Frank C. Wilson. Oxford: Radcliffe Publishing; 2009. 136 pages. $49.00. ISBN: 978-1-84619-378-1.
The monograph Graduate Medical Education is about the current status of graduate medical education in the United States, and the Issues and Options rejoinder is the author's assessment of the future of graduate medical education. Written by Frank C. Wilson, MD, a master orthopaedic surgeon and educator, this work is for a wider audience than orthopaedic surgeons. The intended readership includes orthopaedists who are involved with the education and training of residents and/or the administration of programs that support orthopaedic training. This book will also bring much needed information to surgeons who are curious about the graduate medical education system, shedding light on topics that are often not visible to those who may be part of the graduate education process.
The book starts with the apocryphal story of the modern residency beginning at Johns Hopkins Hospital in the 1890s and ends with a long list of decisions offered in relation to the future of graduate medical education. In between, Dr. Wilson has reduced the complexities of residency to twelve interconnected issues. These issues range from the “E” in GME (i.e., graduate medical education), to finances, to professionalism, to teaching and learning. The issues are presented and discussed in logical order and are reflective of the current status. One problem that the medical profession is currently faced with is the constant change due to ongoing regulation, an example of which is the latest recommendation for duty hours, which limits the postgraduate year-1 (PGY-1) resident to a maximum of sixteen hours of continuous service per duty period. At the time of this writing, licensure and certification are also changing due to public pressure demanding a supply of knowledgeable and competent physicians and surgeons. Such is the increasing rate of change brought on by external forces in the contemporary regulatory environment and by the growing influence of public pressure—one of the main themes of Dr. Wilson's book. Change is the only constant.
This book is a quick read, and the references are insightful and as contemporary as possible in a printed publication. I recommend this book highly to orthopaedic residency directors and orthopaedists who create orthopaedic curriculum or supervise residents in the workplace. All will gain useful information regarding the history and evolution of graduate medical education. The five years that compose orthopaedic residency are governed by rules that have pushed traditional roles, such as the all-powerful department chairperson, into managerial roles. All faculties, both academic and nonacademic, must now be part of a process as much as they are part of the education of surgeons. Practicing orthopaedists will find little of practical value in this book.
The future of orthopaedic surgery is bright indeed as more knowledge, experience, and technology are improving diagnosis and treatment on a constant basis. Fitting the right amount of that knowledge and experience into the years of graduate medical education has been and will continue to be a challenge for educators, administrators, and, now, policy makers. The competence of newly minted surgeons is being scrutinized more closely by external institutions, and, as a new era of electronic information replaces oversized textbooks and paper records, surgical simulation is coming online and financial resources are being scaled back. Dr. Wilson's book provides considerable insight into the current state of orthopaedic residency training and outlines some of the possible options that may profoundly alter the future for the next generation of surgeons. Some of the language used in the recommendations chapter is bit strong (e.g., the “ACGME must continue its efforts …”) and preachy. Although the book is aimed at a limited readership, there is much to be learned in this short, easy read if an orthopaedist is so inclined.