Terry Axelrod on Lifelong Learning

From left to right: Terry Axelrod with his spouse Heather Shapiro and their children Daniel Axelrod (age 20), Charlotte Axelrod (age 15), Madlyn Axelrod (age 23) and Simon Axelrod (age 18) in Kenya, early 2011, while they were involved in a school building programme with Free the Children.

Orthopaedic surgeon Terry Axelrod specializes in complex surgery of the upper extremity at Sunnybrook Health Science Centre. When he was studying hand and wrist surgery in Switzerland on a McLaughlin fellowship, his teachers were among the originators of the AO Osteosynthesis System. They started him on the path of continuing medical education.

The AO teaching program is an exceptionally well organized and well regarded educational system that presents courses around the world. During his fellowship, Terry worked with the AO trauma group in Berne. He got into continuing education through teaching with the AO group faculty, including Jesse Jupiter, Hill Hastings III and Ueli Buchler, all excellent surgeons and teachers.

When he returned to Toronto to join the faculty at Sunnybrook Hospital, Marvin Tile and Joe Schatzker were already participating in the AO programs. They were very supportive of his developing this aspect of his career. He now teaches fracture management all over the world in courses in India, Europe and North America. "I enjoy teaching practicing surgeons, because they have more life experience and complex cases to discuss and analyze. My wife, Heather Shapiro, who is a McMaster trained obstetrician and gynaecologist, learned the importance of life long learning at that institution. We need lifelong learning and we need coaches. Though the AO courses are effective in marketing, they are well - accredited and highly regarded throughout the world. When I finished as Chief of Orthopaedic Surgery at Sunnybrook, I migrated toward teaching more continuing medical education courses and in 2009 I accepted the position as Director of Continuing Medical Education for our department. We all need renewal and this is not limited to academic surgery - it’s a challenge in all aspects of surgery."

"Our department is great at undergraduate and postgraduate education. CME is less emphasized, but the need for all surgeons to continue with life long learning is the focus of my current activity (see also: Gawande, A. Personal Best, The New Yorker, September 26, 2011 or go to: http://www.newyorker.com/ reporting/2011/10/03/111003fa_fact_gawande)

Hans Kreder and Terry are working on a Reduction of Resource Program at Sunnybrook to allow surgeons to continue to be active in the operating room, while making opportunities for younger surgeons to enter practice. Their draft proposal describes the impact of reducing practice by 15% at age 66 and another 15% at age 67. When 2 people do this, there is room for one new surgeon in the division or department. The program phases out operative surgical practice by age 70. There is a focus on mentoring younger surgeons as the senior surgeons reduce their resource utilization and operating room time.

"This is faculty development, not continuing medical education in the usual sense. Working in the operating room with patients is the most effective venue for teaching. Workshops and skill labs are very good, but not as riveting as working in the operating room on human patients. Industry has become the dominant educational force in the post -training period. It is important for all of us to become more involved in this important phase of surgical life.

"The post-grad office at 500 University Avenue has been very effective in supporting post-grad courses under the direction of Ivan Silver. Dimitri Anastakis has recently assumed the responsibility as the new Vice-Dean of the Medical School for Continuing Medical Education. This should be a great boon to the Department’s development in this area. Accreditation Coordinator Karma Fararh is a dynamic staff member who facilitates all of these courses. We need to encourage senior surgeons to participate in mentoring, which is fun and stimulating. Peer mentoring should also be encouraged - surgeons working together to educate each other. We are also developing a longitudinal fellowship of continuing education which will allow an orthopeadic surgeon in practice elsewhere in the province to come and work with a practitioner in our department one half day every other week for six months to become proficient in an area of specialized interest.

I would be grateful for other ideas from readers for workshops that would be helpful for practicing surgeons. These might address retirement, legal management, and other issues that interest our readers."

M.M.