By Myles Clough, M.D., FRCSC
Consultant Orthopaedic Surgeon, Kamloops, BC
Clinical Instructor, University of British Columbia, Department of Orthopaedics

Canadian orthopaedic surgeons, residents and medical students have been among the pioneers in exploring the potential of the Internet for academic activities and communication. Five years is a long time on the Internet, yet in 1996 Dr. Ian Dickie a medical student at UBC, set up and moderated the newsgroup sci.med.orthopaedics, Dr. Don Johnson was building the Practical Arthroscopy site and the Canadian roots of Orthogate were beginning to grow. Over the last few years, the COA meetings have provided the most comprehensive set of instructional courses on information technology in the world of orthopaedics. We have, or had, a flying start in the field. This report investigates the current status of web sites of Canadian orthopaedic training programmes and other Canadian sites.  

What is the purpose of a web site for an orthopaedic training programme?

Setting up and maintaining a web site is a lot of work. Most Canadian programmes have made an effort in this direction (Table 1). But posting the site needs to benefit the programme in some direct way. Attracting high quality applicants to the resident training scheme or to fellowships, would be one obvious tangible benefit. Equally valuable would be contact from colleagues or referring doctors who may refer to a member of staff or to the institution via the web site. The web site should also be used as a means of communication within the institution and showcase its research and teaching. Improving the quality of the Orthopaedic Internet by posting good orthopaedic content may add to the reputation of the programme and certainly upholds the Canadian tradition of innovation and excellence. In a climate where the orthopaedic lifestyle may be unappealing to potential trainees, a dynamic web site that truly reflects our vitality and forward thinking may be an advantage. Thus these sites should include the following - an account of the curriculum and the fellowships available, contact information for faculty, residents and fellows, an account of research opportunities at the institution, a calendar of events and as much orthopaedic content as possible.

How do we stack up?

Table 2 shows that many training programmes have responded to the challenge although few have met it fully. McGill is the only official site to post orthopaedic content, with a series of interesting case presentations (the Montreal Journal of Orthopaedics). If OrthoNet, the residents’ own effort at University of Toronto is included, that institution is also rising to meet the challenge. UBC and Calgary have covered much of the criteria; most of the other programmes have little to no content on their web site. It is probably fair to say that most web sites are running thanks to the enthusiasm of one or two members of staff. This is not enough to sustain a lively web site. A potent advantage of the Internet is the ease of updating and modification. Integrating feedback from the users of the information makes for a vibrant and interesting site. Because the orthopaedic expertise of each teaching institution is widely dispersed, participation in its public showcase should be equally wide.

Table 2

Coverage of Various Topics by the Web Sites of Canadian Orthopaedic Training Programmes

Even if you don’t believe that the Internet is going to play a major role in academic communication, it is clearly here to stay and we should display leadership in this area. Orthopaedic training institutions may not have a lot to gain from a “cool” web site. But the time may come when not having a dynamic site is seen as a sign that we are behind the times; we may have something to lose.

The Internet is fundamentally a clearinghouse for information and there is much concern that patient information on the Internet is misleading and potentially hazardous. If teaching institutions do not post orthopaedic content, this concern is not surprising. Making web pages out of existing teaching and patient information documents is easy. All Canadian training programmes should promote this activity. All department members should play a role.

The COA-ACO web site

http://www.coa-aco.org

The COA has posted a web site since 1997. It has recently been revised and transferred to the server of the Canadian Orthopaedic Foundation. Supervision of the web site is entrusted to the Communications Committee chaired by Dr. Emil H. Schemitsch who is also the Editor of the Bulletin. For the last two years, I have served as Webmaster. Development of the site is under active consideration by the committee (see Box 1) and feedback from the members is very welcome. We plan to post the Bulletin on the COA web site and to have a regular IT segment in the Bulletin.

Box 1

Suggested changes to the COA website:

• Membership database with names and office addresses. Email address optional. Open to the public. No personal informationMembership of COA committees should be posted with contact information. Non-confidential committee papers should also be posted
• COA position papers
• Full text posting of COA Bulletin articles
• Archived mailing lists for the discussion of committee business
• Annual Meeting. Fuller information, abstracts, posters. Keynote events such as the R.I.Harris Lecture should be posted
• Site search engine
• Locums and positions open page
• Canadian Orthopaedic Links
• Site Map

Please feel free to email further suggestions to This e-mail address is being protected from spam bots, you need JavaScript enabled to view it  

Other Canadian web sites

Table 3 gives the addresses of a number of web sites authored in Canada with a brief description of their contents. The list is incomplete and reflects my interests and those (English language) sites which could be found easily from the training programme web sites. Space allows me to highlight only a few. OrthoNet will be discussed in a separate article.

• Orthopaedic Web Links (OWL) is an attempt to make a comprehensive collection of addresses of Internet sites of interest to orthopaedic surgeons. Although it falls far short of this goal, it is by far the largest collection of links of this kind and one of the few with a “straight to the meat” philosophy. The addresses are those of the orthopaedic content pages, not simply the front pages of the institutions. The endeavour is part of the Orthogate project to provide a clearinghouse for the international Orthopaedic Internet.
• Carleton Sports Medicine Clinic has a most informative web site edited by Dr. Don Johnson which showcases his skills in teaching and illustrating sports medicine subjects. The newsletter, Practical Arthroscopy, is also a valuable resource.
• The training programme of the University of Western Ontario does not have a web site but the Fowler Kennedy Sports Medicine Clinic has a valuable site which details the fellowships available, the teaching courses put on and the research in progress at the institution.
• ORCID (Orthopaedic Rare Conditions Internet Database) was conceived as a way to accumulate experience about the really rare conditions that come along once in a lifetime. We each respond to these cases by becoming well informed about the subject but this expertise loses its value, as we never see another case. Since it is so easy to exchange information on the Internet, ORCID was set up as a place where “virtual” experience could accumulate. Please review the site and send in case histories of interesting rarities.
• The Montreal Journal of Orthopaedics owes much to Dr. Edward J. Harvey who has put together case presentations richly studded with references and teaching points.
• Orthopaedic Cyberlink Launchpad is a collection of orthopaedic links made and maintained by a resident in the Calgary programme. Jacqueline Smith also had a major hand in the design of the divisional web site.

Table 3 also gives the addresses of web sites for organizations related to orthopaedics such as the Canadian Academy of Sport Medicine, the Canadian Orthopaedic Nurses Association, CIHR Institute of Musculoskeletal Health and Arthritis and the Royal College. Most major hospitals and private clinics also have a web site and many Canadian members of the AAOS have used the facility to post an office web site. I have not listed these or the Provincial Orthopaedic Associations.

Summary and conclusions

Web sites should serve the functions of promoting the services of the institution, making two-way communication easier and speeding up information exchange. As information is one of the primary products of an orthopaedic teaching institution, there should be a large role for the Internet. It will require a team effort involving all of the staff.

Orthopaedic Internet activity in Canada is still the province of enthusiasts. While some of these are world leaders in the area, there is little integration of the Internet into the normal modus operandi of major orthopaedic institutions. When that paradigm shift occurs, orthopaedic surgeons, trainees and patients will be better served.