History of the Program
A History of the Dartmouth Hitchcock Medical Center Orthopaedic Residency Training Program
Charles F. Carr, MD
The roots of the Dartmouth Hitchcock Medical Center (DHMC) orthopaedic residency training program date back to its founding father, Dr. O. Sherwin Staples, who came to Mary Hitchcock Memorial Hospital (MHMH) in 1946 from Harvard/Massachusetts General Hospital. He was the first orthopaedic surgeon in the state of New Hampshire and was joined shortly thereafter by Dr. Stuart Russell from Michigan State University in 1948. The final two “founding” orthopaedists were Dr. Robert Shoemaker from the University of Pennsylvania in 1955 and Dr. Leland Hall from the University of Minnesota in 1963.
Dr. Staples’ application to the American Board of Orthopaedic Surgery (ABOS) for a residency training program began in 1949. He was unsuccessful in his first two attempts. Ultimately, the ABOS approved a residency training program at Mary Hitchcock Memorial Hospital in 1957 as long as pediatric orthopaedics was taught elsewhere. The first resident, Dr. Robert Orth, started his three-year orthopaedic residency in 1957, spending the first year at MHMH, the second year at the White River Junction VA Hospital and the third year at the Newington Children’s Hospital in Connecticut. The residency training continued as a three-year program (preceded by two years of general surgery) with one resident per year until 1970.
Drs. Roger Hansen and Howard Black were the first residents to be admitted as a pair. This same year, the residency program director position was handed from Dr. Staples to Dr. Hall who accepted reluctantly. The landmark procedure of the first total hip replacement at MHMH was performed in April of 1971. One year later, the first total knee replacement was performed. Two longstanding members of the section of orthopaedics, Drs. Michael Mayor and Robert Porter arrived to increase the number of attending physicians to five.
The next significant change to the residency program occurred in 1980 when the length of rotations at the VA Hospital and Newington Children’s Hospital were shortened to six months each. This allowed for four residents to always be at MHMH while the other two were offsite. 1984 saw perhaps the most significant change that has occurred in orthopaedic training when the ABOS increased the required years of devoted orthopaedic surgery training from three to four. The final three-year orthopaedic class and the first four-year orthopaedic class of residents were selected to begin training in 1984. By 1986, Dr. Hall turned over the reins of the residency program to Dr. Phil Bernini who stayed in this position until 1988 when he assumed the chairmanship of the section. Dr. Jim Murphy assumed the position of program director at that time. By 1990, the attending staff members had swelled to eight with the additions of Drs. Shirreffs, Bernini, Murphy, Nutting, and Carr over the previous fifteen years. After thirty-three years of the fifty-seven year history of the Dartmouth-Hitchcock Residency Training Program, there had been forty-four residents who had started and completed the program.
October 5, 1991 was a historical day for Dartmouth-Hitchcock Medical Center as the entire institution moved from the 100 year old campus in Hanover to a new million square foot complex, four miles away in Lebanon. The Spine Center at DHMC opened in 1997 and created an innovative, comprehensive, multispecialty approach to the care of spine patients. The development was under the guidance of Dr. James Weinstein who had joined the clinical staff of DHMC orthopaedics in 1996 after completing a master’s degree at the Center for Evaluative Clinical Sciences (CECS) at Dartmouth Medical School. This program would soon become a core element of the Dartmouth Orthopaedic Training Program. Our first residents to start and complete the CECS program and receive their master’s degrees during their five-year residency were Drs. Scott Sporer and Randall Schultz in 2001 and 2002.
1998 saw a change in the PGY-1 intern year made by the ABOS. A mandate to complete month long rotations on various subspecialty services, including up to three months in orthopaedics, was introduced. Several years prior to this change (1994), the section had made the decision to join the National Residency Match Program, selecting residents directly out of medical school, making Dartmouth one of the last programs in the country to make this change. 1998 also was a year of change in leadership of the residency program, as Dr. Jim Murphy stepped down to pursue other administrative duties and Dr. Charlie Carr took on the challenges of residency program director. The Spine Patient Outcomes Research Trial (SPORT), a multicenter study based out of DHMC, designed to address the need for high-quality, prospectively collected data on the operative and non-operative treatment of spinal conditions began in 1999. This project allowed for the initiation of many research projects by our orthopaedic residents and brought DHMC orthopaedics national and international recognition. In 2001, our program added a third resident position. The approval of the “extra” resident was coupled with our new Orthopaedic Physician Leadership Training Program at Dartmouth and completion of a sixth year, obtaining a master’s degree at the CECS focusing on evidence based medicine and health care policy. The first resident admitted to the new program was in 2001. The chairmanship of the section of orthopaedics changed hands in 2002. Dr. Phil Bernini stepped down from the position after serving for fifteen years. Dr. James Weinstein assumed the role as section chair in July 2002 and his first accomplishment was to successfully gain institutional acceptance for orthopaedic surgery to become its own department. He also led a restructuring of the new department and residency program into clinical and academic programs that were subspecialty team-based.
As our department continued to grow, so did our residency program, which added a fourth resident per year in 2004. We chose to offer two positions as a five-year clinical tract and the two other positions as a six-year clinical + CECS experience tract. Through an NIH educational grant we have been able to maintain funding for two residents per year in the masters degree program given through the renamed Dartmouth Institute for Health Policy and Clinical Practice (TDI). The first group of trainees admitted with four residents per class graduated in 2009 and 2010. The department’s most recent change in leadership also occurred in 2009 when Dr. Weinstein took over the role as Director of The Dartmouth Institute relinquishing the role of Orthopaedic Department chairman to Dr. Sohail Mirza, who had arrived from the University of Washington in the previous year as the inaugural vice-chair of the department.
Over the past twelve years the Dartmouth Orthopaedic Residency Program has flourished under the leadership of Drs. Weinstein and Mirza. They have championed academic and educational pursuits allowing the program to innovate in many areas. Presently, our twenty two residents (20 on clinical rotations and two in the TDI) rotate through six subspecialty teams at DHMC, spend three months in orthopaedic oncology at Beth-Israel Deaconness Medical Center in Boston with Dr. Mark Gebhardt, rotate through a three month block in pediatric orthopaedics at Children’s Hospital in Boston, and complete a recently “renewed” rotation in general orthopaedics at the White River Junction VA Hospital. Our educational program is robust with conferences held every morning including a two year cycle didactic core curriculum taught by faculty, grand rounds with visiting lecturers, indications conference, pathology conference, research update conference, anatomy prosections and other various conferences throughout the year. The most recent educational offering demonstrating the transition to an earlier, more focused experience in orthopaedics provided to our PGY-1 residents is a bio-skills course. PGY-1 residents are provided a weekly hands-on surgical simulation experience using simulators, orthopaedic surgical equipment with sawbones, and cadavers to perform surgical approaches.
The history and evolution of the orthopaedic training program at DHMC has “mirrored” several other preeminent programs across the country. We feel we deserve to be included amongst the best orthopaedic residency programs as the products of our training (many of you) are proof of that.