Casting: the junior Ortho Pod

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 [email protected]! 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

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 An excellent conversation with Canada’s next top budding Orthopaedic Oncology (Sarcoma) expert, headed to Memorial Sloan Kettering (NYC) for his fellowship, who combined machine learning with oncological data to create high-quality guidelines for metastatic bone tumour treatment. Some of his papers can be found here: https://tinyurl.com/anthonybozzo 0:30: Why Orthopaedic Oncology (connecting with patients, multidisciplinary care) 2:30: Building his reputation (an early interest, two critical mentors, PARITY https://clinicaltrials.gov/ct2/show/NCT01479283 and SAFETY trials https://pubmed.ncbi.nlm.nih.gov/31537562/ ) 3:30: Decision to pursue an MSc (SSP, machine learning self-teaching, MOOCs, fast.ai, talking to industry leaders, guiding management) 6:15: Specifics about his MSc project (novel statistical techniques to guide management of secondary bone tumours) 7:45: MSK fellowship (volume and complexity of cases, informal site visit, observing indications rounds, MD Anderson, talking to fellows/staff) 11:00: Reflections (co-residents, self-care) 11:45: Impactful moments (working with R1s, 2 impactful cases; hip disarticulation, patient advocacy) 15:00: Growth and parting messages 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

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 I interviewed two graduating R5s from the McMaster Orthopaedics program who are headed to the world’s top fellowship programs next year. We talked about their experiences pursuing US fellowships and reflections on personal growth and success during residency. Find out how to make an impression on top US fellowship programs, how to snowball to success, and why finding mentors can help on many levels. Dr. Patrick Thornley (Spine at UWO, Peds/Spine at DuPont): 0-11:15 0:45 - Developing an interest in Spine 2:32 - UWO pros (volume, independence, fellows, MSc, billing, research, reputation, elective) 3:30 - DuPont (structure of program, balance between spine/peds, cervical spine dysplasia) 5:45 - Spine attending position considerations 6:15 - Networking via mentors, site visits, lectureship series, contacts 7:30 - “Volume and Repetition” explained (finding an R3/R5/staff mentor, reading, visualization, cadaver lab, muscle memory, staying late) 10:15 - Drawing on the good moments, caring for patients Dr. Nolan Horner (Sports at Rush): 12:15-23:00 12:20 - Rush Sports (identifying top 5-6 programs, researching online/talking to people, dichotomy of US Sports programs, site visits) 14:30 - Making himself an attractive applicant (site visit, mentors advocating for him, importance of working hard from day 1) 15:15 - How to be successful in residency (first impressions, “snowball effect”: have a plan, develop skills, achieve independence, having a good attitude) 17:15 - Mentorship model (emulate/improve their path) 19:15 - Pro tip: learn from allied health professionals, have a good attitude 20:20 - Final takeaways: 1) have a plan (more planning = more learning), 2) write out all steps in detail post-op, build on that over time 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

I had a great chat with Dr. Adrian Huang, an upper extremity surgeon at UBC (@scrubbedout) about distal radius fractures. We talked about the optimal closed reduction and casting maneuvers, common fracture patterns based on the anatomy, and a neat intra operative technique to maximize exposure without injuring the median nerve. Find some awesome content on his website and social media: IG: instagram.com/scrubbedout/ Website: scrubbedout.com 1:15-3:45 - Definition of “distal radius fracture”, epidemiology, identification in polytrauma/comatose pt 3:45-6:00 - Anatomy of DR, osteology, joints, patterns; that unstable lunate facet - https://doi.org/10.2214/ajr.13.12140 6:15-8:35 - Extra-articular DR fracture management, 5 criteria for ORIF, post-reduction films, critical volar cortex component; https://www.orthobullets.com/trauma/1027/distal-radius-fractures “ORIF Indications” 8:35-16:00 - Closed reduction maneuvers; hematoma block, finger traps, casting technique, common complaints, 1st web space, out to MCPs, distal to elbow crease, hinge at fracture (not wrist) 16:00-16:45 - Smith fractures, reverse molds, median n, close followup 18:00-19:00 - Indications for ORIF are multifactorial; https://www.scrubbedout.com/distalradiuscheatsheet 19:00-23:00 - Modified approach per @scrubbedout; https://www.instagram.com/p/CIZgdXyB35h/ has less median n stretch, Orbay approach; https://doi.org/10.1097/00130911-200112000-00004 . Cover hardware with PQ/BR to reduce need for removal 23:00-26:15 - Avoid damaging NV by not using sharp/self retainers, always fix what you remove (eg: RC ligaments), don’t miss associated injuries (eg: scaphoid/lunate) Check out the 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

A comprehensive guide on how to match to Orthopaedic Surgery, from the start of medical school to match day. This advice can be applied to other countries and all competitive/surgical residency programs, such as Plastic Surgery, Ophthalmology, Dermatology, and General Surgery.  This episode is brought to you by our sponsors. Use the discount codes for great deals! MD Consultants: mdconsultants.ca code ORTHOPOD15 MCAT Prep 101: prep101.com/casting code 350CASTINGPOD My recipe for success includes: 1:10-2:45: Deciding on a specialty, having multiple viable career options 2:45-5:20: Identifying a program of interest, networking with residents, building a network:  http://canjsurg.ca/64-2-e249/ 5:20-7:15: Building your CV and reputation via networking, how to approach networking conversations, research as an avenue for signalling, targeting the selection committee 7:15-9:30: Clerkship electives, starting at small/community sites, understanding your role, trying to soak everything in. Forming good relationships, taking call, rounding 10:30-15:00: CaRMS: starting early on applications, CV (telling a story, hobbies & interests), filling out the CaRMS application info, personal letter structure, process of perfectionism 15:00-19:45: Interview preparations, getting into the right mindframe, top 10 questions, STAR format, practicing and refining answers, prioritizing creativity, minimizing nervousness, optimizing the virtual space: https://cmajblogs.com/5865-2/ Our sponsors: MD Consultants is the best company that helps with medical school applications review, interview preparations, and CASPer studying. To receive a unique 15% off pre-med packages, visit www.mdconsultants.ca and enter code ORTHOPOD15 MCAT Prep 101 is the most comprehensive prep website for MCAT preparation. They offer the most live instruction hours, targeted CARS prep, and individualized study plans with top tutors to maximize the changes of success. Visit www.prep101.com/casting and enter code 350CASTINGPOD for $350 off MCAT packages