Preparing Our Future Workforce: Residents Offer Perspective on Sustainability in Orthopaedic Surgery

Discussions surrounding climate change and the importance of creating a sustainable future to preserve the health of our patients and communities are becoming commonplace. Educating the next generation of orthopaedic surgeons on this topic is a priority. Though literature on this topic is limited, orthopaedic trainees can offer unique insights and contributions to environmental sustainability efforts and education. Trainees are in a unique position to observe differences in practices amongst their surgeon mentors as well as physicians’ habits and behaviors across a variety of settings: the OR, the emergency room, and clinics.

Training and education
Sustainability-focused readings and lectures are not consistently included in medical school or residency curricula. The Association of American Medical Colleges (AAMC) reported a trend toward increased availability of climate-change information within required or elective course contents, from 27 percent (2019 to 2020) to 55 percent (2021 to 2022). Students involved in sustainable quality-improvement education reported both increased knowledge and investment in healthcare’s sustainability performance. In 2022, AAMC took a major step in joining the U.S. government’s pledge to decarbonize healthcare and reduce emission by 50 percent by 2030 and to net zero by 2050. This commitment creates opportunities for trainee involvement.

A survey of residents and fellows across 14 surgical specialties found that a minority received dedicated sustainability training, but almost 90 percent reported they would welcome it. Dedicated education time is sparse in training, but these principles can be incorporated into program and health-system culture and individual surgeon habits. Each of us makes choices when draping and prepping patients for surgery, selecting reusable and disposable items, utilizing telehealth, and segregating trash. The authors recommend conscious integration of considerations regarding waste and emissions during scrub-sink chats, mentorship encounters, quality-improvement projects, research, and existing lectures, as opposed to discrete formal modules.

Resident-led initiatives and projects
Examples of sustainability initiatives proposed and led by residents are reported in general surgery literature. Such initiatives are self-driven, extracurricular efforts. The authors encourage trainees to consider utilizing research time for efforts focused on sustainability. Many areas beg for further study: OR waste, disposable versus reusable products, and telehealth usage, among others. Projects can take the form of full life-cycle assessments or focus on costs, inefficiencies, disposable waste, and reuse opportunities. Many of these projects can be completed in a timely fashion and offer measurable differences to institutions.

Similar to other research and quality-improvement areas, recently completed sustainability-focused projects at the authors’ institution have positioned trainees to lead and educate their peers and colleagues. An assessment of the carbon footprint of open carpal tunnel release demonstrated that significantly less waste and emissions were generated in the procedure room setting than in the OR. Paper and label waste was audited in the authors’ orthopaedic clinic, which allowed for identification of major waste generators that provided little to no benefit to patients, enabling significant reductions in paper waste across clinics. Ongoing efforts target appropriate waste segregation, coordinated OR set reduction, and travel-related emissions reduction with telehealth clinic offerings. Attention to cost, waste, and emissions benefits individual institutions and can be shared and scaled to benefit society.

Faculty engagement
As with all successful, meaningful research, faculty engagement is critical. A small cohort of orthopaedic surgeons are currently acting as champions of sustainable practices in the OR; such leadership efforts are a key enabler to trainee participation. At our institution, we are fortunate to have several attendings with a passion for this topic, demonstrated through grand-rounds presentations, residency-wide emails, and daily informal discussions. This has inspired interest amongst the authors’ residency cohort, and as a result, the authors developed a task force to tackle sustainability projects. Since doing so, the authors have learned of similar efforts and discourse within other programs. The authors’ first resident task force project compared disposable foam to reusable gel pads for patient positioning. The project calculated and projected significant cost savings with the reusable option based on a variety of lifespan projections. Next, the authors will evaluate the emissions associated with each option.

Integrating environmental education into graduate medical education offers opportunities to improve and balance resident education while empowering program graduates with valuable knowledge and skills. Many hospitals have a “Green OR” or similar committees, which offer young surgeons leadership opportunities as well as further information about local initiatives. Practice Greenhealth, the Joint Commission, and the World Health Organization provide free online resources on sustainability in healthcare.

The growing importance placed on environmental protections on the national and global stages is translating into formal regulations and goals for health systems. It is vital that trainees are educated about sustainability so they can participate in conversations about evolving outcome measures, guidelines, and payment frameworks in an informed way. The authors hope trainees will feel empowered to be advocates and foster intellectual curiosity so that we all can optimize environmental practices in orthopaedic surgery and be leaders in greening the OR.

Olivia Grothaus, MD, is a fourth-year orthopaedic surgery resident at the University of Utah and will be pursuing a fellowship in pediatric orthopaedic surgery.

Cameron Wallace, MD, is a second-year orthopaedic surgery resident at the University of Utah and is still exploring his career interests.

Daniel C. Lewis, MD, is a third-year orthopaedic surgery resident at the University of Utah and is planning on pursuing fellowship training in sports medicine.

Logan E. Radtke, MD, is a third-year orthopaedic surgery resident at the University of Utah and is planning on pursuing fellowship training in adult reconstruction.