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Introduction
This is my 14th year as Chairman of the Department of
Orthopaedic Surgery at Children’s Hospital Boston. The term
has been marked by continued growth in the clinical area
and the evolution of subspecialty-based programs which have
become a national model for pediatric orthopaedic programs.
Over the past year, we have solidified the changes in the orthopaedic
research environment with Matt Warman taking over as
Director of Orthopaedic Research and further development of
our clinical research program. The further development of our
research effort underpinning clinical expansion and innovation
will be the hallmark of the future for our department, coupled
with our dedication to resident education.
The Orthopaedic Department as a whole has grown significantly
in size over the past few years. Figure 1 is a schematic
drawing indicative of the size of our department. We have 35
MDs and PhDs, 18 mid-level providers including nurses, nurse
practitioners and physician assistants and 133 clinical and
research support staff, ranging from administrative assistants
through research fellows and post-docs. Significantly, of the 95
clinical support staff, over 60% are college educated individuals,
many with an ongoing interest in medical administration.
The house staff at Children’s Hospital Boston presently
includes 6 Harvard residents in their third year; one Lenox Hill
resident and one Dartmouth resident. We also have 10 post
residency fellows including 3 in pediatric orthopaedics, 2 in
primary care sports medicine, 2 in orthopaedic sports medicine,
1 hand fellow, 1 tumor fellow and 1 hip fellow. In addition, we
have a number of research fellows for variable periods of time,
rounding out the educational and scientific environment.
THE TEACHING PROGRAM
We dedicate tremendous effort to the teaching program for
orthopaedic residents, as this is our primary educational focus.
The conference schedule has remained, for the most part, the
same over the past 10 years with a clinical conference, basic
science conference and fracture conference three mornings a
week. There are Grand Rounds once a week and finally a chief’s
conference focusing on differential diagnosis and operative
indications one morning a week.
We continue to monitor surgical participation, work hour
compliance and performance on standardized tests including
the OITE and Boards, as part of our educational program.
Our residents continue to thrive and gain a tremendous
pediatric orthopaedic exposure during their time at Children’s.
Approximately one resident a year goes into pediatric orthopaedics.
This, combined with a number of fellows, gives us a major
representation of all pediatric orthopaedic surgeons nationally
each year.
Last year, in addition to the standard
educational program, Perry Schoenecker
came as the 20th David Grice Visiting
Professor. Dr. Schoenecker spent three
days with us in a variety of academic
settings which included the Grice
Lecture on adolescent hip problems
causing long-term adult hip pathology.
He focused on methods of altering
these adolescent problems including
periacetabular osteotomy and proximal
femoral osteotomies and their effect on natural history and longterm
outcome of these conditions. In addition to this, he spent
considerable time in the clinic setting and in the operating room,
giving other lectures and interacting with the residents. We are
appreciative to David Grice’s family for endowing this professorship
and allowing us to have this academic time on an annual
basis. The second major academic event that happened last
year was the Festschrift for
Dr. Melvin Glimcher which
celebrated his career, as he
approaches his retirement.
The day included luminaries
in the bone research
area from around the world.
We gathered for a day of
lecture and celebration of
Dr. Glimcher’s career, as
the pre-eminent researcher
in the world, eliciting the
underlying structure of
bone and its structure and
physiology of mineralization.
Dr. Glimcher remains
active in the research world with continuous NIH funding and
an active lab to the present time.
The clinical program in Orthopaedic
Surgery grew with the addition of Dr.
Dennis E. Kramer to the staff. Dr.
Kramer completed his orthopaedic
residency training at Johns Hopkins
University. He completed a fellowship
in Sports Medicine and then joined the
staff in pediatric orthopaedic surgery
and sports medicine. Dr. Kramer joins
Drs. Micheli, Kocher and Murray in the
Sports Medicine Division. In addition to
the members who focus primarily in Sports Medicine, Don Bae
spends some time in the Division of Sports Medicine, focusing
on problems related to upper extremity injuries, in addition to
his major commitment to the General Orthopaedic Program
focused on hand and upper extremity problems.
Last year, the promotions in our department included
Brian D. Snyder, MD, PhD to Associate Professor. Dr. Snyder
is active as the director of the Orthopaedic Biomechanics
Laboratory at Beth Israel Deaconess Medical Center, in addition
to his work as director of the Cerebral Palsy Program at
Children’s Hospital Boston. His publications span the breadth
of pediatric orthopaedics but focus on cerebral palsy. In the
basic science world, Dr. Snyder’s work in biomechanics of
bone, particularly bone with pathologic and neoplastic conditions.
Dr. Snyder has been recognized for this work with the
Kappa Delta Award in the past. Dr. Seymour Zimbler received
promotion to Assistant Professor. Dr. Zimbler has been an
active pediatric orthopaedic surgeon for many years, rising to
the level of Professor at Tufts and chairman of their department.
In returning to our department at Children’s as one of our nonoperative
orthopedists, Dr. Zimbler has been a continued force
in teaching medical students and a participant in the fellows’
conferences on a weekly basis. Dr. Zimbler is a valued member
of the department and a credit to the institution. Dr. Donald
Bae received promotion to Assistant Professor. Dr. Bae, in the
past, has distinguished himself as an outstanding resident in
our program, winning the Marmor Award for the Outstanding
Orthopaedic Resident based on OITE scores, the award for team
work and earning the respect of all staff with whom he worked.
It has been a pleasure to have Dr. Bae on staff at Children’s,
where he excels in his research and clinical productivity. He
certainly deserved his promotion to Assistant Professor and will
continue as a valued member of our staff.
Matthew Warman, MD, accepted
the position as Director of Orthopaedic
Research and the Ormandy Professor
in Orthopaedic Surgery. His appointment
is a combined appointment in
Genetics and in Orthopaedic Surgery,
placing him squarely in the academic
echelon of the quadrangle at the medical
school, as well as being central to
our research program. Dr. Warman will
allow us to focus orthopaedic research
in the future with a genetic bent and an ability to bring aspects
of genetics and developmental biology to orthopaedic problems
with which we are confronted.
Also of note among our staff is the work of Dr. Martha Murray
who now has 2 RO1 grants in elucidating the mechanisms of
anterior cruciate healing in children and adolescents. In studying
mechanisms of possible repair and healing, it has allowed
her to propose possible treatments for this common injury
which will revolutionize management of children with such
athletic injuries in the future. Dr. Peter Waters has expanded his
role as the Associate Chief of the Department. He was promotion
to Professor several years ago. In his work at Children’s,
he serves on the Board of the Physicians’ Organization; he has
expanded his role in the Ambulatory Policy Council and in the
developmental of the Waltham surgical program. Dr. Waters
coordinates the clinical research effort in our department and is
in charge of the Hand and Upper Extremity Program.
Our fellows last year included Dr.
Jennifer Ty, Dr. Scott Rosenfeld, and Dr.
Thomas McPartland. Jen Ty is at UCSF
where she is completing a hand and
upper extremity fellowship. She will
accept a position at DuPont Institute
in Wilmington, Delaware starting this
summer in pediatric hand and upper
extremity surgery. Scott Rosenfeld is
at Texas Children’s Hospital in Houston
in the full-time orthopaedic program,
working with Jacob Weinberg who
had been a fellow with us two years
ago. Tom McPartland graduated from
our program and went to the pediatric
orthopaedic program at the New
Jersey College of Medicine where he is
actively involved in teaching and pediatric
orthopaedic surgery. The present
group of fellows include Yi-Meng
(Beng) Yen, MD, PhD who will join us
as a member of the full-time department at Children’s. Beng
earned his MD/PhD degrees from UCLA. He spent one year
at Steadman Hawkins Clinic as a Sports Medicine fellow and
one year with us in pediatric orthopaedics. He will be pursuing
a career that combines pediatric
orthopaedics and sports medicine, as
he begins his work with us this fall.
Matthew Mayfield, MD came from
Campbell Clinic in Memphis and will
move to Tyler, Texas, pursuing pediatric
orthopaedics this fall. Matthew
Vance, MD will return to southern
California and practice pediatric orthopaedics
in San Diego at the conclusion
of his fellowship.
In the expansion of our orthopaedic program, we have
increased our number of clinical visits to about 83,000 per year;
the number of surgeries to just over 5,000 per year. In doing
this, we have moved a significant amount of our work off-site
to satellites in Waltham and Lexington. The number of day surgeries
continues to increase as patients previously admitted for
procedures have been converted to day surgery, with improved
techniques and improved anesthetic agents. Our Waltham program
includes hand and upper extremity surgery, foot surgery
and sports procedures. I am quite sure that over the coming
years, we’ll see continued increase in our Waltham presence,
with the Longwood campus covering more of the tertiary and
quaternary, as opposed to the secondary procedures. This will
provide a more efficient setting in which to work, as well as a
lower-cost environment. The obvious problem with this movement
from the main campus to the satellites is incorporating
resident education into this more efficient, more rapid-paced
setting. It is necessary for us to do this, as otherwise the resident
experience will become all higher tech hip and spine procedures,
rather than the breadth of orthopaedics necessary for
the education of our residents. We have a committee working
on the development of an improved training program which
will encompass training in the satellites as well as the development
of better teams.
With respect to resident education, there have been significant
changes over the past few years in work hour rules, as
well as changes in supervision. These represent challenges to
education with which we must deal. We presently have a committee
working on changes in resident education to include
greater representation in sports medicine as well as satellite
participation for our residents. At the same time, we are developing
a larger group of mid-level providers, doing everything
from assisting at surgery to facilitating discharges, allowing
us to improve the efficiency of patient care and the efficiency
of our orthopaedic staff surgeons. There will be a continued
increasing reliance on mid-level providers in all settings over
the new few years, facilitating resident education. At the same
time, in order to be more effective, resident education will have
to occur in simulators and other settings in addition to that in
the traditional clinic area. We will be involved in the evolution
of this, I suspect.
At our annual staff dinner in January, Dr. John Hall was
present. He is doing well, retired and quite happy not to be getting
up early for pediatric orthopaedic conferences or surgery.
He reports not missing the surgery but missing the interactions
with his colleagues and peers. He sends his greetings and best
wishes to all of you.
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