Melanie Cole, MS (Host): Welcome to the podcast series from the specialists at Penn Medicine. I’m Melanie Cole. And today, we’re highlighting thought leadership, career development, and expert specialty clinical care in orthopaedics. Joining me today is Dr. Charles Nelson. He’s the President of the American Board of Orthopaedic Surgery, a Professor of Orthopaedic Surgery, and Chief of Adult Reconstruction at Penn Medicine.

Dr. Nelson, thank you so much for joining us today. You’ve been elected president of the American Board of Orthopaedic Surgery, also known as ABOS. Congratulations, and thank you for being with us today. I know this is probably a very busy time for you. But can you tell us a little bit about yourself and the significance of this new position?

Dr. Charles Nelson: I have a strong passion for health equity and optimizing musculoskeletal care for patients through high-quality clinical care, education, research, and advocacy. And I’m privileged to work here at Penn, collaborating with highly qualified individuals and committed healthcare workers in so many disciplines and trying to educate some of the most promising students, residents, and fellows.

Having the opportunity to serve the public and the profession working with the ABOS Board of Directors has been as impactful as any of the opportunities that I’ve had in medicine. And it’s a privilege and a responsibility, I think, of every profession to carry itself in a manner that maintains the trust of the public.

Host: You previously chaired both the ABOS DEI Task Force and the Credentials Committee. How did those experiences, Dr. Nelson, inform this presidency?

Dr. Charles Nelson: Well, during my time chairing the Credentials Committee and serving as the inaugural chair for the DEI Task Force, which subsequently became the DEI Committee, we emphasized and we really utilized a lot of the resources available to us to leverage other innovations within the ABOS, really trying to optimize our credentialing process.

And I can go in a little more detail what the credentialing involves, as well as our oral and written examinations, our continuing certification, and trying to make sure that all those things were as free as possible from bias. We also did an audit on our board, our volunteers, and our staff, and required bias training for all of our oral examiners as well as our question writers. And as President, I’m working to continue those initiatives while also supporting the changing IT infrastructure that’s been necessary in our organization. Also, the transition in our future leadership and really working to leverage, but not be victims of AI, as AI becomes increasingly involved in everything we do.

Host: And we’re going to get into that a little bit because that’s fascinating right now, AI and orthopaedics. The ABOS was founded in 1934. And among other notable things, it certifies orthopaedic surgeons following residency, a period of practice, and training residents must spend in various subspecialty areas. Tell us, why are these elements necessary and so important today, given the extent and intensity of modern medical education?

Dr. Charles Nelson: Well, I think first it’s important to understand that when medicine was practiced in the 19th century and early part of the 20th century, there were really no national standards that were required. So, there were people who learned from other people and may or may not have been performing care that would be considered appropriate by other professionals.

The ABOS was formed with representatives from the American Orthopaedic Association, the American Academy of Orthopaedic Surgeons, and the American Medical Associations in 1934, really so that we could have a national standard. Before that, some states would have certain standards, but they were very inconsistent and not present on a national basis. So, this has, I think, been an important aspect to medical training, and really protecting the public for the last 91 years now that the ABOS has been around.

Now, as far as the minimum amount of training time for residents, those stipulations really come from the ACGME, which is the Accrediting Council for Residencies and Graduate Medical Education. The ABOS follows those standards because they have been set by the accrediting body for graduate medical education. So, we require that residents spend the amount of time that has been recommended by the ACGME before they’re able to sit for their boards in training. So, it’s important that all orthopaedic surgeons get comprehensive orthopaedic education prior to independently caring for patients.

Now, the responsibilities of the ABOS go beyond that to the public. And we’ve also developed a knowledge, skills, and behavior tool, which allows assessment of residents and hopefully better feedback related to skills and behavior during residency training. And then, knowledge is assessed through what’s called the orthopaedic-in-training examination. And then, following training, there’s the written board examinations which assess knowledge. And then, the oral boards assess both knowledge, skills, and behavior once somebody has been in practice for a period of time.

Host: Well, Dr. Nelson, it is such an exciting time in the world of orthopaedic surgery. And you mentioned AI a little bit before, so how is ABOS addressing the integration of emerging technologies like AI in certification and education and practice?

Dr. Charles Nelson: That is a very interesting area, and it’s been a subject of significant interest during many of our board meetings. It’s an opportunity to leverage AI to hopefully improve our efficiency, as well as some of the products and assessment tools that we can utilize.

So, you can imagine, for example, right now there’s a lot of work by our candidates to upload imaging and records to allow assessment of the quality of care that they’re providing on their own patients. You could imagine a time where, provided that you could have appropriate HIPAA protections and everything, where AI could, in an automated way, do that, taking a lot of the work off of the candidates and also making certain that those records are more complete. It would have the ability to identify the key records and allow those who are doing assessments to be able to do so, focused more on the key information. So, I think there’s a lot of potential, but AI also carries certain threats.

We want our orthopaedic surgeons to be involved in lifelong learning, we want them to grow as they continue their careers, and potentially AI could be a method that some people may use to answer questions and act like they’ve done some continuing education that they have not. So, there are some threats of AI and where it may be utilized nefariously that creates some challenges for us as well. So, I think we have to look at all those things.

We have to leverage the opportunities that AI provides. And then also make certain that our diplomates, which is what we call our certified individuals, are performing high-quality care and are maintaining that goal of lifelong education.

Host: So Dr. Nelson, as an educator yourself, what’s changed in the education of orthopaedic surgeons since you were back in medical school? Where are we today as far as preparing surgeons for the challenges of surgery? And one thing I’d like to bring up is the differences that we’re seeing now with robotics and minimally invasive surgery versus some of the standard open repairs.

Dr. Charles Nelson: That is an interesting and challenging area. And there are some places that have adopted robotics and navigation to a much higher degree than others. And you can imagine, I wouldn’t want to be in an airplane if the pilot had only done simulated flying and not actual flying. I think there are definitely challenges in making sure that learners’ education is balanced. I think today’s learners really are more visual learners. They often have perhaps shorter attention spans and seem to benefit to a greater extent from digital or video type of education formats, particularly if they come in smaller bits that can be looked at at different times.

And there’s ways of providing those learning methods with evolving technologies and better resolution, and some of the supports that may help support these type of opportunities for learners. But I think, now and always, the best learning is really practical, hands-on education.

Host: Well, along those lines, you train residents yourself at Penn Orthopaedics. Speak about the role of mentorship in orthopaedic training, because that hands-on training, being able to see it and get involved in it and get your hands involved in it is so important in your field. What’s your advice to medical students, residents, and fellows as they navigate through this very challenging, demanding, but so rewarding career?

Dr. Charles Nelson: It’s a really, really important point. You know, I’ve been fortunate enough to have had some outstanding mentors during my career, and I believe mentorship is critical to the success for all people really in all fields and all institutions. I’ve always been committed to mentoring the next generation of orthopaedic surgeons, particularly our own residents and fellows and junior faculty.

And I would encourage students, residents, and fellows to seek mentors. And particularly, fellows, residents, younger faculty who are underrepresented in their chosen profession, whether it be women or minorities or people with disabilities. They may have less people with whom they have rapport with, so I think the concept of mosaic mentorship where you find multiple people who can mentor you in different ways. You may not find somebody who can mentor you in every way, but you find people who can mentor you in different ways. And I think you have to be outgoing and you have to seek those opportunities. So, I would encourage learners to do that.

Host: Dr. Nelson, Doximity ranks the Penn Orthopaedics Residency Program 13th out of 201 programs nationally. As you look at that, what challenges does the program face in both holding and advancing that position under these rankings? And what would you like medical students, residents, fellows listening to this podcast today to take forward for their patients and their training?

Dr. Charles Nelson: So, I think one of the challenges that all academic programs face at this time, particularly with threats to research funding, decreasing reimbursement in medicine, increasing costs for healthcare systems, personnel and supplies, and some other issues that are going on, I think it creates some challenges in optimizing and providing enhanced educational opportunities for trainees while maintaining high-quality care for the patients that we serve.

But I think there are ways of getting around some of these challenges. And some of those include recruitment of outstanding faculty and outstanding trainees, promoting and providing opportunities, and holding faculty and trainees accountable for excellence, while also diversifying funding and philanthropy to support research, education, and excellence.

My best advice I would say to anybody in any career is find something that you’re passionate about. You’re going to be much more effective working in an area that you’re truly passionate about and that you enjoy. So, love what you do, work hard at what you do, and put the time in to really try to make yourself the best that you can be.

Host: Thank you so much, Dr. Nelson, for taking your time with us today. And to refer your patient to Dr. Nelson at Penn Medicine, please call our 24/7 provider-only line at 877-937-PENN, or you can submit your referral via our secure online referral form by visiting our website at pennmedicine.org/referyourpatient. That concludes this episode from the specialists at Penn Medicine. I’m Melanie Cole.