from spring to fall, possibly November. This is in
keeping with the results of a survey of the AOS membership in 1999 that showed
that the membership preferred fall meetings at nonresort locations. They also
preferred to have the meetings held on a Friday and Saturday, minimizing the
time away from work and family.
Currently, there are 155 orthopaedic residency programs in the United
States and most of the department chairpersons and program directors are
members of the AOA. To be effective, the new AOA must be able to serve those
program chairpersons who are nonmembers. Issues such as preparation for a
Residency Review Committee visit, faculty development, budget, problem
residents, and curriculum, just to name a few, must be presented and discussed
on a fairly regular basis. Reports should be made by the President or Vice
President of the AAOS, the American Board of Orthopaedic Surgery, and the
Chairperson of the Residency Review Committee. Maintaining open lines of
communication among these groups is essential and will ensure that the goals
are clear with regard to what each expects from the other with respect to
resident education. Finally, the original goals of the founders should not be
lost, and key issues of the ACGME and the Council of Deans also need to be
discussed at the annual meeting.
Most new, younger program directors will readily adapt to online
information systems. At the time of merger, the AOS was continuing to develop
a web site and a list serve to enhance communications within the organization
and to deal with key issues in a timely fashion. Continuing web site and list
serve interaction may facilitate improved communications; however, the
electronic medium alone cannot replace an annual meeting.
In the future, being a program director or department chairperson may also
qualify the orthopaedic surgeon for membership in the AOA. The best interests
of both groups are served by focusing on the key issues of transition. The
Academic Leadership Group certainly has the potential to fulfill the needs and
original goals of the AOC when it was founded in 1971. I believe that the
leadership, then and now, has the vision to assemble individuals in the
planning and implementation process with the ability to inspire and incite the
involved membership, thus ensuring the success of this new organization.
The key to the success and survival of all orthopaedic residency programs
is to continually address difficult issues. Resident and fellow funding in a
system where reimbursement is fixed at 1996 levels, the growth and development
of faculty, and the new and equally challenging education of residents in the
six core competencies should provide ample material for stimulating meetings.
Continued cooperation among the AOA, the AAOS, and the numerous subspecialty
societies should facilitate development of the common goals of each group and
minimize our differences, enabling us to work together to solve these and
other common problems.