How long have you been involved with the AO Foundation and in what roles? What were your personal AO Foundation milestones?

My first encounter with the AO was in 1978, when I was still a medical student at the University of Basel, in Switzerland. Martin Allgöwer, one of the founders of the AO Foundation, who was also the chair of the surgical department in Basel, invited students in their fifth year for a weekend to Davos, to participate in a kind of a shortened AO course. Back then, the concept was to work in the morning and then go skiing in the afternoon, which seemed like a great plan to me. I later wrote my doctoral thesis with Martin Allgöwer about the treatment of tibial shaft fractures.

 

In 1983, during my first year of residency at the University Hospital in Basel, I was invited again to Davos. This time, I immediately became an assistant table instructor at the English-speaking advanced course. This meant that I was teaching surgeons with much more experience than myself. Unlike today, where you first have to take basic and advanced principles courses before even thinking of becoming a faculty member, that was not an unusual career path in those days. This may seem odd and unfair today, but the AO courses were much more "hands-on" back then. Literally, the main emphasis in the practical exercises was on the correct handling of the implants and instruments, and not so much on the different choices of treatment. During that time, the AO Foundation was also much smaller, and very much like a family.

 

In 1989, one year after I got my board certificate in surgery, the AO was looking for someone to spend 6–12 months in the US, to teach AO techniques at Jackson Memorial Hospital at the University of Miami. That’s how it came about that I spent one year there in 1990 as a foreign faculty member and clinical instructor. This experience proved to be invaluable for me as well as for my family in many different ways. First and foremost, I experienced that by teaching, you always learn something yourself as well, since before you can start teaching things need to be sorted out clearly in your own mind. Secondly, I encountered patients, pathologies, and also treatment methods that were almost nonexistent in Switzerland (eg, many indigent people, frequent gunshot injuries, and in particular the non-operative fracture treatment according to Sarmiento). Finally, as a side effect, living for an entire year in a foreign country and culture also significantly fostered the bonds in our family.

 

Shortly after I returned to Switzerland, I was offered the position as Surgeon-in-Chief of Traumatology at the Kantonsspital Aarau, one of the eight biggest hospitals in Switzerland. Today, it is one of the 12 level-one trauma centers in the country. This was 23 years ago, and I have remained at the same hospital ever since.

 

My career in the AO continued first as faculty in Davos and then internationally. In 2002, I became an elected member of the AO Foundation Board of Trustees. In 2005, I was elected as a member of the board of AO Switzerland, and in 2006, I became the chairperson of the Specialty Academic Council General Trauma. In 2009, this council was transformed into the AOTrauma Research Commission, which I chaired until 2011. I then became the AO Trauma International Board Chairperson in 2011, and in 2014, I was elected as the incoming AO Foundation President. Finally, at the end of this year’s Trustees Meeting in Amsterdam, I took over the presidency from Suthorn Bavonratanavech.

 

 

What does the presidency of the AO Foundation mean to you personally, and what are your expectations from the organization as a president and a member?

First of all, I see the role of president as a great honor and a sign of appreciation of what one has contributed to the organization over the years. To me, it shows that I have a lot of support and trust within the organization, and I am very grateful for that.

 

Secondly, it is also a big responsibility. The AO Foundation is in good shape, which is great, but still, one doesn't want to risk anything. After all, we are also an employer with over 250 employees. Hence, I also have an economic responsibility.

 

In terms of expectations, I think I should rather ask myself what I can do for the organization, instead of what the organization can do for me.

 

​The organization has already given me so much during my entire professional life. Thus, I do not expect to get something back in addition. As the current president, I am continuing to serve the organization. The opportunity to contribute to shaping the future of the AO is what motivates me to donate my time and my energy.

I have a wish, though: that everyone who is engaged with the AO focuses on the big picture and what is in the best interests of the organization as a whole, over one’s personal opinions.

 

 

What is your vision for the AO Foundation?

The AO Foundation has a longstanding tradition, where all surgeons who are engaged in the organization want to be exceptionally good in treating their patients. This is why, in the beginning, the AO Foundation standardized and established a system for operative fracture treatment. This enabled the average surgeon to achieve better treatment results, and made sharing best practices the main objective. Right from the beginning, the founders also recognized the importance of research as a basis to provide the scientific evidence for new concepts. In addition, AO courses always used the newest technology of medical education.

 

​My vision is that the AO Foundation continues to stay at the forefront in providing continuous medical education, which is based on excellent and unbiased research. The AO should always be perceived as an independent organization that brings together the best surgeons and researchers in the field.

Being part of and interacting with the members of this elite group should also motivate the best talents of the generations to come, and encourage them to join in.

 

What is your vision for AOSpine, in particular when it comes to education and research, and what are your expectations?

Right from the beginning, AOSpine was following a slightly a different strategy to the other clinical divisions. Trauma, CMF, and VET have focused mostly on the exchange of best surgical practices, so the emphasis was more on education and on operative techniques. When AOSpine was established, spine surgery was globally a new and developing subspecialty of orthopedics and neurosurgery. The initial strategy was to establish AOSpine in this new field as an independent and strong brand. In order to achieve this, the first priority was to become an academic society of highest scientific credibility. AOSpine proved to be very successful in pursuing this strategy.

 

​Meanwhile, the AOSpine Knowledge Forums and the GSC are established events in the spine surgeon community and are fostering AOSpine's credibility. In the end, this also contributes to the overall perception of the AO Foundation as an independent organization. Therefore, it is of utmost importance that AOSpine continues with this strategy.

How have you been involved so far with AOSpine?

Since I was never treating any spine patients, I was only an observer from the outside when AOSpine evolved from the rest of the AO. When I became chair of the AOTrauma International Board, I regularly met with initially Luiz Vialle, and then Jeff Wang, my peers from AO Spine, to discuss issues of common interest. However, I have never been really close to AOSpine until last year.

 

I took my first "real dive" into the spine world when I was invited to the AO North America Spine Fellow Retreat in Banff, Canada. It was a great learning experience for me, and I was very impressed by the AOSpine North America fellowship program. Outside of North America, AO fellowships are limited to a maximum of three months, which is a costly endeavor for a hospital, and usually more beneficial for the fellow rather than the hospital. So, when I learned that AOSpine offers one-year fellowships, I was unsure at first if this was really a good concept, since it seemed that the main beneficiaries are the hospitals. However, when I met the individuals who were selected though this process, I was absolutely amazed. They are not only surgically and academically the best in their class; considering their young age, they also excel through their intelligence and remarkably mature personalities. Thus, I am convinced that AOSpine is attracting through these fellowships the best talents in North America every year. The challenge remains, of course, on how to keep them involved.

 

My most recent experience with AOSpine was at the AOSIB retreat in Venice, Italy, this past September. It became clear to me, through the various brain storming sessions and discussions, that while the topics may be different, all clinical divisions face the same challenges, except that AOTrauma and the other divisions have historically focused more on education, while AOSpine was more focused on research.

 

 

What are the challenges for AO, and what is your recommendation for AOSpine to play an even bigger role among the spine societies?

 

​The most important challenge we face is that we must keep on getting the best people on board as early as possible, develop them in the organization, and offer them attractive opportunities to take part. We must continue to foster the established key opinion leaders in the field, and at the same time, provide opportunities for the younger generations. For AOSpine, this is particularly demanding, as it's hard to determine that exact "moment of truth" when a neurosurgeon or an orthopedic surgeon decides to specialize in spine surgery.

In trauma, this process is much more straightforward, as the surgeons are sent to AOTrauma courses very early in their careers. But, despite this challenge, we must try to get these excellent people on board as early as possible and develop them.

 

Another aspect of this challenge is the fact that Generation Y as well as the Millennials tick in a completely different way than the surgeons of my generation. The younger generations are expecting immediate feedback as well as immediate rewards, and they are no longer willing to wait for five or ten years to actively participate in an organization. Younger people move on quickly if they do not find what suits their requirements and needs. We need to find ways to adapt to these needs, in order to make sure that we get the right people on board and retain them.

 

 

Where do you see particular challenges for AOSpine?

In general, I would like to point out that AOSpine is very successfully pursuing its strategy. An important piece of that strategy is the Global Spine Congress. Unfortunately, the current economic environment does not allow the industry to sponsor such events to the same degree that they used to. So, this might be a challenge for the future. Another challenge might be the quality control of AOSpine’s educational activities globally. Obviously, the content of the different educational activities is less standardized than in AOTrauma. In a global organization, this bears the risk that the quality of our education may vary significantly from region to region, and even from country to country. This presents a potential risk in diluting the AO brand, which stands for best-in-class education worldwide.

 

 

What message would you like to convey to AOSpine members?

I believe that AOSpine members can be incredibly proud of their leadership. It has great leaders who are really moving the organization forward.

 

​In addition, AOSpine brings together the best surgeons worldwide from every field of spine surgery. This community is a true "circle of excellence." By joining the organization, members become part of that elite group, and have access to the most renowned experts in their respective field. This, to me, is worth much more than any tangible membership privilege.