AO Milestones Taskforce Works to Understand the Future of Continuing Medical Education and Assessment

AO Milestone’s leader, Roger Wilber, MD, shares hopes and challenges regarding new educational tools


A half dozen large flip chart sheets adorn two of the conference room’s walls, each packed with thoughts, feedback, questions, and possible solutions from this morning’s discussion. Coffee cups are emptied and filled while faces around the room rest in silent concentration and glow with impassioned claims.

There’s a short break, and then the hum of activity crescendos as individuals flow back and forth between the conference room and three rooms down the hall where three different burgeoning surgical education technologies are being demonstrated and reviewed.

It’s the fourth week of August 2021, and as part of a growing project called the Competency-based Training and Assessment Program, or AO Milestones, a handful of AO’s leading orthopedic trauma surgeons have gathered to examine and debate how the next generation of trauma surgeon should be taught.

During their lunch break, I sat down with Roger Wilber, MD, MetroHealth surgeon and AO Milestones’s Expedition Leader, to talk about the tools and technologies being tested that week and how they fit into AO’s plans for future education and assessment.



HoloAnatomy by Interactive Commons at Case Western

The HoloLens itself is obviously an incredibly impactful and powerful teaching tool that I think the more you experience it, the more you realize that this is going to be something that we are going to incorporate and we probably need to incorporate in our educational profile. It increases our efficiency, it improves retention, and I think it makes the experience extremely enjoyable. 

Its use in HoloAnatomy, in particular, is really effective, because it takes something that's traditionally studied in a two-dimensional format, on paper with pictures, and it renders it in a three-dimensional way that not necessarily every mind is able to do. It facilitates and makes that learning process more democratic in a way. 

I think having three-dimensional representation of the fracture classification would be one of our first steps. That would be our first creation of pathology within this anatomy system. I think that'll be valuable. 



Fracture Repair Simulator developed in cooperation with CAE Healthcare

We knew when we started with the CAE simulator that it was going to be our biggest challenge. And that has borne out for us—trying to create something that simulates something that is so difficult to simulate. We don't realize sometimes how complex surgery is because we just develop these skills over a long period of time. 

We're investing time and energy into this sphere of simulation because we're in the simulation business. That's what we do. We've been doing it for decades using artificial bones, but now we're trying to come up with better and higher fidelity—a simulator that allows us also to measure in some way people's performance.



Synbone artificial bone models and RIMASYS pre-fractured anatomical specimen

We're incorporating the traditional model of Synbone in addition to the CAE simulator and the anatomical specimen, and eventually what we would like to do is compare these to one another and see how it affects the overall performance of somebody in real-life scenarios.

We don't know which ones are going to be important right now so we develop them all and hopefully winnow them down to the bare essentials—what would allow somebody to become proficient at something.

The relationship with Synbone has been quite good. They've been very responsive and we have developed a good working relationship with the creation of the models. We're still trying to make the model to the level that we need for the proximal femur module, but I think we'll get there.

RIMASYS is a new venture for us. Partnering with RIMASYS has been good, the working relationship has been very good, and they've been extremely responsive. The biggest issue, I think, with RIMASYS and use of pre-fractured anatomical specimens, is that it's extremely expensive.

This is one of those things that is the highest fidelity we theoretically have outside of the real patient with a broken bone. As a teaching tool, it will be hard to beat that—but it is also the most expensive tool that we have.

Eventually we're going to have to come up with a way to balance out the costs with the benefit. How can we support it? 

Final thoughts

For a lot of what we want to do, what we want to achieve, we have a vision for it, but it's difficult. It's like sending a spaceship to Mars. You start to realize all the things that come into play to make that happen. 

There's a lot of details that have to be ironed out. As we go along, we find more and more of these details that we have to address and somehow work our way around. I'm excited about the challenges. They’re a little bit daunting at times, but I think that the group that we have on this task force is perfectly suited for solving these problems. 


Related pages

Continuing education

Continuing education

AO Trauma NA

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