Improvement of Orthopedic Residency Programs and Diversity: Dilemmas and Challenges, an International Perspective

Document Type: PERSPECTIVE


1 Department of Orthopaedic Surgery, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA

2 Orthopedic Research Center, Mashhad University of Medical Sciences, Mashhad, Iran

3 Universitaets Spital Zuerich, Switzerland

4 University of Tehran, Tehran, Iran

5 Michigan Musculoskeletal Institute, Madison Heights, USA

6 Department of Trauma, Klinikum Dortmund, Germany

7 Department of Trauma, Johannes Wesling Klinikum Minden, Germany

8 Department of Orthopedics, University of Texas, USA

9 Joint Reconstruction Research Center Tehran University of Medical Sciences

10 Fortis Bone and Joint Institute, India

11 Department of Orthopedics, St Vinzenz Hospital Dinslaken, Germany

12 Omsk State Medical University, Russia

13 R.R. Vreden Russian Research Institute of Traumatology and Orthopaedics. Saint Petersburg, Russia

14 Department of Orthopaedic Surgery, School of Medicine University of Zagreb,Croatia


Background: To date, little has been published comparing the structure and requirements of orthopedic training programs
across multiple countries. The goal of this study was to summarize and compare the characteristics of orthopedic training
programs in the U.S.A., U.K., Canada, Australia, Germany, India, China, Saudi Arabia, Russia and Iran.
Methods: We communicated with responders using a predetermined questionnaire regarding the national orthopedic
training program requirements in each respondent’s home country. Specific items of interest included the following: the
structure of the residency program, the time required to become an orthopedic surgeon, whether there is a log book,
whether there is a final examination prior to becoming an orthopedic surgeon, the type and extent of faculty supervision,
and the nature of national in-training written exams and assessment methods. Questionnaire data were augmented by
reviewing each country’s publicly accessible residency training documents that are available on the web and visiting
the official website of the main orthopedic association of each country.
Results: The syllabi consist of three elements: applied clinical knowledge, applied clinical skills, and professional and
management skills. The application of simulation techniques for both teaching and assessment are fundamental to
modern surgical education. The skill of today’s trainees predicts the quality of future orthopedic surgeons. The European
Board of Orthopaedics and Traumatology (EBOT) exam throughout the European Union countries should function as
the European board examination in orthopedics. We must standardize many educational procedures worldwide in the
same way we standardized patient safety.
Conclusion: Considering the world’s cultural and political diversity, the world is nearly unified in regards to orthopedics.
The procedures (structure of the residency programs, duration of the residency programs, selection procedures, using a log
book, continuous assessment and final examination) must be standardized worldwide, as implemented for patient safety.
To achieve this goal, we must access and evaluate more information on the residency programs in different countries and
their needs by questioning them regarding what they need and what we can do for them to make a difference.
Level of evidence: III


Main Subjects