Society & Partner Zone Issue 20, Interviews

In The Spotlight: Prof. Seth S. Leopold

Professor Seth S. Leopold, MD, Department of Orthopaedics and Sports Medicine, University of Washington School of Medicine. As of January 2013: Editor-in-Chief, Clinical Orthopaedics and Related Research ®, Publication of the Association of Bone and Joint Surgeons, published with Springer.

Society Zone in an interview with...

Professor Seth S. Leopold in an interview with Society & Partner Zone

Please tell us a little bit about yourself and your professional background

My first thoughts were of journalism and writing, not medicine. In college, I was a news editor and eventually became the Publisher of The Dartmouth, which claims to be the oldest college newspaper in America. That claim is contested. What isn’t in question is that it was the smallest campus to host a daily paper – so finding news and, even more challenging, turning the goings-on at a very small place into compelling reading – every day – wasn’t always easy. The recipe we used there, though, remains a good one: Innovation, high-quality content, one eye on the bottom line, and an inclusive approach to leadership. The best ideas do not always reside at the head of the table, but rather all around it.

Happily, it’s much easier to get great content for Clinical Orthopaedics and Related Research® than it was for The Dartmouth in Hanover, New Hampshire – orthopaedic surgery is a rich, vibrant, and fast-moving specialty, and CORR® is recognized as a great place to send good papers.

As I alluded to, my undergraduate degree was from Dartmouth College, and I graduated with honors in research from Cornell Medical School. I took my orthopaedic training in Chicago (residency at the U of C, fellowship at Rush-Presbyterian) and then went into the military, where I spent 3 years on active duty as an Army surgeon and as a faculty member of one of their teaching programs. Following that, Rick Matsen, now the emeritus chair at University of Washington, recruited me to Seattle. I’ve been here since. I did a short stint (3 years) as chief of the orthopaedic surgery service at the University hospital and as a vice chair of the department, but found I much prefer science to administration.

More pertinent to my role at CORR® is my interest in understanding and improving peer review. I’ve focused most of my research on trying to figure out how (or whether) we know what we think know, and how best to get the “good stuff” out. We’ve taken a particular interest in and developed some (we think) innovative research approaches to evaluate some of the larger sources of bias that affect peer review.

I’ve had editorial roles at CORR® and JBJS, and I worked with JBJS on rolling out an innovative, fast-paced on-line newsletter for developments in hip surgery, of which I was the first editor-in-chief.

What is The Association of Bone and Joint Surgeons mission and membership base?

The Association of Bone and Joint Surgeons was conceived in 1947 in response to the sentiment that the fairly limited educational programming then available, and the presence of only a single exclusive orthopaedic journal at the time, were insufficient to meet the needs of a rapidly growing field. The organization initially was called the “American Bone and Joint Association.” The purpose of the Association was to give younger orthopaedic surgeons another organization in which to present papers, publish manuscripts and share experiences with colleagues. Membership then was offered by invitation to select board-certified orthopaedic surgeons younger than fifty years of age.

Several years later, they created Clinical Orthopaedics and Related Research® as the official journal of the ABJS. It has been published continuously ever since.

ABJS’s membership is a selective, high-profile, international organization. Its active membership is limited to 90 surgeons (though its roster of senior and emeritus members is much larger), each of whom has made considerable impact on the specialty.

What can professional members expect from the Association?

ABJS members enjoy a stimulating annual meeting featuring presentations from some of the most important and influential thought leaders in the specialty. The ABJS hosts regular workshops, in which the leading thinkers on critical topics are brought together, in person, to tackle critical questions together in these areas; recent ones have covered research into healthcare disparities, computer-assisted surgery, and health-policy issues in orthopaedic surgery. ABJS members also benefit from the relationship from their journal, CORR®, in that members will participate in its peer-review process, enjoy or contribute to the symposia on subspecialty areas and topical questions it hosts, and be invited from time to time to provide commentary and other kinds of solicited content. Peer-reviewed research, of course, comes both from members and non-members; submission to the journal is open, and, obviously, most of its content comes from non-members, as ABJS is a very small organization.

ABJS’s mission is to advance the science and practice of orthopaedic surgery by creating, evaluating, and disseminating new knowledge and by facilitating interaction among all orthopaedic specialties. So, as you can see, it is very much a general-interest organization, and this spirit is reflected in, CORR® the journal it hosts. The Association also sponsors several high-profile research awards, including the Nicholas Andry award, which now is the largest award in the specialty. Members participate in the administration of these awards, which is extremely satisfying and important work, as it raises the visibility of the best science being done in our specialty.

What kind of influence do you think The Association of Bone and Joint Surgeons might have on developments in the orthopaedic field?

For a small society, the ABJS’s reach is strikingly large – as I mentioned a moment ago, the awards excite and inspire researchers (especially younger ones) and disseminate some of the most interesting work that is being done. ABJS’s journal is considered by all to be a jewel in the crown of our specialty, and the best scientists and surgeons send their work to CORR®.

What inspired you to become the new editor-in-chief of Clinical Orthopaedics and Related Research®?

This really is two questions: Why become an editor, and why CORR®?

Taking the first one first…How good information is disseminated — and how to find better ways to get good ideas out — are topics I've always cared about. As I mentioned, early on, I was on the fence about a career in writing or a career in medicine. Though I didn’t become a journalist, I've continued to enjoy writing, editing, and, once I was in medicine, trying to figure out ways to separate the good evidence from the rest of it.

Early in my residency, I found quite by accident (it had been abandoned on a table in the hospital cafeteria, I’ll suggest no metaphor or deeper message here) a copy of the McMasters University Evidence-Based Medicine curriculum. They eventually published this in JAMA as a series called “Users’ guides to the medical literature.” At the time, I found this transformative, and really eye-opening…so you can imagine this was some time ago, as this material now is quite mainstream.

In any case, it struck me that these ideas needed to be taught and learned in our specialty, which, at that time, really wasn’t too familiar with them. With the help of a few close colleagues we made some nice curricula to do this. In different ways, I've been working around the edges of peer review since then — as a reviewer, initially, then as a researcher, and subsequently, as an editor both at JBJS and at CORR®.

As for “Why CORR®?” Well, CORR® has many, many strengths. First off, content quality. The articles published by CORR®, in general, are good articles. Although CORR’s Impact Factor is in the middle of the orthopedic pack, in 2011, CORR® was second in terms of the overall number of citations among general orthopedic journals, and CORR® had the highest Article Influence Score of any general orthopedic journal. The Article Influence Score takes into account the quality of the journals where the citations are made, such that citations of a journal’s articles by a better-quality journal are worth more than other citations; this is analogous to Google's page-rank algorithm, and so probably is a better metric than the simpler (and more easily “gamed”) Impact Factor.

Another of CORR’s strengths is its many relationships with important national and international specialty societies. CORR® publishes the annual proceedings of the Hip Society, the Knee Society, the Musculoskeletal Tumor Society, among others in the United States. CORR’s international relationships also run long and deep; at least a half-dozen major international societies consider CORR® their official journal.

CORR’s quality and its close liaisons with major societies position it uniquely in a very competitive marketplace of ideas as a place to go for important, timely, reliable information.

Why would you recommend Clinical Orthopaedics and Related Research® to the hospital community?

That’s an easy one – CORR’s articles are cited and downloaded with great frequency by scientists and clinicians alike – nearly 30,000 citations and about 360,000 qualified downloads in the most recent year for which I’ve seen statistics. This is because surgeons, non-surgical musculoskeletal specialists and scientists all recognize that the material between CORR’s covers is the most current, relevant, and reliable work available. Whether a surgeon is preparing for a case, a physiatrist is considering her options for non-surgical management of a particular condition, or an oncologist is counseling a patient about the prognosis of a musculoskeletal tumor, they’ll likely look in CORR® for the best-available evidence.

What is special about the orthopaedic community (if you compare it to other medical areas)?

I’d characterize our specialty in general as technologically oriented, fast-moving, and possessing a general tendency towards intervention over non-intervention. As you can readily surmise, these can be strengths or liabilities depending upon the circumstance. Developments in orthopaedic surgery often are made in partnership with collaborators from several commercial industries. This, too, can be an asset or a weakness.

What are the hot topics currently being discussed within the community?

From the outside, one might perceive orthopaedic surgery as a discrete community, or even a slice of the larger community of surgical subspecialties and, from that vantage point, this is accurate. But from the inside – and certainly from where I sit – the orthopaedic community really is many communities. There are at least eight subspecialties within orthopaedics, and on top of that, one has to consider basic science, musculoskeletal education (both post-graduate and medical undergraduate education), as well as health policy as important subspecialties. I’m surely also leaving off some others. So there are actually relatively few topics that get the attention of the entire community.

Broadly speaking, though, regenerative medicine is one everyone’s mind, as is translational medicine. So is the topic of how to deal with failures of drugs or devices (and sometimes how to deal with the fact that this topic is played out in the lay press), and whether or how drugs or devices should be regulated differently. How best to educate the next generation of surgeons and scientists reliably will start a good conversation.

Because most orthopaedic surgeons practice in what you can imagine are “silos of subspecialty,” one has to consider what the role of a general-orthoapedic journal really is. A major goal of mine is to make as many of CORR’s pages understandable to as many readers as possible. Some of the better general-interest science journals do a really good job at this – I’m thinking Nature and Science, for example – and they are very intentional about how they go about it. For example, they dedicate a large portion of their pages to articles that “translate” the discoveries such that a paper, say, from a group in the botany community would be of interest to particle physicists. If it’s in Nature or Science, it’s important, and worth being understood even outside the subspecialty community. The same is true for papers in CORR®. We will use our pages differently, going forward, to take this into account. We will run more commentaries, columns, and features in order to make the great breakthroughs that we publish in one subspecialty of orthopaedic surgery interesting to all others.

What are your plans for the journal?

We’ll look to optimize peer review along evidence-based lines, and I’m developing a number of templates to help us do this. I believe that using templates for this can serve several important goals, including educating peer reviewers (who come to the task with a variety of backgrounds and very variable levels of pre-training), making the process more efficient for reviewers and authors, and, most importantly, increasing the overall quality of what we turn out.

We’re also very interested in new ways of taking what peer review has decided is “the good stuff,” and making sure it gets into the hands of the people who need it — practicing clinicians and scientists. We’ll need to look differently at media, at how journals interact with readers, and also to take a much broader view on who our constituencies are and how we serve them.

It used to be that American journals cared mainly about American surgeons. I think we need to consider surgeons all over the globe (musculoskeletal diseases and injuries do not recognize political borders), but I think we need to add trainees to the roster of important constituencies, and I think we may even need to consider adding the non-professional public and the public's representatives. Health care dollars continue to eat up our national wealth, and as the conversation about this important topic becomes ever more intense, I think good journals are going to want to be a party to it.

I’d like also to put into play some different ways to serve our diverse constituencies, as well; I think general-interest journals like CORR® can do a better job bringing scientists and clinicians together. I think we also can bring diverse populations of orthopedic surgeons together around the subjects that affect the future of the specialty, as I alluded to in my answer to the previous question. Finally, I think we can — really, we must — make more of each journal’s pages comprehensible and interesting to more readers.

Society Zone thanks Prof. Seth S. Leopold for this interview.

Further Information: