Page 18 SA ORTHOPAEDIC JOURNAL August 2002 EDUCATION, TRAINING AND ACCREDITATION

EDUCATION, TRAINING

AND ACCREDITATION

Orthopaedic surgery fellowships
ProfNGJ Maritz

Head: Department of Orthopaedic Surgery, University of Pretoria

O rthopaedic fellowships are becoming more and more popular. The author discusses the advantages and dis-advantages of further training once qualified as an orthopaedic surgeon.

Fellowships were started in the USA in the mid-eighties and were
accredited much later. They have now become very popular and of
the 630 new Orthopaedic Surgery residency graduates per year in
the United States, more than 60% will take a fellowship of at least
one year.

In South Africa there are a few fellowships available, which are
run fairly informally with no accreditation as such. The question
is: How do we see the road ahead? Must we continue and structure
it better and start an accreditation programme?

To answer this question we have to look at the pros and cons of
orthopaedic fellowships. For the registrars these are the reasons to
take a fellowship:
• Extra training in an area of special interest
• Another year's experience to gain confidence
• To add to one's CV
For the institutions, fellowships have the following benefits:
• Teaching: Because they have fewer extraneous commitments,

fellows are more available and better positioned to teach regis-
trars and medical students

• Patient care: Fellows are able to help with the high volume of
patients

• Research: They are ideally situated to do the necessary
research

• They boost the number of physicians in academic medicine at
a time when academic institutions are under great stress

The disadvantages of sub-speciality fellowships include:
• They may interfere with the registrars' training who may then

have less opportunity to gain clinical and surgical experience
• Sub-specialisation may lead to fragmentation of the

Orthopaedic Association. Examples of this are the Hand
Society and now the Spine Society

• Sub-specialisation may lead to regulations that exclude the
treatment of certain conditions from the domain of the general
orthopaedic surgeon. It may also have certain medico-legal
consequences - if you do not have a fellowship in a certain
field, it may be seen that you are inadequately trained to do
certain procedures

I believe fellowships are here to stay, because a sub-specialist
who has additional education and experience and who sees many
similar cases, best serves patients with complex orthopaedic con-
ditions. This may well represent the most cost-effective type of
care.

However, fellowships should be better structured with a clear
goal. The sub-speciality group in the Orthopaedic Association
should most likely, also accredit it.

Business should be involved in the financing of fellowships! OJ

Bibliography
Simon MA. Evolution of the present status of orthopaedic surgery fellowships. JBJS Dec 1998;80(12):1826-1850.