key: cord-0898387-ziddepr7 authors: Stambough, Jeffrey B.; Curtin, Brian M.; Gililland, Jeremy M.; Guild, George N.; Kain, Michael S.; Karas, Vasili; Keeney, James A.; Plancher, Kevin D.; Moskal, Joseph T. title: The Past, Present, and Future of Orthopaedic Education: Lessons Learned from the COVID-19 Pandemic date: 2020-04-18 journal: J Arthroplasty DOI: 10.1016/j.arth.2020.04.032 sha: 80a357e55785bc902caf7b0a9c0fae191a5d354e doc_id: 898387 cord_uid: ziddepr7 Abstract The COVID-19 global pandemic has upended nearly every medical discipline, dramatically impacted patient care, and has had far-reaching effects on surgeon education. In many areas of the country, elective orthopaedic surgery has completely stopped to ensure that resources are available for the critically ill and to minimize the spread of disease. COVID-19 is forcing many around the world to reevaluate existing processes and organizations and adapt to carry out business, of which medicine and education are not immune. The majority of national and international orthopaedic conferences, training programs, and workshops have been postponed or canceled, and we are now critically evaluating the delivery of education to our colleagues as well as residents and fellows. This manuscript describes the evolution of orthopaedic education and significant paradigm shifts necessary to continue to teach ourselves and the future leaders of our noble profession. AOA recommended the specific composition of a board for orthopaedic certification consisting Graduate Medical Education (ACGME) in 1982 [6, 7] . Since its establishment, the ACGME 33 introduced several landmark changes in orthopaedic surgical education. In 1999, the ACGME 34 defined six core competencies in which residents must achieve competency during their training 35 (Table 2) [8]. The accreditation model used by the ACGME shifted from process measures to 36 evaluation of outcomes [8, 9] . 37 Resident, fellow, and surgeon education prior to the advent of computer-based learning 38 and the digital age relied on print and face-to-face interaction for continuing medical education 39 (CME). This was the traditional education model that we accepted as the gold standard in the Maintaining up to date orthopaedic knowledge via peer-reviewed literature was done via 44 subscription to journals arriving via postal mail (Table 3) . Digital and web-based learning 45 platforms were not available through this time period and ABOS/MOC exams required travel to 46 take hard copy tests. However, with the advent of the internet and the ability to share content electronically, resident education in all medical specialties has been going through a gradual 48 transition over the past decade. Just prior to the COVID-19 pandemic, orthopaedic residents and fellows were primarily 50 using digital content for their education in the form of electronic textbooks, journal articles, 51 online presentations, and surgical videos on a variety of websites. (Table 3 ) Web-based learning 52 platforms have rapidly gained popularity for resident education, and in a recent national survey 53 of American orthopaedic residents, a web-based training resource was found to be the most 54 commonly used educational resource, used by 99.5% of respondents [10]. Video-based surgical 55 education, which has been shown to be effective, [11] has grown dramatically in popularity with 56 the advent of on-demand surgical video websites, which now host tens of thousands of surgical inaugural year of the WLA, 55% of eligible diplomats decided to use this format and over 95% 63 said they were either moderately or very likely to continue with the WLA the following year 64 [12]. Finally, even prior to the COVID-19 pandemic, the necessity of gathering for discussion in 65 the way of a formal journal club meeting was being challenged with evidence supporting the use 66 of smartphone messaging applications to lead electronic journal clubs and teach critical appraisal 67 skills to residents [13] . The era of web-based learning, testing, and even group discussion was 68 emerging prior to COVID-19 and will likely be solidified as we modify how we continue to 69 educate ourselves as practicing orthopaedic surgeons and our surgeon trainees in the midst of this 70 challenging pandemic. orthopaedics, many issues need to be addressed such as the milestones system, and of paramount 84 importance will be how training institutions will adapt to provide their trainees' adequate 85 exposure to meaningful surgical opportunities or surrogate to meet ACGME minimum case 86 requirements necessary to graduate and sit for board examinations [16] . The ACGME addressed the COVID-19 pandemic by recognizing that each program will 88 function in one of three stages during the pandemic [17] . As the pandemic affects each region 89 differently, programs will fluctuate within each stage. Stage 1 is business as usual and thus no 90 effect on requirements. Stage 2 will be implemented as clinical demands increase and some 91 residents may be shifted to patient care duties associated with the pandemic. The effects on 92 education will be acknowledged during this stage 2, by suspending accreditation and clinical 93 learning environment review (CLER) site visits. Supervision of residents via telemedicine is 94 allowed but self-study activities are suspended. Virtual lectures and journal clubs are permitted. 95 ACGME fellows will be allowed to function as attendings for up to 20% of the time, and The participating fellows and presenters agreed that, although FOCAL was a productive traditional question and answer periods [24] . Currently, we have difficulties placing all scientific Networking within the orthopedic community has already found ways to expand through 199 the stresses of the pandemic in ways that will likely continue to foster interconnectivity, and residency programs also advance these programs out of the previously siloed educational 207 structure to one more broadly based with national faculty. In many ways, this may serve to level 208 and elevate the playing field for orthopedic education. Fellows and residents, regardless of 209 which program they may train within, will now potentially gain exposure to thought leaders 210 across the nation and not just from their home institution. The COVID-19 pandemic has served as an effective catalyst to expand educational 212 opportunities-particularly with respect to knowledge sharing through web-based technology. Is Video-Based Education an Effective 297 Method in Surgical Education? A Systematic Review American Board of Orthopaedic Surgery A Prospective Review of a Club Format in an Orthopedic Residency Unit Managing 305 Resident Workforce and Education During the COVID-19 Pandemic Evolving Strategies 306 and Lessons Learned American Board of Orthopaedic Surgery. 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Hamilton for