Maggie McKay (Host): If you're in med school and considering your options, one might be Orthopedic Surgery. Today, we'll talk with Program Director of Orthopedic Surgery Residency, Dr. Thomas Golden and Dr. Laura Maharjan, an Orthopedic Surgery Resident Physician, about the Orthopedic Surgery Residency at Community Memorial Health Care. Welcome to Wise and Well, presented by Community Memorial Healthcare. I'm your host, Maggie McKay. Would you please introduce yourselves? Let's start with you, Dr. Golden.

Thomas Golden, MD: Yes, I'm Dr. Thomas Golden and I'm the Program Director for the CMHS Orthopedic Surgery Residency here in Ventura. I attended medical school at the University of Virginia. And, my orthopedic surgery training was in San Francisco, and I've been in practice in Ventura, California now for 40 years, and I've been the Director of the Orthopedic Residency Program for the past 10 years.

Host: Nice. So beautiful in Ventura. How about you, Dr. Maharjan?

Laura Maharjan, DO: Hi, I'm Laura Maharjan. I'm a third year orthopedic surgery resident, and I attended medical school at Texas College of Osteopathic Medicine in Fort Worth, Texas.

Host: Dr. Maharjan, what's the process of choosing a residency program like for a medical student? What are the most important factors to consider when evaluating programs?

Laura Maharjan, DO: That's a great question. It's a tougher process than most people realize. So you start making a list to apply by reviewing the program websites. You choose programs to audition at and you spend two weeks to four weeks at each of those programs. Then you prepare and submit an application through the ERAS, which is the Electronic Residency Application Service, including your personal statement, letters of recommendation, transcripts, and a CV.

Then you attend interviews, and after interviews, you rank those programs based on how well they fit your preferences and goals. Then you can submit your ranking list to the NRMP, which is the National Resident Matching Program. You submit your ranked list of programs, and every program submits a ranked list of candidates, and then you're matched to a residency position based on your mutual preferences, and there are many factors that go into the decision for residency.

First, since orthopedic surgery residency is quite competitive, it is important to apply broadly. And you can look at clinical exposure. For me it was important to have different clinical experiences and exposure to various sub specialties. Then you can assess the interaction between the residents and faculty, consider the work hours, on call requirements, and overall work environment.

Location plays a big role for a lot of people. You can also look at the program's track record for fellowship placements and job placements after residency. And everyone develops their list of important factors based on their individual situation, but these were the most common that students looked at whenever I was applying.

Host: Mmhmm. And what ultimately led you to choose Community Memorial Health Care's graduate medical education program?

Laura Maharjan, DO: Well, I think overall, when I was rotating here, I loved the positive and collaborative work environment, specifically the camaraderie amongst the residents and between the residents and the faculty. Our attendings are very approachable and available and receptive to questions. What I liked about this program was there was a good balance between the autonomy and supervision, especially as an early resident.

And being Latina, it was important for me to give back to my community and given the large amount of Hispanic population in Southern California, I get to serve the Latino community on a daily basis here. And at the end of the day, it's important to find a program that will provide strong training, support, and overall a good fit for your career aspirations and personal life, and I thought this was it for me.

Host: A lot of good reasons. You mentioned the people, and when you think about it, you're usually with your coworkers more than your own family. So yeah, you have to love the people you work with, I think. Dr. Golden, can you describe the philosophy of your residency program? What sets it apart from other programs across the country?

Thomas Golden, MD: Sure, our philosophy is to produce competent orthopedic surgeons who are able to practice with sound judgment and skill, with a strong emphasis on treating co workers and patients with dignity and respect. So, through our faculty mentorship and supervision, as well as simulation and progressive clinical experience, our residents move towards this goal.

So at the completion of training, we're able to certify that our residents are ready to begin the independent practice of orthopedic surgery. In terms of what sets our residency apart from other programs, I think Dr. Maharjan has already commented to some degree on that, but I just want to emphasize the culture of our program, the resident faculty relationships. We have a diverse and compassionate faculty. And then looking at what we've done in the past, we have a hundred percent board pass rate, a hundred percent fellowship match for our graduates. And the graduates end up entering practice in different parts of the country and have all been very successful.

Host: And would you please describe the program's focus on sports medicine, joint replacement, and trauma?

Thomas Golden, MD: Sure. So we have very strong faculty team of sports medicine and recon attendings at our hospital. in addition to mentorship from numerous excellent sports attendings in our sports program; we also send our residents to the Arthroscopy Association of North America Foundations of Arthroscopy course in Chicago.

And we have on site, a VirtaMed arthroscopic simulator, which helps the residents learn arthroscopic surgery. In terms of reconstruction; we do over 1400 joint replacements at our hospital each year, and we have excellent reconstruction attendings. One recent, graduate of our program, completed a university fellowship, and is a trained revision specialist.

And he's joined our faculty, recently. In terms of trauma, we're very strong on trauma. We have, three centers that we send our residents to. One is at VCMC, our sister hospital here in Ventura, which is a level two trauma center. And then we also send residents to Cedars Sinai in Los Angeles and Santa Barbara Cottage Hospital, where they learn trauma at these level one trauma centers. So, overall they get one full year of trauma experience, and my associate program director, is a nationally renowned trauma orthopedic specialist here in Ventura.

Host: That's wonderful. Dr. Maharjan, can you elaborate on the diverse range of orthopedic attendings within your faculty and how it benefits resident training?

Laura Maharjan, DO: Sure yeah, we have attendings from diverse backgrounds and experiences, and as Dr. Golden mentioned, we have graduates from the program that have returned as attendings because they loved our experience, and this fuels their commitment to the success of our residents.

And this is evident by their involvement in our weekly didactics and monthly journal clubs. And like Dr. Golden mentioned as well, at Ventura County, we are uniquely fortunate to have a high concentration of female attendings, which is a rarity in orthopedic programs. And it's such an honor to work alongside these distinguished surgeons and gain insights from their diverse perspectives and invaluable experience. So, we're very fortunate to have these attendings here.

Host: Mm hmm. Did you want to add anything to that, Dr. Golden?

Thomas Golden, MD: I certainly agree with that. We are very fortunate to have five of our graduates in the past six years go on to complete competitive fellowship programs in trauma, sports medicine, joint reconstruction, upper extremity, and foot and ankle surgery; come back to our program and join our faculty.

I think it's really great to have those young attendings here teaching our residents. So for that, I'm very pleased about that part of our curriculum.

Host: I can imagine. What's the program's approach to robotic surgery or minimally invasive surgery?

Thomas Golden, MD: So we actually have a really strong robotic surgery program in orthopedics. So we were one of the first hospitals in California to acquire the Zimmer Rosa robot for total knees and total hip replacements. And we've had that here for the past five years and most of our total joint surgeons utilize that technology. We also have a robot in our spine surgery program. So it's an important part of our practice and our residency to teach robotics.

Host: Mmhmm, Dr. Maharjan.

Laura Maharjan, DO: Yeah, I have to agree with Dr. Golden. I think it provides a lot of value to our training and there's definitely value in learning both the standard instrumentation and robotic surgery. So these tools just increase our surgical skills and they broaden our versatility as surgeons once we're out in practice.

Host: Let's talk about the annual trip to Vietnam. This sounds so interesting. Tell us about what it is, what role the residents and the graduates play in the trip and how the experience benefits their training and future careers. What do you do there, Dr. Golden?

Thomas Golden, MD: Yeah. So I'll start out and then Dr. Maharjan can chime in. But we're very proud of this trip. It's an international medicine trip to Hanoi, Vietnam. We've been doing this for the past five years. We bring a group of surgeons. This year we brought 11 surgeons, seven graduates from our program, and four of our orthopedic chief residents with us. We, arrive in Hanoi. We spend a day in the clinic there and then perform surgeries in the main public hospital in Hanoi. This year we did over 40 surgeries in Vietnam; many of which are very complex reconstructive cases that the Vietnamese surgeons, love to see and collaborate with us in terms of sharing, our knowledge with them.

So it's really a wonderful trip that allows us to utilize our skills and help the people of Vietnam and collaborate with the surgeons there. I know Dr. Maharjan has done some research on talking to some of our previous graduates who have gone over with us, so I'll let her talk about that.

Laura Maharjan, DO: Thank you, Dr. Golden. Yeah, well, I haven't attended the trip myself. This is definitely something that drew me to the program initially. So I got to speak with some of the chiefs that went on the trip this past year and this is kind of what the overall message from them. So overall, the residents and graduates do play a large part in the trip to Vietnam.

It is a very busy trip and has a mix of clinical and operative responsibilities. In the clinic, basically the residents function as junior attendings. So they're responsible for evaluating the patients and then with the aid of their attendings, they diagnose the pathology and make a surgical or non operative plan for the patient.

And once they determine that plan, the resident attending discuss with the Vietnamese surgeons and residents regarding the resources they will have to complete the surgery as close as possible to the way that we would attempt to do it here in the States. So this can take a surprising turn and take lot of preoperative planning and sometimes improvisation. Once in the operating room, the resident can work with the attending side by side with the Vietnamese residents and surgeons as well to complete the operations.

Host: And how does that impact their future careers, the training that they get there?

Thomas Golden, MD: Well, I think that it gives them a much broader perspective about what they've learned here and how to apply that to a situation where they may not be as used to being involved with, but have to, as Dr. Maharjan said, kind of improvise and become a bit more flexible, in terms of utilizing resources. So I think it's really an amazing experience for them to be able to utilize their skills in a unique situation like that.

Host: Sounds like it. What advice would you give to medical students who are interested in applying to your program, Dr. Golden?

Thomas Golden, MD: Well, I think that they should look closely at our program because, you know, we do a very good job of training residents how to become competent orthopedic surgeons. And I think they'll find that spending five years with us is an amazing experience in terms of, resident culture, relationships, compassion and diversity, as I've mentioned of our faculty.

And one thing I'll also mention is that, many orthopedic surgery residency programs throughout the country, don't look as closely as we do at the osteopathic graduates. So, we really do look closely at those graduates and from medical schools, osteopathic medicine and, very much favor that group of doctors for our potential residents.

Host: And Dr. Maharjan, in a nutshell, what would you advise medical students thinking about applying to your program?

Laura Maharjan, DO: Well, our program really emphasizes teamwork and authenticity, so I would tell them to really observe how things are done so they can effectively be a part of the team, and be proactive, stay engaged during cases, seek feedback on how to improve and apply it, and also ask all your questions. Ask questions about the factors that are important to you.

That will make a difference for you when it comes to ranking and most importantly just be yourself, you know, part of auditioning at programs is seeing if you're a good fit as well as we're a good fit for you.

Host: How does the program support work life balance for residents? Because you always hear about residents and how they practically live 24/7 at the hospital.

Laura Maharjan, DO: So our program is really dedicated to promoting a healthy work life balance, and, basically, you know, we strictly adhere to the accreditation guidelines, in terms of work hours. There's definitely flexibility in our weekly schedule to attend to personal commitments if needed. We also have access to mental health and wellness resources, as well as our wellness coordinator, whom we meet on a semi annual basis.

And part of our onboarding actually has workshops on stress and time management, self care, and work life balance. We also have a faculty mentor who provides guidance not only on professional development, but also on managing work life balance. And our program, Dr. Golden basically spearheads this. They really value feedback from residents and it's very an organic thing where we make adjustments to our policies and practices based on our input to really improve the resident experience.

Thomas Golden, MD: And I'll just mention one thing about that, you know, we've had situations, where things happen in people's lives and family emergencies or other things come up where residents need some time to take care of those issues. And so when that happens in our residency, we allow that time for that particular resident.

And not only that, but the residents who remain are now needed to take over the responsibilities of that resident for a particular amount of time, step up to the plate. So one thing that's noteworthy, I think, about our program that really impresses me is how much the residents really watch out for each other when it comes to those kind of things.

Host: It does sound like a very impressive program all the way around. It's like you have covered everything. So, I can see why a lot of people want to work with you and your program. Thank you both for sharing your expertise. We appreciate your time and your insight.

Thomas Golden, MD: You're welcome. Thank you for asking us to do this.

Laura Maharjan, DO: Thank you, Maggie.

Host: Thank you. Again, that's Dr. Thomas Golden and Dr. Laura Maharjan. To learn more, please visit mycmh.org/orthopedic-surgery. And if you found this podcast helpful, please share it on your social channels and check out our entire podcast library for topics of interest to you. I'm Maggie McKay.

Thanks for listening to Wise and Well presented by Community Memorial Healthcare.