Leaders in Medical Education

Dr. Joseph Bernstein, Clinical Professor of Orthopaedic Surgery at the University of Pennsylvania

Jim Eubanks
Oct 21, 2015

Dr. Joseph Bernstein, MD, is a professor and orthopaedic surgeon at the Perelman School of Medicine at the University of Pennsylvania. He graduated medical school from Cornell University Medical College and completed his residency and fellowship at the University of Pennsylvania. He is currently one of the most prominent leaders in musculoskeletal medicine, and leads a national effort called "Project 100" which was recently renamed, "Project 1000," through his leadership role in the United States Bone and Joint Initiative (USBJI). Project 1000 aims to identify 1,000 local musculoskeletal educators throughout the country to share good practices, exchange educational material, and connect faculty for discussion, research, and planning. He also wrote the first textbook on musculoskeletal medicine for medical students, entitled "Musculoskeletal Medicine", which was formally endorsed by the USBJI.

How did you become interested in musculoskeletal medicine?

I am an orthopaedic surgeon, so “musculoskeletal medicine” is what I do every day. (It’s not just political correctness and inclusiveness that makes me use that long name: even in the orthopaedic surgery world, a lot of care is non-surgical.) I became interested in teaching because of my own teachers–Fred Kaplan, Joe Lane, and Ernie Gentchos come to mind.

You wrote the first major Musculoskeletal Medicine textbook for undergraduate medical education, “Musculoskeletal Medicine.”  You also lead Project 1000 (previously known as Project 100), a national effort through the United States Bone and Joint Initiative (USBJI) to increase musculoskeletal education in US medical schools.  Can you share some information about how you got involved with the USBJI?

The textbook was first.  In 1997, my chairman, Dr. Bob Fitzgerald asked me to start a pre-clinical course at the Perelman School of Medicine at the University of Pennsylvania. At that time, I noticed that there was really no book suited to the course that I wanted to teach. So I sent a proposal to create a book to the American Academy of Orthopaedic Surgeons (AAOS) and to a commercial publisher; both were interested. Dr. Joe Iannotti, another influential teacher of mine, recommended that I go with the academy, which I did. In turn, in 2002, AAOS staff members introduced me to Toby King, the director of the US Bone and Joint Decade (as the USBJI was called before the start of its 11th year made the name obsolete). We have been friends and collaborators ever since.

What do you believe is necessary to promote the successful adoption of new information and training strategies in medical education?

One of the great lessons of microeconomics (and there are many) is that decisions are made at the margin. So if a student is paying, say, $75,000 per year to go to medical school, he or she is not going to say, “I might as well buy the best books I can find–my costs will increase less than 2%.” The student will rather say, “I might as well skip the books and use what I can find for free–and spend those marginal dollars on more enjoyable endeavors”. In other words, even though building a great library will not increase average costs by much at all, it will dramatically increase marginal costs, and therefore this money will not be spent–especially for a short course like musculoskeletal medicine (as opposed to say cardiology).  So the first rule is that the information/materials must be free.

Yet, of course it’s not free to create good material (and it’s also not ok to have it supported by advertising either (in my humble opinion).

So the #1 necessity is raising the wherewithal to generate and sustain the materials. I personally believe that crowd sourcing is the way to go: if you cobbled together all of the teaching notes created each year in the US, you’d have one amazing book! So that’s where Project 1000 comes in: we are trying to build a community of musculoskeletal medicine educators–from all schools–such that we can collect and curate the best teaching materials, and share them with each other, and our students, at no cost (beyond the relatively low cost of supporting the sharing on the internet). Christian Veillette MD has been a big leader in this area, and I am following him.

What are some changes you would like to see in the current US healthcare?

It would be naïve to say that ‘we have to get the money out of medicine,’ as health care is approaching 20% of GDP. But it’s neither naïve nor unreasonable to say, “we have to get the money out of the minds of physicians”, and to do that, medical school has to become free. One cannot build a cadre of physicians based foremost (if not exclusively) on professionalism if many of them owe hundreds of thousands of dollars. West Point is free; the Naval Academy is free. As such, graduates of these institutions can serve without the undue influence of school debt (and money making once that debt is paid off).

(Is the Gates Foundation reading this? I hope so!)

Do you have any final thoughts regarding the medical profession that you think would benefit medical students and residents?

I recently had an occasion to rummage through some files and read my medical school application from 30 years ago. I saw that back then, without really knowing what I was talking about, I said something about how wonderful the profession of medicine is, in that you can use your mind, your personality, and in some cases your physical skills to do good for the world, all the while getting respect and a more than decent standard of living. 30 years later, I can reiterate those sentiments, but this time with the emphasis and conviction that comes with experience, i.e., I have enough experience that maybe I do know what I am talking about.

So I would tell—or rather, “remind”—medical students and residents: the profession of medicine is wonderful (even if school or residency is not); and that their future is bright (even if some of us old guys are grousing about how tough things have become).