The body of knowledge that orthopaedic surgeons and trainees are responsible for continues to grow. Granted, surgical applied anatomy has remained constant, but our field continues to enlarge and expand with new techniques and implants being introduced at a rapid pace. Many orthopaedic residents and fellows are in training programs where their work hours are closely monitored, so time spent on clinical work and didactics must be optimized. In addition, most hospitals are closely scrutinizing the outcomes, efficiency, and productivity of their surgeons—regardless of whether they have trainees with them or not. These phenomena are almost at odds with one another and create a challenge for anyone involved with orthopaedic education. Clinical and surgical skills must be taught, but there is a finite amount of time and opportunities to do this.

The presence of orthopaedic industry in clinical and educational settings elicits differing opinions from orthopaedic surgeons. For some, it is difficult to see why sales and education should co-exist, and offerings such as industry-supported labs and courses may be seen as simply agenda-driven events. On the flip side, for others, industry-sponsored courses provide valuable opportunities for trainees to be taught by faculty from other institutions and participate in events such as cadaver labs. In addition, all orthopaedic subspecialties have procedures where implants are used for fixation, arthroplasty, etc. Although some industry-sponsored events are purely focused on surgical anatomy and approaches, many have implants available for procedural practice.

Personally, I am intimately involved in the intersection of this debate. As the residency program director at the University of California, Irvine, I am very much aware of the residency didactic program as well as the hours that our residents spend in sanctioned clinical and educational activities. In addition, I receive numerous solicitations from our orthopaedic industry partners for courses and events they put on. As a trauma surgeon, I work with orthopaedic trauma companies as faculty for some of their course offerings. In addition, I have served as faculty for course offerings from AAOS and the Orthopaedic Trauma Association, organizations that receive funding from multiple industry sources. It is nearly impossible to separate industry and education at every corner, and I don’t believe we need to.

Orthopaedic education should come primarily from the training program. It is the responsibility of the faculty to teach, reinforce, and progress their learners. In addition, there is no substitute for daily hands-on instruction and learning. Graduated autonomy and independence can only be granted after sustained observation. Unfortunately, supplemental events, such as cadaver labs, are not universally available for every program and are an experience commonly offered by our industry partners for trainees. Cadaveric specimens are expensive and require infrastructure for the acquisition, storage, and disposal of the bodies. If a procedure or technique requires an orthopaedic implant, that implant most likely requires a manufacturer to be involved so that the appropriate supplies are available. Finally, exposure to extramural faculty and peers gives learners opportunities to network and hear different opinions and techniques.

Some may argue that technology has advanced to the point where industry-sponsored labs are not necessary. Without a doubt, surgical simulators have become increasingly realistic, allowing learners to practice their surgical skills, essentially on demand. Virtual reality devices, especially those with haptic feedback, can replicate being in the OR and performing a surgical operation to a degree that continues to impress. Although these technologies are becoming more available, some remain very expensive, and they are not universally available at every training program. Orthopaedic trainees benefit from exposure to these modalities but universally note that they are not a substitute for real surgical experience or the learning that occurs from exposure to cadaveric specimens or orthopaedic instrumentation.

Other benefits that trainees obtain from orthopaedic industry include the growing number of supplemental virtual webinars, animated and real-life surgical technique videos, and educational materials posted online. Residents and fellows are increasingly turning to such content, as it is immediately accessible from any electronic device. It is not uncommon to walk into the workroom or OR and see a trainee on their phone, brushing up on a surgical approach or procedure or tuning in to an industry-sponsored webinar or case discussion. Although this material is often free of charge, it is important for educators to remind trainees that industry content is not uniformly vetted and may have varying degrees of industry bias. Many orthopaedic societies (e.g., AAOS), peer-reviewed journals, and other independent educational organizations provide rigorously peer-reviewed electronic resources for online education and training that should be relied on to build core knowledge.

Industry relationships can benefit orthopaedic trainee education. Core teaching and experience must come from the home program through clinical exposure and didactics. Electronic resources and advanced technology can supplement the curriculum, and there are opportunities for orthopaedic industry to complement training programs.

Industry can help support educational courses and provide educational materials for trainees that they may not otherwise have access to. Educators should remain involved in overseeing the involvement of orthopaedic industry in their training programs to help ensure learners are compliant with program, institution, and state regulations.

John A. Scolaro, MD, MA, is chief of orthopaedic trauma, residency program director, and associate professor of orthopaedic surgery at the University of California, Irvine.