Orthopaedic Trauma Association Global Outreach Task Force Proceedings

Abstract

Introduction: 

In 2020, the Orthopaedic Trauma Association (OTA) adopted an updated strategic plan emphasizing global outreach. A task force was appointed to better understand the current global orthopaedic trauma educational demand and how the organization may better partner with our global colleagues. This article provides a description of the process and the results of the findings.

Methods: 

First, the current international demographics of the OTA membership were reviewed. Then, 2 surveys were distributed. The first was sent to all current members of the OTA to determine how important the members believe that global orthopaedics should be to the organization's mission. The second survey was sent out to our international orthopaedic trauma colleagues. The results of both surveys were reviewed, analyzed, and summarized in an executive summary report which was presented to the OTA Board of Directors earlier this year.

Results: 

The responses from the membership survey indicated a keen interest in the development of global outreach within our organization. The global outreach survey received 72 responses from 28 different countries, mostly lower and lower-middle income countries. This included many countries in Asia and Africa who had no prior relationship with the OTA. Most respondents were already using online educational materials and expressed a desire for more high-quality online offerings as well as regional resource-specific orthopaedic trauma courses.

Conclusion: 

The overwhelming majority of member respondents believe that global orthopaedics is highly important and central to our mission. Similarly, a majority of the international respondents believed that global orthopaedics is necessary and worthwhile. They expressed a need for more educational opportunities and collaboration, particularly in the areas of online offerings as well as regional, resource-specific courses.

1. Introduction

As described in its mission statement, the Orthopaedic Trauma Association (OTA) is an international organization which promotes excellence in care for the injured patient through provision of scientific forums, support of musculoskeletal research, and education of orthopaedic surgeons and the public. It is composed of a membership who provide care and improve the knowledge base for the treatment of injured patients. OTA members provide worldwide leadership through education, research, and patient advocacy. It is a constantly evolving organization.

In 2020, the OTA Board of Directors developed and adopted a new strategic plan for the organization. This plan contained 5 key initiatives, and one of these was the strengthening of global outreach “to promote the OTA as the primary global resource for orthopaedic trauma care through international collaboration while advocating for global trauma care and humanitarian assistance.” To better understand the global demand for educational materials, a task force was assigned to perform a global orthopaedic trauma educational needs assessment.

The members of the Global Outreach Task Force were appointed by the OTA Board of Directors, and many of the appointees had prior international orthopaedic experience. It was acknowledged by the group that the OTA already has a robust international membership, primarily made up of members from higher-income countries (Fig. 1). It was also noted that the OTA likely can predict what educational resources and programming is most relevant to these higher-income countries because they are similar in resources to our own, and they already have active OTA representation and participation. Therefore, the decision was made to focus more on the low-income countries (LIC) and lower-middle income countries (LMIC) with whom the OTA does not already have a relationship and who shoulder a large burden of the global orthopaedic trauma volume.¹

Figure 1.: Current OTA international demographics.

2. Methods

The Global Outreach Task Force decided to administer 2 surveys. Both were deemed to be exempt from institutional review board and Animal Use Committee review. OTA leadership was involved in the design and implementation of the surveys, and they were both administered by email with a link to SurveyMonkey. The first survey was emailed to the entire current OTA membership. This survey was intended to gauge how important members believe that global orthopaedics should be to the organization's mission. It consisted of 11 questions and gathered basic demographics, member's level of experience with global orthopaedics, how important global orthopaedics should be to the OTA's mission, and what areas they would like to be more personally involved.

The second survey was administered with the help of SIGN Fracture Care International and OTA Alliance. These 2 organizations already have extensive experience with global orthopaedic education in lower-income countries. They provided valuable insight and advice in the development of the survey questions, and they also assisted the task force by sharing their international email contact lists. This allowed the survey to reach surgeons in many countries where the OTA does not already have a presence.

After the surveys were administered, responses were received for approximately 1 month before the data were reviewed. SurveyMonkey's data evaluation tool was used by the OTA staff to compile reports and spreadsheets. These reports were then reviewed by the task force and were used to make recommendations to the OTA Board of Directors. An executive summary of the findings and recommendations was presented to the OTA Board of Directors at the 2022 spring meeting, and it was shared with the Humanitarian and Global Outreach Committees at the 2022 annual meeting in the fall.

3. Results

The membership survey yielded 110 responses. Most were active members (57%), followed by international (17%), clinical (11%), candidate (9%), emeritus (3%), and research (2%). Most respondents worked in an academic institution (65%) and to a lesser extent in private (17%), combination academic/private practice (11%), and other (7%) settings.

The highest percentage (39%) of the respondents had been in practice for at least 21 years, 25% had been in practice 0–5 years, 22% had been in practice 11–20 years, and 14% had been in practice 6–10 years. There were 96 male respondents (87%) and 12 female respondents (11%). Most respondents identified as White or Caucasian (68%), followed by Asian/Asian American (18%), Black/African American (9%), and Hispanic/Latinx (3%). The continent with the highest number of respondents was North America with 88 (80%), Asia with 9 (8%), Europe with 5 (5%), Africa with 4 (4%), Australia with 2 (2%), and South America with 1 (0.1%).

Many of the OTA member respondents had previous international orthopaedic experience. The organizations represented include the United States Military; SIGN International; OTA Alliance; Orthopaedics Overseas; Institute for Global Orthopaedic Trauma; international militaries; The College of Surgeons of East, Central, and Southern Africa; Pan-African Academy of Christian Surgeons; the World Health Organization; and many other nongovernmental organizations. There are also many languages spoken by OTA members (Spanish, Russian, French, Italian, Farsi, Cantonese, Hindi, Japanese, Greek, and Afrikaans).

When asked whether global orthopaedics is important to the mission of the OTA, a majority of members responded that it is very important (65%) or important (29%). Only a very small percentage believe that global orthopaedics was somewhat important (3%), not so important, or had no value (0.9%) (Fig. 2). Members were given the opportunity to indicate which type of outreach they would be interested in personally providing. The categories included the development of online materials or curricula (33), disaster relief (69), hosting international colleagues at their institution for observation (54), financial sponsorship (26), and mentorship/teaching/collaboration both with (96) and without (39) international travel. Most of the respondents also provided their contact information, creating a member global outreach volunteer database.

Figure 2.: Importance of global outreach to the OTA membership.

The global outreach survey received 72 responses from 28 different countries, many of which were countries where the OTA does not have membership (Fig. 3). When asked what factor has prevented the respondent from becoming an OTA member, the membership cost and issue with form of payment were the most common responses. Some respondents had previously used OTA-sponsored virtual educational events, mostly video lectures, webinars, and Fracture Night in America. Far fewer numbers had attended in-person meetings or courses (Fig. 4). When asked which of the OTA online resources the respondent had used, the Journal of Orthopaedic Trauma was the most popular, followed by OTA International. Of those who had used OTA educational offerings, the majority believe that the content was appropriate for their practice environment. The survey asked which platforms in general were preferred for receiving continuing education, and the most popular platform was YouTube, followed by VuMedi, OTA online, and AAOS (Fig. 5).

Figure 3.: Countries represented in the OTA membership.

Figure 4.: Results from global survey regarding in which virtual events the respondent had participated.

Figure 5.: Results from global survey regarding preferred continuing education platforms.

When asked whether international collaboration is important, all respondents said “yes.” Similarly, all responded “yes” when asked whether they would be interested in content specifically intended for resource-limited countries. The offerings they believed would be of greatest value to them were videos, regional in-person courses, academic mentorship, virtual in-person courses, virtual case review, virtual global orthopaedic textbook, and virtual grand rounds, in that order (Fig. 6). The survey also allowed them to provide additional comments, and many took the opportunity. The desire for exchange programs and payment methods for those who do not have international credit cards were mentioned, along with many other topics.

Figure 6.: Results from global survey regarding which educational modality would be of greatest value.

4. Discussion

Based on the survey results, the Global Outreach Task Force generated some recommendations and also suggested the OTA committees which would be most appropriate for their consideration.

1. Decrease barriers to membership - Current OTA dues are $10 for L/LMIC countries, and this itself is unlikely to be a barrier. Those who responded to the global survey were offered 1 year of free membership as a token of appreciation, and this resulted in 27 applications. We recommended that the OTA explore other options for payment because some L/LMIC individuals do not have access to credit cards. We also recommended that the OTA discuss allowing full access to OTA online in LIC based on location as identified by IP address. These 2 recommendations have already been addressed by the organization. One of the biggest barriers to membership may be that surgeons in L/LMIC may be simply unaware of our organization's offerings. (Membership committee)
2. Creation of L/LMIC online content - The addition of LIC content to our existing resources could be very valuable. Additional resident core curriculum lectures, videos, textbook, etc. that discuss treatment of fractures in resource-limited environments would enhance our current offerings. International members from LIC should be asked to collaborate on these projects. (Education Committee, Video Library subcommittee, Publications committee)
3. Combine all L/LMIC online content - We recommended that the OTA work with existing groups who offer online curriculum for L/LMIC countries such as IGOT, SIGN, OTA Alliance, etc. and combine all resources by either allowing these groups to post their material on our website or adding links to this content from our website. (Education Committee, Video Library subcommittee, Publications committee)
4. Develop an OTA YouTube Channel - The task force was divided on this. Some believed that this should not be done because it is not possible to track who is accessing this information, and they preferred that the educational materials be accessed from the OTA website. They also expressed concerns about having open access to videos which some may consider graphic. Others believed that this would be an extremely effective way to get the OTA educational content into the hands who need it the most, in the location where the survey identified they are already getting a majority of their online material. The task force acknowledges that L/LMIC surgeons may not be aware of all that the OTA has to offer, and YouTube may be an effective way to introduce our organization's peer-reviewed, high-quality educational offerings. (Public Relations Committee, Video library subcommittee)
5. OTA International Mentorship/Collaboration program - This program would pair a L/LMIC international member with a North American OTA member based on similar identified interests (research, education, case collaboration, exchange program, etc.) for a discrete time. Structure and oversight would be provided by the organization. (Humanitarian Committee, YOTS)
6. Regional Online Courses with local faculty that are resource appropriate - This is already underway. The task force agrees that there is a demand for more of this type of educational programming. (Education Committee)
7. Formal collaboration with other organizations (SIGN, OTA Alliance, Orthopaedics Overseas, etc.) as well as L/LMIC orthopaedic societies to reach more of our international colleagues and promote the OTA brand/educational resources - AAOS list of international orthopaedic societies may be used to solicit submissions for videos, core curriculum, etc. Current OTA members with contacts in L/LMIC countries could be asked to help share details and benefits of OTA membership. We also support actively expanding membership of L/LMIC orthopaedic societies into the International Orthopaedic Trauma Association, which is already underway. (International Relations Committee, Publications Committee, Video Library subcommittee, OTA admin)
8. OTA Online Discussion Forum Community - We propose to set up an additional community for L/LMIC surgeons to be able to present cases applicable to their environments. This would require North American as well as international and/or regional moderators. (Discussion Forum Committee)
9. Use OTA Membership Survey Results - The membership survey produced a valuable database of our members who find global orthopaedics important and are interested in being more involved. The task force proposes that these members be offered the opportunity to participate in the development and implementation of some of the above proposed projects. (Humanitarian Committee, International Relations Committee)
10. Committee Collaboration - The task force recommends that the Humanitarian Committee assist the board of directors in the development and implementation of these projects, working collaboratively with each committee and providing longitudinal follow-up. All of these charges would be added to the Humanitarian Committee agenda and the other relevant committee's agenda to carry forward.

The main limitation of this study is primarily attributed to the low response rate for both surveys. The response rate for the member study was 110/1907 (6%), and it is impossible to calculate the response rate for the international study because of an unknown denominator. It is likely that those OTA members who are most interested in global orthopaedics and who see value in it were most inspired to complete the survey. Similarly, it is likely that by sending the global survey link in an email we are only receiving responses from those surgeons who have access to the internet and are receiving a skewed representation of the needs of this international community.

5. Conclusion

These surveys of the OTA membership and the global orthopaedic trauma community provide a springboard for the development of a more robust collaborative relationship with our global orthopaedic trauma colleagues. It was an attempt to seek out and listen to the needs of surgeons who may be operating and educating themselves in orthopaedic environments very different from those in North America. The demand for high-quality global orthopaedic trauma educational material and collaboration is undeniable, and the OTA is well equipped to provide this. The OTA has already made substantial changes and has implemented programs based on the information obtained by these surveys. There is a continued vast opportunity for improved global involvement, particularly in resource-limited countries.