Report from the 2003 J.J Fahey North American Travelling Fellowship A Canadian Perspective

Brian K. Kwon, M.D., FRCSC
Clinical Assistant Professor, Department of Orthopaedics
University of British Columbia
Vancouver, BC

The American Orthopaedic Association established the North American Travelling Fellowship (NATF) in 1970. The AOA renamed the programme the John J. Fahey, MD, Memorial North American Travelling Fellowship in 1991 in honor of former AOA president John J. Fahey, MD, who contributed $20,000 to the fellowship. The NATF is designed to provide young orthopaedic surgeons who have just completed residency training the opportunity to spend four weeks travelling to orthopaedic centres in the United States and Canada. Five fellows - four U.S. and one Canadian - participate in the programme each tour. Regional tours take place in odd years in the fall. Today the NATF remains one of the most prominent travelling fellowships in orthopaedics and serves to identify the future leaders of the specialty. Since its origination, 150 fellows have participated in the programme.

Last fall I had the honour and privilege of carrying the Canadian Orthopaedic Association banner on the 2003 J.J. Fahey North American Travelling Fellowship (NATF). The description of this tour is somewhat daunting, and one cannot help but feel that he/she really does not belong in the company of the illustrious alumni of past Fellows. The directory of which includes household names in Canadian and international orthopaedics such as: Drs. Tredwell, Waddell, Petrie, Kellam, Yong-Hing, McDonald, Labelle, ODriscoll, Miniaci, King, Marks, Schemitsch, and Masri, to name a few. Nonetheless, with the strong pedigree of Canadian orthopods to have preceded me, I packed my laptop and headed for Saskatoon to start my most unforgettable five-week experience as one of the 2003 North American Travelling Fellows.

My American counterparts on the tour included Drs. David Glaser of the University of Pennsylvania, James Guille from the A.I. Dupont Institute, Jason Koh of Northwestern University, and William Mihalko from the University of Buffalo. We began our tour at the Canadian sites which included the University of Saskatchewan followed by the University of Manitoba. At the University of Saskatchewan, we were graciously met at the airport by Dr. William Dust, Chairman of the Division of Orthopaedics, who had organized a full schedule of both academic and social events for our stay in the Prairies. At X-ray rounds on our second day in Saskatoon, the chief residents were grilled by my American colleagues on an extremely complicated case of fibrodysplasia ossificans progressiva. Both residents had answers for everything that was thrown at them, leaving a tremendous impression of the exceptionally high quality of Canadian training our residents receive, even at a small institution. Our next stop was Winnipeg, where in the midst of a torrential downpour, Drs. William Rennie and Peter McDonald met us at the airport to shuttle us into town. While Dr. McDonald hosted us for an afternoon of golf and a dinner at his home, Dr. Rennie personally chaperoned us through Winnipeg for our stay, which, in addition to a stimulating set of lectures, included what ended up being deemed as our best restaurant meal on the trip (given the number of fantastic restaurants we visited during our trip and the amount of weight we all gained over five weeks, this is actually quite a feat).

Upon leaving Winnipeg, we headed south for a four-week whirlwind tour through the Midwestern United States. This took us through Minneapolis (University of Minnesota), Rochestor (Mayo), Chicago (Northwestern and the University of Chicago), St Louis (Washington University), Iowa City (University of Iowa), Indianapolis (University of Indiana), Memphis (Campbell Clinic), Birmingham (University of Alabama), Houston (University of Texas Medical Center), and Dallas (Southwestern and the Texas Scottish Rite Hospital). Along the way we were graciously hosted by such orthopaedic luminaries as Drs. Marc Swiontkowski, Richard Cofield, Richard Gelberman, James Beatty, Terry Canale, Randall Loder, Jody Buckwalter, Reg Cooper, and Robert Bucholz. At many centres, time was arranged for the five fellows to just sit and talk with the respective Chairmen to get their perspectives on academic orthopaedics and their invaluable advice about establishing oneself within the orthopaedic academic community. At each centre we presented talks on our research, but ultimately I think we were the ones who gained the most knowledge from each of our respective hosts.

At the end of what was a long five weeks on the road, I arrived back in Vancouver to resume my practice and my PhD, filled with many great memories of my travels, important contacts, and a much expanded outlook. The many hours on the road impart much time for reflection, and in particular, consideration of a number of questions that the travelling fellowship afforded a unique opportunity to gain some perspective on.

What were the elements that contributed to the professional/academic success of this individual?

When you are sitting across the table from the likes of Drs. Gelberman, Swiontkowski, Buckwalter, Weinstein, Beatty, and Bucholz, it is hard not to wonder what they did at our stages of their careers that sent them onto their pathway of orthopaedic stardom (and as a corollary, what we would need to do to emulate that). What lessons could we learn from them at this early stage of our orthopaedic careers? Obviously, these were all extraordinarily talented, hard-working individuals, but what other aspects contributed to their success? Cumulatively, there were a few underlying themes, both demonstrated not only by these Chairmen but also by some of the successful members of their faculty. Clearly, many had great mentors and role models as they began their careers, and in turn, they were mentoring and supporting their young recruits. The importance of this I think would be hard to overestimate. Having a supportive Chairman with a strong vision for the future, and being part of a clinical subspecialty group with firm commitments to research were key. I was struck by the pervasive issue of financial compensation clearly, these are difficult and challenging times in academic medicine in the United States, just as they are in Canada. With the lure of big money in American private practice, it became clear during my travels that individual success in academics was influenced by and associated with financial security and satisfaction. Simply put, individuals who were happy with their current financial situations were seemingly also the most successfully engaged and committed to their academic endeavours. While this should not seem like such a striking revelation, perhaps more interesting is the acknowledgement of this correlation. In the end, is it so blasphemous to propose that academicians who are charged with taking on complex, quaternary level cases, teaching residents and medical students, and conducting research achieve some level of satisfaction with their financial compensation? Some of the most successful programmes we visited in the United States had a very clear answer to this question.

So on that topic, what were the key elements of success at a departmental level?

Again, here, the importance of leadership and strength at the Chairman level was hard to understate. This appeared to have a significant impact on the academic strength and vision of the department, and in many ways had a profound influence on the morale and productivity of the rest of the group. Certainly, it seemed that the Chairman had a tremendous role in defining and establishing the culture of academic productivity. While this amounted to a general expectation for academic productivity in some centres, it was extremely formalized in one particular institution. An individuals publications for the year were counted, the impact of each journal accounted for, and a score was established to determine if the individual would receive a monetary bonus. In this context of academic productivity, it was also evident that orthopaedic departments around the continent are actively engaging local basic science departments to develop multi-disciplinary collaborations, representing the expansion and recognition of the need for translational research in musculoskeletal disorders, and the leadership role that orthopaedists can play in this process. Finally, in close relation to the point I raised in the elements of individual success, the importance of the financial satisfaction of the clinicians to the departmental success was very apparent. Clearly, it was difficult to run a productive department with dissatisfied clinicians in this regard.

Of course, there were many lessons and insights gained from these five weeks on the road. Perhaps what was particularly valuable for me was to see how fortunate I was from both an individual and departmental perspective to be in my current situation in Vancouver. With a strong, supportive Chairman, a great group of individuals to share a practice with, and an extremely fertile research environment, it would be certainly hard to beat. Clearly, we Canadians have the opportunity to do world-leading research; both on a clinical and basic science level, and in this regard, need not cower in the shadows of our American colleagues. As we move forward in the 21^st century, I think that Canada can and will play a leadership role in the advancement of the international orthopaedic agenda.

As a final note, recognizing that I, as a young orthopaedic surgeon, have benefited immensely from the environment I am in, I should wish to take this opportunity to thank those who helped to make my NATF possible. This would include, of course, the Canadian Orthopaedic Association, which I was proud to represent on every step of the tour. My Chairman, Dr. Clive P. Duncan, who has provided enormous support to my endeavors along the way, and my clinical partners and mentors, including Drs. Marcel Dvorak, Charles Fisher, Peter Wing, and Michael Boyd, who tolerated my absence during the tour and who continue to support my basic science interests in spinal cord regeneration. One could not ask for a better working environment. And finally, Dr. Tom Oxland and Dr. Wolfram Tetzlaff who have mentored me in the basic sciences of biomechanics and neurobiology respectively. To all, I am deeply indebted for an extraordinary, once-in-a-lifetime experience on the 2003 North American Travelling Fellowship.

Figure Legends

1. Saskatoon - group shot with Dr. Dust

After two interesting days of lectures and case presentations, Dr. Dust (Chairman of the Division of Orthopaedics) hosted the fellows for a fascinating tour of the Canadian Light Source, Canada's only synchotron. Pictured here outside the Canadian Light Source, from l to r, are Drs. Brian Kwon, University of British Columbia; James Guille, Dupont Institute; William Dust, University of Saskatchewan; William Mihalko, University of Buffalo; David Glaser, University of Pennsylvania, and Jason Koh, Northwestern University.

2. Winnipeg - group shot with Dr. Rennie

Our second stop on the tour was Winnipeg, where Dr. William Rennie, Chairman of the Section of Orthopaedics of the University of Manitoba, graciously hosted us. Pictured here are the fellows with Dr. Rennie and Dr. Peter MacDonald, former North American Traveling Fellow (and golfer extraordinaire!). Back row, l to r: Drs. Rennie, Glaser, Mihalko; Front row, l to r: Drs. Kwon, Guille, Koh, MacDonald.

3. Houston - outside of NASA

The local hosts made every attempt to show us part of their cities. In Houston, we were treated to a very interesting tour of NASA, where we got to witness "mission control" and munch on astronaut food. As one can see, the Americans were a bit homogeneous in their dress code for
non-academic events. From l to r: Drs. Mihalko, Guille, Kwon, Glaser, and Koh.

4. Mayo - Canadian Honker Restaurant

This restaurant can be found directly across the street from the original Mayo Clinic building in Rochestor. It was difficult to turn this photo-op down, as I was feeling a bit homesick.