AAOS Now Podcast

In this episode of the AAOS Now Podcast, host Doug Lundy, MD, MBA, FAAOS, sits down with two guests who offer differing perspectives about the American Board of Orthopaedic Surgery (ABOS) Knowledge, Skills, and Behavior (KSB) Program.

David F. Martin, MD, Executive Director of the ABOS, offers the board's perspective on why the Knowledge, Skills, and Behavior (KSB) Program exists, why it is now required, and where it's headed; Ellen Lutnick, MD, a PGY5 at the University of Buffalo and chair of the AAOS Resident Assembly Executive Committee, shares her experience of living with the program day to day.

Together, they trace the KSB Program from its 2018 launch through its 2025 requirement for residents entering the ABOS Part I exam pathway.

Dr. Martin explains that the program grew out of decades of interest in competency-based medical education and a recognition that time alone doesn't guarantee a resident has developed adequate orthopaedic knowledge, surgical skill, and professional behavior. He walks through why the ABOS made participation mandatory, how the program integrates with ACGME case logging, and the distinction between formative feedback – meant to help residents improve – and summative feedback, like board exams, that produces a pass or fail outcome.

Dr. Lutnick describes how the program was rolled out at Buffalo, what it's actually like to request feedback after or before a case, and how she's learned to be strategic about which cases to submit for evaluation. She also speaks candidly about receiving feedback she disagreed with, how professional behavior assessments surface blind spots, and what other residents have told her they would like to see change about the KSB Program.

The conversation closes with a look at where the program might go next, including whether the ABOS will eventually tie participation to specific performance scores rather than just completion numbers. Dr. Martin encourages residents to reach out with feedback so ABOS can continue to make the assessments even more helpful and easier to incorporate into a resident’s busy schedule.

Key topics covered in this episode:

The origins of the KSB Program and its roots in competency-based medical education

Why the ABOS chose to make KSB participation a requirement for the Part I exam

Integration between the ABOS case entry system and the ACGME

The difference between formative and summative assessment in residency training

Strategies to help residents decide which cases to submit for surgical skills evaluation

How professional behavior assessments are designed to identify outliers rather than track linear growth

The role of verbal vs. written feedback in resident education

Resident perspectives on receiving and processing critical feedback

Survey fatigue and efforts to streamline the evaluation process

What residents want to see improved, including access to individual professional behavior results

Where the program may be headed, including the possibility of performance-based scoring requirements

Residents starting to navigate the KSB Program will find real value in hearing how a peer has learned to use the tool strategically, not just to meet a requirement, but to actively shape the feedback they receive.

Host: Doug Lundy, MD, MBA, FAAOS, Deputy Editor, AAOS Now; Chair, AAOS Now Podcast Workgroup

Guests: David F. Martin, MD, Executive Director, American Board of Orthopaedic Surgery; Professor, Orthopaedic Surgery and Rehabilitation (Winston-Salem), Wake Forest University School of Medicine

Ellen Lutnick, MD, Chair, AAOS Resident Assembly Executive Committee; PGY5 and Resident Research Coordinator, University of Buffalo Department of Orthopaedics and Sports Medicine

In this episode of the AAOS Now Podcast, host Ahmed Emara, MD, speaks with Nathan Mesko, MD, FAAOS, to explore the limits of orthopaedic surgery and the difficult decisions surrounding “heroic” measures.

Dr. Mesko draws on 13 years of experience in orthopaedic oncology and joint reconstruction to unpack what "heroic" really means in surgery. He argues that heroism has less to do with technical difficulty – ”can I perform this procedure” – and more to do with what a patient is being asked to endure to reach a surgeon's envisioned outcome.

Throughout the conversation, Dr. Mesko returns to a central idea: Surgical capability should always be outpaced by wisdom. He walks through how to recognize when the push toward a heroic operation is being driven by the surgeon rather than the patient, and he offers concrete techniques for having honest, humane conversations with patients around amputation, cancer diagnoses, and end of life. He also discusses the emotional toll of these decisions, including guilt, escalation of commitment, and how surgeons can build the humility and self-forgiveness needed for a sustainable career.

The episode closes with a personal story that illustrates why staying present with a patient and not turning away from them, even after a frustrating conversation, can matter even more than the surgery itself.

Key topics covered:

Defining "heroic" measures in orthopaedic surgery and how that threshold shifts over a surgeon's career as the surgeon matures, including the evolution from saying "yes" to every procedure to knowing when to say "no”

The challenges of actually getting informed consent for maiming or life-altering procedures, such as sacral resections and proximal femoral replacements, given the challenge of explaining to patients how much the procedure will impact their daily life

Recognizing when surgical momentum is being driven by the surgeon rather than the patient, including escalation of commitment and the sunken cost fallacy in surgical decision-making

The value of physically equalizing the conversation, such as pulling up a chair and sitting down rather than towering over the patient, to build trust and openness

The importance of listening to patients before recommending treatment options to ensure that the treatment aligns with the patient’s goals and personal wishes

Strategies for guarding against unnecessary repeat interventions, including peer consultation and pausing after setbacks

Rethinking success in orthopaedics beyond X-rays and implant longevity, including patient-reported outcomes

Managing surgeon guilt, self-forgiveness, and separating outcomes from the integrity of the decision-making process

The importance of never leaving a patient without a clear next step or follow-up plan

Listeners are encouraged to reflect not only on how they operate, but on how and why they decide to operate at all.

Host: Ahmed Emara, MD, member, AAOS Now Editorial BoardGuest: Nathan Mesko, MD, FAAOS, Vice Chair of Global Clinical Operations, Center Director for Orthopaedic Oncology, and Associate Professor, departments of Orthopaedics (Integrated Surgical Institute) and Hematology/Oncology, Cleveland Clinic

In this episode of the AAOS Now Podcast, host Stuart J. Fischer, MD, FAAOS, speaks with two leaders in orthopaedic data science about how physician-controlled registries are transforming outcomes measurement, implant evaluation, and clinical decision-making. From the early vision of a national joint replacement registry to a new real-time data partnership with Epic, the conversation traces how far the registries have come and where they are headed.

Drs. James Huddleston and Steven Glassman share concrete examples of how registry data is driving practice change. They also address how the data supports Clinical Practice Guidelines and research, why surgeon and patient information is protected from outside access, and what the integration of AI and patient-reported outcomes means for the next generation of orthopaedic registries.

Key Topics Covered in This Episode:


Origins and goals of the AAOS registry portfolio: How orthopaedic surgeons built a physician-controlled data infrastructure to protect procedures and drive evidence-based care


Data sources and infrastructure: AJRR's use of hospital and ASC submissions, Medicare claims for complete follow-up on Medicare patients, and a new Epic Community Registries partnership for real-time data capture


Registry scale and participation gaps: Why AJRR has surpassed five million procedures while spine, shoulder and elbow, and musculoskeletal oncology registries are still building volume


Real-world clinical impact: How AJRR data has influenced cementless knee adoption, robotics use in unicompartmental arthroplasty, and the growth of triple-tapered femoral stems in hip replacement


Research and CPG applications: How the Registry Analytics Institute supports physician-led and industry-sponsored research, with strict controls on data dissemination


Patient-reported outcomes: The longstanding role of PROMs in spine and the challenges of scaling PROM collection for hip and knee under new government mandates


Data privacy: Why registry data remains de-identified and inaccessible to insurers and government agencies, and what individual surgeon dashboards can offer


International comparisons and ISAR: How AJRR benchmarks against registries in England, Wales, and beyond, and why U.S.-specific data remains essential


AI and the future of registries: How AJRR is piloting AI-powered EHR extraction to improve data completeness without human intervention

About Our Guests:

James Huddleston III, MD, FAAOS, is Professor of Orthopaedic Surgery at Stanford Hospital; Co-Chair of the AAOS Registry Oversight Committee; and Chair of the American Joint Replacement Registry Steering Committee

Steven D. Glassman, MD, FAAOS, is Professor of Orthopaedic Surgery at the University of Louisville School of Medicine; Medical Director at the Norton Leatherman Spine Center; Chair of the AAOS Registry Oversight Committee; and past Chair of the American Spine Registry Executive Committee

In this episode of the AAOS Now Podcast, host Richard Schaefer, MD, FAAOS, sits down with two of orthopaedic surgery's most dedicated advocates for medical student mentorship, William Levine, MD, FAAOS, and Amiethab Aiyer, MD, FAAOS, for a candid conversation about the residency Match process. 

The discussion tackles the nuts, bolts, and controversies of today's highly competitive application landscape, including how signaling helps students whittle down the number of programs they apply to, why away rotations may have gotten out of hand, and whether every student really needs to do a research year. 

Drs. Levine and Aiyer share how their decades-long professional relationship helped shape their commitment to guiding the next generation of orthopaedic surgeons. They explain that mentorship is a bidirectional partnership in which the mentee must put forth more than just a desire to learn. They talk about the importance of building a diverse "board" of mentors across institutions. And they encourage students to seek out mentors, including near-peers, who have their “finger on the pulse” of the rapidly-evolving Match process. 

The episode closes with a candid challenge to prospective applicants: Before attempting to match into orthopaedic surgery, ask yourself why you want to be an orthopaedic surgeon. According to Dr. Levine, mentors should require all of their mentees to answer that question — and if the answer is iffy, encourage them to consider a different specialty. 

Key Topics Covered in this Episode


How the residency Match process works: from application to Match Day


Building a mentorship "board": why one mentor isn't enough and how to cultivate relationships across institutions


Mentorship as a bidirectional partnership: what mentees must bring to the relationship


The origin of OrthoMentor: how Drs. Levine and Aiyer began collaborating to fill a nationwide advising void and how students at institutions with limited advising resources can still access current, accurate guidance


Signaling and application caps: understanding the data behind limiting program applications (yes, 100 applications is too many)


Away rotations: how many to do and why cohort strategy matters when applying


Research years: when they help, when they don't, and what to look for in a productive year


Schools without home programs: unique challenges and where to find current guidance


Pursuing the right path: why students should reflect on their motivations before pursuing a career in orthopaedic surgery, and why where you train isn’t as important as what you do with the opportunity

About Our Guests

William N. Levine, MD, FAAOS, the Frank E. Stinchfield Professor and Chair, Department of Orthopaedic Surgery, Columbia University College of Physicians and Surgeons; Chief of the Orthopaedics Service at New York-Presbyterian/Columbia University Medical Center; and Editor-in-Chief Emeritus, Journal of the American Academy of Orthopaedic Surgeons

Amiethab Aiyer, MD, FAAOS, Division Chief of foot and ankle surgery and Associate Professor, Department of Orthopaedic Surgery, Johns Hopkins School of Medicine; Deputy Editor, Journal of the American Academy of Orthopaedic Surgeons

In this episode of the AAOS Now Podcast, host Richard Schaefer, MD, FAAOS, sits down with two of orthopaedic surgery's most dedicated advocates for medical student mentorship, William Levine, MD, FAAOS, and Amiethab Aiyer, MD, FAAOS, for a candid conversation about the residency Match process. 

The discussion tackles the nuts, bolts, and controversies of today's highly competitive application landscape, including how signaling helps students whittle down the number of programs they apply to, why away rotations may have gotten out of hand, and whether every student really needs to do a research year. 

Drs. Levine and Aiyer share how their decades-long professional relationship helped shape their commitment to guiding the next generation of orthopaedic surgeons. They explain that mentorship is a bidirectional partnership in which the mentee must put forth more than just a desire to learn. They talk about the importance of building a diverse "board" of mentors across institutions. And they encourage students to seek out mentors, including near-peers, who have their “finger on the pulse” of the rapidly-evolving Match process. 

The episode closes with a candid challenge to prospective applicants: Before attempting to match into orthopaedic surgery, ask yourself why you want to be an orthopaedic surgeon. According to Dr. Levine, mentors should require all of their mentees to answer that question — and if the answer is iffy, encourage them to consider a different specialty. 

Key Topics Covered in this Episode


How the residency Match process works: from application to Match Day


Building a mentorship "board": why one mentor isn't enough and how to cultivate relationships across institutions


Mentorship as a bidirectional partnership: what mentees must bring to the relationship


The origin of OrthoMentor: how Drs. Levine and Aiyer began collaborating to fill a nationwide advising void and how students at institutions with limited advising resources can still access current, accurate guidance


Signaling and application caps: understanding the data behind limiting program applications (yes, 100 applications is too many)


Away rotations: how many to do and why cohort strategy matters when applying


Research years: when they help, when they don't, and what to look for in a productive year


Schools without home programs: unique challenges and where to find current guidance


Pursuing the right path: why students should reflect on their motivations before pursuing a career in orthopaedic surgery, and why where you train isn’t as important as what you do with the opportunity

About Our Guests

William N. Levine, MD, FAAOS, the Frank E. Stinchfield Professor and Chair, Department of Orthopaedic Surgery, Columbia University College of Physicians and Surgeons; Chief of the Orthopaedics Service at New York-Presbyterian/Columbia University Medical Center; and Editor-in-Chief Emeritus, Journal of the American Academy of Orthopaedic Surgeons

Amiethab Aiyer, MD, FAAOS, Division Chief of foot and ankle surgery and Associate Professor, Department of Orthopaedic Surgery, Johns Hopkins School of Medicine; Deputy Editor, Journal of the American Academy of Orthopaedic Surgeons