Published 2/26/2025
|
Selina C. Poon, MD, MPH, FAAOS
In an interview for AAOS Now, Selina C. Poon, MD, MPH, FAAOS, sat down with Mehmet Demirhan, MD, professor of orthopaedics and traumatology at the School of Medicine at Koç University in Istanbul, Turkey, and president of the Turkish Society of Orthopaedics and Traumatology. Dr. Demirhan discussed differences in orthopaedic training and practice between Turkey and the United States, as well as the importance of collaboration with AAOS and the need to maintain general orthopaedic knowledge despite the growing popularity of subspecialties.
Dr. Poon: I recently learned that there are two national orthopaedic societies in Turkey: the Turkish Society of Orthopaedics and Traumatology and the Turkish Association of Orthopaedics and Traumatology. What are the main differences between the two societies?
Dr. Demirhan: The umbrella society in Turkey is the Turkish Society of Orthopaedics and Traumatology (TOTBID), established in 1970. The Turkish Association of Orthopaedics and Traumatology (TOTDER) was established in 1937 in Istanbul, so it’s the older of the two societies.
TOBID is the biggest orthopaedic society in Turkey and is responsible for national congresses and international relationships, [including] with the European Federation of National Associations of Orthopaedics and Traumatology (EFORT), the Asian Pacific Orthopaedic Association (APOA), and AAOS. It is also responsible for governmental issues and advocacy in Turkey.
Please describe the path to becoming an orthopaedic surgeon in Turkey.
We have a school of medicine that is actually 6 years, and this [includes the] equivalent to U.S. undergraduate education. After these 6 years, we have a nationwide exam. It is similar to the U.S. Medical Licensing Examination. After this exam, [students] have the chance to choose a specialty area. For example, orthopaedic residency is another additional 5 years. Altogether, it is 11 years to become an orthopaedic surgeon.
You may ask about fellowship after residency. As you know, in Europe and Turkey, we don’t have established fellowships. We have a recognized fellowship under the rules of the European Union for hand surgery. Pediatrics and spine recognized fellowships will probably come in the next few years. Turkey also has the same regulations as in Europe, and we do not have any regular fellowships in the [orthopaedic] subspecialty areas. If a surgeon has the interest, they can take the opportunity to engage and learn about the subspecialties in different societies and different clinics throughout Europe.
In the United States, we are very subspecialized, especially in the big cities. But it seems like in Turkey, you are more trained as generalists, and then if you have an interest, then you can pursue it or just limit your practice to a certain subspecialty.
Yes, the 5-year residency program is the general orthopaedic program. After that, we have voluntary board exams. The Turkish Educational Council of Orthopedics and Traumatology is responsible for this exam. This is a voluntary exam, similar to [that of] the American Board of Orthopaedic Surgery. This exam is [also] very similar to the [European Board of Orthopaedics and Traumatology] exam.
After passing this exam, the surgeon can then have the chance to subspecialize in a different area. In the last decade, subspecializing is also very popular in Turkey. From the patient’s side, they ask whether you are a shoulder and elbow surgeon or are you a spine surgeon. ... But in general, we have to finish the general orthopaedic training before we start subspecialization.
TOTBID has a specific delegate for AAOS. How do we foster greater exchange between your society and AAOS?
From our side, we have great collaboration with AAOS. We were the guest nation at the AAOS Annual Meeting several years ago. We also have educational collaborations. The Orthopaedic Knowledge Update is translated into Turkish with permission from AAOS.
We will continue to have collaborations with AAOS because I think it is very important. We also have the same collaboration with EFORT and APOA. In our national congress, we have, for example, APOA and EFORT special sessions. We are also glad that some AAOS members have attended our national meetings in the past. We will be happy to continue to host AAOS members at our Turkish orthopaedic meetings.
We recognize in EFORT and our national congresses that the general attendees are unfortunately decreasing. The subspecialty congresses are becoming more popular. However, the general orthopaedic congresses—even though I am a shoulder and elbow surgeon—are an educational update on the other subspecialties for me. We need to have more attractive congresses for the [general] orthopaedic surgeon, otherwise we lose power in general orthopaedics. Even during the AAOS Annual Meeting in San Francisco, ... there is a lack of general symposia or discussions. Industry influences are also very important, and we need to be cognizant about this influence. We all need to think about how we are going create, in next decade, general orthopaedic congresses, like in AAOS, EFORT, or APOA.
Selina Poon, MD, MPH, FAAOS, is a pediatric orthopaedic surgeon and director of research at Shriners Children’s Southern California in Pasadena, California. She is also a former member of the AAOS Now Editorial Board.