Casting: the junior Ortho Pod Ajay Shah

Hey everyone! Our last episode with Dr. Goel was one of the last pre-recorded episodes we had. With the ending of several sponsorship contracts, and new responsibilities in the hospital, I'm taking a short hiatus. This will allow me to brainstorm new topics, find new people to interview, and get Casting back to the high quality show that I wanted it to be. Feel free to e-mail with suggestions, introductions, and ideas at castingorthopod@gmail.com! Cheers!

Be sure to support our sponsors: MD Consultants: mdconsultants.ca | MCAT Prep 101: www.prep101.com/casting 

Tune in to an absolutely phenomenal conversation with Dr. Danny Goel, UBC-affiliated upper extremity orthopaedic surgeon and founder of PrecisionOS, a virtual reality software for surgical education. His pioneering innovation is set to revolutionize the traditional model of surgical training, and has been adopted by residency training programs across Canada just in time for the nationwide implementation of CBME. We talk about the germination and evolution of his idea, the non-linear process of innovation, receiving feedback to iteratively improve a project, and how to identify problems worth solving. 

Timestamps:

2:00 - Explanation of PrecisionOS software

4:00 - Limits and next steps for computing

6:15 - Germination and evolution of surgical education idea (2016-2017)

8:00 - Needs assessments with stakeholders

9:15 - Iterative improvement (2017-2021)

11:00 - Key to being an entrepreneur (seeking out negative feedback)

13:00 - Encouraging people to become competent past their stage of training

14:30 - Turning the apprenticeship model of surgical education upside down

17:10 - Next 5 years: worldwide surgical education through virtual ORs & remote collaboration

20:00 - RCTs to establish efficacy

22:00 - Advice to innovators (pursuit of problems, innovation =/= entrepreneurship, paying attention & self-auditing). Everyone is best positioned to solve the problems they face on a daily basis.

24:00 - Intent: improving patient care (intrinsic)

25:00 - Three next steps: 1) working with industry sponsors, 2) increasing computing power/tech, 3) expand outside Ortho. COVID has propelled VR to the forefront

27:00 - Final Messages: Keep the patient at the centre of the innovation

Check out our sponsors:

MD Consultants: mdconsultants.ca helps pre-med students with CASPer, MMI, and panel interview prep. Enter code: ORTHOPOD15 for 15% off pre-med packages.

MCAT Prep 101: www.prep101.com/casting Improve your MCAT scores with customized study plans, specialized tutors, CARS-specific training, and high-yield workshops. For a $350 discount off MCAT Tutoring Plans, enter code: 350CASTINGPOD

Be sure to support our sponsors: MD Consultants: mdconsultants.ca | MCAT Prep 101: www.prep101.com/casting

"When the truth is on your side, you have nothing to fear". Dr. Simul Parikh (https://twitter.com/ParikhSimul) is well-versed in the issue of physician over-supply, and an advocate for current trainees. I spoke to him about the damaging effects that over-supply has on patients, doctors, and systems. We delve into the root problems that cause over-supply and maldistribution, and cross-pollinate between efforts in Canada and the USA to synergize solutions to the critical issue of Orthopaedic Surgeon Under/Unemployment in Canada. See this fantastic article for an overview of the article (https://coa-aco.org/unemployment-and-underemployment-of-orthopaedic-surgeons/)

Timestamps:

2:10 - What is oversupply? What is substantial oversupply? 

5:00 - How does oversupply affect patient care and clinical decision making?

7:30 - What effects does oversupply have on physician wellbeing?

10:15 - How does maldistribution occur? What does Canada do to address maldistribution in a country with low population density?

12:30 - How would changing institutional composition and mandates influence maldistribution?

17:15 - Why should we fix oversupply?

19:00 - What is the roadmap to fixing oversupply (1-acknowledgement, 2-institutional changes, 3-billing changes)

22:15 - What is the root cause of the growing oversupply?

24:45 - How can institutions keep the same workload without hiring more residents?

26:00 - What changes can be made to compensation to prevent the forces that lead to oversupply?

27:15 - What can trainees do to open up the conversation & advocate for themselves?



Message on Twitter, Instagram, or E-mail if you have anything to say!

Check out our sponsors:

MD Consultants: mdconsultants.ca helps pre-med students with CASPer, MMI, and panel interview prep. Enter code: ORTHOPOD15 for 15% off pre-med packages.

MCAT Prep 101: www.prep101.com/casting Improve your MCAT scores with customized study plans, specialized tutors, CARS-specific training, and high-yield workshops. For a $350 discount off MCAT Tutoring Plans, enter code: 350CASTINGPOD

Be sure to support our sponsors: MD Consultants: mdconsultants.ca | MCAT Prep 101: www.prep101.com/casting

Message on Twitter, Instagram, or E-mail if you have anything to say!

Summary

We had some great feedback on the "How to match to Orthopaedic Surgery" episode, so we decided to release a panel from newly matched residents in Orthopaedic Surgery. The panel includes:

Carl Lavediere (McGill [c/r])

Patrick Park (McGill [c/r])

Zachary DeVries (Ottawa [c/r])

Akshdeep Bhatia (U of T [c/r])

Alice Wang (UBC [c/r])

Ajay Shah (McMaster [c], U of T [r])

We discussed how to impress on electives, the highest-yield tips from the CaRMS process, and managing lifestyle during busy electives. The entire panel is condensed into 1 hour for your efficiency. Reach out if you have any questions or want any more information - I've already had some great conversations with rising Ortho keeners.

Timestamps

1:45 - Introductions (academic background, interest in Orthopaedics)

9:30 - Preparing for electives (how to impress, what to read, how to show knowledge, how to function as an effective clerk)

18:30 - Lifestyle during electives (call requirements, budgeting time, expectations for residency)

27:30 - Elective arrangements (community versus academic, 2 versus 4+ weeks, sites, visiting versus home)

34:15 - Pre-clerkship observerships (building relationships, being a familiar face)

40:15 - Final reflections on CaRMS process (must-know tips for matching successfully)

51:00 - Listener questions (determining ROL, asking for reference letters)

Check out our sponsors:

MD Consultants: mdconsultants.ca helps pre-med students with CASPer, MMI, and panel interview prep. Enter code: ORTHOPOD15 for 15% off pre-med packages.

MCAT Prep 101: www.prep101.com/casting Improve your MCAT scores with customized study plans, specialized tutors, CARS-specific training, and high-yield workshops. For a $350 discount off MCAT Tutoring Plans, enter code: 350CASTINGPOD

Spotify: https://open.spotify.com/show/73920lBBROizWoRt9IwWHs?si=-LJOdTAETCC2R-HMxfb0sQ&nd=1

Apple Pods: https://podcasts.apple.com/ca/podcast/casting-the-junior-ortho-pod/id1550706714

Metacarpal Fractures

Dr. Alison Wong (Founder of: https://sketchymedicine.com/, Dalhousie Plastic Surgery graduate, Hand Surgery fellow at Shock Trauma, Baltimore) talked with me about Metacarpal Fractures. High-yield takeaways are the recognition of common MC fracture patterns and their mechanisms, assessing angulation/malrotation, performing a standard Jahss reduction maneuver, and balancing fixation with movement to prevent stiffness.

Timestamps:

1:30 - Background (40% of all hand fractures are MC, 80% are MC neck)

3:30 - Boxer’s (swinging, 5th MC neck)

4:45 - X-ray principles (3 views, assess angulation [apex dorsal])

6:15 - Angulation (5th tolerates more, 20/30/40/50-60, biomechanics cause extensor lag)

8:00 - Reduction via Jahss maneuver (https://www.aliem.com/trick-of-trade-reducing-metacarpal/ - see second video)

9:00 - Malrotation (scissoring, flexion cascade, fingernails. Scissoring video: https://imgur.com/a/XADr6dI)

12:15 - Extensor tendons (injury, fight bite, lag, MC head fractures, infections. Always ask what they punched)

14:15 - How to splint (immobilization in the safe position [see video above], ensure MCPs bent, IPs straight, wrist slightly extended. ORIF = less rigid fixation to allow tendon gliding and no stiffness)

17:30 - ORIF options (CRPP retrograde, anterograde bouquet technique for distal fractures: https://imgur.com/a/9Sn3Y31)

20:15 - MC shaft fractures (same exam, same signs. Polytrauma will need rigid fixation to allow hand for rehab/transfer, isolated injury can be nonop. More options for ORIF: IM nail, lag screw, plate/screw construct)

23:45 - Problem with hand fractures (rigid fixation versus stiffness)

26:30 - Main complication of MC fractures: pain/weakness with grip due to malrotation

27:15 - Bennett’s versus 1st MC base versus Rolando fractures (Geometry and deforming forces: https://imgur.com/a/jl6lMBN, APL as main deforming force. Treat with CRPP + traction/pronation)

30:45 - Case (Demographics: Age/Sex/Handedness/Smoking/Occupation, Injury: Mechanism/DOI, Symptoms: Numbness/Paraesthesia/Pain, Exam: Extensor Lag/Malrotation/NV status)

33:15 - Patient factors inform management

34:30 - https://sketchymedicine.com/

Check out our sponsors:

MD Consultants: mdconsultants.ca helps pre-med students with CASPer, MMI, and panel interview prep. Enter code: ORTHOPOD15 for 15% off pre-med packages.

MCAT Prep 101: www.prep101.com/casting Improve your MCAT scores with customized study plans, specialized tutors, CARS-specific training, and high-yield workshops. For a $350 discount off MCAT Tutoring Plans, enter code: 350CASTINGPOD

Be sure to support our sponsors, MD Consultants: mdconsultants.ca and MCAT Prep 101: www.prep101.com/casting (see below for details)!

In the last episode of the R5 Retrospective series, I interviewed Dr. Colm McCarthy, an alumnus of the Mac Ortho program, who is currently completing his fellowship in Arthroplasty at Harvard Medical School (Brigham & Women's Hospital). Our fascinating conversation started by talking about why he chose Arthroplasty, and Harvard, how CBME will shape Orthopaedic Surgery training, and how to maximize your chances of being successful in the SF Match (US Fellowships). Enjoy!

1:50 - Harvard Arthroplasty Fellowship (4/5+ days in OR, fellow-specific teaching & networking, mentorship/career guidance)

3:10 - Why Harvard (complex primaries/revisions, double constructs)

3:35 - Why Arthroplasty (similar to choosing a specialty, based on personality types, QALY/QoL outcomes)

5:10 - Why an Arthroplasty Fellowship (more revisions, seeing complex cases gives you tools, develop skills)

7:10 - Where do you envision yourself (MEd = academic, Cross-trained in arthroplasty/trauma = highly employable, options open)

8:05 - Surgical Education (Oslerian model falls apart, Feedback based approaches on movements, Giving feedback through CBME, Exams are less helpful than competencies)

10:20 - Benchmarks for Competency (Are you prepared for Independent Practice? Skills, Boundaries, Safety, Knowledge)

10:40 - CBME (Highlight weaknesses and extend exposure [mini-fellowships])

12:05 - What Should be the Ultimate Goal of Surgical Training (Generalist v Specialization, Knowledge of how to explain/understand/counsel patients on all of Orthopaedics)

14:40 - Transition to Practice in Fellowship (Billing, Booking Clinics, Workflow, Dictations in Canada vs USA. Envisioning how to setup your practice)

18:30 - Transitioning from a Student to Colleague

20:30 - How did you know that Harvard would be right? (Right place to learn/fit in/afford, Working with Dr. Estok, Double Cup Constructs, Being Frugal, Observerships)

23:40 - Canada/US Fellowship Applications (Personality based, SF Match, Rolling Applications)

26:40 - Reflecting on Residency (Evolution of Struggles, Battle buddies, Why Orthopaedics)



Check out our sponsors:

MD Consultants: mdconsultants.ca helps pre-med students with CASPer, MMI, and panel interview prep. Enter code: ORTHOPOD15 for 15% off pre-med packages.

MCAT Prep 101: www.prep101.com/casting Improve your MCAT scores with customized study plans, specialized tutors, CARS-specific training, and high-yield workshops. For a $350 discount off MCAT Tutoring Plans, enter code: 350CASTINGPOD