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Day #25 – Salt Lake City, UT & Denver, CO – October 18

Our last morning in Salt Lake City with the University of Utah crew, and we were up early for our last series of academic presentations for the 2017 NATF tour. We were met by Dr. Tashjian and Dr. Gililland who kindly transported us to Spencer F. and Cleone P. Eccles Health Sciences Education building where we delivered our talks in the Dr. Claudius Y.  and Catherine B. Gates Lecture Hall. We were met by a large, enthusiastic crowd of medical students, residents, researchers and attendings who had come from several sites to hear us speak and we felt very welcome indeed!
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After a kind introduction of the AOA and NATF tour, Christina led off, one last time, with her talk on her perspective on the American healthcare system. With many surgeons in the audience who have traveled to Canada and have Canadian colleagues, her concise review of the differences between the two health care environments in which orthopaedic surgeons are working was well received!
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Mac followed next with his excellent presentation on creating value beyond the operating room and how, in a very short time, he has led a team at UPMC, to introduce and transform the collection of patient reported outcome measures to improve care and reduce costs. As the Utah Department of Orthopaedics has also been working on this, they were extremely interested in what he had to say and listened with rapt attention!
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Scott was the third presenter, delivering his talk on upper extremity war surgery for the final time. As always, the audience was shocked by the violence of the IED explosion Scott presented to set the stage for his presentation, and his talk was extremely well-liked by the group. It was excellent as always and we continued to be impressed by the outcomes he and his team can achieve for these amazing patients.
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Next up was Brian, as always lamenting the fact that he had to follow Scott’s excellent talk, but nonetheless, doing a great job presenting his approach to treatment of irreparable rotator cuff tears with superior capsular reconstruction. He did a wonderful job summarizing the literature and outlining the results of his research and we all learned something new again! We particularly liked his addition of his photos with his lovely wife skiing in Park City during his residency rotation in Utah!
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Lastly, closing out the academic portion of the 2017 NATF tour was our “keynote speaker” Dr. Ravi! Bheesh did a fantastic job delivering his controversial talk on the impact of overlapping surgery on outcomes of hip fracture surgery and total hip replacement. This segued beautifully into a group Q&A period focusing primarily on outcomes, value and the role that surgeons should be playing in the changing healthcare environment to improve care delivery and surgical outcomes for our patients.
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After finishing the talks and Q&A, we were presented with a lovely parting give by Dr. Brodke and took the opportunity to take our group photo with our great host Dr. Tashjian and the leaders of the Orthopaedics Department Dr. Saltzman and Dr. Brodke. We were then transported back to the hotel, and after saying our final goodbyes, packed up our belongings and boarded an Uber to the SLC airport for our trip to Denver.
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We arrived safely at the airport and after getting through security without difficulty, with Mac stopping at FedEx to ship some gifts home to his ladies, we boarded the plane on-time for the easy 1 hour 20 minute trip to Denver. Despite being warned there might be some turbulence on our final descent, the trip was easy and painless, and the clear sunny skies offered a beautiful view of the eastern foothills of the Rocky Mountains as we arrived!
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After collecting our luggage and boarding our shuttle, we traveled to our hotel and met Department of Orthopaedic Surgery administrator Ellen Bagwell, who had been instrumental in arranging our trip. She presented us with a lovely welcome gift, including CU Orthopaedics sunglasses, a water bottle and earphones! As a result of bad traffic between Denver and Boulder, we decided not to make the drive for lunch, instead walking across the hotel parking lot to a local restaurant, The Kitchen Next Door. The food was great and we had the opportunity to learn about the health system and department structure from Ellen, and Christina took the chance to try out her new sunglasses in the beautiful afternoon sunshine!
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After finishing lunch, we returned to the hotel for some rest, relaxation, work, and Scott and Brian went for a run (with Brian now taking the chance to wear his sunglasses!) At 5:45 we grabbed an Uber to the home of Professor and Department of Orthopaedics Vice Chair Evalina Burger’s home for a casual dinner of some great BBQ with several of the faculty. It was a beautiful evening to sit out on the back patio and we enjoyed each other’s company, as well as her home filled with mementos from her numerous South African hunting trips, immensely. We got to meet Dr. Robert D’Ambrosia, the longest running consecutive Chair in Orthopaedic Surgery. It was a memorable night and we liked getting to know the group in such a relaxed environment.
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After saying our goodbyes, we made our way back to the hotel, and, as it was the last night we would all be together, we took the opportunity to celebrate the success of the tour by sitting on the patio around the fire pit reminiscing over the last four weeks. We discussed everything we had learned, what we are going to take back to our practices and what we hoped to do differently as we continued on our paths moving forward. It was an awesome way to end the evening and highlighted how close we have become over the last four weeks. We had quickly become fast friends and will likely stay that way in the future.
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Day #24 – Salt Lake City, UT – October 17

Day #2 in Utah, and we were at the University of Utah Orthopaedic Clinic by 7 am to have a nice hot breakfast and then divide up again for a morning of clinic with our respective subspecialty providers. Scott spent the morning with Dr. Hutchinson in the operating room where he observed the complicated surgical care of a multiply operated on elbow to improve range of motion. They then moved on to a procedure known as a Swanson arthroplasty for a patient with rheumatoid arthritis. It was an enjoyable morning and he learned a lot!

Mac spent time in clinic with Dr. Charlie Saltzman. It was a great experience for him, and there was great a variety of pathology and symptomatology among the patients they saw. In particular, there were a number of complex cases that Mac had the opportunity to evaluate with Dr. Saltzman, and he also really enjoyed talking with this master Foot & Ankle surgeon about his approach to total ankle replacement design and indications.

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After a observing the difficult revision shoulder replacement yesterday, Brian took the plunge into Dr. Tashjian’s challenging shoulder & elbow clinic. Their discussions covered a wide breadth of topics, including periprosthetic infection, total elbow arthroplasty, and distal biceps reconstruction, and he even extended Brian a courtesy copy of his textbook on the unstable elbow! Brian then to Dr. Burks’ clinic to revisit their earlier discussions regarding high tibial osteotomy and allograft ACL reconstruction with inside out meniscal repair. As the former lead of the Metcalf Conference, Dr. Burks always has an ample supply of pearls and insights that he is more than willing to share!

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Bheesh had the chance to spend the morning in the OR with Adult Reconstruction surgeons Dr. Jeremy Gililland and Dr. Chris Peters. They both had very interesting cases, including a total knee replacement complicated by retained hardware after trauma. Bheesh was particularly impressed by Dr. Gililland’s willingness to show off his fashionable sterile vest that he wears in the OR, though we’re not sure Bheesh will be taking this particular practice back to Toronto until he sees the evidence in support of this practice : )

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Finally, Christina had the awesome opportunity to join Dr. Brodke and Dr. Lawrence in the clinic at the UUOC. Before clinic started, she took the opportunity to catch up on the blog and then Dr. Brodke gave her a tour of the beautiful facilities, including the administrative floor, research space, housing both basic science and biomechanical research capabilities, physical therapy space with therapy pool, operating rooms and clinic. She felt very at home given the design similarities between UUOC and her own Missouri Orthopaedic Institute! Clinic was a great experience as she moved between the two providers, getting to see an awesome selection of complex spinal pathology, both preoperative and postoperative, and discuss varying techniques for spinal realignment and reconstruction and complication management!

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After finishing up our clinical time for the day, we reconvened at the hotel and met Dr. Steve Aoki, Sports Surgeon, and Dr. Tashjien for the scenic drive to Park City, a beautiful ski resort town. On the way, we passed the Utah Olympic Park, site of the 2002 Winter Olympic bobsled, skeleton, luge and ski jumping events, where according to Dr. Aoki, people now think it’s a good idea to go down the ski jump in large inner tubes in the winter! Seems our trauma and spine surgery colleagues at UU won’t go out of business any time soon…

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Upon arriving in quaint Park City, we made our way to High West Distillery & Saloon where we partook in some delicious snacks and beverages and got to know Dr. Aoki and Dr. Tashjian better. It was a great place to chill out and chat about the area, and we had a lot of fun!

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Once we finished our late “lunch”, we took a tour of the lovely downtown, stopping intermittently into some shops to peruse the wares, with Christina and Mac making a new, albeit inanimate, friend. The highlight by far was the Burns’ Cowboy Shop, where Mac found some great boots for his adorable 2 and 4 year-old daughters, and Christina resisted dropping some hard-earned spending money on a beautiful pair of goat leather boots which she was sure her residents would have loved : )

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After returning to SLC, we made a quick pit stop at the hotel to change into more dinner-appropriate attire, then headed out to Current restaurant, a great seafood place, to have dinner with Drs. Tashjian, Aoki, Spina, Gililland and Tyser. The food and drinks were fantastic, as was the atmosphere and we enjoyed spending time with each other and the group. Unfortunately Dr. Lawrence was not able to join us, despite chauffeuring us to dinner, because of a scheduling conflict with a conference call. It was the nicest, and cheapest, Uber ride we’ve had the entire trip!!!

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Calling it a night around 9pm, we headed back to the hotel with Drs. Tashjian and Spina, and turned in to start packing and get ready for our last round of academic presentations at the next morning’s Orthopaedic Surgery Grand Rounds.

 

 

Day #23 – Salt Lake City, UT – October 16

Our first day in Salt Lake City saw us starting bright and early and dividing up to attend clinics and OR’s at the two sites for Orthopaedic Surgery, the University of Utah Hospital and the University Orthopaedic Center. Christina traveled to the main hospital where she attended the OR with Dr. Brodke as Welland his partners, and her friends from AOSpine North America, Dr. Brandon Lawrence and Dr. Ryan Spiker. While the cases were getting set up Dr. Brodke gave her a tour of some of the hospital, including the beautiful “sky lounge” for attending physicians, complete with sleeping spaces, work rooms and even a treadmill desk, and later they had lunch in the beautiful Point restaurant at the cancer center with almost 360 degree views of the valley! She attended a variety of different surgeries, big and small, cervical and thoracolumbar, and picked up a number of great practice pearls to take back to Missouri!
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MaC spent the day in the OR with Dr. Tim Beals, Associate Professor and Foot & Ankle surgeon, at the Orthopaedic Center. They had a great list of day surgery of cases including a syndesmosis case and lesser toe reconstruction. They also had the chance to have an extensive discussion about the management of syndesmosis injuries in the presence or absence of fracture, particularly that associated with suspensory versus screw fixation. Furthermore, they had discussions regarding efficiencies in the operating room and the evaluation of cost as it ties to clinical outcomes.
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Scott had the opportunity to observe Dr. Doug Hutchinson, Professor of Hand and Microvascular Surgery and Director of the Utah Hand Surgery Fellowship, do three quick elective cases prior to the start of his clinic with wide awake hand surgery. It was a great experience and hopefully something he will be able to implement when he returns home. He then spent time with Dr. Nick Kazmers, another also a Penn fellow and hand and upper extremity surgeon, doing a complex upper extremity procedure involving the bones and nerves. In the afternoon he went for a run in the beautiful neighborhoods around the hotel.
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Brian spent the morning in clinic with Professor and Sports and Upper Extremity Surgery pioneer Dr. Bob Burks discussing AC joint injuries, failed Latarjet procedures, and ACL reconstruction.  He then watched Dr. Pat Greis, also a Professor and Sports surgeon, perform a complex knee ligament surgery on a high level athlete, followed by a complex revision shoulder procedure by Dr. Tashjian. It was a busy, and extremely useful and educational day with all the experiences spawning incredible conversations and extensive Q & A sessions.
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Bheesh spent the morning at the VA hospital with Dr. Jeremy Gilland, a mechanical engineer and adult reconstruction surgeon. They discussed the advantages of gap balancing over measured reduction, as well as the differences between the VA and other hospitals. Bheesh then spent time with Dr. Chris Pelt, tenured Associate Professor and adult reconstruction surgeon, in his clinic and also had a very productive meeting with Dr. Brook Martin, an epidemiologist and Research Associate Professor in Orthopedics with an adjunct appointment to Population Health Sciences. They had an extensive discussion regarding Dr. Martin’s extensive experience with randomized controlled trials and large database studies.
After making our way back to the hotel following our clinical experiences, we met Dr. Tashjian and Dr. Ryan Spiker, from the Spine Surgery service, to travel to a fantastic dinner at Pago, a great little restaurant with awesome menu. We were joined by Dr. Charles Saltzman, Chair if Orthopedic Surgery and Director of the American Board of Orthopaedic Surgery, Dr. Bob Burks, Professor and Sports Medicine and shoulder surgeon, and Dr. Alan Stotts, Associate Clinical Professor and Pediatric Orthopaedic surgeon. We thoroughly enjoyed the atmosphere, food and conversation. After dinner, we walked across the street and enjoyed gelato for dessert at Dr. Saltzman’s recommendation, which was a great one!
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We then returned to the hotel for a brief powwow in the hotel restaurant, discussing our experiences during the day, as well as enjoying a heated conversation between Scott and Bheesh regarding vascularized fibula grafting for avascular necrosis of the hip. We turned in just after 9pm to catch up on some sleep and prepare for another jam packed day.
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Day #22 – Los Angeles, CA & Salt Lake City, UT – October 15

Day #22 of our trip was fairly relaxed compared to most as it was a travel day without any daytime scheduled events. We had the opportunity to sleep in a little bit as our flight did not leave LAX until 11:05 am. Meeting up at the airport, we had breakfast and talked over our visit with the UCLA and Cedars-Sinai groups. We had a brief chuckle over our Southwest boarding positions for the flight as poor Scott was with the C group despite the fact that he had reminded us all to check in at 10 am the day before! After boarding the plane and settling into our respective seats, we took off without event and said goodbye to the beautiful city of L.A.

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The 1 hour and 20 minute flight to Salt Lake City was a pretty painless one and, with no clouds in sight and the sun shining, treated us to some beautiful views of the city nestled in the mountain valley as we descended prior to landing.

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After landing and quickly collecting our bags, our third try at transportation to the Marriott hotel right near the University Orthopaedic Center worked like a charm – the first shuttle company we had been booked with went bankrupt a few weeks prior and failed to inform the department’s administrative staff, and we abandoned the second shuttle we reserved when they attempted to fit all five of us and our luggage, plus an additional passenger, into a minivan and the somewhat unfriendly driver refused to let us assist him with Tetris-ing our luggage into the bag of the van despite the fact that we had done it about a dozen times during the trip! So, Uber it was, and a very comfortable 20-minute extended SUV ride later, filled with lots of laughs over the shuttle issues, we arrived safe and sound at the hotel : )

With some time to kill before dinner, Brian and Scott took the opportunity to go for a run in the hills around the hotel and enjoy the exquisite scenery and the rest of us caught up on some work and blogging. Then, at 5:45 we were met by our local host Dr. Robert Tashjian, Professor of Orthopaedics and Shoulder & Elbow surgeon, as well as third year resident Travis, who transported us to the fantastic restaurant the Copper Onion. We were joined by Dr. Darrel Brodke, Vice Chair of Orthopaedic Surgery and Director of the Division of Spine Surgery, a friend of Christina’s since her first fellowship, spine fellow Dr. Jeremy Shaw and another one of the PGY3 residents. It was a great dinner and we had a great time getting to know one another.

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After returning to the hotel, the five of us visited the hotel restaurant to discuss the day and continue our dinner conversations about work-life balance, and shared with each other our thoughts about hobbies, family and personal time, and the ways we try and make these things a priority with our busy schedules. Again, there were lots of laughs, and there also seemed to be some collective relief as we realized we aren’t alone in our struggles with this important issue! We turned in around 11pm, looking forward to a great day of clinical observation with the Utah faculty.

 

Day #21 – Los Angeles, CA – October 14

After a great night out on Friday, we were up early Saturday morning to meet Stacey at 7:30. Fortunately, Mac was up the earliest and had already made a Starbuck’s run! We hopped in the van and traveled to the home of Chair of the Department of Orthopaedic Surgery at Cedars-Sinai, Dr. Mark Vrahas, where we were treated to a lovely breakfast on his beautiful back patio. We were joined by several of the faculty, including Dr. Kremen, and really enjoyed our laid-back visit with the team, taking the opportunity to learn more about their practices and the Cedars group.

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After finishing breakfast and traveling back to the guest house around 11 am, we had some free time before our afternoon events. Bheesh and Christina both took the opportunity to see family who lived in the area and who had traveled to L.A. to see them after being away for three weeks. Mac ran some errands and got a haircut, preparing for his return home. Brian and Scott caught up with family via phone and went for a run as well.

At 3 pm we then made our way to the California Science Center parking lot to meet Dr. Vrahas and Dr. Dave Thordarson, Foot & Ankle surgeon and Director of Orthopaedic Research, as well as his incredibly welcoming family for tailgating prior to the USC vs. Utah football game at the incredible Los Angeles Memorial Coliseum. It was a beautiful day and Dr. Thordarson’s family couldn’t have been nicer to us, inviting us to share their food and drinks and entertaining us with stories about the school. Scott took only a little ribbing for his look of disappointment when Navy lost to Memphis, and Christina was very happy that her husband had been able to come out for the weekend and had joined the group for the game.

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After cleaning up the tailgate, we headed into the stadium to find our seats for the game. It was a fantastic atmosphere, with over 72,000 people in the stadium! USC was playing fairly well, but by half-time it appeared as if Utah would win handily. Fortunately, after clearly regrouping in the locker room, the Trojans were able to turn it around, with sophomore quarterback Sam Darnold leading three long scoring drives to take the lead, turning the game into a nail-biter. With 42 seconds left, the Trojans defense was able to stop Utah’s final attempt at a 2-point conversion to hold onto their 2-point lead, defeating the Utes 28-27!

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Buoyed by the win, we then made our way home to get some sleep after our jam-packed 2-day tour of L.A. with the amazing UCLA and Cedars crews. It had been a great, albeit quick, visit, and once again we were sad to have to leave so quickly the next day.

Day #20 – Los Angeles, CA – October 13

Rising early after a good night’s sleep in our cozy AirBnB house and guest house, we prepared for the day and were met by Stacey at 7 am, who had kindly arrived with a Starbucks order to help us wake up! We then traveled to the Luskin Conference Center at UCLA where we met several of the distinguished faculty for a relaxed breakfast in the adjoining restaurant. With some time to spare before conference started, we took half an hour to perfect our presentations, catch up on emails and load photos to our 2017 NATF Dropbox folder.

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Starting promptly at 8:30, we were given a warm welcome by Dr. Jeffrey J. Eckardt, well known Orthopaedic Surgical Oncologist and former Chair of the Department of Orthopaedic Surgery. Christina then introduced the group to the “geography” of the 2017 NATF tour, taking them through the sites we had visited since arriving in Vancouver on September 24. She then followed with her presentation on her perspective on the American health care system which was quite well received by the group.

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Mac was next with excellent introduction to “Creating Value Beyond the Operating Room” which the group also enjoyed. For both of the first two presentations it was clear, based on the number of hands going up during the brief Q&A periods, that the topics of health care reform, quality and value are at the forefront of the minds of the faculty. The questions were excellent and resulting discussions high-level!

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Dr. Kris Jones, Orthopaedic Sports surgeon, then gave us a great presentation on osteochondral allograft transplantation and the investigations he and his team have been conducting to identify ways to expand graft availability while preserving clinical outcomes. His series of elegant investigations clearly demonstrated that the use of available lateral femoral condyle allografts are acceptable for patients with medial compartment osteochondral defects of the knee and we were all very impressed by his work!

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After a short break, Scott then delivered his talk on upper extremity war surgery. As always, he did a great job explaining his clinical and academic work, and appeared very humbled to receive a heartfelt thank you from one of the audience members for his service in the Navy and dedication to providing exceptional care to America’s wounded military personnel.

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Dr. Nick Bernthal, a rising star in the orthopaedic oncology world, then gave us an amazing introduction to “The Wild West of Personalized Medicine” and the groundbreaking work he and his team are doing related to individual tumor biology for targeted second-line chemotherapy as well as orthopaedic infections. He also highlighted the importance of leveraging the connections we have made, and will continue to make, during our tour into research collaborations, something we all hope to be able to do in the future.

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Brian followed with his discussion of superior capsular reconstruction for irreparable rotator cuff tears, which seemed to be a somewhat more controversial topic than at other centers where he had given this talk. The audience had several questions regarding the technique, but he handled them with ease and did the group proud!

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Next came Bheesh, discussing the cardioprotective effect of total joint arthroplasty, again a stimulating topic based on the questions and discussion. Perhaps it had to do with the different patient population on the west coast compared to those at our centers…but as always Bheesh’s explanation of the meaning of his study’s results was impressive, and his mastery of the details of the statistical analysis and limitations of the his study were not lost on the audience.

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Last but not least, Dr. Bernthal provided us an introduction to the unique 2-year, NIH-funded research fellowship program available at UCLA. It provides an amazing opportunity for orthopaedic surgery residents, and other trainees, to gain experience in conducting basic science research and he was happy to report that the funding for the program had been renewed for another 5 years, an amazing achievement!

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Having completed the academic program, we were then presented with a lovely gift of UCLA hats by Dr. Eckardt, and then got our group photos with, and without, the hats!

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Next, Dr. Bernthal took us on a quick walking tour of the surrounding UCLA campus and athletic facilities. We were particularly impressed by the Athletic Hall of Fame and the basketball/volleyball arena which was state of the art! The weather was beautiful and it was awesome to be surrounded by all the students. It gave the atmosphere a great energy which we hadn’t had the opportunity to experience on any of our other stops.

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Stacey then returned to pick us up for a short trip to the Cedars Sinai Medical Center, where we arrived at the Winnick Family Clinical Research building to have a delicious lunch with several of the senior residents and Dr. Guy Paiement, former 1987 NATF cohort member and Residency Program Director. After lunch we attended an afternoon academic conference, where Dr. Paiement introduced us to the group, and also shared with us a walk down memory lane from his NATF tour, after which we delivered our second presentations of the day, which, fortunately, were the same as the morning talks.

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Interspersed between our talks, we had the pleasure of listening to several excellent presentations by members of the Cedars team, including PGY3 resident Dr. John Garlich who spoke on his pilot randomized controlled trial of the novel use of virtual reality for pain control in orthopaedic surgery patients (see pic below!). A fascinating concept and we will be looking forward to seeing the final results once the study is completed!

Next was Dr. Melodie Metzter, who introduced us to her animal model of type II diabetes and how she is using it to understand the impact of diabetes on bone metabolism and lumbar spine fusion. Christina was particularly interested on this topic given her preliminary investigations on the impact of Vitamin D and outcomes of spine surgery (not to mention the paucity of lectures we had heard related to the spine!).

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PGY5 resident Dr. Sean Rajaee then shared with us his examination of the increasing rates of revision total hip arthroplasty and indications for this using the HCUP Nationwide Inpatient Sample. It was an excellent talk with provocative findings that generated some great discussion among the fellows and faculty regarding surgical indications and implant choice.

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After this, Dr. Carlos Uquillas, a recent addition to the Cedars-Sinai affiliated Kerlan-Jobe Orthopaedic Clinic delivered his talk entitled “Anterior Cruciate Ligament: Repair Revisited”. Again, this somewhat controversial topic led to a lot of discussion among the faculty and Brian in particular.

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Lastly, Dr. Tom Kremen introduced us to his work on enhancing ACL graft incorporation using novel minimally invasive activation of endogenous stem cells, a great summary of his investigations into a way to decrease issues related to tunnel widening after ACL reconstruction.

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After returning to the guest house to rest for a little bit and allow Brian and Scott to get in a quick run, we all got changed for a night out with Dr. Bernthal and a great group of the UCLA faculty including Dr. Nelson SooHoo (Foot & Ankle), Dr. Rickn Bowen (Pediatrics & Sports Surgery), Dr. Kris Jones (Sports Surgery), Dr. Don Park (Spine) and Dr. William Oppenheim (Pediatric Orthopaedics) and Dr. Alex Stavrakis (Arthroplasty). We started at Chateau Marmont, the castle on the hill which has hosted the likes of Jim Morrison, John Lennon & Yoko Ono, F. Scott Fitzgerald, Heath Ledger and John Belushi, for an amazing dinner and conversation. Despite not seeing any celebrities that we aware of, Christina in particular, was thrilled to have had the opportunity to visit this iconic locale.

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After finishing dinner, we walked a short distance, continuing our conversations along the way, to the legendary Comedy Store, “the greatest comedy club in the world”. Founded on April 7, 1972 on Sunset Boulevard, it was the first all-stand-up comedy club in the world. We were treated to excellent seats in a cozy corner booth in the main room, and got to see some incredible acts, including Chris D’Elia, who has starred in dozens of movies and TV series including Chicago Hope and Whitney. We laughed like crazy and had a great time with the UCLA team.

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Calling it a night around 12:30 am we caught an Uber back to the guest house and turned in to catch some shut-eye before a 7:30 am pick-up for breakfast and a leadership discussion with the Cedars faculty. It had been a long day, but a great one and we were looking forward to a great time on Saturday.

 

 

 

Day #19 – Palo Alto, CA & Los Angeles, CA – October 12

Our last day in Palo Alto, and we were able to sleep in a bit, getting picked up at 8:30 by the guest house shuttle to travel to the Stanford Medical Center for a tour of the Stanford Byers Center for Biodesign. After joining Dr. James Wall, a Biomedical Engineer and Pediatric Orthopedic surgeon, as well as an alumnus of the biodesign fellowship, we walked a short distance to the beautiful building and were all incredibly impressed by the facilities. He explained the intensive curriculum involving clinical observation, intellectual property development and marketing. The output of the program over the last 15 years has been incredibly impressive, with at least 150 patents being filed and more than 40 start-up companies being founded based on work by the graduates of the program!

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We then returned to the Stanford Medical Center and were met by PGY5 Orthopaedic Surgery resident Dr. Tyler Johnston, who was kind enough to take us on a tour of the hospital campus and take us to the Lacob Family Sports Medicine Center for a tour of their facilities. Dr. Calvin Hwang, a primary care Emergency and Sports Medicine physician, educated us about center where a multidisciplinary team of primary care sports physicians, orthopaedic surgeons and physical therapists care for more than 900 student athletes on more than 30 collegiate teams. Nestled at the center of the training facilities for the Stanford varsity teams, the center is well positioned to provide rapid, exceptional care to the athletes and get them back to play as quickly and safely as possible.

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Next, after saying goodbye to Dr. Hwang, we traveled back to the Stanford Visitors’ Center and briefly joined a walking tour, before realizing that Tyler had done such a great job of showing us around there was no need to continue. Instead, we decided to ascend the historic Hoover Tower, a 285 foot tall structure completed in 1941 which houses the Hoover Institution Library and Archives, as well as a small museum dedicated to its namesake. The views from the observation deck of the hospital and Stanford campus were spectacular despite the smoke, and amazingly enough, it was even Tyler’s first time to the top!

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We then stopped for lunch at a great restaurant on campus, Vino Enoteca, before returning to the guest house to collect our luggage and hop in our cars for a trip to the airport. Though we took off from San Jose airport a little bit late, we arrived in Los Angeles without incident, and the views out of the airplane windows were beautiful as the sun was setting. We were met by Cedars-Sinai orthopaedic surgery residency program coordinator Stacey Wilson, who graciously transported us to our lovely AirBnB accomodations, where we enjoyed a great meal and some relaxing time watching TV as a group before turning in to prepare for a busy academic day at both UCLA and Cedars-Sinai.

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