by David S. Hungerford, M.D.
to the members of the Faculty of the
Johns Hopkins Department of Orthopaedic Surgery

Traditional educational paradigms consist of considerable didactic content delivered live in a classroom setting. Most meetings of societies and Instructional courses also use this format. The method of learning can be characterized as 'vaporware,' since it has been conclusively shown by multiple studies that retention even as soon as the next day is usually in the single digit range (percentage-wise). The traditional method of textbook writing and writing of chapters and articles does produce educational material of substance and durability, but they suffer from lack of availability, i.e., the information is not where you want it when you want it. Even videos and CD's suffer from availability and from the linearity of the content, i.e., you have to pretty much start from the beginning and proceed to the end. In addition, the content is often too elementary for the advanced learner and too advanced for the beginner.

What is required is a methodology that provides just the right educational material at just the right time in just the right amount. It has also been shown that the 'teaching moment' occurs when the individual has the need for the information that is being taught. An example of the forgoing would be a lecture on skeletal dysplasias. It is particularly relevant for the residents rotating through he pediatric service, but not relevant for the residents on the adult reconstruction service. By the time the latter rotate to Pediatrics they are likely to have forgotten what they probably failed to learn in the first place. Furthermore, adults learn best in 'chunks,' i.e., modules or learning objects that are usually no more than 20 minutes long.

There are four levels in the educational hierarchy:

  • Wisdom
  • Knowledge
  • Information
  • Data

There is a logical flow from the lowest to the highest. The problem in developing an educational curriculum that meets the needs of those to be educated is that every person brings a different set of knowledge information and data to the educatinal encounter. Therefore, the formal didactic episode generally consists of a transfer of data and information and very little time spent on knowledge and none on wisdom. Even the bedside or operating room 'teaching moment,' which should be optimal for transferring knowledge and wisdom, suffers because the student does not bring sufficient data and information to the event.

There is a methodology which is becoming increasingly available which has the potential to transform the educational experience, not only for our residents but also for any orthopaedic surgeon who would chose to avail himself of it. It would put our department in the forefront of orthopaedic education and make patients and referring physicians alike think of us when they are looking for a referral place for their complex and difficult patients. It is called computer based, or better, Web-based training, WBT. Imagine what the impact would be if the next time a faculty member presented a paper and a hand-out at a local, regional, national or international meeting, he could say,

   "This presentation will be available at our website,, for the foreseeable future. Please feel free to review it at any time. Moreover, all the presentations of our faculty are available on-line and are searchable by any word that appears in the presentation. So the next time that you have a problem case or a question, please consult our site. If the answer to your question is not yet available, the question will be automatically transformed into an email to our site administrator, and we will try to post the relevant information in a timely way and notify you."

I propose that we, as a department, seek to transform every significant presentation of every faculty member in the department for the next two years into an electronic document that can become a part of the database. In so doing we will launch the department into the next millennium as THE source of orthopaedic education and information in the world. Not a bad place to begin!