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By Jaimo Ahn, MD, PhD, April 26, 2024

As academic orthopedic surgeons, we all love education, and have contributed to teaching throughout much of our careers. Despite that dedication, few of us have actually created a useful, lasting and tangible product that could affect the lives of thousands of learners, including those we have never met. Over the last several decades, Joe Bernstein and his colleagues, Steve Pinney and Christian Veillette, have created a knowledge compendium, aptly called Orthopaedia, that does just that. Joe has done more for medical student musculoskeletal education, even beyond the thousands he has personally taught and mentored, than just about anyone in orthopedic practice today. I had a chance recently to catch up with Joe to get his thoughts on education and Orthopaedia.

Dr. Ahn: Dr Bernstein, Thank you so much for being a consummate student educator and mentor and for sharing your wisdom through the AOC. I have a few questions for you that may help our membership—learners of all levels from student, trainee to leadersmove orthopaedic surgery and musculoskeletal health forward.

You have been a dedicated educator your entire career. Why has this been such a critically important part of your work-life?

Dr. Bernstein:
The short and selfish answer is simply that teaching medical students is great fun. You get to meet smart and engaged young people–and especially now that students can fact-check you with their smartphones under the table as you talk, you are compelled to stay on top of your game. Another selfish reason is that you can introduce your vision– “the world according to me”– to the leaders of the next generation. In musculoskeletal medicine, for example, I try to brainwash students about my priorities:  mastery of anatomy, and surface anatomy in particular (when the patient says “it hurts right here!” it’s good to know what’s there here); “epistemic modesty”, that is, recognizing the limits of what we know and how we know it;  and last, the power of Bayesian thinking– starting out with a few ideas, calibrating their likelihood, and refining the probability  estimates as more information comes in.  A more theoretical but equally true answer is that teaching can, as the venture capitalists put it, “scale”: your efforts are amplified. Even the busiest practitioner sees only a few thousand patients per year, but if you teach 150 students well, perhaps tens of thousands will benefit.

Dr. Ahn: What experiences forged your love of learning and teaching and, in turn, how have you expressed that in your educational efforts.

Dr. Bernstein:
Behind any engaged teacher is a series of engaged teachers. Teaching, especially in the medical field, is a tradition passed down from one generation to the next. In fact, the very first line of the Hippocratic Oath acknowledges the obligation to teach, born from the debt we owe to our own teachers. I am proud to be a part of this tradition.

I got started in academic medicine because of exceptional mentorship I received from Dr. Joe Lane as a medical student and Dr. Fred Kaplan as a resident. Among their many remarkable qualities, Drs. Lane and Kaplan possessed the rare ability to step back and let their students take center stage, empowering us to take ownership of our projects. Through this, I came to understand that their work served a dual purpose: not only to achieve the specific goals of the current study but also to nurture and develop the next generation.

The Lane-Kaplan method has not only started my career,  but has sustained it over the years as well. My enthusiasm is continually rekindled by the eager students I have the privilege to collaborate with–you included! Many of them have gone on to become colleagues and mentors themselves–you included!–perpetuating the tradition.

Dr. Ahn: Can you tell us more, specifically about Orthopaedia and how we can use it to learn and educate?

Dr. Bernstein: is a comprehensive peer-reviewed introductory resource for medical students, distributed free of charge online.  The genesis of this book dates back 25 years, when Kevin Freedman and I first reported in the JBJS that many excellent medical students could not pass a basic exam in orthopaedic-related topics. A subsequent study then documented that most medical schools lacked required orthopaedic-related courses. Orthopaedia is part of the effort to fix that, by making available an affordable and reliable text that builders of new courses could use.

Affordability matters a lot for students. (The Musculoskeletal Medicine text I edited in 2003 had the daunting price of $129 and many students were daunted!) In fact, given the availability of free information on the internet, the market-clearing price for books aimed at students is $0.00. Of course, not all of the information available for free is correct (or even if “correct,” that which is not validated is not reliable for patient care). In short, there is a need for a free-but-validated resource for students. Yet just as having all the mice agree that it would be wonderful for the cat to wear a bell around its neck yet none would volunteer for the job of placing it, having a need and meeting the need are two independent, indeed orthogonal issues.

My partners, Steve Pinney and Christian Veillette, and I tried various things over the years, but really did not make headway until we got lucky: a viral pandemic struck! That’s a lame joke, as Covid was a global disaster, but there was a silver lining, in that many smart and knowledgeable people were sent home with little to do. For them, the opportunity cost of writing, editing or peer reviewing an Orthopaedia chapter went down precipitously. We were thus able to recruit more than 300 volunteers to complete the work.  This was not quite like Isaac  Newton finishing the Principia when he was sent home from Cambridge in the Great Plague, but it was good enough!

So here we have a comprehensive book, peer reviewed and free.  Now our challenge is to get the word out. To that end, I am grateful for the chance to chat with you and all teachers. I can be reached at or******@up***.edu

Joseph Bernstein, MD, MS

Clinical Professor of Orthopaedic Surgery
Department of Orthopaedic Surgery, University of Pennsylvania


Article by:

Jaimo Ahn, MD, PhD

Gehring Professor & Associate Chair of Orthopaedic Surgery
Department of Orthopaedic Surgery, University of Michigan

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