Dr. Robert Litchfield

Dr. Robert Litchfield: Teaching by Example

January 09, 2004

Dr. Robert Litchfield is currently the Chair of the Department of Surgery at the University of Western Ontario. In addition to serving on several boards and traveling with the Canadian Alpine Ski Team, Dr. Litchfield exemplifies a commitment to teaching and medical education. He is currently the Director of the Arthroscopic and Orthopedic Learning Centre at the Fowler Kennedy Sports Medicine Clinic, and is also Director of the London Health Science Centre, which hosts hands-on workshops for orthopedic surgeons six to eight times a year. In this interview, he discusses the unique research contributions of his late colleague, Dr. Alexandra Kirkley, as well as his hopes for the future of surgical education.

Body1: At what point in your life did you know you wanted to be a doctor?
Dr. Litchfield:
I had a knee problem in high school—it was OCD, Osteochondritis Dissecans—and I ended up having an operation in my first year of university. It turned out to be one of my current partners who did the operation. Orthopedic surgery seemed to fit my interests: I was interested in science and interested in sports, and the experience of having surgery myself really spurred me on. It was always about being an orthopedic surgeon. I was very interested in the mechanical, practical parts of surgery. If I weren’t an orthopedic surgeon, I wouldn’t be a doctor.

Body1: What do you feel is your greatest contribution to orthopedics?
Dr. Litchfield:
My great contribution has been teaching, I think at the research and fellow level. I really focus my energies on the teaching side of things. I’m now the surgical director for an advanced surgical skills lab at our University, and my mandate is surgical education even beyond orthopedics. It’s a multi-specialty lab we’re developing. It includes general surgeons, urologists, ears-nose-throat specialists, thoracic surgeons: anyone who’s trying to acquire new skills, this lab will welcome. We tend to become very subspecialized in surgery. The lab allows us to cross-breed ideas and technology much better. Our industry—the medical implant industry—tends to choose different specialties, and often creates products that are very specific for a specialty. We don’t share ideas enough.

Body1: Can you give us an example of this kind of cross-breeding between specialties?
Dr. Litchfield:
Definitely the use of devices: different devices that would have more than one application. Unless the surgeon can look at a device and try it in his hands, he doesn’t know whether it might work for him as well. The crossing of specialties has also been very evident in using surgical simulators, using basic skills. There’s a lot of crossover in basic surgical skill from one specialty to another, particularly now that we use endoscopy.

Body1: Your curriculum vitae also shows a commitment to continuing medical education.
Dr. Litchfield:
Clearly, we’re all learning continuously. If a surgeon thinks they’re finished learning when they’re done with their fellowship, they’re mistaken. Technology changes daily. Surgeons need to commit to a career of continuing to learn.

Body1: Are you pleased with the willingness of surgeons to educate themselves, or is this one area where you would like to see changes?
Dr. Litchfield:
I think the motivation of surgeons is a concern. I’m worried the motivation is to be competitive, in terms of the marketing aspect of medicine. I think the motivation needs to be what’s best for patient care, to ignore the headline-grabbing marketing aspect.

Body1: What do you think is your greatest contribution to teaching?
Dr. Litchfield:
I think it has been in the area of shoulder research. I think that there are more people who are not as comfortable operating on the shoulder, so it was easier to move people up the learning curve in the shoulder lab. I think general training for shoulders has been deficient in the past. Shoulder injuries were not front and center because we were less able to fix things.

Body1: So you think that’s improving?
Dr. Litchfield:
Body1: Is it a result of new techniques, or new technology?
Dr. Litchfield:
Both. New techniques; new technology; surgeons becoming more confident and competent with the shoulder.

Body1: Can you tell us a little bit about your current research interests?
Dr. Litchfield:
We do much in research. Our unit is very strong in randomized clinical trials. Most of our research is clinical, and that was based on the leadership of our colleague, Dr. Sandy Kirkley, who died tragically in a plane crash just over a year ago. She’s being honored with a research center and chair in our University. Her influence is very strong in a number of research institutions: she was the chair of the Scientific Committee of ISAKOS (the International Society of Arthroscopy, Knee Surgery, she was on the AOSSM Research Board; and she initiated a group in Canada called Joint Canada, which is initiating multi-center randomized clinical trials. Those efforts have now gotten a lot of people doing those randomized multi-center clinical trials, and that’s what’s going to answer the major questions in orthopedic medicine. She was certainly a leader in orthopedic clinical trials, and we’ve carried on that tradition.

Body1: For our readers who might not understand the significance of a "randomized" trial, can you explain this concept in layman’s terms?
Dr. Litchfield:
A randomized trial randomly assigns patients to two different treatments, without knowing which treatment is better, and then assesses the effectiveness and outcome of those two different treatments. Randomization removes bias from the patient or from the surgeon as to which treatment is better.

Body1: If you could bring about one positive change in your specialty within the next five years or so, what would it be?
Dr. Litchfield:
That we allow our trainees to start operating with a greater degree of skill when they’re in the operating room, and to create an efficient mechanism for active surgeons to upgrade their skills.

Body1: Do you think those changes are on the horizon?
Dr. Litchfield:
Yes, very much so. I think there’s a huge swing in how we teach operations, how we evaluate the success of operations, more scientifically. I think the momentum is enormous right now. I think we are seeing these changes already. We’re seeing many surgical societies around the world adopting policies to make sure their membership are current in terms of their skill level. We’re certainly seeing a greater number of fellows learning skills outside the operating room, in a lab environment, so that they’re safe, they’re efficient with a valuable resource, and they’re proficient with new technologies before a patient is subjected to their skills.

Body1: In the past, surgeons were doing their learning on the patients, so to speak; is that correct?
Dr. Litchfield:
That was always the model: see one, do one, teach one. It was always you learning on the patient. There are a number of surgical simulators that are very useful now; it’s a large growth industry, surgical education research.

Body1: For our readers who may be looking for an orthopedist, how would you recommend they find a good one?
Dr. Litchfield:
I think it’s still word of mouth. I think they should look for people with subspecialty training in the area in which they may have problems; that is helpful. I think the primary care givers, like physical therapists, are excellent resources in judging the quality of the surgeon.

Last updated: 09-Jan-04

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