Information Technology and Orthopaedic Education

Myles Clough, M.D., FRCSC
Kamloops, BC

Christian Veillette, M.D., FRCSC
Toronto, ON

The arrival of computers has not materially changed the way in which medical students and orthopaedic trainees learn the subject. Indeed the teaching of musculoskeletal medicine has been the recent subject of severe criticism and reform of the educational process is a major goal of the Bone and Joint Decade1. This article is an entry to the literature on the use of information technology (IT) both in orthopaedic trainee education and in CME, as well as a brief review of useful Internet resources.

There are several teaching initiatives that take advantage of IT. One early suggestion was computerized examinations2 closely followed by instruction in biomechanics3. Chew & Smirniotopoulos used an interactive video disc to teach trauma radiology to orthopaedic residents4. The residents approved the programme and their post-test scores improved significantly. CD-ROM-based computer-assisted education was also shown to improve trainees' post-test exam scores5,6. Sinkov et al (2004)7 investigated the educational use of the Internet by trainees and consultants and found that both groups preferred online textbooks.

photo6.jpgThe seemingly simple concept of supporting lectures with specifically posted web-based information8 was not reported until 2007. Johns Hopkins orthopaedic programme has also developed a system of this type9, but for protection of copyright, it requires a password. The mystique surrounding creation of webpages seems to inhibit this very valid way of reinforcing what has just been taught. The trainees themselves have usually initiated online posting of notes/reviews on orthopaedic subjects10,11,12 although these efforts have been continued after the completion of training in many cases. The Southern Orthopaedic Association's project to produce an online peer-reviewed textbook (http://www.orthopaediccare.net/)13 authored by experts, has only delivered a few chapters, but they are of high quality. Ongoing CME is provided online by the AAOS - Orthopaedic Knowledge Online (www.aaos.org/oko)14, Orthopedics Hyperguide (http://www.ortho.hyperguides.com/)15 Ortho Supersite (http://www.orthosupersite.com/)16, eMedicine (www.emedicine.com/orthoped/)17 and Medscape (www.medscape.com/orthopaedics/)18 amongst others. Sites for subspecialty information include the Electronic Textbook of Hand Surgery (http://www.eathonhand.com/)19 and the East Lancashire Foot and Ankle Hyperbook (http://www.foothyperbook.com/)20. Several of the subspecialty societies post valuable educational resources. Especially notable are the OTA Basic Fracture Course (http://www.hwbf.org/ota/bfc/)21 and the Trauma and Fracture Care Residency Core Curriculum Lectures (http://www.ota.org/res_slide/index.html)22 also from the OTA. The latter constitutes downloadable PowerPoint presentations which may be adapted for anyone's use (with suitable crediting). The POSNA Core Curriculum (http://www.posna.org/members/coreCurr/coreCurriculum.cfm)23 presents discussion points about key features of paediatric orthopaedics. Work has also been done on computer simulation of surgical activities24 with Virtual Reality Simulators25. Models of arthroscopy seem to be attracting the most attention26,27,28.

The rise in popularity of social networking and Web 2.0 technologies has resulted in improved sharing of information. The Association of Bone and Joint Surgeons (http://www.abjs.org/) has initiated development of a web-based collaborative orthopaedic knowledgebase called Orthopaedia (http://www.orthopaedia.com/). Orthopaedia has been built on a wiki framework which allows members of the community to add or edit articles, post comments, contribute documents, submit news updates in a single, searchable, structured repository.

Those interested in Orthopaedic Informatics not only have to understand, promote and participate in the developments taking place in this arena. They also have to interpret them to the orthopaedic community and recommend changes to the educational system29,30 that will be appropriate for the future. It is a truism that we "learn to learn", but the new reality is that the methods and modalities of learning are changing as well31.

References

  1. Bernstein J, King T., and Lawry G. V. Musculoskeletal Medicine Educational Reform in the Bone and Joint Decade J. Bone Joint Surg. Am., October 1, 2007; 89(10): 2308 - 2311.
  2. Gouw G.J., McQueen D., Letts R.M. Computer corner #13. Computerized examinations in orthopaedics. Orthop Rev. 1986 Apr;15(4):256-60.
  3. Calhoun J.H., Allen B.L. Jr, Meek-Chilton J., Clark R. Computer-assisted instruction in orthopedic biomechanics. Orthop Clin North Am. 1986 Oct;17(4):599-604.
  4. Chew F.S., Smirniotopoulos J.G. Teaching skeletal radiology with use of computer-assisted instruction with interactive videodisc. J Bone Joint Surg Am. 1995 Jul;77(7):1080-6.
  5. Thomas R.L., Allen R.M. Use of computer-assisted learning module to achieve ACGME competencies in orthopaedic foot and ankle surgery. Foot Ankle Int. 2003 Dec;24(12):938-41.
  6. Vivekananda-Schmidt P., Lewis M., Hassell A.B.; ARC Virtual Rheumatology CAL Research Group. Cluster randomized controlled trial of the impact of a computer-assisted learning package on the learning of musculoskeletal examination skills by undergraduate medical students. Arthritis Rheum. 2005 Oct 15;53(5):764-71.Available at http://www3.interscience.wiley.com/cgi-bin/fulltext/112099753/HTMLSTART
  7. Sinkov V.A., Andres B.M., Wheeless C.R., Frassica F.J. Internet-based learning. Clin Orthop Relat Res. 2004 Apr;(421):99-106.
  8. Citak M., Haasper C., Behrends M., Kupka T., Kendoff D., Hüfner T., Matthies H.K., Krettek C. A web-based e-learning tool in academic teaching of trauma surgery. First experiences and evaluation results Unfallchirurg. 2007 Apr;110(4):367-72.
  9. Netorthodoc 2008 [Webpage] Available at http://www.netorthodoc.org/
  10. Wheeless' Textbook of Orthopaedics 2008 [Webpage] Available at http://www.wheelesonline.com/
  11. South Australian Orthopaedic Registrars' Notebook 1997 [Web site] Available at http://som.flinders.edu.au/FUSA/ORTHOWEB/notebook/home.html
  12. Orthoteers Orthopaedic Resource 2008 [Web site] http://www.orthoteers.com/
  13. Orthopaedic Care: Medical and Surgical Management of Musculoskeletal Disorders 2006 ed Koman L.A. Southern Orthopaedic Association [Web site] http://orthopaediccare.net/
  14. Orthopaedic Knowledge Online: Your Source for Orthopaedic Learning 2008 Ed. Grana W.A. AAOS [Web site] Available at http://www5.aaos.org/oko/login.cfm requires registration
  15. Orthopedics Hyperguide 2008 Sponsored by Howmedica Editors D'Ambrosia R.D. & Frassica F.J. [Web site] Available at http://www.ortho.hyperguides.com/ requires registration
  16. Ortho Supersite 2008 Sponsored by Slack Inc [Web site] Available at http://www.orthosupersite.com/ requires registration
  17. Orthopaedic Surgery Articles eMedicine 2008 [Web site] Available at http://www.emedicine.com/orthoped/index.shtml requires registration
  18. Orthopaedics Resource Centers - Medscape 2008 [Web site] Available at http://www.medscape.com/orthopaedics/ requires registration
  19. Electronic Textbook of Hand Surgery 2008 Eaton C.J. [Web site] Available at http://www.eatonhand.com/
  20. East Lancashire Foot and Ankle Hyperbook 2008 Ed. Barrie J. [Web site] Available at http://www.foothyperbook.com/
  21. Basic Fracture Course: Orthopaedic Trauma Association 2008 [Web site] Available at http://www.hwbf.org/ota/bfc/
  22. Trauma and Fracture Care Residency Core Curriculum Lectures 2008 [Web site] Available at http://www.ota.org/res_slide/index.html
  23. Core Curriculum Pediatric Orthopaedic Society of North America [Web site] Available at http://www.posna.org/members/coreCurr/coreCurriculum.cfm
  24. Jaramaz B., Eckman K. Virtual reality simulation of fluoroscopic navigation. Clin Orthop Relat Res. 2006 Jan;442:30-4.
  25. Tsai M.D., Hsieh M.S., Jou S.B. Virtual reality orthopedic surgery simulator. Comput Biol Med. 2001 Sep;31(5):333-51.
  26. Sherman K.P., Ward J.W., Wills D.P., Sherman V.J., Mohsen A.M. Surgical trainee assessment using a VE knee arthroscopy training system (VE-KATS): experimental results. Stud Health Technol Inform. 2001;81:465-70.
  27. McCarthy A.D., Moody L., Waterworth A.R., Bickerstaff D.R. Passive haptics in a knee arthroscopy simulator: is it valid for core skills training? Clin Orthop Relat Res. 2006 Jan;442:13-20.
  28. Cannon W.D., Eckhoff D.G., Garrett W.E. Jr, Hunter R.E., Sweeney H.J. Report of a group developing a virtual reality simulator for arthroscopic surgery of the knee joint. Clin Orthop Relat Res. 2006 Jan;442:21-9.
  29. Podcasting comes to Med School Curriculum: WebWeekly News from the Harvard Medical Community Jan 30th 2006 [Webpage] Available at http://webweekly.hms.harvard.edu/archive/2006/0130/student_scene.html
  30. Hungerford D.S. 2006 A new paradigm for orthopaedic education [Webpage] Available at http://www.aboutjoints.com/physicianinfo/topics/paradigm.html
  31. Boulos M.N., Maramba I., Wheeler S. Wikis, blogs and podcasts: a new generation of Web-based tools for virtual collaborative clinical practice and education. BMC Med Educ. 2006 Aug 15;6:41. [Web site] Available at http://www.biomedcentral.com/1472-6920/6/41#B24

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