Education in orthopaedic trauma.

Education of the orthopaedic surgeon in trauma care presents a unique challenge because of the need to acquire knowledge about the overall resuscitation of the patient as well as having a sound working knowledge of the treatment of injuries to other organ systems and how that treatment interplays with orthopaedic care in such complex disorders such as adult respiratory distress syndrome. The orthopaedic trauma educator requires special dedication and skill because much teaching occurs at night and on holidays and weekends in the context of emergency surgery where immediate decisions are required and procedures must be executed expeditiously and with minimal morbidity. An ideal educational program in trauma provides ready availability of the attending with close supervision of a team of residents lead by an experienced chief or fellow to whom appropriate graduated responsibility for decision making and execution of surgery is provided. A formal didactic course with a complete multidisciplinary curriculum is essential. The managed healthcare movement has the potential to disrupt the educational process and clinical research in orthopaedic trauma by reducing referrals to major trauma centers; by making high quality trauma treatment, particularly in the indigent population economically impractical; and by interfering with the patient care and educational and research process by early transfer of patients to other providers removed from the trauma center environment. Orthopaedic trauma educators must work with their institutions, national organizations, government, and the healthcare industry to develop methods to preserve and advance the education and research in trauma care which has served our population so well and is so important for the health and productivity of society in the future.