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Improving Access to Orthopaedic Surgery, for Providers and Patients Alike

Cara A. Cipriano, MD

With her appointment as Chief of Orthopaedic Oncology at Penn Medicine in September 2021, Cara Cipriano, MD, MSc – the Department of Orthopaedic Surgery's only female joint replacement surgeon – quickly became a force in improving inclusivity within the department.

She's involved in recruiting prospective residents and selecting them. "Along with others, I review all of the applications of the women residents and help determine which get interviews. From there, I'll reach out to them, as needed, to answer any questions they may have," she says. "We want our women candidates to feel encouraged as they move through the review process."

But Dr. Cipriano, who is also the department's Director of Undergraduate Medical Education, believes she'll have an even greater impact at an earlier phase of the education and training process. Prospective residents, after all, have already decided to go into orthopaedics.

"As the physicians of the future, medical students represent an opportunity to diversify the pipeline of orthopaedic surgeons," says Dr. Cipriano, a graduate of the Perelman School of Medicine at the University of Pennsylvania. "Given the widespread stereotypes about orthopaedic surgeons, students come to medical school with formed opinions about our field and whether they fit (or don't fit) within it. As educators, we have the opportunity and responsibility to reverse these preconceived notions through our interactions with the students."

Beyond maintaining an increased presence throughout the pre-clerkship curriculum, Dr. Cipriano is also engaging with a range of student interest groups. "Our interactions with students who have not already selected orthopaedic careers is especially critical because it will help counteract stereotypes and attract more diverse students to our field," she says.

And she established the Inclusive Orthopaedics Scholarship, which is designed to offset the financial burden of an elective rotation at Penn for a visiting medical student, as well as provide mentorship during and beyond that month. This year, two inaugural Inclusive Orthopaedics scholars were selected by the Culture Committee.

Fundamentals, and the Next Phase

Developing a more inclusive culture is not Dr. Cipriano's only priority as the Director of Undergraduate Medical Education. She's also outlined plans to improve students' understanding of musculoskeletal diagnosis and treatment; better prepare students for succeeding in an orthopaedic surgery residency; and develop residents as educators.

"Musculoskeletal complaints are widespread and common, so all physicians should graduate with a basic understanding of conditions such as fractures, degenerative disease, and nerve compression syndromes," Dr. Cipriano says.

To this end, the department's faculty and residents now have a greater presence at the medical school's gross anatomy labs; lectures; and problem-based learning sessions, including the weeklong course, Orthopaedics 200. She's also actively participating on the Anatomy Task Force, a medical school initiative that is aiming to integrate anatomy into all four years of a student's education.

In the future, Dr. Cipriano aims to broaden the roster of musculoskeletal electives as well.

"The current Orthopaedics 300 courses are all sub-internships: focused, immersive experiences intended for students who have decided to apply for orthopaedic surgery residency," she says. "The new electives will be designed for students who wish to gain more exposure to musculoskeletal medicine as they prepare for careers in specialties such as family medicine, emergency medicine, and pediatrics."

For the students positioning themselves for an orthopaedic surgery residency, the current sub-internships, Dr. Cipriano says, are a unique opportunity to "experience a subspecialty in depth, develop relationships with residents and faculty, and gain support for their application," all of which have become essential to gaining an edge amid an increasingly competitive field.

In an effort to further support potential applicants, Dr. Cipriano, in partnership with the Leo Leung Orthopaedic Society, has also started hosting group advising sessions during critical periods of the application process. Faculty and residents provide guidance on selecting an away rotation, interviewing, and, ultimately, forming a rank list.

A formal near-peer mentoring network is in development, too.

Finally, a medical educator track was introduced earlier this year. Participating residents are becoming familiar with the principles of adult learning while developing and executing research or quality improvement projects related to medical education.

Graduates of the program, Dr. Cipriano says, will have a portfolio that will make them "competitive in the academic job market. They will also be better prepared to evaluate opportunities; negotiate for support, funding, and protected time; and begin practice with an intentional focus."

She expects medical students to benefit from the new track, as well, with participating residents becoming more knowledgeable about their field and dedicated to the quality of the students' education.

Patient-centered Care, Present and Future

Within her own practice, Dr. Cipriano is focused on the diagnosis and treatment of primary and secondary tumors of the musculoskeletal system, as well as primary and revision joint replacement. In both her daily interactions and long-term planning, she is guided by a simple, but often elusive, principle: patient-centered care.

The team is constantly striving to improve accessibility and convenience for orthopaedic oncology patients. As part of this, Dr. Cipriano sees patients at both the Perelman Center for Advanced Medicine, in Philadelphia, and Penn Medicine Radnor. They also organize same-day imaging and biopsies at both locations whenever possible.

"It's very easy to feel overwhelmed by a new diagnosis," Dr. Cipriano says. "So we're working diligently to ensure the steps that follow are as uncomplicated as they can be, and that our patients have immediate access to us. Dr. Kristy Weber, Director of the Sarcoma Program at the Abramson Cancer Center, and I will see a new patient any day of the week. And if a current patient has a concern, we'll find the time to see them that day."

Dr. Weber also leads the weekly tumor boards, during which leading experts in medical oncology, radiation oncology, pathology, radiology, neurosurgery, and GI surgery, in addition to orthopaedic oncology, discuss the treatment of each sarcoma patient.

Faydra Davis and Nicole Koffke, RN, are both helping to facilitate consultations with Drs. Cipriano and Weber and the ensuing treatment. Davis serves as the administrative coordinator for the Sarcoma Program, serving as the main point of contact for all patients and referring physicians. She will schedule the initial consultation with either Dr. Cipriano or Dr. Weber and then all subsequent appointments and testing.

"We can efficiently and effectively help our patients navigate this system, ensuring they receive immediate and excellent care," Dr. Cipriano says.

The number of clinical trials at Penn continues to grow, and significant strides are also being made in the division's clinical research labs.

"Through collaborative projects with radiation oncology and neurosurgery, we are currently investigating strategies of local disease control, including surgical and nonoperative treatments," Dr. Cipriano says. "These projects are designed to address the unanswered questions we encounter in our own practices, with the goal of providing answers that will improve patient care beyond our institution."

Penn Medicine, Philadelphia, PA 800-789-7366 © , The Trustees of the University of Pennsylvania

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