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The View From Outside the US (2026 Traveling Fellows - Ep 3) · AHF Podcast

• 0:21
  Joseph M. Schwab: Hello, and welcome to the AHF Podcast.
• 0:24
  Joseph M. Schwab: I'm your host, Joe Schwab.
• 0:26
  Joseph M. Schwab: This is the third and final conversation in our series with the 2026 AHF Traveling Fellows.
• 0:33
  Joseph M. Schwab: And if you've heard the first two episodes, you know the setup.
• 0:36
  Joseph M. Schwab: About two weeks on the road, city to city, scrubbing in with some of the most experienced and innovative anterior hip surgeons in the US.
• 0:46
  Joseph M. Schwab: Well, today's conversation has a twist.
• 0:48
  Joseph M. Schwab: My guest came to the fellowship from outside the United States, and he's now had a couple of months back home in his own practice to figure out what actually stuck.
• 0:59
  Joseph M. Schwab: Dr.
• 1:00
  Joseph M. Schwab: Justin Chang is an adult hip and knee surgeon at Humber River Hospital in Toronto, trained at St.
• 1:06
  Joseph M. Schwab: George's, University of London, and the University of Toronto.
• 1:10
  Joseph M. Schwab: A different healthcare system, but a shared experience with our other fellows.
• 1:15
  Joseph M. Schwab: And this gives us a chance to ask what anterior hip surgery in the US looks like from the outside.
• 1:22
  Joseph M. Schwab: Justin, welcome to the AHF Podcast
• 1:27
  Justin Chang: Thanks for having me
• 1:29
  Joseph M. Schwab: So it's been a couple of months since the Traveling Fellowship ended.
• 1:33
  Joseph M. Schwab: Now that you've had some time to go back to your own practice and your own routines, what's the first thing that comes to mind when you think about your experience during those two weeks?
• 1:47
  Justin Chang: I mean, I think af-after you come back, there's, there's so many things that you've learned and so many different things you've seen, and it's trying to f- trying to figure out, like, what, what aspects of each, of each, like, surgeon's, you know, care, whether that's, you know, from an operative perspective or preoperative or, you know, even, you know, the technology they use.
• 2:07
  Justin Chang: Like, what, what can, what can I incorporate into my own practice, and what's feasible to incorporate into my own practice?
• 2:14
  Justin Chang: And I found that there's a, a lot at the beginning, so it's just trying to figure out, you know, taking small steps from everybody and trying to, you know, incorporate that into my own practice to make, you know, you know, life and surgery easier for myself.
• 2:27
  Joseph M. Schwab: Hmm.
• 2:28
  Joseph M. Schwab: So before the fellowship, where were you, where were you at in your journey with anterior approach?
• 2:34
  Joseph M. Schwab: G- give me a little bit of background about where you kinda came to it from.
• 2:39
  Justin Chang: Yeah.
• 2:40
  Justin Chang: So when I, I did my fellowship, uh, in London, England, um, it was all posterior approach.
• 2:45
  Justin Chang: Um, when I started at Humber, uh, I decided from the beginning to just switch to anterior approach.
• 2:52
  Justin Chang: I had a few really good mentors at the hospital, uh, Dr.
• 2:56
  Justin Chang: Rodriguez and Dr.
• 2:57
  Justin Chang: Kane, who kind of taught me and took me through it.
• 3:00
  Justin Chang: It was during COVID.
• 3:01
  Justin Chang: There was a lot of, you know, delay.
• 3:02
  Justin Chang: There was a lot of, you know, minimal surgery going on anyway, so I kinda took that as an opportunity to do almost like a mini fellowship with them.
• 3:09
  Justin Chang: so I was able to learn, um, learn the basics and the start of anterior approach, you know, before I really started my practice.
• 3:17
  Justin Chang: So I s- I've been doing anterior approach for five years, um, and it's my, you know, my primary approach for ninety-five percent of all hip cases.
• 3:29
  Justin Chang: And, uh, in the last year or so, I've been, you know, starting to, to do a little bit more of, you know, revision work or complex work with anterior approach.
• 3:38
  Justin Chang: And, you know, the goal of fellowship was really to gain more experience in, you know, complex, complex cases, you know, in- increasing exposure, and, you know, fine-tuning, uh, little tricks and tips for, you know, making my, you know, normal primary surgeries better
• 3:55
  Joseph M. Schwab: Hmm.
• 3:56
  Joseph M. Schwab: So I was gonna ask you if you remembered what you thought the program was going to be before you started, and maybe what your intentions were, and how the actual experience was the same or different than what you expected?
• 4:12
  Justin Chang: I think a lot of it was, you know, one thing that I did not appreciate was, um, you know, everything else around the surgery.
• 4:19
  Justin Chang: Uh, I knew I would go and see some amazing surgeons.
• 4:22
  Justin Chang: I knew I would learn surg-- like different, you know, techniques.
• 4:25
  Justin Chang: I knew I would pick up, you know, different technologies that I would want to incorporate into my practice in the future and, you know, be able to see some, you know, really, uh, you know, outstanding surgeons make complex cases look easy.
• 4:36
  Justin Chang: Um, that's kinda what I expected, and that's, that's what, what happened.
• 4:41
  Justin Chang: So, you know, that part I was, you know, expecting and, you know, very, you know, grateful f-for that opportunity.
• 4:47
  Justin Chang: But I think a lot of the other, um, o- the other aspects of the fellowship that I did not appreciate, you know, before is, you know, building the, the network with other surgeons, uh, you know, around the United States.
• 5:00
  Justin Chang: Uh, you know, now I feel comfortable, you know, messaging, uh, any of them really about, you know, advice or complex cases.
• 5:08
  Justin Chang: Um, even just building the cama-camaraderie with, you know, my fellow traveling fellows.
• 5:14
  Justin Chang: Like the f- the four of us in our group, we still talk regularly and, uh, you know, you know, throw cases back and forth with each other and ask for advice and, you know, that's like kinda a really nice thing that came out of this, um, that, you know, maybe did not appreciate, you know, before.
• 5:31
  Justin Chang: And, you know, just generally about, you know, how people run their practice, um, how to be efficient, um, how, how follow-up works, uh, how different technologies can help make, you know, systems more e-efficient or decre- system and, and things like that that I, you know, that is important, but when I came on the fellowship, I thought more purely of kinda surgical techniques and s- and like, you know, surgery.
• 6:00
  Justin Chang: But, you know, really it's, it was a, like the whole package of surg- of, of like a hip replacement and, and the perioperative care, uh, that surrounded that, that, you know, I didn't appreciate would be so valuable
• 6:13
  Joseph M. Schwab: S- so was there a particular moment that you think sort of captures what you're describing about what you experienced on the fellowship?
• 6:22
  Joseph M. Schwab: Uh, was there, was there something where you, uh, a moment that you can think of where you realized,"Oh, this is gonna be a bit more than what I had just signed up for"?
• 6:33
  Justin Chang: Honestly, it was, it was the first hour in, uh, our first stop in, uh, Dr.
• 6:38
  Justin Chang: Sah's OR.
• 6:40
  Justin Chang: And we saw, you know, even just the sterilization process, how everything was in small lean cubes, how the flow of the surgery worked, um, the different technologies that were there, and how they were testing, you know, comparable ones.
• 6:57
  Justin Chang: Um, even, even teaching, uh, like, uh, D- uh, Dr.
• 7:02
  Justin Chang: Sah was using like a special like lens to, um, to like virtually transmit like his surgery to someone else, like across the country, and they're able to, they're able to like ask questions and draw on his, on his screen basically during the surgery.
• 7:20
  Justin Chang: and this is all, this is all like the first case.
• 7:22
  Justin Chang: Um, so I was like, uh-- I remember thinking like, wow, this is not just like...
• 7:27
  Justin Chang: You know, I was trying to take notes on like the technique and stuff, but even just like looking at the tray setup, looking at how quickly they process things and, you know, the, the number of trays needed for all the cases and, and then I realized that there, I was, there's, there's so much that I was gonna learn about everything
• 7:43
  Joseph M. Schwab: So, uh, l- let's talk a little bit about technique because you, you know, you are-- One thing about doing a traveling fellowship is that you don't just see one surgeon's technique, right?
• 7:53
  Joseph M. Schwab: You see multiple surgeons who are all very good, um, at doing the same approach.
• 8:00
  Joseph M. Schwab: W- what did that exposure to multiple surgeons' different techniques teach you about anterior approach?
• 8:12
  Justin Chang: I mean, I think overall it just reaffirms that there's lots of good ways, uh, to do the same thing.
• 8:18
  Justin Chang: Um, some of the, some of the, like, especially like retractor, uh, placements, uh, some of these surgeons, you know, did some that were similar to what I, what I was doing and what I had been taught, and there's some little tricks that other surgeons use that I thought, oh, that would be like much easier in my practice, or I've, you know, I've struggled exposing that bit of the acetabulum and seeing how they position retractors.
• 8:41
  Justin Chang: Or one thing I learned actually is just how they use some of the retractors and hook it under the, the ladder in the, in the HANA table.
• 8:49
  Justin Chang: Um, and I just remember thinking like, wow, like I've never thought of that, and it like basically negates the use of like an extra assistant for me.
• 8:58
  Justin Chang: Or when I teach now I can-- I have a-- Instead of standing, you know, you know, more superior or like more north on the table, I can't really see.
• 9:05
  Justin Chang: Now I can just put that retractor in the ladder, and I can stand and watch the fellows ream.
• 9:10
  Justin Chang: Um, so I found even like things like that, like changed my practice immediately.
• 9:14
  Justin Chang: Um, so I think the, the retractor tips, the gaining the exposure tr-tricks, like those were-- There's-- And there were a lot of little things that I hadn't thought of that make things a lot easier.
• 9:26
  Justin Chang: And some of the things the surgeons just did like intuitively, like didn't even really think about until you, you asked them.
• 9:33
  Joseph M. Schwab: Hmm.
• 9:33
  Justin Chang: Um, so I found like little tricks like that were like extremely valuable.
• 9:38
  Joseph M. Schwab: Did-- How did you decide what to adopt and what, what to take back from, uh, any one of the surgeons versus identifying something that was maybe interesting but just worked for that surgeon?
• 9:56
  Justin Chang: some, some of it is practical.
• 9:57
  Justin Chang: So, um, you know, some of the surgeons, uh, would use, you know, special retractor devices that we don't have available or wouldn't be cost-effective in our system.
• 10:07
  Justin Chang: Uh, so some-something like that, maybe like, like using the gripper was maybe not feasible immediately, uh, for myself, even though, you know, I thought it was a fantastic tool.
• 10:17
  Justin Chang: Um, and then some of the stuff seemed much more simple, uh, that I could incorporate very quickly.
• 10:22
  Justin Chang: So, you know, switching from using a Charnley to using a Gelpi, uh, using, you know, like I mentioned, the cobra with the hook on the la- on the ladder of the HANA table to, you know, you know, kind of increase my space around the OR and allow me to, like, see better and not have so many people crowded around.
• 10:38
  Justin Chang: So some of this stuff was more, you know, practically it was easy to switch, and some of it would've been, you know, cool to see, but, like, maybe practically more difficult to get into our system or would just take a little bit longer
• 10:50
  Joseph M. Schwab: So your kinda stated interest was in being able to expand your repertoire into, um, more difficult cases, revision cases, things like that.
• 11:00
  Joseph M. Schwab: Did you have an opportunity to experience any of those types of cases on the fellowship, and w- what did you take away from it?
• 11:10
  Justin Chang: Yeah, for sure.
• 11:11
  Justin Chang: I mean, in Houston we saw, you know, uh, like an, uh, nail conversion, uh, with Anay Patel to a total hip placement via the anterior approach, which I dabbled in, but, you know, struggled with, and just seeing like different exposure techniques and tricks to get the nails out.
• 11:25
  Justin Chang: Um, so, you know, just seeing someone who is, you know, very experienced in that case just, you know, provides more confidence that like, yeah, you can do it.
• 11:34
  Justin Chang: Um, and then OrthoCarolina with, you know, uh, John Masonis and Bo Mason was incredible.
• 11:39
  Justin Chang: They-- like we saw, you know, a whole bunch of complex revision cases in, in only two days, um, including, you know, femoral revisions, um, and, you know, osteotomies and, uh, you know, like custom tri-flange through the anterior approach.
• 11:55
  Justin Chang: So these things were, were very helpful.
• 11:57
  Justin Chang: And also we had multiple labs where we could, you know, practice the techniques that we had kind of just seen, uh, in person.
• 12:05
  Justin Chang: So, you know, that was helpful to kind of-- It was helpful to kind of make sure that like a-the anatomy made sense and, you know, confidence that, you know, we're not gonna do any harm by, you know, increasing these exposures
• 12:20
  Joseph M. Schwab: W- was the bigger lesson a, a particular technique or surgical technique, a, a tip or trick, or was it more about how the surgeons that you got to observe approached the problem?
• 12:31
  Joseph M. Schwab: Or maybe a mixture of both
• 12:34
  Justin Chang: Probably a mixture of both.
• 12:36
  Justin Chang: Um, you know, I'd seen some complex cases, um, and, you know, cup cages and things like that through the anterior approach from one of my colleagues, Dr.
• 12:43
  Justin Chang: Rodriguez does a lot of them.
• 12:45
  Justin Chang: Um, but just seeing other surgeons tackle the same problems, um, and, you know, I think one, one of the challenges they make, they make everything look so easy that you think you can just do it.
• 12:54
  Justin Chang: Um, but the way they can talk through issues and explain, you know, when you need to add your releases, when you need to do an osteotomy, things like that, I think were-- Just seeing it in person and, and seeing the exposure made y- made me realize that, you know, this is, like, feasible and, you know, um, and, and, and so in many ways, you know, easier than doing it from the, like, a posterior approach
• 13:20
  Joseph M. Schwab: So, uh, because most of your training was in posterior approach, I'm, I'm interested in, in hearing, um, after seeing so many surgeons, um, working, uh, performing the anterior approach in this fellowship, does it feel like more so the approach is just a set of technical steps, or does it feel like there's sort of a broader philosophy to it?
• 13:48
  Justin Chang: I mean, I think both really.
• 13:50
  Justin Chang: Um, the steps are important to, like, understand how to, how to, like, perform an operation safely and, you know, minimize any, any damage to, you know, like femoral nerve or, you know, the neurovascular bundles.
• 14:01
  Justin Chang: But I do think there's a-- the overall approach of, you know, minimizing soft tissue trauma, uh, maximizing early recovery.
• 14:10
  Justin Chang: I think these principles, you know, and you're-- we're seeing it, you know, in the knee as well with more and more surgeons doing, you know, subvastus approach and things like that.
• 14:17
  Justin Chang: But I think, you know, the overall principle of, you know, minimizing the amount of soft, soft tissue trauma, um, is, is something that, you know, I think is important for, for, you know, patients' early recovery The other thing is that like in the last, you know, ten, fifteen years, a lot of surgeons doing anterior approach, um, generally, not, not the ones with obviously, but you know, probably were trained in, you know, uh, posterior approach for, or in Canada, the lateral approach is, is still quite popular.
• 14:48
  Justin Chang: Um, so a lot of surgeons were trained in the posterolateral approach to the anterior approach kind of early career or mid-career.
• 14:58
  Justin Chang: Um, so they still feel comfortable, you know, doing complex cases, you know, from, you know, posterior lateral approach.
• 15:03
  Justin Chang: I think now, you know, more and more surgeons are starting with the anterior approach.
• 15:07
  Justin Chang: It is their preferred and most comfortable approach.
• 15:09
  Justin Chang: So I think the idea that, you know, for a lot of cases to just switch to a posterior approach for the most complex cases is actually gonna be more and more of a challenge for younger surgeons and kind of understanding, you know, how to, how to do the complex cases from your own comfort level, meaning, you know, the anterior approach again, um, is probably gonna be something that's gonna become more and more important, uh, because otherwise you're gonna have sur-surgeons who rarely do a posterior or lateral approach doing-- trying to do, you know, their hardest cases from that approach that they do very infrequently.
• 15:42
  Justin Chang: So I think, you know, learning how to do the, the cases from the anterior approach, uh, is, is gonna be like an extremely important thing, you know, for the newer generation of surgeons who've been basically almost exclusively trained in the anterior approach.
• 15:58
  Joseph M. Schwab: Hmm.
• 15:59
  Joseph M. Schwab: Ha- did your definition of maybe what a good anterior hip surgeon is, um, change with the fellowship?
• 16:11
  Justin Chang: I think what-- I think we saw some, like, true masters of surgery.
• 16:15
  Justin Chang: So it was, um, you know, I've seen some good anterior approach surgeons, and then, uh, we saw some, like, true masters of surgery.
• 16:23
  Justin Chang: Um, so it's definitely something to, like, aspire to, you know, emulate in the future.
• 16:27
  Justin Chang: Whether that target is ever attainable, unsure, but you know, I think they were, um, definitely, you know, eye-opening to see, like, what, what surgeons can do through the anterior approach.
• 16:41
  Joseph M. Schwab: Hmm.
• 16:41
  Joseph M. Schwab: So y- you, you brought experience from practicing outside the US, um, in, in both the Canadian system, the English healthcare system, or at least training there.
• 16:52
  Joseph M. Schwab: Um, how did you see the anterior approach practiced in the US compared with what you were used to?
• 17:00
  Joseph M. Schwab: And were the differences that surprised you better or worse or just different?
• 17:09
  Justin Chang: I think in, you know, where I work at Humber River, um, you know, we've tried to emulate, you know, some of the techniques and things in the US, so, you know, we, we use the HANA table.
• 17:19
  Justin Chang: Um, we use, uh, enhanced technology, uh, to do the surgeries.
• 17:23
  Justin Chang: So I think some of it was, um, you know, fairly similar.
• 17:26
  Justin Chang: You know, throughout Canada, Canada, I think, um, there are more surgeons doing, you know, off-table anterior approach, um, maybe because, uh, initially it'd be difficult to, you know, obtain a HANA table.
• 17:38
  Justin Chang: Um, but you know, obviously some advantages of off-table as well.
• 17:42
  Justin Chang: But, you know, for what, what I saw was like relatively similar.
• 17:46
  Justin Chang: Um, the one thing that, uh, I did pick up on a lot was, um, you know, the, the efficiency of care and working in like, like a surgical center environment.
• 17:59
  Justin Chang: In Canada, it's still primarily, um, within the hospital system.
• 18:04
  Justin Chang: There's now kind of early beginnings of surgical centers performing, uh, you know, hip replacement, but, uh, traditionally it's all been in hospital.
• 18:14
  Justin Chang: So seeing like how, how the flow works and how the efficiency works and how s- how you can im-improve safety in a, in a surgical center was something, you know, trying to, you know, bring back to Canada.
• 18:29
  Joseph M. Schwab: Hmm.
• 18:29
  Joseph M. Schwab: Were there things that you observed that you thought surgeons in the US, um, could learn or adopt from the way you had been practicing anterior hip surgery in your environment?
• 18:42
  Justin Chang: There's always things you can learn, like technical tricks.
• 18:45
  Justin Chang: I think one thing that, you know, we've done at our hospital well is that we've been able to, you know, maximize efficiency in a hospital setting.
• 18:52
  Justin Chang: So I know traditionally in, in, in the United States, the surgical centers are very efficient, the hospitals are not.
• 18:58
  Justin Chang: Uh, we've, we've been able to create a system where we can, you know, have an efficient care and efficient workflow within a hospital.
• 19:08
  Justin Chang: So I think that's one thing that, you know, potentially, you know, an American hospital come and look at, you know, what we do in Humber River and see, you know, how, how our nursing team, our perioperative team, how-- and our ane- anesthesia team, how, how we all work together to perf- to be able to, to have that efficiency within a, in a hosp- in a public hospital scenario or sit-situation
• 19:32
  Joseph M. Schwab: Mm-hmm.
• 19:34
  Joseph M. Schwab: So I wanna go back to a point you made just a little bit ago about, um, kind of observing master surgeons,'cause you, you s- you spent two weeks, um, watching these surgeons who are very experienced.
• 19:48
  Joseph M. Schwab: Did that experience, um, anything about watching them change the way you think about expertise or mastery?
• 20:01
  Justin Chang: Uh, for sure.
• 20:01
  Justin Chang: I mean, I think a lot of it is, you know, careful soft tissue handling and exposure.
• 20:08
  Justin Chang: And, you know, a lot of, a lot of orthopedics is, you know, you see the preoperative X-ray, you see the postoperative X-ray, and it's very impressive what they can do based on what the X-ray looks like.
• 20:17
  Justin Chang: But, you know, just seeing some of these surgeons and how they handle the soft tissue and how they expose, um, how they do their, how they do their releases, how they know, like, when enough release is enough to kind of minimize how much soft tissue trauma is required, and to safely do the operation.
• 20:38
  Justin Chang: Um, like that is the, the thing I picked up the most,'cause I mean, when I was doing my anterior hips before, I would do basically a full, full release of the superior capsule conjoined tendon, um, to gain exposure because, you know, I just really needed to, to see everything to, to do the operation safely in my own hands.
• 20:56
  Justin Chang: And just seeing how they're able to, to do that with less, you know, exposure, um, and s- and kinda show, you know, at what point, you know, at what point when you expose the femur is that enough, enough exposure to safely, you know, broach the canal?
• 21:12
  Justin Chang: Or, you know, how to, how to minimize trauma when, when you're exposing the acetabulum and, and, and, you know, different ways to, you know, avoid trauma getting the reamers in and out.
• 21:22
  Justin Chang: Um, so I think a lot of it was, you know, minimization of soft tissue trauma intraoperatively and different-- Everyone had their own tricks to, to, to do that and just trying to pick up on as many as you can.
• 21:35
  Joseph M. Schwab: Did you notice any aspects or did anything strike you about the way they handled, um, things that weren't specifically surgery?
• 21:46
  Joseph M. Schwab: Like how they communicated, how they talked, how they made decisions, or maybe how they handled uncertainty.
• 21:53
  Joseph M. Schwab: Did you get any, any sense, um, for, uh, how that may be different in somebody who's a, a master surgeon?
• 22:05
  Justin Chang: You mean like technically or just around the surgery itself?
• 22:09
  Joseph M. Schwab: Um, uh, b- actually in, in any of your interaction with them.
• 22:12
  Joseph M. Schwab: Just, uh, so soft tissue handling is great, that's certainly surgical, but any non-surgical, um, cues or behaviors or, or things that you noticed.
• 22:22
  Joseph M. Schwab: Or, or maybe not
• 22:25
  Justin Chang: Yeah, I just think, uh, I mean, I-- with, uh, with Dr.
• 22:27
  Justin Chang: Sah, just seeing how responsive he was with his patients, um, how, uh, involved he was with, you know, every patient interaction.
• 22:37
  Justin Chang: Um, he had a team of PAs, but he was always the one kind of quarterbacking the ship, and he, uh, or captaining the ship, and he al-- he was, he was very present with all of his patients and very accessible.
• 22:49
  Justin Chang: And you could tell that the, the patients, you know, really appreciated that and, you know, noticed that it was a step above.
• 22:56
  Justin Chang: And that's something that, you know, I've been trying to take back to my own practice, even as my practice itself is getting busier and busier and, and, and the one thing I've noticed with him is that despite the volume he does, he still maintains that communication with the patients.
• 23:12
  Justin Chang: And I think especially when, you know, inevitably complications occur, I think the patients, they just still trust you, and I think that's, you know, important, and that's something that I, I noticed that I thought would be...
• 23:24
  Justin Chang: I didn't know how feasible that would be a-as your practice grew to the, you know, doing volume of that size, but he was still able to maintain that, which I think was, uh, you know, very important.
• 23:36
  Joseph M. Schwab: Well, and you, you kind of preempted my next question, which was w- you know, are there other things that you wanted to bring back to your own practice, your own operating room, um, to help you continue developing as a surgeon based on what you saw?
• 23:49
  Joseph M. Schwab: So Dr.
• 23:50
  Joseph M. Schwab: Sah's, um, approach to patients is one.
• 23:53
  Joseph M. Schwab: Were there others?
• 23:57
  Justin Chang: Yeah, I mean, that, that's for sure one.
• 23:59
  Justin Chang: I mean, there's, there's so many things we could talk about, um, you know, just from, from the surgery, um, you know, looking at, you know, we've done a lot of work, you know, minimizing trays and, and pans, but, you know, continuing to optimize, you know, your preoperative setup to make things more efficient.
• 24:16
  Justin Chang: Uh, at, um, Dr.
• 24:18
  Justin Chang: DeCook's place in Atlanta, um, they have one team which, you know, is, is continuously, uh, you know, obtaining timing so you can, you know, keep on track and, you know, try to continuously collect data to identify, you know, where you can become more efficient.
• 24:34
  Justin Chang: We've done a tri-- Uh, we did a trial with that at Humber, and so they came and, you know, checked all my times for, for, for a couple lists.
• 24:41
  Justin Chang: So we're trying to, like, incorporate, you know, some of that to, you know, con- continuously try to improve our, our systems at Humber.
• 24:49
  Justin Chang: Um, I mentioned all the things about, you know, intraoperatively, you know, in terms of, you know, little tips and techniques.
• 24:57
  Justin Chang: Um, one of the techniques that, that I, I was very interested in was, like, OrthoGrid, um, with the, you know, AI software and X-ray, and that's, you know, a technology that is not yet available in Canada.
• 25:08
  Justin Chang: It's still undergoing Health Canada approval, but something that I'd be interested in, you know, bringing back to Canada and, and using for, for our own patients.
• 25:18
  Justin Chang: And just seeing, you know, generally postoperative care and the team is, you know, easier in the United States, I think, um, because, uh, r- in Canada, you know, a lot of it is on the surgeon itself.
• 25:32
  Justin Chang: Um, in the, in the US, you know, every surgeon we saw had, you know, a, a team of PAs helping them.
• 25:38
  Justin Chang: Um, in Canada, we don't have that as of yet.
• 25:41
  Justin Chang: Um, if, um, PAs are becoming more and more, you know, popular, and they're very in demand.
• 25:46
  Justin Chang: Uh, it's very difficult to get into PA school in Canada.
• 25:49
  Justin Chang: Um, so hopefully, you know, in, in, in the next, you know, few years, you know, the, the government and the-- will understand the value of PAs and how it can help, you know, surgeons, uh, with patient care and managing burnout and things like that.
• 26:06
  Justin Chang: And I think, you know, being able to have a team around you would be, uh, and, and a PA that kinda knows exactly what you do and, and can help with, you know, the patients perioperatively, uh, would be something that, you know, I would love to be able to bring back to Canada at, at some point
• 26:22
  Joseph M. Schwab: Hmm.
• 26:23
  Joseph M. Schwab: So l- let's talk a little bit about some of the more social aspects of this, because if a, a friend of yours, a colleague, another surgeon asked, um, w- whether it's actually worth two weeks away from your practice and maybe your family and, um, two weeks where the work is gonna pile up, what would you tell them?
• 26:47
  Justin Chang: I mean, it was a very-- it was an invaluable experience.
• 26:51
  Justin Chang: Um, you know, just to...
• 26:54
  Justin Chang: I mean, the surgery speaks for itself in learning the, you know, the, the intraoperative tricks and, you know, the technologies you wanna bring.
• 27:01
  Justin Chang: And, and that part, you know, as I mentioned before, like, you know you're gonna get that from the fellowship.
• 27:06
  Justin Chang: Um, but it's the, it's the, the network you can build, um, you know, with, with your co-fellows, but also with, you know, the s- the surgeons that you go visit.
• 27:16
  Justin Chang: Uh, that ability to, you know, be able to just pick up the phone and call, like, one of the world experts in anterior hip surgery and just ask them for advice, um, is, is extremely valuable and, uh, you know, would never have that without this.
• 27:33
  Justin Chang: Um, and just having that, like, the group of, of guys that I went on, on the traveling fellowship with and, you know, being able to, you know, throw cases back and forth and, you know, we still talk, you know, every few days and, um, about surgery and life and, you know, just having that, having that, you know, that friendship, you know, with colleagues also, you know, is an experience that, you know, is hard or impossible to replicate.
• 28:02
  Justin Chang: Um, it is a challenge, uh, being away, um, especially, you know, in Canada, we're fee for service, so that's basically no, no working for two weeks.
• 28:10
  Justin Chang: Um, you know, in some other, um, places where you're salaried, it's, it's a bit more feasible, uh, to go away.
• 28:18
  Justin Chang: Um, it can be challenging for the family, especially a lot of us have, have, have young families.
• 28:23
  Justin Chang: But, um, I think, um, if planned ear- or, like, w- because it was planned early, we kind of made arrangements, um, you know, f- for, for help from, um, my wife's family to come and help her with the kids while I was away.
• 28:36
  Justin Chang: But, you know, I think those two and a half weeks, um, were, you know, invaluable to, you know, progression of my career.
• 28:42
  Justin Chang: And even since then, like, I've been able to, you know, become more confident doing s- like some more challenging cases and, and, um, you know, bringing, you know, more upfront about, you know, what technologies I would like to bring in the future and things like that
• 28:58
  Joseph M. Schwab: Hmm.
• 28:59
  Joseph M. Schwab: I- is there, is there a type of surgeon this fellowship just isn't built for?
• 29:09
  Justin Chang: I don't, I don't think so.
• 29:11
  Justin Chang: I think everyone-- Th-there's, there's something you can learn from every surgeon, and it may not always be what you think.
• 29:18
  Justin Chang: Um, I think even the most, the most experienced surgeons would, would learn a lot, uh, whether it's, you know, whether it's how the practice is run or how to be more efficient or even o-one thing, um, in Alex Sah's OR that, um, was surprising is just, like, the sterilization trays.
• 29:38
  Justin Chang: Uh, even, like, looking at, you know, the different types of trays used for sterilization, how can we-- how that process can be done quicker.
• 29:45
  Justin Chang: I was like, even, even something like that is, is looking like, oh, well, if we, if we brought something like that back to Canada, you would need physically less trays'cause you can sterilize it so much quicker.
• 29:54
  Justin Chang: Like, even there's lots of, there's lots of little things that you, you don't, you don't think you're gonna learn.
• 29:59
  Justin Chang: Um, so I don't think so.
• 30:01
  Justin Chang: I think, I think there's, there's so many different aspects of care, uh, within the surgery and around the surgery that, you know, it'd be an invaluable, you know, experience for anybody.
• 30:13
  Justin Chang: But, you know, even more experienced surgeons, you know, I think can learn a lot
• 30:18
  Joseph M. Schwab: So, clearly you've spent a lot of time thinking about the anterior approach and, um, you know, your time on the fellowship facilitates that.
• 30:27
  Joseph M. Schwab: Where do you see anterior approach hip replacement surgery going?
• 30:34
  Joseph M. Schwab: What, what direction is it heading?
• 30:38
  Justin Chang: I mean, I think it's well on the way to being the, the primary approach and the majority of hip replacements being done by the, by the anterior approach.
• 30:47
  Justin Chang: Uh, as I mentioned before, I think that like the-- because a lot of the, the s- the junior surgeons or the graduating surgeons coming through fellowship, you know, are gonna be exclusively doing the anterior approach, I think the reality is that the revision work, more people will be comfortable doing it through the anterior approach as that is their, like, more preferred approach.
• 31:08
  Justin Chang: So I think more and more revision work will become, will be done anteriorly.
• 31:12
  Justin Chang: I think, um, you know, maybe despite what Joel Matta thinks, uh, hip resurfacing is probably gonna make some sort of a resurgence and, um, you know, I think being able to do that safely from the anterior approach also, you know, there are definitely surgeons who are doing that already.
• 31:29
  Justin Chang: Um, but that may be, you know, something, you know, coming more in the future, you know, doing, uh, re-resurfacing through the anterior approach.
• 31:36
  Justin Chang: So I think, you know, more and more surgeons feeling comfortable doing, you know, the mo- the most complex cases, the anterior approach, uh, will become more, more of the norm rather than, you know, select experts.
• 31:50
  Justin Chang: Um, so I think that's the, the way, the way it's going or the way it will likely have to go.
• 31:57
  Joseph M. Schwab: Are you incorporating hip resurfacing in your practice at the moment or no?
• 32:02
  Justin Chang: Not yet.
• 32:03
  Justin Chang: Uh, I'd like to.
• 32:04
  Justin Chang: Um, so that's, that's a, a target for the next, you know, year
• 32:10
  Joseph M. Schwab: Um, if you could go back to the beginning of the program, the beginning of the fellowship, knowing what you know now, um, is there something different that you would tell yourself about what to prepare for, what to expect?
• 32:28
  Justin Chang: I think I would tell myself to, to not be so focused on just the surgery and just, you know, really take, take note of, of, of everything.
• 32:39
  Justin Chang: Uh, one, one aspect that I found like most valuable was the, you know, just the informal discussions at dinner or in the car about, uh, practice building, um, becoming like a surgeon leader.
• 32:55
  Justin Chang: Um, you know, how, how marketing has changed in the US with, with surgery, um, how people use social media.
• 33:04
  Justin Chang: Um, like all these things that, you know, maybe were a lot less prominent or relevant, you know, in the last decade is, is becoming more and more mainstream.
• 33:15
  Justin Chang: So like how, how has that changed things or how does that change the look of, of, you know, practice building or career building and how necessary all that is.
• 33:24
  Justin Chang: Um, so I think, you know, I would tell myself to, yes, you know, take notes on the surgery, look at the techniques, but make sure that you spend time, you know, talking to surgeons about, about how they built their practice, um, what, what they wish they had done differently or wish what, what has really helped them
• 33:45
  Joseph M. Schwab: So, um, we-- I, I've got one final question.
• 33:50
  Joseph M. Schwab: It's actually not even really a question.
• 33:51
  Joseph M. Schwab: It's a, it's a fill in the complete this sentence type, uh, situation.
• 33:56
  Joseph M. Schwab: Um, and, uh, but before I do that, I, I just wanna, um, you know, thank you for, for taking the time with us and, and thank you for sharing your experience with the fellowship.
• 34:06
  Joseph M. Schwab: And here's what I want you to do, Justin.
• 34:09
  Joseph M. Schwab: Um, I want you to take the sentence: The biggest thing I took away from the AHF Traveling Fellowship wasn't a technique, it was blank.
• 34:20
  Joseph M. Schwab: And fill in the blank for me
• 34:24
  Justin Chang: The biggest thing I took away from the Anterior Fellowship wasn't a technique, it was the importance of building a network, uh, with other surgeons, you know, around the world and being able to rely on that, you know, in the future to, you know, ga- get advice, um, for my own practice
• 34:44
  Joseph M. Schwab: Excellent.
• 34:45
  Joseph M. Schwab: Well, uh, Justin, um, really appreciate you taking some time today to share your opinions and your thoughts and your experience about the Anterior Hip, uh, Foundation Traveling Fellowship and, um, and for joining me today on the AHF Podcast.
• 35:01
  Joseph M. Schwab: Thank you so much
• 35:04
  Justin Chang: Thank you
• 35:06
  Joseph M. Schwab: So that's all for today's episode of The AHF Podcast.
• 35:10
  Joseph M. Schwab: If you found value in this conversation, share it with a friend or colleague, or just drop us a comment to let us know.
• 35:17
  Joseph M. Schwab: And make sure to connect with us on LinkedIn to join the discussion between episodes.
• 35:22
  Joseph M. Schwab: There's a link to our brand-new LinkedIn page in the description.
• 35:27
  Joseph M. Schwab: Find us every Friday with episodes on Apple Podcasts, Spotify, YouTube, and all major podcast platforms.
• 35:35
  Joseph M. Schwab: I'm your host, Joe Schwab, reminding you to keep those hips happy and healthy