SICOT-APOA: Future of Orthopaedic Training in the Digital Era

0:04Welcome, friends. It is our great

0:06pleasure to introduce you to SICOT

0:08Pioneer.

0:09>> [music]

0:10>> Pioneer is a program of innovative

0:12orthopedic networking, e-learning,

0:14education, and research that was

0:16designed to fill the gap left by the

0:17absence of face-to-face meetings,

0:19courses, and other activities during the

0:222020 [music] coronavirus pandemic. But,

0:24Pioneer has become so much more than

0:26this in the intervening year. Pioneer is

0:29a virtual, but also very real, community

0:31of like-minded orthopedists striving to

0:33help not only themselves, but one

0:35another.

0:37With the latest video conferencing and

0:38educational technology, as well as a

0:41groundbreaking online platform, SICOT's

0:43[music] Pioneer events, activities, and

0:45resources are reaching every corner of

0:47the globe with over 55,000 views of our

0:50webinars so far. We're forging new

0:53partnerships, [music]

0:53signing agreements with 12 other

0:55international academic societies, and

0:57building an enduring network we hope

0:59will last for many years to come.

1:02So, what can you expect from us? Free

1:05webinars led by key opinion leaders from

1:07[music] around the world and across all

1:09fields of orthopedic surgery and

1:10traumatology, as well as chat shows with

1:13some of the most interesting [music] and

1:14inspiring surgeons on the planet.

1:17Opportunities to take an interactive

1:19role in these webinars by participating

1:21in polls and live discussions.

1:25Free on-demand Pioneer playback service.

1:28Watch our webinars again and again in

1:30your own time. And coming soon, our new

1:33bespoke learning management system will

1:34host podcasts, an online version of the

1:37famous SICOT diploma exam, virtual

1:39training modules, surgical technique

1:41courses, a discussion forum, and much,

1:44much more.

1:45>> [music]

1:45>> We hope you'll join us on this

1:47pioneering journey as we push the

1:49boundaries of what is possible in online

1:51orthopedic education together.

1:55>> [music]

2:11[music]

2:22>> Hey, a very good morning, good

2:24afternoon, and good evening, ladies and

2:26gentlemen, from wherever you are joining

2:27us in the world. Absolute pleasure to

2:30have all of you joining us for this

2:33webinar. I'm Vikas Khanduja, Professor

2:35of Orthopedic Surgery in Cambridge, UK,

2:37and also one of the founders of SICOT

2:39Pioneer, and currently the president of

2:41SICOT. As I said, it's an absolute

2:43pleasure to welcome all of you logging

2:45in from different corners of the world

2:47onto this fantastic platform and this

2:50webinar. Now, SICOT Pioneer, as you've

2:53heard, was born during the COVID times

2:55as a small platform, and has grown

2:57enormously over the few years that we've

3:00seen. We've embraced a digital future

3:03for SICOT, and throughout the platform,

3:06we've been able to have over 117 events

3:09in this time, and I've had over 140,000

3:13views, as you will see, from 110

3:15different countries around the world.

3:18So, big thank you for joining in and

3:20following us.

3:21Now, today's webinar is exactly about

3:25the issue that I've just told you about.

3:27It's focused on education and digital

3:29innovation, and we are absolutely

3:32grateful to the Asia Pacific Orthopedic

3:34Association to partner on in this

3:36webinar with us. We've got their

3:38president, their past president, Onda,

3:41David, all of them, all the stellar

3:43faculty to actually help us in this

3:45webinar as well. And a big thank you to

3:48our education committee and their

3:49chairs, Muhammad Nizamul from Pakistan

3:52and Vishnu Sandil from India who

3:55actually worked very hard to get the

3:56right faculty on this webinar. The

3:59stellar faculty including Ted Mah as

4:01well to give you talks.

4:04And I'll get Muzammal and Vishnu to

4:07introduce all of them to you in a

4:09minute. Now we'll try and make it as

4:11interactive as possible for you.

4:14And if you can't join us today, you can

4:16access this on our on-demand platform as

4:20well which is again got over 90,000

4:22views. If you do have any questions,

4:25please do post in the chat box. Once

4:27again, a big thank you and hopefully

4:30please do enjoy the webinar. Over to you

4:33Vishnu and Muhammad.

4:36>> Thank you very much

4:38my dear friend because

4:40uh

4:41thank you for

4:43giving the APOA to have this joint

4:46webinar with SICOT on future of

4:49orthopedic training in the digital era

4:51which is very important.

4:53Uh and we are very happy to collaborate

4:55with SICOT as APOA leadership. And

5:00today as you mentioned, we have David as

5:05a past president and also the chair of

5:07the APOA education committee.

5:10Ted Mah is also a past president of

5:13APOA. We have Frederick Deico,

5:16our secretary general from the executive

5:19committee. And Bedri Karismailoglu who

5:22is the chair of the young surgeons forum

5:26in APOA. So we we

5:29uh

5:30tried our best to

5:33to contribute to this very important

5:36webinar. I'm in Azerbaijan now for a

5:39meeting and the opening ceremony is

5:42going on at the moment. That's why I

5:44need to leave to give a talk in the

5:48opening ceremony. I I wish very

5:52good very beneficial

5:54webinar to all of you. Thank you.

5:59>> Thank you Onder for joining us despite

6:01despite your tight schedule and and once

6:04again I'm really thankful to the APO

6:07leadership to show up in such big

6:09numbers for this important webinar. A

6:11big thank you once again.

6:13>> A big pleasure. Thank you.

6:16>> Thank you very much Dr. Professor

6:21Kanduja and Dr. Ananta. It is great

6:24privilege for me as a chair of SICOT

6:25education committee to moderate today's

6:27session especially with a SICOT

6:29president Professor Vikas Kanduja and a

6:31such outstanding panel from the APOA.

6:34Our topic of webinar today is the future

6:36of orthopedics and training in the

6:38digital era with AI, virtual learning,

6:40digital assessment and global

6:42collaboration rapidly transforming

6:44education. So, today's session will

6:46explore how we can use these

6:47opportunities to shape the future of

6:49orthopedic training. We have an

6:51excellent faculty from around the globe

6:53and we can follow by interactive

6:55discussion. So, let us begin and explore

6:57of future of orthopedics in education

6:59together.

7:01Let

7:02me begin with the inviting our first

7:03speaker Professor Vikas Kanduja

7:06from the United Kingdom. Professor

7:07Kanduja is a current president of SICOT.

7:10He is a consultant orthopedic surgeon

7:12and has been actively involved in SICOT

7:14leadership and international orthopedic

7:16education. His presentation is titled is

7:19SICOT SICOT transforming global

7:21orthopedic education through digital

7:23innovation. Professor Kanduja, we are

7:25very pleased to have you with us. The

7:28floor is yours.

7:30>> Thank you very much Muhammad and Vishnu

7:32once again for setting up this webinar.

7:34Fantastic faculty, fantastic topics.

7:37I'll try and take you through our view

7:40of trying to transform a global

7:43orthopedic education through digital

7:46innovation. I bring you greetings from

7:48our biomedical campus in Cambridge, and

7:50if any one of you wanted to visit would

7:52be a pleasure and delight

7:55to to have you here. So, for us the

7:57impetus really not only for us, but

7:59probably for most societies and

8:01eventually these around the world, the

8:03impetus really was COVID-19. And soon

8:06after that

8:08there were multiple issues affecting

8:10organizations. So, physical congresses,

8:13cadaver courses, fellowships, exams were

8:16a threat. If you're medical students,

8:18your classroom learning, your

8:20attachments to clinical firms, you were

8:22missing exams. If you're doctors in

8:24training, you had missed learning

8:26opportunities. Your learning curve is

8:28was going to be much steeper and longer.

8:31Your clinics and theaters were affected

8:33because you're not getting training in

8:34there, and again you were missing exams.

8:37If you're doctors in practice, you

8:40reduced clinical exposure significantly,

8:42especially in the elective orthopedic

8:44setting.

8:45In the outpatients, your operating was

8:47less on the elective operations, and

8:50physician learning was impacted. So, all

8:52of this was impacted significantly at

8:54the start of the pandemic.

8:57And above all this, you had issues with

9:00illness, physical exhaustion,

9:02psychological distress, needed for

9:04debriefing, supporting, counseling, and

9:06obviously focusing on self-care.

9:09And that's when all these alternative

9:12modes started happening. So, if the

9:13students were in trouble, medical

9:15students, they had to do something. So,

9:17virtual cadaver dissections came on

9:20board at that time, and they have

9:21stayed.

9:22We came on with virtual ward rounds

9:25because you obviously couldn't visit

9:26these patients, and virtual ward rounds

9:28started happening, and that was big

9:29news.

9:31Virtual outpatient consultation started

9:33happening around the COVID time, which

9:34has become pretty much the norm at the

9:36moment. But if you look at it that time,

9:38it was it was a novelty. And we we're

9:41doing it regularly now.

9:43We started live streaming

9:46operations. This is Professor Shafi

9:48Ahmed from London. He was the first one

9:51to do an operation general surgery

9:54watch via the Google Lens and watched by

9:57thousands of

9:58students all around the world. So live

10:00surgical education started happening.

10:03And then a virtual reality came up in a

10:06big way around the same time and that

10:08started impacting surgical training as

10:10well. But all these things were

10:12happening around the COVID time because

10:14you wanted to look at alternative ways

10:16of actually imparting education. Low and

10:19high fidelity simulators started

10:21happening as well for arthroscopic

10:23surgery and now even for some open

10:26surgery.

10:28We in our own organization uh basically

10:30went from uh cadaveric uh courses from

10:34big meetings. In fact, one of our own

10:36big congresses uh probably for APO as

10:38well actually was a virtual congress

10:40during COVID times. We had to do

10:42everything virtually. And now this

10:44platform would not have really happened

10:47if we didn't have COVID.

10:49So we evolved and we evolved

10:51significantly and rapidly because there

10:54was a time of distress.

10:56And and I look at this chart uh and it

10:59actually uh resonates very nicely with

11:02what was happening at least in our

11:03organization. So if you've got an event,

11:07let's say the COVID here, uh phase one

11:09is you're reacting and responding. So

11:11all your activities are actually going

11:13down in that phase or your performance

11:15is going down. Phase two, you're

11:17redirecting to your new uh reality.

11:20Phase three, if you're really prepared

11:22and if you're really focused, you're

11:24rebounding back to the future. And then

11:27phase four, you can seriously start

11:29accelerating opportunities. So if you've

11:31got if you've got good leadership, then

11:33you can seriously lead even in a

11:36disruptive crisis to a positive outcome.

11:39And that's what we've seen to a large

11:40extent within our own organization. So,

11:43from Excel sheets, we landed up having

11:45using apps,

11:47different modalities of actually

11:49communicating with our membership. And

11:51we were one of the first orthopedic

11:53societies to launch our own video

11:56webcasting platform. SICOT Pioneer is

11:59one of them. Our own educational

12:01repository, which has got over thousands

12:04of educational material there now,

12:07adequate advertising, and then a formal

12:09program coordinator. Sufian has done an

12:12immense job behind the scenes to make

12:14sure that this runs immensely well. And

12:17we launched SICOT Pioneer, which is a

12:19program of innovative orthopedic

12:21networking, e-learning, education, and

12:23research. And within this, you've got

12:26webinars, you've got surgical

12:27techniques, you've got tête-à-tête,

12:29you've got podcasts, you've got the exam

12:31resources,

12:33a lot more happening within SICOT

12:35Pioneer.

12:36Because of that, we've been able to have

12:38partner societies like yourself

12:40collaborate with us. And to the last

12:42count, I think we've got over 70 partner

12:44societies collaborating with us on this

12:47platform and APOA as well.

12:50We've collaborated with OrthoTV in

12:53India. So, this is being telecasted on

12:55OrthoTV in India. And the China chapter

12:58discussions are still ongoing for some

13:00of these webinars so that it can reach

13:02different corners of the world.

13:05And obviously, nothing is is going to be

13:08taken for granted. So, you really need

13:10metrics. So, we've been very careful in

13:12making sure that we are documenting

13:14everything. And you can clearly see that

13:16we are pretty much touching all around

13:18the world over 110 to 115 countries. And

13:22the thing that is really really

13:25heartwarming is that we are reaching

13:27countries or as far as Cayman Islands,

13:30Maldives, Mauritius through this

13:32platform. So, this is really

13:34revolutionizing education reaching

13:36different corners of the world which all

13:39all the people all the all the trainees

13:40around in this area would not be able to

13:43access this kind of education without

13:45this platform.

13:47And then you obviously want to find out

13:49as well how is this actually affecting

13:52affecting you do these are these series

13:55useful at all or not? And again our

13:58service actually show that in terms of

14:00seniority

14:02a lot of senior consultants and

14:03consultants in practice are actually

14:05attending these events and it is

14:08significantly impacting their practice

14:10as well. It's helping them in their

14:11practice. This is data of around 10,000

14:1510,000 people who have attended these

14:17events and it's pretty much like the

14:20Orthoflix effect. Lots of views, lots of

14:23people watching this and if you again

14:25you want to put numbers onto it we've

14:27done over 117 events, more than 150,000

14:31views over these last few years. Over

14:3450,000 have been live over 90,000 on

14:37demand. So, there will be a number of

14:39people who will actually come and watch

14:41this later and then we've got a fan club

14:44for Surgical Pioneer which has got over

14:4511,000 members on it now.

14:48So, based on the success of this we've

14:50actually expanded that and we've

14:52launched the Pioneer Learning Management

14:54System and that's focused really on the

14:58way surgeons learn and that's the Fitts

15:00and Posner model of learning. So,

15:02obviously the first phase is cognitive

15:05where you learn what to do or the theory

15:08behind the operation. The next phase is

15:10associative where you're mastering a

15:12basic form of movement. You learn how to

15:14do it. And the final bit is autonomous

15:16where you're actually flying solo and

15:18doing that operation. So, we put that

15:22onto our certification program V-Train.

15:26The pilot module was with ACL

15:28reconstruction. So, the focus here is

15:31that we have a 4 to 6-month course. They

15:35will be which is modular. So, every

15:37month will have different modules.

15:40And then at the end of each module, you

15:42have uh exams which you need to clear.

15:46At the end of this whole course, you

15:47will have a major exam which you'll need

15:49to clear as well. And then we have an

15:51optional

15:52um a cadaveric course and an optional

15:55fellowship as well. So, technically in 6

15:58months, 4 to 6 months,

16:00uh there will be one procedure that you

16:02will be certified for and you will know

16:04everything about. You'll know the

16:05theory, you'll know the practical, and

16:07you would have gone seen gone and seen

16:09somebody to actually do that procedure

16:12as well.

16:13And in each of the subspecialties, SICOT

16:15has got 15 subspecialty areas. We are

16:18developing three to four procedures in

16:20each of these. So, the aim is that we

16:22will have over 150 procedures which are

16:25common procedures in each of these

16:26subspecialties where we'll be actually

16:29doing certification on these procedures.

16:31So, we've just started off and hopefully

16:33Roman will tell you a bit more about the

16:35pelvic and acetabular fracture module

16:38that has just come up the V-Train

16:39program. And that again is embedded in

16:42SICOT Pioneer.

16:44This is also a great way of actually

16:46international collaboration with

16:48different surgeons who do the same

16:49procedure who'd be coming in for

16:51teaching and also educating others.

16:55The other thing we've done is we moved

16:57our whole SICOT diploma exam online. So,

17:01we do the online MCQ module and we also

17:05do the online viva module. So, the whole

17:08thing has been shifted. In 2023, we

17:10tried it and now we do it eight times a

17:13year

17:14uh and it's working extremely well. So,

17:16people from any corner of the world

17:19could actually be taking this exam

17:21digitally. We've got a new examiner

17:23board with 31 examiners. We've got Mark

17:25Patterson who leads that. Uh database

17:28questions of over 100 over 800 and we've

17:32got a transparent and differential

17:33payment system for low, middle income

17:36and low income countries as well for the

17:38exam.

17:40We've also launched something called the

17:42virtual fellowship, which has done

17:43extremely well. So, if you're sitting in

17:45Vietnam or Cambodia and if you wanted to

17:48do a fellowship for 6 weeks with

17:50somebody in the States on limb recon,

17:52now that's possible and we've done the

17:54pilot. And again, and that's run

17:56extremely well. So, these four programs,

17:58SICOT Pioneer,

18:00SICOT V Train, that is a certification

18:03program, then comes SICOT V Fellowship

18:05and the V Exam have all been built

18:07around a virtual ecosystem and we are

18:10continually expanding on that. The next

18:12bit is the research education, which you

18:14are working on setting up a research

18:16course within the V Train, so you can

18:18actually become research active if you

18:20wanted to.

18:22So, in summary, what we've done is

18:24harness the power of technology, uh

18:27created and expanded a new brand with a

18:30new audience. As you can see, over

18:32150,000 views with an overwhelmingly

18:34positive feedback. We've got on-demand

18:37content and reaching inaccessible areas

18:39has been the key and very reassuring.

18:42Most importantly, we've got key opinion

18:45leaders from around the world who are

18:46actually partnering like all your good

18:48selves on this webinar today, giving it

18:50academic credibility. And finally thing

18:53final thing is we've tried to keep it as

18:55much as possible to keep it real so that

18:58the face of face to face component is

19:00not missed, but is essential. And then

19:02we wrap it up with a face to face

19:04component with the fellowships 2 weeks

19:07at the end of V Train or with our annual

19:09congress or now the SICOT Edge platform

19:11as well as an adjunct. And this would

19:14not have been possible without immense

19:17effort from our SICOT headquarters,

19:19Sufian, Linda, and Katia working behind

19:22the scenes. Our our our

19:26uh technology partner, Strategile in

19:28Singapore, who really helped us in terms

19:30of setting this up. And all you

19:32individuals, our committee members, our

19:34subspecialty leads, and the key opinion

19:37leaders from different societies around

19:38the world who made it happen. And on

19:41that note, a big thank you to all, and

19:44thank you very much for inviting me to

19:46start this session off. Thank you.

19:51>> Thank you, Dr. Vikas, for an excellent

19:54talk, and we can see how the SICOT

19:56Pioneer platform has grown over the

19:59years. Thank you for an deeper insight

20:02over the SICOT Pioneer and its

20:04functioning. So, next I call upon Dr.

20:07Professor

20:08David June, who will talk on how AI

20:11changes the education game. Professor

20:13David June is currently the chair of the

20:16APLN Education Committee, and he's also

20:19pioneer of the APLN Journal Club, where

20:22he's actively

20:24using the module platform and the module

20:26network, and how to improve its

20:29education over

20:31over different parts of the world. So,

20:33he's also been the past president of

20:36APLN and the past president of uh Asia

20:39Pacific Arthroplasty Association. Over

20:42to you, sir. Thank you.

20:44>> Thank you, Vishnu.

20:48I'm going to speak to you about AI and

20:50education, and I heard Vikas talking

20:52about this whole curve they had to go

20:54through in order to get online.

20:57Thing is, I've been online since 2011.

21:00Uh at that point, I was introduced to

21:03Moodle, and I've been using it to teach

21:05medical students for 8 weeks every year

21:08since 2012.

21:10Um

21:11and actually it's been a a fantastic

21:13thing.

21:14During the entire

21:16lockdown period of the COVID, all my

21:19lessons were online. We taught people

21:21who were not even in medical school.

21:24They were at home.

21:25We mixed up them

21:26tasks to do. We set them tasks to wander

21:29around into the area around which they

21:31lived and uh

21:34actually [snorts] do video uh logs about

21:36uh handicap people and handicap

21:38facilities. And and you know, we taught

21:41them how to to do vlogs. We taught them

21:43how to interact online with each other

21:45on Moodle.

21:47And it's been a dream uh for the last

21:48few years in that line.

21:51And as far as APEUA was concerned, we

21:54had uh much rockier start. We actually

21:57started after the the pandemic because

22:00it was much more difficult to put up

22:03this platform on our website. We had to

22:05completely rewrite our website

22:08uh

22:09into Moodle. So, our website actually

22:12functions on Moodle, which is an

22:13educational website, as you know.

22:17Let's just talk about medicine today. I

22:19mean, because he's talking about, you

22:20know, all this we'll teach you how to do

22:22this. We'll teach you how to tell you

22:23how to do this. This ABCD will give you

22:25an exam.

22:26What does that really mean?

22:29Are we practicing evidence-based

22:31medicine?

22:32Which is what does the data show?

22:35Or are we teaching evidence-based

22:37medicine, which asks,

22:39"Hey, this is the question. I said that

22:41that was the answer.

22:42That is the answer."

22:44Which one would we prefer?

22:47Um

22:49you know, I I I grew up in a very

22:50strange era. I grew up

22:53I started as a houseman in the 1980s.

22:56And

22:57I did surgery as one of my postings.

23:00And in my posting

23:02uh as a registrar, we had to do highly

23:04selective vagotomies because that was

23:07what the professor was good at doing.

23:08They did a lot of highly selective

23:10vagotomies. Patients would come back

23:12with recurrent ulcers, and the professor

23:14would say, "Well, we just didn't do the

23:17operation right."

23:18And the weight of the evidence online at

23:21least, and the weight of talk on

23:24in life in the life, and the weight of

23:26pressure in exams was that

23:29acid was the problem.

23:31And then long comes this fellow Barry

23:33Marshall from Australia who says, "Well,

23:35guys, it's not it.

23:38It's due to H. pylori.

23:40It's due to a germ."

23:42And kind of nobody believed him.

23:44So, Barry had to drink a whole mixture

23:47of these germs, give himself ulcers, and

23:49give himself what he described as the

23:52worst halitosis in his life,

23:55and cure himself.

23:57And today we no longer do those

23:58operations, and Barry has a Nobel Prize.

24:02So, now we have this problem that as we

24:05get more and more senior, we're so full

24:06of ourselves that we don't let anyone

24:09else in. There is no democracy in

24:11thought. There's no um

24:14argument about anything.

24:16When in fact, there should be argument.

24:20So,

24:21Einstein got it right. He said,

24:22"Insanity is doing the same thing over

24:24and over again and expecting different

24:26results. We are just doing the operation

24:28wrong." Well, it's not the operation.

24:30And you know, in my entire passage

24:33through

24:34learning in orthopedics, it's been the

24:36same.

24:38People have said all sorts of things to

24:40me. My bosses have said all sorts of

24:42things to me. I've you know, sat for

24:44exams and

24:45had to give the official answer, only to

24:48have it proven wrong.

24:51I've also been an examiner for

24:53more than 30 years.

24:55Uh and again,

24:57I try my best not to become too

25:00enwrapped with what I believe, and I try

25:02to like give everyone the benefit of the

25:05doubt, but I can tell you, it's very

25:06difficult.

25:09So, therefore, we are in a rut, and we

25:11are hoping that there's something that

25:13will come and rescue us,

25:15I feel at least,

25:17uh, from this rut.

25:19So, this is Gemini. Gemini is part of

25:21the Google suites. It's a very new

25:23thing. I use it a lot. I actually pay

25:25for it.

25:26So, I

25:27I sometimes I just need a picture, and I

25:29just said to Gemini, "Make me a picture

25:31of a horse-drawn cart stuck in a deep

25:33country rut."

25:34Okay? And that's just It's just done

25:36that for the for me. So, I said, "Well,

25:38okay, well,

25:39now make me a picture of a charming

25:41princess on a steed coming to the rescue

25:43of this farmer with large letters AI

25:46emblazoned on her tunic."

25:48There we go.

25:50Really not that difficult. It took me

25:52about 2 minutes, actually, with the

25:53Gemini.

25:55And you can pretty pretty much I mean,

25:56there's so many YouTube videos now just

25:58done using this sort of technology that

26:01it's amazing.

26:03But, what is AI?

26:05AI is derived from a large language

26:08model. A large language model

26:11is what happens when you have the

26:12internet for more than 30, 40 years, and

26:15there's a lot of stuff that's been put

26:16on on. I mean, there's a whole of

26:18Wikipedia for a start, which is, by

26:19itself, absolutely massive. And it was

26:23all created by human power.

26:25There was no single person that put

26:27everything up there. It was all done by

26:30a whole pile of people all over the

26:31world just contributing and continuing

26:34to contribute. That's just one. There's

26:36all the other websites like Psych

26:38Pioneer, Psych

26:40AOS, etc., etc., etc.

26:43And they are the foundation layer of the

26:45LLM.

26:47All that data, all that text, all those

26:49pictures, all those videos

26:51have now been put together

26:54into a core engine that is now trained

26:57to recognize the links between these

26:59things,

27:00the so-called contextual dependencies,

27:03and creating a world

27:06that

27:08LLM understands. And a world that

27:10hopefully the LLM after alignment and

27:13fine-tuning and training

27:15presents to us

27:16as a version of the truth.

27:21But then what is AI?

27:23That's exactly what I said. It takes all

27:25that stuff on your left, puts it to some

27:27kind of brain,

27:29uh

27:30some kind of algorithm, and comes up

27:32with a report on the other end. And any

27:34of you who have used this know it's just

27:37absolutely amazing and wonderful.

27:40Um sorry, this is my Okay. But you can

27:43see that

27:45>> [clears throat]

27:45>> on the left of it, a lot of the stuff

27:47that is in that There's a lot There's

27:49just a pile of rubbish.

27:51The same bias, the same

27:54uh

27:55self-interested people trying to put

27:57that put uh

27:59uh to promote a product, uh you know,

28:02that's just rubbish.

28:04What you want out of this

28:07is the treasure.

28:09And how do you get it? That's the

28:10problem. You really only want to get the

28:13LLM to look at the treasure and not the

28:15rubbish.

28:18So,

28:19one way to do this

28:21Hi Vishnu, that's you.

28:23is with the prompt.

28:25Um actually with the prompt, if you ask

28:28the right question, you may or may not

28:29get the right answer. I know this

28:31because I struggle with ChatGPT, and it

28:34seems to tell lies even though I try to

28:36push it towards the truth. I You can

28:38actually push the ChatGPT or GPT all the

28:41way, and it used to give way, but you

28:44know that the people that want to like

28:46push their agenda have actually got to

28:48it much more than me and it's it's very

28:50very interesting.

28:52So, how do you get to the gold?

28:55Well,

28:57this is what I use. Different people

28:59would use different things. I use these

29:01three things in the main and some other

29:03stuff as well.

29:05Let's just start with the one on the

29:06left. That's Gemini.

29:08Gemini is simply just Google itself, the

29:11Google search,

29:13incorporated into a large language

29:14model. It does troll the whole internet.

29:17When you ask it a question specifically,

29:19I say, "Oh, where is the National

29:21Library?" No problem.

29:23Give you everything you need. Google

29:24itself will do that anyway.

29:26You would say, "Well, what is the

29:27function of the National Library?"

29:29Then Gemini would give you a very

29:32well-rendered answer with all the

29:35different

29:36functions of the museum and how it

29:38interacts with the people, so on and so

29:40forth.

29:41If you ask it, "Well, do the statins

29:44actually save lives?"

29:46You know, in my personal opinion, you

29:47don't get the truth

29:48because somebody's got to it already.

29:51So, what you want is that somebody can

29:54cannot interfere with it

29:56and you only want something that is a

29:58large language model that only trolls

30:01published data.

30:03And then you can query it within the

30:04published data. I really I really love

30:06this thing, consensus.app.

30:08It's a It's a website

30:10um and it it's just amazing.

30:12If you have, like me, an institutional

30:16access to publications,

30:19Consensus will give an answer by

30:22trolling only published data,

30:24published journals, and come up with

30:27articles relevant to what you say.

30:29If you ask it a question like, um you

30:31know,

30:32does a cemented total hip

30:35uh do a better job than a cementless

30:38total hip? Um it You actually troll all

30:41the data available, all the

30:43publications, all the uh

30:46consensus models out there. And it'll

30:49say give you a a a

30:51a bar chart that says yes or no. And and

30:54all the individual papers as well

30:57related to that question. You can click

30:59it on any of those and get a

31:01synopsis, the abstract.

31:03Or you can, if you choose and you have

31:05the access, actually click on the link

31:07and open the paper itself.

31:09Now, if you take what you get from

31:11Gemini and you take from what you get

31:12from Consensus and wherever else you

31:14look

31:15and you put all that together,

31:17you can load all those things as files

31:20into Notebook LM, which in itself is

31:22another amazing amazing thing.

31:26This is Notebook LM.

31:29It takes your source data. You can see

31:30there's a column there

31:32uh on on the computer on the left.

31:35That's all your source data you can put

31:37articles in there, you can put videos in

31:39there. Same. This is that

31:42it's an LLM in itself. It only trolls

31:45those things that are you put in there.

31:47It will not troll anything else, only

31:49those things.

31:51And then it can give you a summary

31:53depending on how what questions you ask

31:54at the bottom there. It can give you a

31:56summary of what that is

31:58relevant to your question.

32:00On the right-hand side is what is a

32:02whole amazing suite of tools. You can

32:04generate a mind map, you can create a

32:05timeline, you can

32:07uh on the left hand create interactive

32:09quizzes, you can create a study guide,

32:11you can generate an audio overview, you

32:14can create um

32:15um

32:17create videos

32:18with two voices. You can have two voices

32:21arguing with each other. You can have a

32:23deep dive where they go to every fine

32:25detail or just a superficial reading of

32:28the data.

32:29Uh and I'll show you what you can do

32:31with it later.

32:33Then then having developed all this

32:35stuff, all your pictures like the one I

32:38got from Gemini and

32:41all this PowerPoint assistance, you can

32:44put the whole thing into CapCut.

32:46And then you get a video.

32:49All right? So,

32:50we've done that.

32:52We put that into our journal club. We

32:54just want to see what we can do on this.

32:57And I'll just give you an example of

32:59what is this.

32:59>> Severe deterioration of the joint that I

33:03mean, you've been feeling it every

33:05single time you take a step or climb a

33:07flight of stairs.

33:08>> It's a terrible feeling.

33:09>> It really is. And the doctor points a

33:11pen at the screen and says the words

33:13you've been dreading. They say, "You

33:14need a knee replacement."

33:15>> Right.

33:16>> Now, after that initial shock wears off,

33:19your immediate next question, the

33:21question almost every single patient

33:22asks,

33:24>> Yeah, completely intact.

33:26>> Got it. So, we have the unconstrained

33:28standard knee relying on your own

33:30ligaments, these

33:32>> and stone to a total knee replacement.

33:34>> [clears throat]

33:35>> The clinical thought process is often,

33:36you know, you're young, let's preserve

33:38your ligaments and just do a partial

33:40now. When it inevitably wears out in 15

33:42years, we'll convert it to a total knee.

33:45>> So, the high failure rate of the partial

33:47knee is almost baked into the treatment

33:49philosophy for some doctors.

33:51>> In many ways, yes.

33:52>> But if the partial knee is so

33:53mechanically sensitive, if it requires

33:55the perf-

33:58>> Well, so there you go.

34:00I'm not saying that this is the

34:02solution or the panacea to all our

34:04problems, but this is a different way of

34:05looking at the solution to our problems.

34:08This democratizes the process of

34:11learning.

34:12The difference is that you want to have

34:15a point of view, you put it up there.

34:17Other people can put a different point

34:20of view up and argue with you as time

34:22goes by. You can gate it for a day or 2

34:25days or a week or whatever you have free

34:26time for.

34:28And you can have different moderators

34:29there.

34:31And we've worked it out so that

34:35you saw that that little video clip

34:37there and all that. That was actually

34:39from my headphone, just recorded from my

34:40headphone. That is if you go to our

34:43website, log on and do the lesson. I did

34:47that as a student.

34:48But you can also

34:50get the APOA app and do exactly the same

34:53thing. And for moderators and people who

34:56are very keen to participate on the fly,

34:58on the walk, between OTs and all that,

35:00this makes that entirely possible. You

35:02never have to log on.

35:04It just functions like your

35:07WhatsApp.

35:09So, I thank you again for inviting me.

35:11I shall stop sharing.

35:15And [clears throat]

35:19>> Thank you very much, Professor Sechuan.

35:21I

35:21>> Okay.

35:22>> I think AI will certainly change the way

35:26the next generation of surgeon learns

35:28and presentation and your presentation

35:30give us a lot to think about it. Now,

35:32our third speaker takes us into another

35:35exciting area, the virtual

35:38immersive surgical education.

35:41Dr. Betri Karali Ismailoglu is an

35:44orthopedic surgeon from Turkey with an

35:46interest in foot and ankle surgery. He

35:48currently serves as the chair of APOA

35:51Young Surgeons Forum.

35:52His presentation is virtual live

35:54surgery, bridging geographic barriers

35:57through immersive learning.

35:59The ability to observe and participate

36:01in surgical education without being

36:02physically present in the operating room

36:04will have a major impact on global

36:06training. Dr. Betri, the floor is yours.

36:10>> Thank you so much for the kind

36:13introduction.

36:14I'm really honored to be among these

36:17great faculty and I'll try to

36:20summarize my

36:22view of on the virtual reality and my my

36:24my work on the virtual reality. That's

36:26how we trying to make it more

36:29uh uh reachable around the world.

36:32So,

36:36Yeah, so let's talk about

36:38intercontinental education. Where it all

36:40started we all know that it's all

36:42started with the COVID and now

36:46we we all like we these kind of programs

36:49like C code pioneer and all all the

36:51societies have been doing it's always

36:53great and we are always trying to come

36:54up with new

36:57ideas how to make it better and more

37:00beneficial for the people and for the

37:03students for the residents. And and

37:06at at first they were great like we were

37:08really

37:09I mean I was amazed just to join in into

37:11a room with

37:13like filled with faculties all around

37:15the world and which I will not be having

37:17any chance to see them in person.

37:20But nowadays I think we are trying to

37:22find new ways interact more and I I

37:25think the the question is is it possible

37:28to have more real-time interaction

37:30virtually

37:31and I think the answer is yes and I I'll

37:34try to summarize you how absolutely we

37:36can achieve that.

37:38So, virtual live surgery is something

37:40that I'm trying to work on it like for 2

37:42years and I think it it's great because

37:44it allows participants to observe and

37:46interact with with kind of virtual

37:48surgical environment understand

37:50step-by-step procedural workflow and

37:53discuss key points with the faculty in

37:55real-time and also the enhanced the 3D

37:58understanding of the surgical procedure.

38:00So, you can either have people active

38:03participants VR group and but they have

38:05to have access to VR hardware and or or

38:09you can just

38:11stream it live stream to and people can

38:14can watch them through the zoom or some

38:16some similar applications.

38:20So, what

38:21it provides us, it can democratize

38:23access anywhere from the world, like

38:25from Pakistan, from

38:27China, can reach to a faculty and go

38:30into a same room and discuss the

38:32surgeries and then also the applied the

38:35surgical steps. And so they can actually

38:38all have almost a hands-on experience.

38:40And it can enhance the confidence and

38:43also it's a scalable and repeatable

38:45model. So you can just go into some

38:48other surgical rooms and try some other

38:51surgeries.

38:52So our first step was trying it on on a

38:57local course surgical VR based surgical

38:59training course. So we just gathered

39:02everyone in the same room and and we

39:04just

39:05connected to the internet and we we just

39:08tried everything and it's working

39:10smoothly. And

39:12it worked fine. Everybody was

39:15like understanding the procedure.

39:16Everybody was able to just replicate the

39:19procedure. And it actually decreased the

39:21costs of the

39:22the courses. It decreased the need for

39:25any additional equipment and cadavers

39:27and etc. Of course to to an extent. So

39:31this is

39:32a snippet from

39:34VR session.

39:36You can see that several

39:38guest surgeons are watching the lead

39:40surgeon doing the surgery. This is a

39:43form of hallux valgus

39:45education module and and they can

39:47interact. They can ask questions. They

39:49can discuss the trajectory of the screw.

39:51They can discuss where

39:55to put the K-wire and actually replicate

39:57it like after lead surgeon does

39:59everything, they can discuss on the

40:01post-operative

40:033D model and also they can

40:05do the same surgical steps by I mean by

40:09the faculty and watching over them

40:12whether they are doing it correctly or

40:13not.

40:14And and you can do the osteotomies. you

40:16can just

40:18make the correction, put the screws, put

40:20the K-wires, and also discuss the

40:23post-op models, the CTs of the patients

40:25are there, and you can also share your

40:28presentations through that

40:31virtual reality room.

40:33So,

40:34now what we wanted to do is like to make

40:37it more more like a worldwide live

40:40surgery. So, we will

40:43by the help of like Asia Pacific

40:45Orthopedic Association, we will we will

40:47just spearhead as young surgeons forum,

40:49we will spearhead a new session, people

40:52from different countries joining in, and

40:55two expert faculty members, six to eight

40:58selected young surgeons with VR

41:00headsets, they can jump in the same

41:01room, but the rest also will be able to

41:04watch it through the live stream

41:08record.

41:10So, we actually made a demo where it

41:13works perfectly, and then we had people

41:16joining from

41:17Australia, United States, Turkey, and

41:20and we managed to have the same

41:23environment even though we were like in

41:25different continents, we were able to

41:28get into the same room, discuss

41:29everything, and and without any lags,

41:32without any any problem. So,

41:36since that demo worked fine, we are

41:38working on our

41:41inaugural events that we will

41:43do with Asia Pacific Orthopedic

41:45Association. So, this is going to be our

41:47inaugural events for the hallux minimus

41:49and hallux valgus surgery. Peter Lym

41:52from Australia and Christopher Miller

41:53from United States will be joining us as

41:55faculties, and and people from

41:57participants from Turkey, India, South

42:00Korea, and and many more

42:01are applying for it, and you can also

42:05follow the announcements about this

42:07event in our Instagram

42:09page. So,

42:10we will take some applications. Google

42:12has their VR headset, so we can join

42:16make them join in into the VR surgical

42:18environment and then the the rest will

42:20be watching it over the Zoom.

42:22Uh

42:23and in on a in a larger scale, we are

42:25trying to develop a a library a

42:28curriculum that we try to integrate into

42:31AOPA foot and ankle fellowship. So, we

42:34will be able to have uh people uh having

42:37meeting with the faculties in the VR

42:40surgical room and then maybe a few

42:42months later meeting at the same

42:44uh hospital and doing some surgeries

42:46together and that will kind of prepare

42:48them uh how how everything is working

42:51out in in that in their environment and

42:53how the faculties actually approach to

42:55the cases. So, it will be uh just like a

42:57pre pre

42:58meeting uh verb between those faculty

43:02and uh attending. So, as conclusion, the

43:04possibilities extend far beyond uh

43:07conventional online meetings and and it

43:10I think I think VR uh live surgery can

43:12democratize access to high-quality

43:14education across the globe and that's

43:17now even more achievable. And I think

43:20global societies can collaboratively

43:22develop educational content and deliver

43:25immersive learning experience

43:26experiences to their their members. And

43:29despite rapid progress, uh hardware

43:31related limitations still remain a

43:33challenge. So, you need to have the

43:34hardware to be able to in that

43:37uh 3D environment, but the the costs are

43:40decreasing fastly because the the the

43:43the headsets are now it's it's even more

43:45cheap than ever before.

43:48Thank you so much for uh

43:50listening and uh you can as I said, you

43:53can just follow our Instagram page

43:55aopa.ys2

43:57to just uh be able to join this uh VR

44:00live surgery event. So, we really want

44:03your uh presence there. It will be

44:05really valuable to us. Thank you so much

44:07for everything.

44:10>> Thank you, Badri, for an

44:12excellent innovative talk

44:14to show how the innovations can cross

44:17barriers and be helpful for the

44:20next generation. So, next I call upon

44:22Professor Edward Ted Ma.

44:25Professor Edward Ma is a professor of

44:27surgery in Flinders University, South

44:30Australia, and is a practicing hand and

44:33upper limb surgeon in Adelaide.

44:35He was a past president of APLAA and the

44:38inaugural president of APLAA Hand and

44:41Upper Limb Society.

44:43So, he'll be talking on

44:45creation of

44:47anatomy digital instruction lab in

44:50Malaysia. Over to you, sir.

44:53>> Thank you so much, Vishnu.

44:54Uh can you see my slide, okay?

44:58Great. Thank you so much.

44:59What I'm going to show you today is the

45:01uh results of uh some the work that

45:04we've done with Malaysia, particularly

45:06in the

45:07Islamic University of Malaysia in

45:09Kuantan, East Coast of Malaysia.

45:12And I'll talk about the launching of

45:13anatomy digital instruction lab, uh

45:16replacing cadavers with

45:19uh with a technology, basically.

45:21And the way it started with that, of

45:23course, there's a need for these digital

45:24transformation. That you got to face the

45:26challenges, but you cannot do alone. You

45:29need external help like us to help you

45:31to provide solutions uh to the challenge

45:33that you have. More importantly to uh

45:36support a

45:37provide support system and future

45:39proving that for you, so that technology

45:41can continue to be useful.

45:44The challenges at the International

45:46University

45:47uh Malaysia is that they try to convert

45:49existing

45:50uh a cadaver lab you see there into AI

45:53digital lab.

45:55And the focus is really on anatomy

45:57teaching, surgical teaching, training,

45:58and research, and more importantly to

46:00provide remote access capability.

46:04So, the

46:06the request is the quite extensive and

46:08complex requirement across multiple

46:10disciplines.

46:11Uh there's a budget which is very modest

46:13in in limit because it's

46:14government-funded. The quality could be

46:17high in hot cutting-edge technology AI

46:19system and uh to be used. And of course,

46:22you got to accommodate over 150 students

46:24each time. And that's quite a challenge.

46:27And more importantly, to future-proof it

46:28for at least in 5 to 10 years.

46:31What about in-house development of AI?

46:34It's usually not very possible for any

46:36university because there's a constraint

46:37and they're mainly time poor uh and

46:40resource poor. And if they were to make

46:42a wrong decision, it can be very

46:44expensive mistake and as a result, then

46:46most of them have decision inertia.

46:48Therefore, you need external help like

46:51consultant of to provide objective brand

46:53agnostic expertise.

46:55And of course, you have to utilize the

46:56local AI for security.

46:59So, we did that about 2 years ago before

47:01the starter in the proof of concept.

47:02This At that time, we using the HoloLens

47:05uh with Gear XR. And this is a virtual

47:07reality that you can see on the lens

47:09very clearly in terms of learning

47:10anatomy.

47:12The problem with that though is actually

47:13quite expensive to use because you have

47:15150 students per headset is about uh

47:17$1,500 US per headset. So, it's not

47:20possible to have that many of the

47:21headsets to use and also the technology

47:24connected. We look at then uh the um the

47:27anatomy um

47:28table available in the market. There are

47:30four of them: Anatomage, Primal

47:32Pictures, and the Indian system. And

47:35really, we'll come back to really the

47:36Anatomage table. Why? Because it's

47:39really about 75% global market. It's

47:41well tested over many years now. It's a

47:44proven system and applicable beyond

47:46anatomy. There's other system, body

47:47system can be used. More importantly,

47:50you can download upload your DICOM file

47:52from MRI scan whatever and convert into

47:54a image for you that can actually

47:56analyze.

47:58So, this is the uh knowledge table I

48:00have flat down and vertical.

48:03Now, poor problem is when you have 150

48:06students, how many tables do you need?

48:08What's the budget constraint that you

48:09have? And what size of the lab do you

48:12have? Look at this here. The The table

48:14itself, you put about 10 people around

48:15it being pretty crowded. Anything more

48:17you probably can't see. If you put 150

48:19students, where do they fit? And if you

48:21have enough money to buy table, where do

48:23they fit into your lab? So, that's not

48:25possible.

48:26Therefore, we provide a solution where

48:29we look at how we can cater the limited

48:31budget to cater for the demand that you

48:34require. And we come up with two

48:36knowledge table and six mirror table

48:38that we custom made for them. And only

48:40that we're able to download and

48:43transcript in real time so that student

48:45can be remotely access to this either if

48:47you're not well at home or they they're

48:49somewhere away.

48:50So, remote access capability is quite

48:52important. And this is what they look

48:53like in real life. This is

48:55Quantan today in Islam University.

48:58And this is you know, the the teachers

49:00that we have them to train.

49:03And this was launched in May of this

49:04year just a few months ago.

49:06Now that you have the table now, the

49:08next problem is the navigation issue.

49:10The reason for that is there's so much

49:12variability and in that details that

49:14that's embedded into the system, how do

49:17you allow how do you teach a a lecturer

49:20to really master it quickly? And that's

49:22where technology comes in. Now, there's

49:24so many things you can do here.

49:26And to for them to put the lesson plan

49:28through quickly may not be possible if

49:30they spend months to to learn. But we

49:32can overcome this system by building an

49:34AI system for them. Therefore, we

49:36develop a proper AI system to provide

49:39holistic strategy to use the table by

49:41doing an AI setting up a AI

49:44infrastructure for you effective

49:46utilization for teachers to train, for

49:48students to learn, and I have them to

49:51adapt lesson or lecture plans to

49:53increase efficiency. And that will fill

49:55the educational innovation needs of the

49:57university.

50:00So, the mixed design support system is a

50:02sophisticated AI model to support

50:04teachers and students. We can actually

50:06streamline that through YouTube, so that

50:08they can get remote access. And of

50:10course, you know, we allow them to use

50:12in surgical training and also surgical

50:14research.

50:17The important consideration of AI in

50:18medical education is really is one, you

50:20get you easily overwhelmed by the

50:22technology landscape. You need to have a

50:25reality check and also the valid expert

50:27consultation collaboration.

50:30The fact is the technology landscape is

50:31overwhelming. AI opportunities are

50:34endless. The range of options can be

50:36paralyzing for any institution.

50:38Therefore, technology alone does not

50:40solve your educational challenges.

50:43The reality check is how do you choose

50:46the right system that meets all the

50:47criteria? How do you balance the need,

50:49budget, quality, and scalability?

50:51How do you future proof your investment?

50:54And how do you ensure the educational

50:55effectiveness not blindsided by

50:57technological sophistication?

51:00So, to do that, we need to then develop

51:02the AI for the institution, not only the

51:04hardware, but the software component and

51:06its evolution. Therefore, you need to

51:09develop a value expert consulting

51:10collaboration to navigate complexity

51:13with the institution. We brand and

51:15diagnostic advice and strategic guidance

51:17that align with the education goal and

51:19protect institution investment proving

51:21that for you. Therefore, we can bridge

51:23the gap between institutional needs and

51:26technical capabilities.

51:28Thank you so much for your attention.

51:35>> Thank you, Professor Omar,

51:37thank you for the talk, Professor Omar.

51:40>> Uh this is

51:42Thank you so much for a great talk,

51:44Professor Omar. Digital anatomy teaching

51:46is particularly interesting because it's

51:47going to potentially make high quality

51:50anatomy education accessible to much as

51:53wider audience. So now we move to a

51:55digital competency assessment. Our next

51:58speaker is

51:59Professor Roman Pfeifer

52:02uh from Switzerland.

52:03Professor Pfeifer is a senior attending

52:06physician in the Department of

52:07Traumatology at University Hospital

52:09Zurich and

52:11assistant professor of translational

52:13polytrauma research at the University of

52:14Zurich. His clinical and academical

52:17interests include polytrauma, spinal and

52:19pelvic surgery. He also has a

52:21significant involvement in SICOT and

52:23European trauma education.

52:25His presentation is digital competency

52:27tracking e- portfolios

52:29portfolios and AI assisted skill

52:32assessments. This is important topic

52:34because digital education is not only

52:36about the learning. We also need

52:38reliable ways to access competency and

52:40progress.

52:41Professor Pfeifer, the floor is yours.

52:43Thank you.

52:46>> Yeah, thank you very much.

52:48Um

52:49I don't know I always

52:51hear myself twice.

52:53I want to change.

53:05Just to

53:09>> Are you open two devices?

53:17>> I don't know I have a

53:18always hear myself twice.

53:21Can you hear me now?

53:25>> Yeah, you have you have logged in twice.

53:27I think you should log off from one

53:29device.

53:32>> Can you Can you close me or do you need

53:35my second profile? I don't know how to

53:36do that.

53:39>> No, you can exit from one of the this

53:41another one, the second one you can

53:43exit.

54:01There is one more Roman Empire showing.

54:15>> But why am I talking to my wife?

54:26Can you hear me now?

54:28>> Yeah.

54:30So if you can you

54:31>> You're still echoing.

54:32There's two Roman Empires and you're on

54:34a headphone.

54:35Can you try your headphone and see if

54:37it's off?

54:39>> But uh

54:40the other open is muted.

54:44>> Yeah.

54:45Can you now speak?

54:47>> No.

54:47What's

54:49No.

54:50Can you hear me now?

54:51>> Yeah.

54:52>> Yeah, okay.

54:54>> You can share your screen.

54:57Yes, great.

54:58>> How do I get the second

55:00screen off? I don't know exactly how to

55:02do that.

55:11>> [snorts]

55:11>> I have only one here. Oh.

55:17>> Yeah, now it's okay. You can share the

55:19screen.

55:27>> So can you see my presentation?

55:31>> No.

55:32>> No, not yet.

55:40>> Please wait. Excuse me.

55:43Probably we can start with the next. I I

55:46need to solve it, otherwise it's not

55:47possible.

55:49>> Okay.

55:55So, next speaker will be Dr. Anna Maria

55:58Sarona de la from the orthopedic surgeon

56:01based in uh

56:03Mexico. She has a particular interest in

56:06joint pathology and arthroscopy and

56:08she's

56:09actively involved in teaching and

56:11resident education.

56:13She's a member of the SICOT Young

56:15Surgeons Committee.

56:16And she'll be speaking on

56:20Yeah.

56:20Ethics, data privacy, and patient

56:23consent. Over to you.

56:33>> Thank you very much for the invitation.

56:36And thank you, my friends, that we have

56:39come very long way in this webinars.

56:43So, the first I want to start with a

56:46simple idea, and it is digital training

56:49can cross borders, time zones, and

56:52resource limitations. This is a major

56:55opportunity for orthopedics, but patient

56:58dignity has to travel with the video.

57:01When we record or stream,

57:04we are not only creating education

57:06material, we are handling a person's

57:08body, vulnerability, and data, and that

57:11changes our responsibility.

57:16In the past, any case presentation was

57:19usually local and temporary, and today

57:22the same surgical video can move from

57:24the OR

57:26uh to a webinar as today, or an archive,

57:29or any assist in AI system, and finally

57:32to learners around the world.

57:35With every transfer, the audience

57:38changes, and it can be reused, and the

57:40possibility of the deletion may change.

57:44So, the question is, can we record this?

57:47Or it is, can we control what happens

57:50when we are recording, and we can still

57:53respect the patient dignity?

57:58So, there's a common mistake in assuming

58:00that if you delete the face of a

58:02patient, you are protecting their

58:04privacy. In surgery, that often is

58:06false. Why? Because a scar, a tattoo, a

58:10rare deformity, or even a special

58:13implant can identify a patient.

58:16So, the identification is not just

58:19editing a photo. You need to reassess

58:23and protect every single information of

58:26the patient.

58:28HIPAA describes methods such as safe

58:30harbor and expert determinations,

58:33but the practical principle is still

58:35very simple. You need to remove every

58:37single identification directly of the

58:40patient that could reasonably make

58:43someone identify them.

58:47One of the most important things about

58:50this ethics is about consent,

58:53not just for surgery. It's for teaching,

58:56recording, streaming, and any AI

59:00analysis, or even social media, one of

59:02my favorite

59:04aspects here.

59:06We need to do special and very separate

59:09specific conversations about this with

59:11patients. Patients should understand

59:14what is the purpose,

59:15what is the audience, what is the

59:17format, and how and how much is going to

59:20be this type of information in the

59:23internet.

59:24They they almost they must know also

59:28that refusing will not affect their

59:30care.

59:31Timing here matters a lot. Asking

59:34immediate before the surgery will make

59:37patients very anxious and vulnerable.

59:39So, it may compromise how they feel

59:41freely to accept or deny.

59:44Whenever is possible, you should do the

59:47consent earlier in a car commerce

59:50setting. And we should never promise

59:52complete deletion because we don't we

59:54don't control that type of of

59:56technology.

59:59So, I'm going to share um

1:00:01some of data that I've I've I've

1:00:04researched about how social media is

1:00:08controlling a little bit the

1:00:09conversation.

1:00:10So, in 2025

1:00:13an orthopedics study was made with

1:00:16patients uh about how they feel that

1:00:19their doctor were in social media.

1:00:21So, 31%

1:00:23use social media for health information

1:00:27and 45% visited their own physician's

1:00:30social media accounts for several times,

1:00:33and 20% said that um

1:00:36social media can influence the choice of

1:00:38their physician. And that's all right.

1:00:41So, social media really matters, but

1:00:43content matters, too.

1:00:46There are so many intraoperative and

1:00:49intra-ER

1:00:50um images that have made polarized

1:00:54decisions and responses around users.

1:00:57There was a study that um

1:00:59there was 656

1:01:02parents in plastic surgery pediatrician.

1:01:06And up to 93% of this these parents were

1:01:09expecting consent before child image was

1:01:13posted.

1:01:14And about 40% felt that their children

1:01:17shouldn't be exploited in social media

1:01:20events.

1:01:21So, patients that necessarily reject

1:01:24social media, but they expect as as we

1:01:27all expect transparency, control, and

1:01:30respect.

1:01:38So, consent, of course, is very

1:01:40necessary, but it is not always

1:01:42sufficient. There was another study that

1:01:45they were using a term medutainment. And

1:01:48medutainment means that

1:01:51the patient becomes like the

1:01:52entertainment of the social media in

1:01:55physicians.

1:01:57Even if you have a signed form, the

1:01:59patient not not always is going to to

1:02:03understand what is the full context of

1:02:05the audience out there in social media.

1:02:08So, they need to know if the images of

1:02:10their themselves are going to be copied,

1:02:13reposted, or even taken out of context.

1:02:16So, you need to to address that fact.

1:02:18And if they are going to be feel free to

1:02:20refuse what the surgeon is asking for

1:02:23them just in the in the table.

1:02:27So, we need to address the fact that

1:02:28professionalism must be go beyond any

1:02:33legal compliance.

1:02:35So, if you sign something with your

1:02:37patient does not makes your like how do

1:02:40you say?

1:02:42Not a signed form does not make every

1:02:45use of a patient's body

1:02:47ethically accepted.

1:02:49So, you need to to control your purpose,

1:02:53the tone, the context, and

1:02:56everything on the tape.

1:03:00So, before an event, [clears throat]

1:03:03uh any live stream

1:03:05surgery, you need to to written all the

1:03:08consent. You need to define the

1:03:11audience, the scope, and the approved

1:03:13platforms. And also, you need to have a

1:03:15plan.

1:03:17During an event, you need to minimize

1:03:19any visual field, avoid names, and

1:03:21unnecessary conversations, and you have

1:03:24to have a moderator who can stop any

1:03:27appropriate inappropriate questions for

1:03:29the audience.

1:03:30After a while afterwards, we need to

1:03:33access control, retention, deletion

1:03:35deletion policies,

1:03:37and then an audit trail of those

1:03:39information, and a withdrawal pathway

1:03:42when feasible.

1:03:44I think

1:03:45I mean, this is an educational

1:03:48digital education equivalent of a

1:03:50surgical safety checklist. We need to

1:03:53check every single role briefing and a

1:03:56contingency plan.

1:04:00So, AI, of course, is not the enemy of

1:04:02the surgical education. In fact, I think

1:04:04it has

1:04:06many many many features that we can

1:04:08already enjoy.

1:04:10And we can improve it by a training

1:04:13through captions, translations,

1:04:15indexing, any clip generation, and

1:04:18technical skills assessment. But it also

1:04:21created a lot of

1:04:23secondary use risk with patient

1:04:25information.

1:04:26So, a video uploaded for one purpose may

1:04:29be out store AI stored outside the

1:04:32hospital and processed in another place,

1:04:35access to a vendor, or or used in any

1:04:38other purposes. So, before uploading any

1:04:41surgical video or pictures,

1:04:43we should know five things. The first

1:04:45one, what data will leave the

1:04:48institution,

1:04:49um

1:04:50whether they are using for model

1:04:52training,

1:04:53where and how long are they going to be

1:04:56stored, how can access the raw video,

1:04:59and whether they can truly retrieve or

1:05:01being deleted.

1:05:03AI does not transfer that

1:05:05responsibility. It adds it it adds

1:05:08another layer of governance, so we need

1:05:10to take account of that.

1:05:12I will show you some um

1:05:15cases that were like very mediatic

1:05:19because of the uh unappropriate uh use

1:05:23of this information. So, the first is a

1:05:26NY Med television series. In 2016, a

1:05:30hospital agreed to have $2.2 million uh

1:05:33dollar HSS settlement

1:05:36because they were no they were

1:05:38disclosing two patients' protected

1:05:40health information.

1:05:42So,

1:05:43no, allowing media into a clinical space

1:05:46is not the same as obtaining patient

1:05:48authorization.

1:05:50So, that's one one of the cases. There

1:05:52was another one that

1:05:54um

1:05:55in Manassas Healthcare

1:05:57center, and the the then again, there

1:06:01was like uh sharing information of

1:06:03patients, and they they were some

1:06:05lawsuits involved, and they it was very

1:06:08mediatic at that time.

1:06:11And there was another case of a nurse

1:06:13that was uh doing a

1:06:15selfie and a video selfie, and she was

1:06:18sharing some

1:06:20uh sensitive content of a patient in a

1:06:23monitor area. So, again, viral content

1:06:26can be still unethical and unlawful.

1:06:31So, for the closing message, this is

1:06:34actually very simple. We can educate

1:06:36globally, as we're doing today, but the

1:06:39consent of must be locally, and govern

1:06:43must be continuously. Before pressing

1:06:46record, please

1:06:48have your consent be very specific,

1:06:51de-identify as much as you can, and have

1:06:54control of all the data that is going to

1:06:56be out there in the social media. Thank

1:06:58you very much.

1:07:01>> Thank you so much, Dr. Anna. That was an

1:07:03important

1:07:04reminder

1:07:05that innovation in edu-

1:07:07education must always go together with

1:07:09the patient privacy consent and ethical

1:07:12responsibility.

1:07:13Dr. Roman, are you uh going to continue

1:07:16your presentation?

1:07:17>> Yeah, really apologize.

1:07:20Um for this technical issue. I hope it

1:07:22it works now.

1:07:24Um

1:07:29Can you see it? Is it visible for you?

1:07:32>> Yeah.

1:07:32>> Yeah. Yeah.

1:07:33>> Okay. Really apologize. I don't know why

1:07:35how how it happened, but

1:07:37I would like to discuss with you

1:07:39about the digital competency tracking.

1:07:42So, it's a big issue at the moment in

1:07:43our area.

1:07:45And um

1:07:46Um

1:07:47our anesthesiologist mainly started with

1:07:49it, but now this topic mainly goes step

1:07:52by step also into the surgery. And now

1:07:54we're going to show you a little bit uh

1:07:56what how we deal with it. So, initially,

1:07:59a few um words about like definition

1:08:02what we exactly going to speak about.

1:08:03So, this is a tracking

1:08:05of uh

1:08:06um

1:08:07competency mainly for um yeah, doctors

1:08:11or the trainees, the residents. And this

1:08:13is a systematical tracking, a

1:08:15longitudinal assessment whether this

1:08:18clinical practice, professional

1:08:20activities

1:08:21if they are safely performed, if they

1:08:23are independent, and they have them

1:08:25consistently over a period of time.

1:08:27Probably the old-fashioned documentation

1:08:29of like training like it was before with

1:08:32the numbers and procedures. So, usually

1:08:35um sorry, to nowadays we see it seems to

1:08:37leave this strategy.

1:08:39And then this uh

1:08:42um this this education

1:08:44um method is called the competency-based

1:08:47medical education. So, this is main more

1:08:49or less the goal of it is to reduce the

1:08:53reduce the um

1:08:55reduce the difference here between the

1:08:57expected competence and also the uh the

1:09:00actual competence. So, we want to um

1:09:03improve the competencies of our

1:09:04residents, our trainees.

1:09:07And this

1:09:08after introducing this, so it seems to

1:09:11be very focused

1:09:12on the needs of the trainees and I will

1:09:14show you later

1:09:17how it works in at least in our in our

1:09:20university. So one main step of this um

1:09:25training is the in the such so-called

1:09:27entrustable professional activities. So

1:09:30the main competencies mainly come from

1:09:33the knowledge of this trainees. So

1:09:36usually it's the what they how they

1:09:38learn, how they prepare. The skills as

1:09:41you especially in the surgical field

1:09:43it's very important and also the

1:09:44attitude. So how they learn, how they

1:09:47want to learn, how they how is the

1:09:48motivation and the the

1:09:51the let's say the all um

1:09:53the the the attitudes regarding the

1:09:55learning process. And the here is the

1:09:58especially the knowledge mainly it's

1:10:00covered by different exams and

1:10:02questions. The skills so we have

1:10:05different simulations what we can do

1:10:07practical

1:10:09practical skills can be also

1:10:14also done on dummies. What especially

1:10:17here is self-reflection and also this

1:10:19learning process is very often not so

1:10:21easy and here we have developed a system

1:10:24so it's called prepared um

1:10:27uh

1:10:29it's like the um

1:10:32educations the the EPAs which I usually

1:10:35show you step by step now. The main GS

1:10:38mainly here to have different

1:10:40competencies that surgeons or let's say

1:10:44anesthesiologists have and we can

1:10:46classify the level of the competencies

1:10:49in the in the in the daily practice. So

1:10:52initially it's like you it's like a

1:10:55martial arts you have different belts,

1:10:57yeah? So, initially it's like

1:10:59observational

1:11:00competencies only. So, the residents

1:11:02observe only only initially and then

1:11:05they have direct supervision. It's so

1:11:08let's say maybe the

1:11:10the surgeon and the resident needs to do

1:11:12an external fixation in trauma. So, you

1:11:14do it directly with your

1:11:16supervisor. Indirect supervision, you

1:11:18supervision you usually do it with

1:11:20supervisor standing beside you but very

1:11:23close to you and then you have this then

1:11:25supervision probably your supervisor is

1:11:28in your own his own room.

1:11:30And then we have reached the level of um

1:11:33the level where you supervise all the

1:11:35trainees. So, usually for that we

1:11:39um so the

1:11:42our hospital or a university developed

1:11:44such a um

1:11:47such as an app. So, you see all these

1:11:49different levels um in this app. So,

1:11:52you can

1:11:53you can download every resident, every

1:11:55trainee has it.

1:11:57And so, I this is my example how you can

1:11:59you can use it as an example here for

1:12:01the anesthesiology but also you have

1:12:04you're now developing a similar

1:12:05competencies also for orthopedic and

1:12:08general surgery. So, on one side you

1:12:10have the trainee who wants to learn

1:12:12anything and on the right side we have

1:12:13supervisor visor who has all this

1:12:16knowledge. And they have two different

1:12:18um platforms this is from the same app

1:12:21um and the

1:12:23on one side you have trainee and on one

1:12:26side you have supervisor for initially

1:12:28you register for it.

1:12:30The second step is uh

1:12:32you choose different different uh

1:12:35trainings what you would like to do.

1:12:37Let's say this is an mainly

1:12:39anesthesiological

1:12:40content but um now in the next years at

1:12:44least next years we're going to develop

1:12:46here also orthopedic and general surgery

1:12:48content. Let's say external fixation or

1:12:51thoracic tubes in a trauma. And uh

1:12:54trainee is going to choose here the

1:12:57the um training he wants to perform. And

1:13:01this need to be confirmed initially by

1:13:03supervisor. He can scan uh the QR code

1:13:06and now he's connected to the um the app

1:13:10uh together with the trainee.

1:13:12After the performing this uh

1:13:15um surgical intervention, you can you

1:13:18can describe the complexity of this

1:13:21intervention. Whether was it rather

1:13:23simple or was it rather complex. So, the

1:13:26you So, the trainee can do that and

1:13:29um and also the supervisor can do it on

1:13:31the

1:13:32on their on his own cell phone.

1:13:36So, the next level is to be described

1:13:38the levels of competency. Initially, the

1:13:41trainees can do it by themselves. They

1:13:43can assess as assess

1:13:45their own competencies. And on the right

1:13:48side, the super

1:13:49visor also can uh

1:13:51um define which level of the competency

1:13:55the trainee has. In the end, you see in

1:13:57the

1:13:58in the app, for example, so this is

1:14:02putting an external fixation was rather

1:14:05simple. And then

1:14:07mainly the entrustable

1:14:09uh activities and competencies

1:14:12are here more or less. The trainee says

1:14:14that he needs a direct supervision. Um

1:14:17but the uh supervisor means that

1:14:20indirect supervision is here sufficient

1:14:22in this uh um let's say in this

1:14:25procedure. So, this is what they usually

1:14:28do. In the end, the super supervisor can

1:14:30provide some feedback for the trainee.

1:14:33For example, he can write document uh

1:14:36what kind of clear skills or knowledge

1:14:38this trainee should can improve. For

1:14:41example, here to improve the oxygenation

1:14:44or let's say prepare more like

1:14:47prepare the x-rays. And

1:14:51or check the x-rays or check the the the

1:14:54circulation and perfusion of the

1:14:56extremities after the surgery whatever

1:14:58is needed here from the side of

1:14:59supervision supervisor and in the end

1:15:02the

1:15:03trainee can see that is own

1:15:06at his own app all these recommendations

1:15:09from the supervisor.

1:15:11Finally he can even see as a whole list

1:15:14of all these different

1:15:16recommendations and idea from the

1:15:18supervisor and he can theoretically put

1:15:20it on the list. For example, yeah yeah

1:15:22first I need to prove oxygenation

1:15:25perfusion and I need to check the

1:15:27position and prepare the x-rays and

1:15:30prepare the surgery

1:15:31appropriate and then we have like main

1:15:33goals what the trainees can address.

1:15:38So usually this is like was one process

1:15:41but the trainees go over with this

1:15:43process many times. Usually there's a

1:15:45procedure. The next procedure might be a

1:15:47different surgical intervention or the

1:15:50same as another another trainee

1:15:53with another supervisor and then they do

1:15:55perform it and they this

1:15:58after the surgery there's a period of

1:16:00evaluation

1:16:01and after that

1:16:03you can again choose another procedure

1:16:06or whatever you can even repeat with

1:16:09another supervisor just to show that you

1:16:12probably get better. So you repeat it

1:16:14many times and hopefully with a period

1:16:16of time

1:16:18depending on your own experience and

1:16:21your own

1:16:22development you are probably get

1:16:26get your more experience.

1:16:28The end on both sides you can have a

1:16:31have a very nice statistics about the

1:16:34trainee experience and probably the last

1:16:38procedures also the experience with

1:16:40these different supervisors.

1:16:42You can put everything in the in a in a

1:16:45dashboard. For example, you can this is

1:16:48a for example 1 year. You see one this

1:16:50is 1 week. We have in total like 52

1:16:52weeks in a year.

1:16:54They can do per week different um

1:16:57um

1:16:58uh different assessments. So, uh let's

1:17:01say up to 30% 30 to 31

1:17:05um assessment in a

1:17:07in a

1:17:09um in the in the week. And

1:17:11theoretically, trainees can even do

1:17:13something like a competition. So, we say

1:17:15for example, they do who did who did the

1:17:17most

1:17:18um assessments per week in the end. Over

1:17:21the year, you can observe how is the

1:17:24assessment here. um

1:17:26How is the number of assess How is the

1:17:28number of assessment over the period of

1:17:30time and how successful are these

1:17:32trainees.

1:17:34So, you can actually actually theoretic

1:17:35actually also go into the details. So,

1:17:38it's here even more complex intervention

1:17:40and see step-by-step the development

1:17:43of this resident and trainee. So, this

1:17:45is a tool what we have developed in the

1:17:48in the in our university, but

1:17:50that it have a like all everything in

1:17:52our life advantages and disadvantages. A

1:17:54big uh big benefit is so you can

1:17:58um you can observe the development of

1:18:00the resident um um

1:18:02the very closely if you have access to

1:18:05these uh platforms. So, it's uh it's it

1:18:09um it's also very important for

1:18:10residency programs so residents have a

1:18:13better feedback and can understand so

1:18:15they do milestones to I need to do

1:18:17anything to the to be better in this

1:18:19procedure. Let's say external fixation

1:18:21or minor surgeries. But, the big barrier

1:18:24it is also can be also sometime um I'm

1:18:27consuming in the daily practice and some

1:18:30of the administrative task might be here

1:18:32also difficult to documentation

1:18:34especially. And um also the role how we

1:18:37use it in a let's say in the final exams

1:18:40is also questionable.

1:18:42So, I would like to thank you. This is

1:18:44just an example from our

1:18:46from our clinical practice, let's say

1:18:48with this in this topic. But, I would

1:18:50like to mention also like in

1:18:52the throughout virtual training, we also

1:18:55very active in this in a pelvic and

1:18:57acetabular fracture. Let's hope we can

1:18:59do next course already next year in

1:19:01January. So, if you're interested,

1:19:03please

1:19:05um apply. Thanks a lot.

1:19:09>> Thank you, Dr. Roman. You have a very

1:19:12good talk on digital competency and

1:19:15I would say evolution. So, finally, our

1:19:18last speaker will talk on the global

1:19:20mentorship and international

1:19:23collaboration.

1:19:26So, Dr. Frederick Joseph is an

1:19:29experienced orthopedic surgeon and has

1:19:31held several leadership positions within

1:19:34the Philippine Orthopedic Association

1:19:36and the APOA. He currently serves as the

1:19:39Secretary General of the Asia Pacific

1:19:41Orthopedic Association. Over to you,

1:19:43sir.

1:19:45>> Good evening. Thank you so much, Vishnu.

1:19:48Yes,

1:19:49I'd like to thank the SICOT and the APOA

1:19:51for this opportunity to speak to you. My

1:19:53name is Frederick Diko. I'm the

1:19:55Secretary General of the APOA and I come

1:19:57from the Philippines.

1:19:59I will speak to you about global

1:20:00mentorship without borders to building

1:20:02the future of orthopedics through

1:20:04international collaboration.

1:20:07So, I'd like to call attention to this

1:20:09very webinar as a joint program, which

1:20:12is a good example of collaboration,

1:20:14which we'll be talking about. Orthopedic

1:20:16knowledge does not belong to any one

1:20:18country. It belongs to the world.

1:20:21We know that orthopedic issues are truly

1:20:23global. All nations anywhere in the

1:20:25globe will have the similar problems,

1:20:28some population, trauma epidemics,

1:20:30traffic injuries, sports injuries, and

1:20:32the like.

1:20:33And the key and the solution is

1:20:35international collaboration.

1:20:38At present, Asia Pacific accounts for

1:20:40over 4.7 billion people, and Europe, and

1:20:43Africa, and the Americas together

1:20:45represent the entire world's orthopedic

1:20:47needs.

1:20:49The global health worker shortage is

1:20:51already at 14.7 million. This is back in

1:20:532023, and it's projected to decrease

1:20:57uh to 11.1 million by 2030. And this is

1:21:00not just in orthopedics.

1:21:02Um shortages remain uneven depending on

1:21:04where you are in the world. What's

1:21:06important to to know is that orthopedic

1:21:08surgeon density varies across countries.

1:21:10In 2018 data,

1:21:12the largest number of orthopedic

1:21:14surgeons per 100,000 people was in

1:21:16Sweden, and the least number was in

1:21:18Ghana, 0.09 per 100,000 people. And all

1:21:22other nations fall in between this.

1:21:24So, international mentorship and

1:21:26collaboration can work together to

1:21:27inspire and capacitate the already

1:21:30existing orthopedic workforce.

1:21:34The WHO Global Alliance for Care of the

1:21:36Injured has us noted that this is a

1:21:38system-level inequity, and not not just

1:21:41a simple

1:21:42lack of surgeon availability.

1:21:45Mortality rates for life-threatening but

1:21:47potentially survivable injuries are so

1:21:49different depending on where you are.

1:21:52For low-to-middle-income countries, you

1:21:53can have up up to 36% mortality. And in

1:21:57a high-income setting, this goes all the

1:21:58way down to 6%. So, ironically, patients

1:22:01with same or similar injuries have

1:22:03dramatically different chances of

1:22:05survival depending on which health care

1:22:07system they are in.

1:22:10So, just to highlight numbers,

1:22:12musculoskeletal disorders account for

1:22:14over 1.7 billion people, and annual

1:22:18deaths from trauma account for over 5

1:22:20million people. Low-and-middle-income

1:22:22countries will have more than 90% of

1:22:24deaths from orthopedic trauma, and the

1:22:26prediction by the WHO is that by 2050,

1:22:30there will be 2.1 billion people more

1:22:32than 60 years old. And the And the

1:22:34shortage of the orthopedic workforce is

1:22:36always highlighted in many Asia Pacific

1:22:38nations.

1:22:40It's important to note that 90% of

1:22:42injury deaths occur actually where

1:22:44surgical resources are often least

1:22:46available.

1:22:48This workforce disparity can be

1:22:49addressed by global mentorship.

1:22:53So, we ask ourselves, how do we share

1:22:54the expertise? How do we share and

1:22:57develop people and build capacity where

1:22:59it is most needed?

1:23:01The answer may lie in collaborations to

1:23:03get from different organizations. In the

1:23:06our case, the Asia Pacific

1:23:07Orthopedic Association and the SICOT

1:23:10work together. Um the countries in blue

1:23:13represent uh countries where SICOT

1:23:14national representatives are present.

1:23:17The green countries are the APOA member

1:23:19countries, which account for over 65,000

1:23:21orthopedic surgeons. And in yellow are

1:23:24uh countries where APOA and SICOT

1:23:26coexist. So, with this in mind, you can

1:23:29have shared knowledge, global

1:23:30mentorship, strong partnerships, and

1:23:32even better outcomes for our patients.

1:23:36Now, let's talk about mentorship.

1:23:38Traditional teaching will benefit from

1:23:40mentorship.

1:23:41Sponsorships will allow for leadership

1:23:43development. A mentor teaches, a sponsor

1:23:46can open doors. A global mentor can

1:23:48change a career. It helps to build a

1:23:50capacity to address the disparities we

1:23:52identified earlier. It can take the form

1:23:55of career guidance, research

1:23:56collaboration, virtual case discussions,

1:23:58visiting fellowships, leadership

1:24:00coaching, and lifelong professional

1:24:02relationships.

1:24:03Now, why is international mentorship a

1:24:05little different? So, traditionally,

1:24:08mentorship will have a local perspective

1:24:10involving a single institution with one

1:24:12mentor with limited exposure, but having

1:24:15a big but a local impact. When you go

1:24:18global, you involve multiple health care

1:24:20systems. You can have a network of

1:24:22institutions working together. You can

1:24:24have an entire team of mentors with

1:24:26diverse practices that can be shared

1:24:27with each other having a bigger

1:24:29international impact.

1:24:32The power of international societies

1:24:33cannot be underestimated. The APOA and

1:24:36the SICOT are known for these strengths

1:24:38working together. Regional and global

1:24:40excellence can create extraordinary

1:24:42opportunities.

1:24:44Successful collaborations are already

1:24:46present around the world. The AO

1:24:48Foundation has its worldwide fracture

1:24:51education. It has faculty exchanges and

1:24:53the global research network. The APOA

1:24:55has traveling fellowships, young surgeon

1:24:57exchanges, and international congresses

1:24:59held annually. In Europe, collaborations

1:25:02are also present in ESCA, EFFORT, and of

1:25:05course in SICOT. Mentorship now is known

1:25:08to extend beyond borders.

1:25:11Just a simple case example. When a young

1:25:13surgeon from Southeast Asia go goes on a

1:25:16traveling fellowship and visits a first

1:25:18world country such as Japan, he learns

1:25:20robotic knee arthroplasty. He returns

1:25:22home. He establishes his first robotic

1:25:24program and mentors the next generation.

1:25:27Hereby we we see one fellowship

1:25:29impacting hundreds of patients. Another

1:25:32example is international research

1:25:33collaboration where, for example, a

1:25:35hospital in the Philippines can work

1:25:37with a hospital in Australia and another

1:25:39hospital in Germany

1:25:41producing a multicenter study. And this

1:25:43will produce a high impact a form of

1:25:45publication and the possibility of

1:25:47establishing international guidelines

1:25:49which can then be reflected back to the

1:25:51hospitals involved. We can have larger

1:25:53sample sizes, better evidence, diverse

1:25:56populations, and a stronger external

1:25:58validity.

1:26:00So, an example of digital mentorship

1:26:02will involve involve a young surgeon

1:26:04with a virtual mentor. Will have he will

1:26:06have international case discussions,

1:26:08collaborations for research. He will be

1:26:10presenting in different conferences and

1:26:13may have faculty appointments. His

1:26:15career can now develop across continents

1:26:17without even leaving his home.

1:26:21The COVID pandemic accelerated

1:26:23collaboration. The tools available we

1:26:25are all very familiar with. Distance is

1:26:27now no longer the primary barrier.

1:26:31But there are of course challenges to

1:26:33international collaboration. Challenges

1:26:35such as funding which can be solved with

1:26:38shared grants. Time zone differences

1:26:40which can be solved by having rotating

1:26:42meetings. Um difference in languages

1:26:45where English can be used but having

1:26:46translation support. Different health

1:26:49care systems can be harnessed producing

1:26:52mutual learning. Unequal resources can

1:26:54be answered with bidirectional

1:26:56mentorship. Keeping in mind that

1:26:58mentorship is never one directional.

1:27:00Both mentor and mentee will benefit from

1:27:02each other. And every country has

1:27:04something valuable to teach.

1:27:07So the future of global mentorship

1:27:09really lies in knowledge exchange

1:27:11through coaching, simulation,

1:27:13proctoring, international registries,

1:27:15databases, producing clinical guidelines

1:27:18and multinational randomized trials.

1:27:22At this point this is a good call to

1:27:24action for everyone watching tonight.

1:27:26Now you can have five commitments per

1:27:28year. Commit yourself to mentoring one

1:27:30young surgeon every year. Commit

1:27:32yourself to participate in one

1:27:33international collaboration. Share one

1:27:36educational resource globally every

1:27:38year. Welcome one visiting fellow if

1:27:40this is possible. Keeping in mind that

1:27:42you have to build friendships beyond

1:27:44national borders. Because as we know

1:27:46friendships will always precede

1:27:47collaboration.

1:27:50Let me leave you with these thoughts.

1:27:51Knowledge multiplies when it's shared

1:27:53and mentorship can create surgeons.

1:27:56However, collaboration will always

1:27:58transform health care systems.

1:28:00The true measure of an orthopedic

1:28:02surgeon is not only the patients whose

1:28:04lives they restore but more so the

1:28:06surgeons whose lives they inspire.

1:28:09Thank you very much.

1:28:11>> Thank you so much Dr. Diogo. This was a

1:28:13very nice presentation. I think this

1:28:16brings uh today's one of the central

1:28:19message of today's webinar that

1:28:21technology should ultimately help us to

1:28:23connect people, the knowledge, and

1:28:25opportunities across the border.

1:28:27Thank you to all seven speakers for

1:28:29their excellent presentations today.

1:28:32Uh I think we have covered a wide range

1:28:34of topics today from artificial

1:28:36intelligence, virtual surgery, to

1:28:38digital anatomy, competency assessment,

1:28:41ethics, and now the finally the global

1:28:43mentorship.

1:28:45Now, we have some time for discussion.

1:28:46We have some questions. Uh my first

1:28:49question is to Professor David Chun. Are

1:28:51you here, please, sir?

1:28:54>> Here I am.

1:28:55>> Uh sir, question is from you that how do

1:28:58you think

1:28:59AI will change the role of traditional

1:29:02orthopedic teacher?

1:29:06>> Well, actually, everybody said that

1:29:07actually.

1:29:09>> Everybody said that actually.

1:29:11We are so [clears throat] used to saying

1:29:12what we believe to be true.

1:29:15And we're not used to being challenged.

1:29:17And actually, we need to be challenged.

1:29:20And the only way to challenge somebody

1:29:22when you're junior

1:29:23is with facts.

1:29:25And the facts are out there.

1:29:27And the the your access to facts

1:29:30and the public's access to facts, by the

1:29:32way, is the same by the same token is

1:29:35excellent today.

1:29:36Any smart person can find out anything

1:29:38they want

1:29:39uh using the same tools I showed you.

1:29:42So, if the public are smarter than your

1:29:44boss,

1:29:46what's the problem, you know, where

1:29:48where how are we going to go forward

1:29:49here?

1:29:51Really.

1:29:52That's what I tell my own medical

1:29:53students. I say, "Listen,

1:29:55your tutors are going to tell you this,

1:29:57this, this, this, but when I look up

1:29:59YouTube, just YouTube,

1:30:01here's what's out there. Okay? And these

1:30:04are not

1:30:06uh

1:30:07>> [clears throat]

1:30:07>> small-time uh

1:30:09people talking they are actually medical

1:30:11researchers professors that go on

1:30:13YouTube just so they can spread spread a

1:30:15message that is important for the rest

1:30:19of the world.

1:30:21And even if you believe or you don't

1:30:22believe it's out there and people will

1:30:24challenge you and you better be prepared

1:30:27to defend yourself.

1:30:29That's how AI will change all of us.

1:30:31You just try ask any question to Google

1:30:33or for anything you want. You you get an

1:30:35answer.

1:30:36It's going to be a pretty good answer

1:30:37actually.

1:30:42>> Thank you so much Professor. My next

1:30:44question is to Professor Mike. Are you

1:30:49The question is from you that what are

1:30:51the main barriers to establishing a

1:30:53digital anatomical laboratories in low

1:30:55resource settings like Pakistan,

1:30:57Bangladesh, etc.

1:31:00>> I think the it's not so much the money

1:31:02side. You do need some money to set up.

1:31:04It's not the technology side I mean not

1:31:06the hardware side

1:31:08because you can buy anything just like

1:31:09buying an iPhone but how do you use it?

1:31:11The main part is you need to have

1:31:12someone to help you to develop a system

1:31:15that can cater for what you need. For

1:31:18example, if you want to develop a

1:31:19lecture plans you can. You want to

1:31:21develop the teaching program for some

1:31:23specific area like system teaching like

1:31:26for example learn about the anatomy of

1:31:27the heart then learn about the how it

1:31:29works in terms of blood flow. Learn

1:31:31about the the the the the nervous system

1:31:34of the heart how it actually works in

1:31:36terms of reflecting the ECG. That is

1:31:38required AI development not just

1:31:40hardware. The hardware is only one of

1:31:42the problem and in particularly hardware

1:31:44changes. So we got to be brand agnostic.

1:31:47You know, that we don't care what brand

1:31:48it is. We got to look at look for the

1:31:50hardware together with software that

1:31:52best solve your problem with a budget

1:31:54that you have and that is being clever.

1:31:56That's very important to think about

1:31:58that way.

1:32:02>> So we are already out of time. So, we

1:32:05come to end of the today's webinar. My

1:32:07sincere thanks to all our speakers for

1:32:09sharing their expertise and vision. I

1:32:11would also like to thank the SICOT and

1:32:13APO leadership, head offices, and

1:32:16everyone involved in making this

1:32:17collaboration possible. Today's message

1:32:19is clear. The future of orthopedic

1:32:21education will be digital,

1:32:23collaborative, and global.

1:32:25But, technology is only a tool. It's

1:32:27true value lies in how we use this to

1:32:29improve learning, training, and

1:32:31ultimately the patient care. On behalf

1:32:33of SICOT Education Committee, thank you

1:32:35to all our speakers and everyone who

1:32:38joined us today.

1:32:39We look forward to seeing you in next

1:32:41future SICOT Pioneer programs. Thank you

1:32:44very much and have a wonderful day.

1:32:46Thank you so much.

1:32:47>> Thank you,

1:32:47bye all.

1:32:48>> [clears throat]

1:32:49>> Thank you.

1:32:50>> Thank you, bye-bye.