Lessons in Orthopaedic Leadership: An AOA Podcast
Lessons in Orthopaedic Leadership: An AOA Podcast
Beyond Time-Based Training: What Makes a Competent Surgeon?
Dr. Doug Lundy sits down with two leaders at the forefront of residency education: Dr. Tessa Balach, past chair of the Council of Orthopaedic Residency Directors (CORD), and Dr. Trent Guthrie, current CORD chair to discuss the future of Orthopaedic Education.
Their conversation explores the shift toward competency-based medical education in orthopaedic surgery. Technology's transformative role in surgical education emerges as another focus of the discussion.
Regardless of your career stage, this discussion provides a crucial perspective on how orthopaedic training is evolving to meet tomorrow's challenges.
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Welcome to the AOA Future in Orthopaedic Surgery podcast series. This AOA podcast series will focus on the future in orthopaedic surgery and the impact on leaders in our profession. These podcasts will focus on the vast spectrum of change that will occur as the future reveals itself, reveals itself. We will consider changes as they occur in the domains of culture, employment, technology, scope of practice, compensation, and other areas. My name is Doug Lundy, host for this podcast series. Joining us today, we have two distinguished guests. First is Dr. Tessa Balach is Professor and Vice Chair of Education of the Department of Orthopaedic Surgery and Rehabilitative Medicine at the University of Chicago, specializing in musculoskeletal oncology. She is the Associate Chief Medical Officer of the clinical learning environment. She went to college at the University of Chicago, went to medical school at the New York Medical College and returned to do her residency and fellowship at the University of Chicago. She was a Leadership Fellow of the AAOS from 2018 to 2019, a practice enhancement traveling fellow with the Ruth Jackson Orthopaedic Society in 2014, and is the past chair of the American Orthopaedic Association's Council of Orthopaedic Residency Directors (CORD).
Douglas Lundy, MD, MBA, FAOA:Also joining us today is Dr. Trent Guthrie. Dr. Guthrie is Assistant Professor of Orthopaedic Surgery at Henry Ford Health in Detroit, Michigan, where he serves as the Program Director of the Orthopaedic Surgery Residency Program. He went to medical school at the University of Texas Southwestern, did residency at Wayne State University and his fellowship in orthopaedic trauma at the Combined Twin Cities Orthopaedic Trauma Fellowship in Minneapolis, Minnesota. Dr. Guthrie is the current chair of the Council of Orthopaedic Residency Directors and I'm happy to have another trauma surgeon on the podcast with me as well. So, Tessa and Trent, welcome to the podcast. Thank you. Thanks for having us. Trent, you're currently running the show and Tessa, you were doing it right before Trent, so both of you guys have a tremendous amount of insight into this. But first we have a CORD Conference coming up right.
Trent Guthrie, MD, FAOA:Right. So we have worked over the past year to create a freestanding CORD Conference. You may recall, in the past we were at the AAOS meeting for a couple hours in a basement somewhere, but now we have moved separate from the Academy and that has allowed us to have a little bit more of an educational program to provide for our members and also has allowed us to collaborate more with ARCOS, which is the association of program coordinators. S o we had some great conversation last year, some great collaboration between the coordinators and the program directors and had a fantastic meeting in Nashville in February. This year coming up, which will be 26 in February, we'll be down in Jacksonville, Florida, which will be hopefully a little bit nicer weather than Nashville in February, and we're really looking forward to again collaborating with ARCOS and having a great meeting there.
Douglas Lundy, MD, MBA, FAOA:I did my fellowship in Nashville but I'm not sure I ever stepped outside because, like you, in a trauma fellowship you don't really get to go out. I'm sure oncology is the same right, Tessa?
Tessa Balach, MD, FAOA:Pretty similar.
Douglas Lundy, MD, MBA, FAOA:So we, kind of the three of us, are kind of assuming everybody knows what CORD is about. Tessa, can you tell us what CORD is to the folks that may not know what CORD is?
Tessa Balach, MD, FAOA:It is a group comprised of, obviously, residency program directors, associate program directors. We have been welcoming our medical student, clerkship or rotation directors, as well as fellowship directors in all specialties. The goal of the group is not only to provide some education for people who are leading educational programs in orthopaedic surgery, but to bring us together to talk about new ideas, best practices, what's up and coming and build some camaraderie and build a network of support as we and our individual programs are navigating this. And, I think, one of my most favorite things about CORD is our meetings, both at the annual meeting with the AOA and our winter meeting. And, as Trent mentioned, the really nice thing about the new format for the winter meeting is we have more time to spend together, to talk, to dive into what we as educators are all really passionate about. So there are subgroups and subcommittees within CORD. So if you are a CORD member itching to get involved, there's opportunities to do that on a bigger level.
Douglas Lundy, MD, MBA, FAOA:And Trent, do you have any specific agenda items or anything that is going to come up in this court conference that could tickle somebody's fancy on that?
Trent Guthrie, MD, FAOA:Well, I think that we are always trying to create an agenda that appeals to everyone throughout the audience. I think we have some seasoned program directors who have a pretty good understanding of what it's all about, but they need some updates on some of the new best practices. What's new in education, and particularly competency-based education and that's a bigger theme that we may get into a little bit later is we're seeing a transition from more time-based education to more competency-based education as we move forward over the next few years, or few decades even, and we're really trying to weave that into all of our sessions. In addition, we're also trying to appeal to new program directors, associate program directors, who are aspiring to move up in the ranks, and really teach them some kind of nuts and bolts of how to run a residency program.
Trent Guthrie, MD, FAOA:The administration of medical education is its own language in and of itself. There are a lot of administrative details through the ACGME and through our ABOS and other organizations that you really need to try and get onto that learning curve early so that by the time you become a full program director you can really hit the ground running. So our meeting coming up in February Dr. Milo Sewards is our program chair for the meeting. He has a great agenda put together. In addition to some of those nuts and bolts talks, he's working through an agenda of what happens when things don't go according to plan. So we're trying to weave in kind of some topics like that into all of our meetings so that again we can appeal to the entire audience.
Douglas Lundy, MD, MBA, FAOA:Beautiful. Yeah, I'd love to get into some competency-based discussion in a minute, but first let's talk about the future of CORD. So, Tessa, let me have you start off with before you became CORD Chair. Where did you see the changes and the direction of CORD before you became Chair, and then through your time, and then Trent, can you take it from there, launching into the future, and both you guys, whatever your thoughts are on that. So, Tessa, if you want to start off and then Trent will pick it up from there, so, Tessa, if you want to start off, and then Trent, I'll pick it up from there.
Tessa Balach, MD, FAOA:Sure, I started my tenure as the CORD Chair in 2021.
Tessa Balach, MD, FAOA:We started to make some connections during my time in the leadership space with our medical student directors.
Tessa Balach, MD, FAOA:We thought really pointedly about sort of that transition from undergraduate to graduate medical education in regard to the application process, the advising we're doing for students and leading them through that, and then, as I finished my time in the role and passed things to Trent, we wanted to think even more purposefully about how we are engaging fellowship directors.
Tessa Balach, MD, FAOA:I think there's a tremendous opportunity to support the work that they are doing in that last piece of graduate medical education before those trainees step into practice. There's a lot changing in the accreditation space in the as Trent alluded to earlier, the competency-based medical education space that you know, when you're a fellowship director for one fellow a year or two fellows a year, you might feel like you're on an island, and so I think creating a space where we can support fellowship directors across the specialties has been the newest addition to kind of the scope of offerings that CORD brings to the orthopaedic education community. And I'll let Trent take off on that, because we launched a new Fellowship Directors Forum this year that I'll let him share a little bit more about.
Trent Guthrie, MD, FAOA:I would agree that I think it's been a little bit myopic, if you take the 30,000-foot view of residency education and just education in general. I think our goal as educators is to train the next generation of orthopaedic surgeons right, and again, it's a little bit myopic to say that five years when they're in their residency is all that we should be focusing on. And so I think that, rightly so, over Tessa's tenure, and hopefully through mine and beyond, we're going to start to reach out into medical schools and beyond, into fellowships and even perhaps beyond that. But I think that we really need to be focused more on that whole continuity, the whole spectrum from early learner through resident and to practicing surgeon.
Trent Guthrie, MD, FAOA:And so, yes, we had a fantastic Fellowship Director's Forum this year. Dr. Felicity Fishman helped to spearhead that. We had some great sessions on kind of remediating fellows as they're in there just one year of fellowship, what does that look like? And also trying to have some conversation with program directors. The residency level how do we better prepare our residents to be successful fellows moving forward, and then fellowship directors how can they prepare their fellows to be successful surgeons beyond that? So I think the theme that hopefully you're hearing is that, yes, we all wear program director hats, but we all are looking beyond those walls and trying to affect change throughout the years of education for our future surgeons.
Douglas Lundy, MD, MBA, FAOA:That's fantastic. The AOA is all about the development of leadership in orthopaedic surgeons.
Trent Guthrie, MD, FAOA:Could both of y'all, Trent let's start off with you this time kind of give your personal gleanings of what your involvement in CORD early on as an Associate Program Director and sitting at the table with some icons in education.
Trent Guthrie, MD, FAOA:I remember my very first CORD meeting, I was at a small group session sitting next to Anne Van Heest and she just welcomed me right into that table as a complete peer and we had some great conversations about leadership and residency education and I'll always remember that one.
Trent Guthrie, MD, FAOA:But I think getting more involved in CORD over the years I think has also been a great leadership journey, I think you know I give great credit to Tessa for the work that she did, putting together several working groups during her time to try and solve some of the real crucial problems that we were seeing in residency education. At the time I had the great honor to chair a working group on preference signaling and we did some work there to affect some change in orthopaedics and really be leaders in that space nationally. With regards to the other specialties out there and that's another podcast in and of itself to dive into that. But you know, being able to lead a small working group as someone who was just an interested member in CORD and to be selected and to be able to affect some change there. I think was a tremendous opportunity and I think that's just one small example of the opportunities that are available for anyone who's interested and willing to put in the time and effort to lead.
Tessa Balach, MD, FAOA:I think one of the things I've loved the most about my time in the AOA and court is that it hits on two things I love a lot, which is education. I share this with a lot of people. I come from educators, not physicians being able to take advantages of opportunities to foster my own sort of leadership journey but also, as I've moved forward on mine right, bring others along onto that path and help them develop those skills to be leaders in their institutions, in the AOA, in court, etc. And so court and the AOA has been a great opportunity for me to do a lot of that. I've been given opportunities to serve on national committees. I was on the Milestones 2.0 committee thanks to being in CORD. I've sat at the ABOS right thanks to my role in CORD and in.
Tessa Balach, MD, FAOA:As Trent mentioned, when I was the CORD chair, I did put these working groups together. I knew that the ambitions I had to examine all the pieces of the residency recruitment process was going to be impossible for me to tackle on my own, but a great opportunity to increase member engagement, and we created nine working groups. Each one had a chair. Trent was one of them. There are lots of others who have been able to step into that and then that has boosted their engagement in the group and on the committee. So that was really fun for me not only to you know, in the years I've been a member not only of CORD but of the AOA to foster my own leadership but that of others, and that's probably the educator in me right that thinks about helping others succeed and realize all of their potential. So it's really one of my favorite places to be.
Douglas Lundy, MD, MBA, FAOA:The big thing in the room is the competency-based education. I heard Larry Marsh and Anne Van Heest and folks talk about this extensively at the ABOS meeting you see the other members of the carousel there and at the symposium that we did year before last it spoke up on the resident unions. They were talking extensively of how residencies are run in these other countries. So we're not the first ones to figure out this competency-based stuff. So can y'all define what competency-based training is about, where it's going and what are the pitfalls and the benefits of that as we move forward?
Tessa Balach, MD, FAOA:is focused on getting our learner to the point of competency right, and hopefully even a little bit beyond that, and using those as markers for completion of a program, as opposed to simply time.
Tessa Balach, MD, FAOA:Those of us who cook and bake know that sometimes that steak needs a little more time on the grill to be the perfect temperature, and I think the same goes for learners, and for those of us who have spent time in education whether it's a year or two year or decades know that people learn at different rates, have different skill sets, have different strengths, have different areas that they need a little more attention on, and competency-based medical education helps to do that on a more individualized, thoughtful basis, as opposed to if you stay here for five years, you're going to be, you're going to be ready to go and that stake is going to be perfect.
Tessa Balach, MD, FAOA:But we know that that's not, that's not the case, and and so the. That is it, I think, in its, in its, at its core. And so what's been? What we've been seeing, not only in orthopaedics but across graduate medical education and all of the specialties, is this move towards competency based education and development of tools and processes to help us be successful in implementing that, because it's a huge shift in how we sort of assess, measure, write and move residents along in our current world as opposed to that of a competency-based medical education world.
Trent Guthrie, MD, FAOA:Yeah, I agree. I think that this is such a broad topic and becomes a little bit nebulous and people start having conversations and realize that they're not even in the same space. And I think if you take a step back and realize what our ultimate goal is, we're trying to create orthopaedic surgeons who are competent to move into independent practice. If you have your ABOS hat on or you have your program director hat on or you're a consumer in the real world trying to figure out, is this surgeon able to do what they say they can, you know we're all trying to hit at the same thing and that's competency. And there are a number of different ways to measure competency and we've seen that across a number of different specialties and, more broadly, a number of different countries. You said that before, Doug that a lot of different countries Canada, Australia, UK, a lot of places are ahead of us on this. I would say they're just in a different place and you know, if you talk to a lot of the people you know, particularly in Canada, Toronto did a fantastic job. They had a huge pilot in the mid-2000s trying to create a competency-based curriculum and training program and it worked fairly well. But at the end of the day, they came to some of the same decisions that, yes, some people are ready a little bit earlier, some take a little bit more time years to kind of get through what we need to get through in order to learn what we need to learn from a medical knowledge standpoint, from a surgical skills standpoint and a clinical decision-making. There just is a certain experiential component to all of it. So, yes, we can break it down into very discrete can you do a carpal tunnel release on cadaver? Can you do a carpal tunnel release on cadaver? And we can come up with some check boxes and make sure that people can check all those boxes, but does that mean that they're ready to care for patients with carpal tunnel syndrome out in the real world?
Trent Guthrie, MD, FAOA:I'm not sure, and that's where the complexity comes in of being able to create curriculum and assessment scheme and then ultimately, a determination of competency. So it's a monumental task and I credit everybody who's come before us and done a tremendous amount of work to get us where we are In terms of leadership. I think that, looking at other specialties, I feel very fortunate with all the work that has been done in our specialty before, that we're in a pretty good place. Compared to other specialties. I feel like we're fairly well advanced just in terms of having assessment tools and having a fairly discrete curriculum that's been developed over the years. So I think that you know we'll continue to grow and we'll continue to work towards that. I think ultimately it's better for our surgeons in the future, it's better for the public and you know it's. There's a lot that goes into it clearly.
Douglas Lundy, MD, MBA, FAOA:I appreciate that and I was thinking when I was thinking of the Canadian experience that I had with it. It was because just recently I was in the airport with Emil Schemitsch for probably about three hours and we were chatting through this stuff the airport with Emil Schemitsch for probably about three hours, when we were chatting through this stuff. And one thing that came up as I was talking with Emil is I'm like how do you so you cut somebody short six months, so they're done in four months, four years and six months, or you run them longer. Now it's five years and six months. How does that work with fellowships? Does that mess everything up? And I don't want to quote meal out of context, but he was suggesting that you would either cut a year off or add a year on to your residency. What are your thoughts on that? Because I'm going to toggle some bumps in the road.
Tessa Balach, MD, FAOA:And that, as Trent mentioned, how monumental this all is. Those are the pieces that I think we as an orthopaedic education community are still trying to figure out. I think about that in my own residency as I use some of the assessment tools that have been provided to us by the board. You know, how do we manage this going forward if someone needs to change the pace in the setting of 20 other residents who might be on a more predictable schedule. I don't have an answer for that yet, but I think you've nicely pointed out one of the challenges. But I think the benefit of understanding who needs help, where they need help and how we can get them to that finish line successfully in someone who might be struggling is really important for me, because I think we lacked some of that ability with clarity and as much objectivity as possible, which is always a hard thing. But I feel like I have a better sense of where my residents are on their path towards graduation with some of these assessment tools than I did five and 10 years ago.
Trent Guthrie, MD, FAOA:Yeah, I think that's a great point In my mind, if I look into the future as best I can and see where we're headed, I think that we're headed to a place, just like Tessa said, where we can more accurately and earlier diagnose someone who may be falling off of that curve and be able to intervene earlier and get them to where they need to be with the right resources, as opposed to somebody else who may finish early, quote, unquote. I think that you know where they're going to end up is they're going to be a fantastic surgeon at the end of their training, right? They're going to be competent maybe a few months early, but they're going to use that extra few months to be an even better surgeon in the long run, or maybe become a clinician educator or clinician scientist, and I think that there should be room for all of that. I think another big issue to me with the rollout or and not all of them are going to be able to scale to do something like Toronto did I remember talking to one of the surgeons in Toronto about, well, what happens if somebody finishes a rotation early?
Trent Guthrie, MD, FAOA:Well then, that blows up their call schedule. They have to float fellows into cover and that isn't a problem at Toronto, where they have 50 or 60 fellows and can do something like that. But if you do that to a two or three resident a year community program, I think that that's certainly going to cause some disruption and above and beyond that, I think, have to have some significant changes in how we fund and how we manage graduate medical education education.
Douglas Lundy, MD, MBA, FAOA:Now, at the AOA meeting this year we had a symposium on early subspecialization in residence. So, for instance, if I know I want to do trauma surgery, then I can finish all my core things, make sure I have my minimums, but I'm never going to do carpal tunnels, never going to scope knees again, so why don't I just go into the trauma suite and work with the trauma surgeons the rest of my residency? Is that another way of doing competency-based, where you're clearly checked out on the minimums and the competency and everything outside of your chosen area of specialty. So for the remainder of your residency you can just knock in total choice or do tumors or fractures or sports or whatever. How about that?
Trent Guthrie, MD, FAOA:I have some very strong feelings about this and I may show my gray hair here, but I think that residency education should be. Your residency year should be to learn to be a general orthopaedic surgeon, trauma surgeon, on a tumor service. I am working all over the body and I'm seeing approaches that I've never seen before and I'm just getting a much better sense of my surgical skills and my boundaries as a surgeon when I'm not doing the thing that I'm going to do the rest of my career. You said I don't need to do any more carpal tunnels. Well, guess what?
Trent Guthrie, MD, FAOA:Like two weeks ago, I did a carpal tunnel on a patient that had a blasted distal radius and had an acute carpal tunnel syndrome. So I mean, you never know when you're going to need those general orthopaedic skills as a practicing surgeon. So I don't think that you can get enough general orthopaedic surgery training during those residency years to then be able to say you know what, I'm good, I'm going to go and just do my thing. So I don't know. I know there was some dissent in the room, but that's where I fell out.
Tessa Balach, MD, FAOA:I'm similarly on the side of.
Tessa Balach, MD, FAOA:I think residency training is to become a well-rounded, competent, general orthopaedic surgeon.
Tessa Balach, MD, FAOA:But balanced and well-rounded, I think, is the key to it, and part of the ACGME minimums and guidelines from the ABOS about how resident experiences should be shaped guide us towards that in our programs. You know, back in the day when we had the blue bar graphs and my residents were doing far too many spine cases and not enough sports cases, we knew that needed to be rebalanced so that they could come out and have that foundational knowledge in all of the subspecialties of orthopaedic surgery to be a great spine surgeon or to be a great tumor surgeon or traumatologist. I firmly believe that I am a better orthopaedic oncologist because I was first a competent, well-rounded orthopaedic surgeon. Because when then people come to my office, I can understand whether they have an oncologic condition or something that's non-oncologic and still general orthopaedic, playing into their pain, their symptoms, whatever they're struggling with. And I worry that if we get too subspecialized too soon we will lose that and probably not be able to care for our patients as well as they should be cared for.
Douglas Lundy, MD, MBA, FAOA:If y'all remember my last slide in my presentation during that symposium should you specialize or not? The answer was yes.
Tessa Balach, MD, FAOA:I like that a lot. I like that last slide.
Douglas Lundy, MD, MBA, FAOA:I remember it kind of decreased a little of the tension that Trent was talking about in there. All right, let's talk about anything else that's going to change in residency education. So y'all can look out as far as you can see. Look all the way to the horizon. What does it look at now? Having prefaced that the baby boomers are getting older?
Douglas Lundy, MD, MBA, FAOA:However, I think I read recently that the millennials are the largest generation ever in the history of the planet. Yet simultaneously with that, in the United States, the graduating the seniors in high school right now is the largest class of high school seniors that the United States has ever seen and will ever see, because the population is decreasing after that. So after this year, we will graduate less high school students every year. I know you guys working at those big universities focus on this, because the kids that are going to start enrolling in their bachelor's degrees when they come out of high school is going to go down year after year. So, with all these demographic shifts out there, what does residency training and the education of orthopaedic surgeons look as far as you can see? Let's start with you, Tessa.
Tessa Balach, MD, FAOA:I think one of the biggest things is adopting to all of the technology that is coming into the world, coming into medicine and coming into orthopaedics. We see that medical students and residents learn really differently than we learn. There are no textbooks anymore on anyone's shelf. I mean I had multiple five-volume textbooks on my shelves and I would read the book and highlight and do all those things, and so people are acquiring knowledge differently. We look and are able to search for information differently. We can search the literature in ways that are faster, easier than ever before and you know, even on day-to-day things in the hospital, residents do things really differently than we did. There are no more paper orders, you're not handwriting things, you don't have to memorize doses of medications. Make sure that we are still supporting the acquisition of foundational knowledge and skills while adapting to living in this faster-paced space where there's more technology and more knowledge. I think is going to be really interesting.
Tessa Balach, MD, FAOA:The CORD meetings for the last year had a focus on AI. Certainly our summer meeting we talked a lot about that. I think understanding how that can be helpful to us from an assessment tool, from creating dashboards to helping us understand where our learners are in the trajectory of their path towards residency graduation, how we can safely use AI to support learning, right, I mean, there are good ways to use it to find and have information at your fingertips. So I think that's the thing I think about a lot as I look towards the future. The foundations of you still have to learn how to hold the knife and retract and do neurovascular dissections, and put a plate and screws on and do a nail. That stuff is going to look pretty similar. Sure, technology in the operating room is changing, but I think at a slightly different pace than what's happening outside of the operating room.
Trent Guthrie, MD, FAOA:Yeah, I think one of the big take-home points that I got from all the AI sessions that we had at the past few meetings was that surgeons are not going to be replaced by AI. Surgeons are going to be replaced by surgeons who are able to use AI and other technologies, and I think that that's something we see in education too. There's a really interesting talk by Dr. Moore at this summer meeting about using artificial intelligence to help with resident education. To really be able to take a deep dive and give a resident some learning assignments, have them work through learning assignments, take an assessment at the end, based off of that assessment, then that can help to drive okay what's the next learning module that this trainee needs and that is adaptable, based on what rotation you're on, what PGY year you're currently in, and you know. That can, I think, create a much more efficient landscape for us in residency education moving forward.
Trent Guthrie, MD, FAOA:But I don't want to step too far away from it because I do think that technology is going to continue to advance and I might disagree with Tessa a little bit. I do think that at some point a robot's going to be able to put in a plate and screws better than I can, but the one thing that we always need to be competent in is patient care, communication, having ethical physicians at the bedside. I think that those are things that are very difficult to AI away from us, and so I think, more than anything, those are the skills that we need to double down on those professional behaviors and, as we move forward into more of a technologically based specialty.
Douglas Lundy, MD, MBA, FAOA:We get a little controversial here maybe. How do you see the future rolling out in the development of our workforce in terms of looking more like the demographics that we serve? These are not easy lifts. I mean just we've been able to do that here in our program at this place. But how do you see the future regards in terms of us developing a workforce more consistent with the population that we care of?
Trent Guthrie, MD, FAOA:Well, I think certainly, the literature is crystal clear that having a workforce that closely resembles your population is able to provide better care for that population, and so I think, if we always have that as our North Star, I don't think there's any controversy here.
Douglas Lundy, MD, MBA, FAOA:So as we talked about a little bit earlier, the demographic changes in the country are such that this year's high school graduating class is the biggest class that we'll ever see, and so there'll be less kids going through high school, less people going into college and then medical school and residency after that, which are going to have to take care of the workforce from here. So there's a certain amount of generational interest in that. Now, how we look at the generations we train really varies. Some people think that, oh my gosh, the millennials and the alphas are the worst ever. They don't do anything right, they're always so lazy compared to us, and all this. On the other hand, I personally don't see that when I look at our residents, they work just as hard, have just as much care, just as much compassion, just as much ethic as I ever remembered when I was in training. What are your thoughts on the generational issues as we move forward in terms of residency training, Trent, why don't you start?
Trent Guthrie, MD, FAOA:Yeah, I agree. I think it's. Generational issues is always a topic that comes up at symposia over the years and I've never really found a lot of traction in that. I think that, yeah, we can try to stereotype certain people in certain generations, but at the end of the day we're dealing with a bunch of individuals. And to your point, Doug, I think that if we go through a selection process and get highly successful individuals who are highly motivated to become orthopaedic surgeons, I think that a lot of those generational differences that you read about on Wikipedia just don't play out.
Tessa Balach, MD, FAOA:So you know, that's obviously one person's opinion, but I haven't really seen that bear out over my years of training their approach, their education approach, the acquisition of knowledge, I think from a work ethic, gritty, want to be there, want to stay late, want to get there early, want to take great care of patients. That doesn't seem to have changed. We select for that in our recruitment processes. We want people who share the same values around hard work and patient care and ethics that we all have in orthopaedic surgery, as academic surgeons, as community surgeons. And so, to agree with Trent, I think some of those differences that we may see in other parts of the world, the generational differences we may see in other parts of the world, are blunted a little bit in orthopaedic surgery. They certainly learn differently and that's something that I've had to adjust to, but that is. That's just technology and times, and I'm happy that they share the again, the work ethic and the values that that I did as a resident.
Douglas Lundy, MD, MBA, FAOA:This has been a very interesting discussion with the past cord chair and the current cord chair in terms of where the future in orthopaedic surgery is going in terms of residency, education and all the complexities and issues associated with that, as we continue to build our workforce and as we, as leaders, are going to lead that next generation into taking care of us as we get older. So, Dr. Balach and Dr Guthrie, thank you so much for being on the podcast.
Tessa Balach, MD, FAOA:Thanks so much for having us.
Trent Guthrie, MD, FAOA:Thanks for having us. I think that that's a fantastic segue into our next summer CORD meeting in 2026, which will be in Albuquerque.
Douglas Lundy, MD, MBA, FAOA:The theme there is shaping tomorrow's orthopaedic workforce, so that dovetails nicely in our last conversation, so I hope y'all will take advantage of that and go visit these fine folks at the CORT conference and continue to develop our leadership in orthopaedics, and I look forward to seeing y'all again on another podcast in this channel series. Thank you.