The house of academic medicine is supported by four pillars, which include clinical care, administration, research, and teaching. These pillars sustain the diverse missions of academic medical centers. Our subspecialty of orthopaedic surgery is also supported by these pillars.
Clinical care is the largest and strongest pillar of academic medicine and orthopaedics. All value in health care begins with service to patients, and providing high-quality, safe health care is critical to the success of all medical centers and all orthopaedic practices.
Administration is a necessary pillar. Competent, knowledgeable, and diligent administrators are very important for medical centers and orthopaedic practices, as they manage the complex processes associated with the clinical and academic missions.
Research is an essential pillar of academic medicine and orthopaedic surgery. Besides providing new knowledge, new services, new products, and innovations that improve the care we offer to our patients, research can generate additional revenue for medical centers.
During my career, research in orthopaedics has led to subspecialization in orthopaedic surgery, which, in general, has improved patient care. Specific clinical advances that I have observed include arthroscopic surgery, microsurgery for neurovascular reconstruction, cartilage restoration, cementless hip replacement, instruments and navigation for total knee arthroplasty, advances in spine surgery, and techniques and products for orthopaedic trauma care. These innovations have succeeded because they relieve pain and improve function for orthopaedic patients. Orthopaedic research improves the lives of our patients, and research is an essential pillar in the house of orthopaedics.
Teaching is the fourth pillar of academic medicine and orthopaedics, although teaching can be an undervalued and overlooked pillar. Teaching generates less revenue than clinical care and research, generates administrative costs, and takes time to do well. Despite the critically important fact that teaching programs train the next generation of physicians and orthopaedic surgeons, the importance of the teaching mission has diminished over the last decade at some medical centers.
During my career, I have developed and accumulated several thoughts on the teaching mission in orthopaedic surgery. I am the son, grandson, and son-in-law of teachers, and I was taught the value of education and teaching at an early age.
Orthopaedic surgeons are bright, motivated, and accomplished men and women. We deserve a lot of credit for who we are and for what we have accomplished. However, we did not achieve our goals alone. We owe much of our success to our teachers.
My first teachers were my parents, who taught me the values that I use every day in my personal life and in my professional life. My parents and family have taught me many life lessons, and my gratitude for their love and their teaching continues.
As physicians, we have encountered many teachers during our extended education in high school, college, medical school, and residency. Some teachers were great, some teachers were not so great, but all teachers taught us something. Our orthopaedic teachers include professors, partners, residents, nurses, administrators, and secretaries as well as our patients, who may be our most valuable teachers, because they taught us our profession.
Our orthopaedic teachers taught us about fractures, dislocations, infections, tumors, and arthritis. They taught us the anatomy, physiology, and pathology of these problems. They taught us to love orthopaedics.
Our orthopaedic teachers taught us the primacy of patient care. They taught us the importance of pain-free function to orthopaedic patients. As orthopaedic surgeons, we have no value, and no profession, without our patients.
Our orthopaedic teachers taught us to be careful, competent clinicians. They taught us to make clinical decisions with evidence-based data and to carefully choose the best treatment for each patient.
Our orthopaedic teachers taught us to care. This lesson of caring began at home, but it continues at work. Caring is essential to our profession.
Our orthopaedic teachers taught us to be honest with our patients, our colleagues, and ourselves.
Our orthopaedic teachers taught us to deal with failure. All surgeons have complications, all surgeons fail from time to time, and fear of failure can be a great motivator. Our orthopaedic teachers taught us to learn from failure and to keep learning as we age.
Our orthopaedic teachers taught us to celebrate successes and milestones, such as your orthopaedic residency match notice, your first patient, your first surgical incision, and your letter of congratulations from the American Board of Orthopaedic Surgery. As orthopaedic surgeons, we have much to celebrate.
Perhaps the most important thing our orthopaedic teachers taught us is how to operate. Our privilege to operate on human beings may be the most personal and the most intense human service that exists in our world. We should never underestimate the privilege and the responsibility of treating our patients with surgical procedures.
Teaching is a common thread woven into the fabric of the medical profession. As doctors and as orthopaedic surgeons, we are all teachers. We teach a broad spectrum of colleagues every day. We teach at work, and we teach at home. We teach patients, students, residents, friends, and family. We teach with words, and we teach with actions.
As I reflect on teaching in orthopaedic surgery, I have a few wishes for orthopaedic teachers of the future.
Teach quality. Advocate for high standards in patient care, promote patient safety, and never compromise on quality.
Teach passion for orthopaedics. Bring a passionate, positive attitude to work every day. This will reinforce your commitment to quality health care, and your patients will notice your upbeat attitude.
Teach access and availability. Encourage your support staff to make you available to patients as much as possible. I teach my residents that the No. 1 thing to look for in a job search is "access to patients." Patients need access to you, and you need access to patients. You cannot succeed, and you cannot prosper as an orthopaedic surgeon, without patients.
Teach science. Use evidence-based information to make patient care decisions. Avoid the common trap of relying on marketing information to make patient care decisions. Use level-I evidence to evaluate innovations and new technology whenever it is available.
Teach the value of listening. We can learn more, and we can solve more problems, when we listen carefully to our patients, colleagues, friends, and family.
Teach precise surgical technique. Patient outcomes following orthopaedic surgery are more dependent on surgical technique than on surgical implants. Pay attention to the details of surgical anatomy and surgical technique. "Close enough" is not good enough. Our patients depend on us for successful outcomes, and we alone are responsible for our surgical technique.
Teach teamwork. Health care is delivered by teams of professionals. Orthopaedic surgeons do not provide care alone. In my orthopaedic subspecialty of adult reconstruction, we depend on our hospitals and our colleagues in order to provide uniformly high-quality care for our patients having a total joint arthroplasty. Teamwork is essential to deliver this high-quality health care.
Teach change. Embrace valid improvements in health care that enhance quality or safety. Do not resist changes because they did not exist when you were a resident. Learn the value proposition of increasing quality while decreasing cost. Surgical site signing, timeouts, checklists, quality improvement initiatives, and apologies for adverse outcomes are "good changes" that will make you a better surgeon.
Teach continual improvement. In orthopaedic surgery, if you are not getting better, you are getting worse. We must improve our knowledge, our skills, and our judgment every day and every year. I teach my residents that the No. 2 thing to look for in a job search is a "learning environment." Fifty percent of orthopaedic surgeons leave their first job. When you start your practice, keep learning, keep improving. You need to improve every day in the event you choose to or need to look for a new job.
Teach humility and humor. We are not as good as we think we are, we are not as bad as some people say we are, and we need a good laugh every day!
Teach tolerance and inclusion. Diversity is not a goal, it is an attitude.
Teach the value of orthopaedic surgery and orthopaedic surgeons. We fix injuries, we relieve pain, and we improve function. We change lives. Our work has been judged to be clinically successful for individuals and cost-effective for society. Surveys of public trust consistently place doctors at the top of the list. However, societal perception of our value, as measured by reimbursement for our services, has diminished over the last two decades. Stand up for reimbursement relative to our value. Avoid apologizing for the cost of orthopaedic care. We improve lives; we are worth the expense. However, be careful about the public perception of your words and your actions. No whining!
In sharp contrast to my suggestion that we should stand up for ourselves, I also encourage you, and exhort you, to teach and demonstrate professionalism. Act responsibly. Be kind at work and at home. Give back to your community. Practice orthopaedic surgery with competence and compassion. Servant leadership is a virtue. Raise the bar for high standards of behavior in words, actions, dress, and all aspects of your personal and professional lives.
Teach patience. More importantly, practice patience. The relationship between our profession and society is complex. Be patient when your students, your patients, and the world are not listening to what you are teaching.
Teach excellence. Be the best. Expect the best from your students. You are orthopaedic surgeons. You are the best and the brightest. Make your teachers proud of you.
Finally, teach balance. Orthopaedic surgery can be an intense, high-pressure, all-encompassing profession. Orthopaedic surgeons perform better at work and enjoy life more at home when they can balance their personal and professional lives.
In conclusion, my take-home message is simple. As a young orthopaedic teacher, please think about your own teachers. Think about what they taught you and think about what you learned from them. Think about how your teachers helped you to accomplish your goals. Think about how you can help your students to accomplish their goals.
Teaching and teachers help us to define our lives and our profession. Teachers made a profound difference in my life. As an orthopaedic teacher, you can make a difference in the lives of others.