Another approach to integrating the Internet with academic orthopaedics has been to explore the results of electronic searching for orthopaedic information. An early example in 1999
considered foot and ankle problems and even then noted that 41% of the sites found were commercially oriented. Groot et al (2001)
also noted poor quality information on ankle sprain and suggested that a search "by an experienced information officer" might be preferable to one undertaken by an orthopaedic surgeon. A more hopeful position is taken by authors detailing searching techniques
and websites to help find useful orthopaedic pages
. The focus now is on teaching orthopaedic surgeons electronic skills so that they can find and evaluate useful orthopaedic web pages. Recent workshops presented at the Congress of the Egyptian Orthopaedic Association and elsewhere, stressed hands-on learning of electronic skills. These skills cannot be learned simply by listening or reading.
While most people are satisfied that they can use Internet search engines and can find publications on Medline, the truth is that using these assets is a learned skill. It is easy enough to find something on the subject but much more difficult to be sure that the search is comprehensive and doesn't overload you with extraneous material. Learning to frame your searches that include all you need and still leave you with a manageable number of citations takes time and effort. A fundamental part of Orthopaedic Informatics is convincing people it is important to learn these skills and establishing the best methods of teaching them.
Posting webpages on the Internet is a simple matter. Most popular word processing programmes allow the user to save a document as a webpage, making the production into a simple secretarial task. Posting a page produced by this means is also a simple matter, requiring a File Transfer Protocol (FTP) programme and the appropriate passwords. Nearly all Internet Service Providers offer space on the Internet for their subscribers so the cost of posting webpages is very low. Many sites also function as databases; registrants can add material directly to the site without any processing. Despite all this, even from academic departments, the production of webpages with orthopaedic content is sparse
and the quality of the production is low
. The Canadian situation was summarized as follows -
"Web sites should serve the functions of promoting the services of the institution, making two-way communication easier and speeding up information exchange. As information is one of the primary products of an orthopaedic teaching institution, there should be a large role for the Internet. It will require a team effort involving all of the staff.
Orthopaedic Internet activity in Canada is still the province of enthusiasts. While some of these are world leaders in the area, there is little integration of the Internet into the normal modus operandi of major orthopaedic institutions. When that paradigm shift occurs, orthopaedic surgeons, trainees and patients will be better served."
In contrast, webpages associated with orthopaedic practices, clinics or hospitals are now extremely common
. These sites are posted on the assumption that they increase patient recruitment and they tend to present information, even patient education information, in a "come-hither" way. There has been some research in the primary care situation on the success of this gambit but none, as yet, in orthopaedics. A cost/benefit analysis of practice websites would be illuminating and perhaps surprising. A hand surgeon with an excellent and informative website
estimates that only one patient a year is recruited through his website. He believes the primary role of the practice website is to inform his patients, improve communication and reduce redundant work
Orthopaedic surgery is a very visual subject and relies heavily on illustration using images from Xrays, clinical and operative photographs. In many hospitals radiology is now digital and the introduction of digital radiology initially caused problems
with the provision of clinical orthopaedic services. These problems tend to resolve themselves over time and most clinicians now accept the benefits of digital radiology.
Orthopaedic surgeons have a key role in producing illustrations for teaching, research and archive purposes
. The skills need to produce excellent digital images
include capture, using digital cameras or scanners, editing and archiving
. Although the Electronic Skills Pavilion at the Annual Meeting of the AAOS usually covers these topics, little has appeared in the orthopaedic literature
Digital presentations (usually using the Powerpoint (TM) format) are now the norm for scientific presentations at orthopaedic meetings and many in-hospital presentations. There have even been suggestions that these presentations will replace journal articles
. Although it is common to encounter poor or distracting presentations, attempts to teach presentation skills
are few. This may be another subject that can only be taught "hands-on"
. ISOST is developing a section of the Orthogate website for hands-on workshops in various electronic skills