Orthopaedic Graduate Medical Education: A Changing Paradigm

Orthopaedic surgeons traditionally have been trained with use of an apprenticeship model, with experience being measured on the basis of case log documentation and with competency being determined by senior mentors. Over the past decade, medical education has undergone a major paradigm shift, with increasing emphasis on teaching toward competence as a specialist, including operative skills, essential knowledge for practice, professionalism, and the use of evaluation methods thought to be credible, accurate, reproducible, and transparent. The primary use of an apprenticeship model may result in graduates never having performed some procedures or never having managed patients with certain diagnoses. Alternatively, the competency model may result in graduates performing well on certain standard procedures but perhaps not demonstrating competency on relatively rare entities. While the provision and assessment of medical education have become more complex in proportion to advanced technologies and novel procedures, delivering excellence in education itself has become increasingly difficult as a result of duty-hour restrictions, …