American Orthopaedic Association Research Articles

Sex Diversity and Equity Among Fellows of the American Orthopaedic Association.

We hypothesized that women are underrepresented among fellows of the American Orthopaedic Association (AOA) relative to their prevalence among faculty at departments of orthopaedic surgery. Clinical faculty at departments of orthopaedic surgery that are affiliated with residency training programs were analyzed for AOA membership. Participation-to-prevalence ratios (PPRs) were calculated for men and women with AOA membership relative to their prevalence among orthopaedic surgeon faculty. A PPR of <0.8 or >1.2 indicated under- or overrepresentation, respectively. PPR values between 0.8 and 1.2 indicated equivalent representation. Sex disparities in AOA membership were explored by academic rank and orthopaedic subspecialty. There were 4,310 orthopaedic surgery faculty, and 998 (23.2%) had AOA membership. Overall, women formed the minority of members in the AOA study cohort (11.4%), but they had equivalent representation relative to their prevalence among faculty (10.0%, PPR = 1.14, p = 0.210). In the AOA study cohort, women were the minority at each academic rank, including assistant professor (20.2% versus 79.8%, p < 0.001), associate professor (16.8% versus 83.2%, p < 0.001), and full professor (7.0% versus 93.0%, p < 0.001). However, women had greater representation in the AOA study cohort at each academic rank than would be expected based on their prevalence among faculty, including the assistant (PPR = 1.45), associate (PPR = 1.56), and full (PPR = 1.27) professor levels. Similarly, in the AOA study cohort, women were the minority in each orthopaedic subspecialty, but were only underrepresented in pediatric orthopaedics (PPR = 0.74). Women had greater representation in the AOA study cohort than would be expected by their prevalence among faculty in hand surgery (PPR = 1.51) and orthopaedic sports medicine (PPR = 1.33). In contrast, men had equivalent representation in each orthopaedic subspecialty. Women form a minority group in the AOA, but they exhibit greater representation in the AOA than would be expected based on their prevalence among faculty at each academic rank, and they have greater representation than men, who exhibit equivalent representation across all academic ranks. Collectively, these results disproved our hypothesis, and suggest that women are participating in the AOA at rates that are greater than their prevalence among faculty. Equitable participation of women in orthopaedic surgery is necessary to promote diversity and inclusion in the specialty. The AOA may be an important catalyst for future positive diversity and inclusion efforts within orthopaedic surgery.

Preference signaling in orthopaedic surgery: applicant perspectives and opinions.

Orthopaedic surgery has become increasingly competitive over the years, with the COVID-19 pandemic creating additional challenges for applicants and programs. To promote an equitable match experience, the American Orthopaedic Association (AOA) introduced a formal preference signaling (PS) system into the 2022-2023 application cycle. PS allows applicants to indicate their heightened interest in specific programs, which improves the likelihood of receiving an interview and ultimately matching at their desired residency program. The objective of this anonymous survey is to assess applicants' opinions and perspectives toward PS in orthopaedic surgery prior to the 2022-2023 match results. Additionally, we sought to evaluate the signaling strategies being utilized by applicants. An anonymous 22-question survey was distributed to applicants of an orthopaedic surgery residency program (34.2 % response rate). Responses were collected after the application submission deadline but before the match lists and results were available. This survey included questions germane to demographics, signal utilization, signaling reasons and strategies, and opinions toward PS.Descriptive statistics were calculated utilizing R (version 4.2.1) and RStudio. Most respondents (96.1 %) participated in PS, and 96.7 % utilized all 30 signals. Signaling encouraged 24.2 % ofapplicants to apply to fewer programs. In accordance withguidelines, 83.2 % of respondents signaled each away rotation program; however, only 53 % signaled their home program. Applicants commonly signaled 1-10 "reach" and "safety" programs each. Proximity to Family and Perceived Operative Experience were the most important reasons forsignaling, whereas Program Prestige was the least. A program's social presence and virtual interview option did not influence many applicants' decisions for signaling. Most applicants believe that the COVID-19 pandemic and pass/fail licensure examinations influenced PS adoption. Sixty-seven of 149 respondents (45 %) claimed that applicants and programs benefit equally from PS, while 41 % believe programs benefit more. Nearly half (40.94 %) knew very littleor nothing about PS. During the inaugural introduction of PS in orthopaedic surgery, nearly every applicant utilized all 30 signals, prioritizing factors like family proximity and perceived operative experience over program prestige. Thisshift reflects the importance of geographic location andpresumed training quality. Despite unfamiliarity toward PS, personalized signaling strategies were implemented, accompanied by a slight decrease in application volumes. The30 allotted signals in orthopaedic surgery may serve as aninformal application cap due to the necessity of signaling aprogram for an interview invite. However, improved educational efforts are needed to enhance the understanding and maximize the benefits of PS for both applicants and programs.

A comparison of foot fractures relative to other fragility fractures: a review and analysis of the American Orthopaedic Association's Own the Bone Database.

Osteoporosis can clinically result in fragility fractures. Evidence regarding the risk factors and characteristics of foot fragility fractures compared to non-foot fragility fractures is limited. The American Orthopaedic Association's Own the Bone (OTB) is a bone health initiative with a substantial dataset. The purpose of this study was to examine and compare characteristics of patients presenting with isolated foot fragility fracture to those with a non-foot fragility fracture. Between January 2009 and March of 2022, 58,001 fragility fractures occurred that were included in this cohort. A total of 750 patients had foot fragility fracture(s) and 57,251 patients had a non-foot fragility fracture that included shoulder, arm, elbow, forearm, wrist, spine, ribs, pelvis, hip, thigh, knee, tibia/fibula, and ankle. Demographics, fracture history, bone health factors, medication history, and medicationuse for each patient were reported in the OTB database. This data was utilized in our secondary cohort comparative analysis of characteristics and the risk of future fractures between foot fragility fracture and non-foot fragility fracture groups. Foot fragility fracture patients have a significantly higher probability to be younger (66.9years old), female (91.5%), and have a higher BMI (28.3kg/m2) compared to non-foot fragility fracture (p < 0.0001) patients. Patients with a foot fragility fracture are nine times (OR = 9.119, CI = 7.44-11.18, p < 0.001) more likely to have had a prior foot fragility fracture. Young, female patients with a prior foot fragility fracture are at higher risk of a future foot fragility fracture, and this risk increased as BMI increased. Foot fragility fracture patients are more likely to be female and younger compared to patients with a non-foot fragility fracture. A foot fragility fracture is a sentinel event considering that a prior foot fragility fracture is strongly predictive of a subsequent foot fragility fracture. 3 (retrospective cohort).

Dr. Newton Shaffer (1846-1928): Renowned Orthopedic Surgeon and Founder of the American Orthopaedic Association.

An unsung hero of American orthopedic surgery is the largely forgotten Dr. Newton Melman Shaffer (1846-1928). Upon graduating from medical school at New York University, Shaffer began his career training at the Hospital for the Ruptured and Crippled in 1867. Shaffer then went on to practice at St. Luke's Hospital and New York Orthopaedic Dispensary and Hospital where he became chief. Here, Shaffer made major contributions to the field in treating clubfoot and tuberculosis. He then declared orthopedics as a separate entity from general surgery at the 10th International Medical Congress. He helped start the American Orthopaedic Association to push for the recognition of American orthopedics to the international community. In 1900, Shaffer opened the first state-run hospital for underprivileged children requiring rehabilitation. During his career, Shaffer advocated for conservative orthopedic treatments, aided in the invention of medical devices, contributed largely to academic orthopedics, and successfully advocated for the inception of the field of orthopedic surgery.

AOA Critical Issues Symposium: Advancing Diversity, Equity, and Inclusion in Orthopaedic Surgery.

In recent years, the medical field has recognized the pivotal role of diversity, equity, and inclusion (DEI) in enhancing patient care and addressing health-care disparities. Orthopaedic surgery has embraced these principles to create a more inclusive and representative workforce. A DEI symposium that was sponsored by the American Orthopaedic Association convened orthopaedic surgeons, researchers, educators, and stakeholders to discuss challenges and strategies for implementing DEI initiatives. The symposium emphasized the importance of equity, and fostered conversations on creating equal opportunities and resources. Speakers covered key topics, including establishing DEI divisions, metrics for success, DEI leadership, and available resources, and promoted excellence and innovation in orthopaedic surgery through a more diverse and inclusive approach.

American Orthopaedic Association's (AOA) Council of Orthopaedic Residency Directors (CORD) 2022 Summer Conference: Top Abstracts

In a continuing collaboration between the American Orthopaedic Association's (AOA) Council of Orthopaedic Residency Directors (CORD) and JBJS, the following 10 abstracts highlight the scientific research presented at AOA's annual national meeting held in June 2022. These abstracts embody CORD's purpose and mission:“The American Orthopaedic Association's Council of Orthopaedic Residency Directors (CORD) program strives to recognize best practices in orthopaedic residency education and fellowship education based on ACGME [Accreditation Council for Graduate Medical Education]-defined essential knowledge and skills in each of the residency education competency areas. CORD provides a forum for academic orthopaedic leaders to exchange ideas, discuss solutions to challenges, and find ways to teach residents in orthopaedic programs effectively.” We hope this education-related research will inspire further inquiry to advance the development of future orthopaedic surgeons.

Identification of Factors Associated with Orthopaedic Surgery Residency Programs That Preferentially Match Students Who Performed an Elective Rotation Before the Interview Process.

The role of elective rotations in the orthopaedic residency selection process varies between programs. Our study aims to identify factors associated with residency programs that interview and match a greater proportion of applicants who have completed an elective rotation with their program. Data were collected through the American Orthopaedic Association's Orthopaedic Residency Information Network database. Bivariate correlations and multivariate regression models were used to identify independent predictors of programs with a greater proportion of interviewees or residents who completed an elective rotation at the respective program. One hundred seventy-eight of the 218 existing residency programs were included in this study. Programs that offered fewer interviews and more away rotation positions per year were associated with a greater odds of its interviewees (OR = 0.36, p = 0.01; OR = 4.55, p < 0.001, respectively) and residents (OR = 0.44, p = 0.04; OR = 4.23, p < 0.001, respectively) having completed an elective rotation with the program. In addition, programs with fewer attendings (OR = 0.39, p = 0.03) and in-person interviews (OR = 3.04, p = 0.04) matched a greater proportion of their rotators. However, programs that interviewed applicants during the elective rotation were less likely to match their rotators (OR = 0.35, p = 0.04). Certain program characteristics independently predict the likelihood of a program interviewing and matching their rotators. These findings may provide information for applicants and programs regarding the rotation process. III.

Preference Signaling Survey of Program Directors-After the Match.

The 2022 to 2023 orthopaedic residency cycle implemented a preference signaling program (PSP), allowing applicants to send "signals" to up to 30 programs to demonstrate their genuine interest. With the conclusion of the 2022 to 2023 cycle, the primary purpose of this study was to analyze program director (PD) perceptions of the PSP after the match cycle and provide a retrospective evaluation of the effects of the PSP on the orthopaedic resident selection process. A 21-question survey was distributed to 98 PDs (32.7% response rate). Contact information was obtained from a national database. Most respondents (96.9%) participated in the American Orthopaedic Association's PSP. The majority (93.7%) view preference signaling as a positive change. Most PDs (56.2%) reported a decreased number in applications received compared with previous years. Receiving a preference signal was ranked among the most important factors in resident selection, and most PDs agreed that preference signaling should be used to screen applicants (84.4%) and differentiate similar applicants (96.8%). Moreover, 65.6% of PDs indicated that they would not rank or invite applicants to interview without a signal or completion of a formal away rotation. PDs report that in the 2022 to 2023 cycle, 98.5% of applicants who matched at their program had sent a preference signal. Preference signaling was one of the most important factors assessed during its inaugural application cycle and is anticipated to remain a key tool for screening and differentiating candidates. Applicants should strategically select signal recipients to enhance their success in the match.

The History of Academic Leadership Education in Orthopaedic Surgery.

The growth of the American academic orthopaedic community over the last 53 years has been accompanied by an expanding need for academic leadership education. The transition of the Association of Orthopaedic Chairmen, to the Academic Orthopaedic Society, to the American Orthopaedic Association through its Academic Leadership Committee and American Orthopaedic Association Council of Residency Directors is reviewed. Academic orthopaedic community members recognized that the evolving leadership needs of the academic community could be better addressed by transitioning to a new organization, the Academic Orthopaedic Society and eventually by creating a new structure within a well aligned and well-resourced existing organization, the American Orthopaedic Association. Organizational and leadership flexibility has been vital to serving the evolving need of the American academic orthopaedic community for leadership education.

The Impact of Signaling on the 2022 to 2023 Orthopaedic Residency Application Cycle: A Survey of Incoming Residents

Background: During the 2022 to 2023 orthopaedic surgery residency application cycle, “signaling” was added, allowing applicants to communicate strong interest to 30 programs of their choosing. This study's purpose was to evaluate signaling's impact on the 2022 to 2023 application cycle. Methods: A cross-sectional survey was distributed to applicants who applied to a single residency program. We evaluated how many interviews the average applicant received, what proportion of interviews came from programs they had signaled, and what percentage of applicants matched at a program they had signaled. We stratified data by American Orthopaedic Association status, United States Medical Licensing Examination (USMLE) Step 1 and Step 2 scores, research items, sex, and race. Results: This survey was distributed to 611 applicants, with 124 (20.3%) responding to the survey. Ninety-five respondents (76.6%) matched. The percentage of applicant interviews that came from signaled programs was 78.7%. Ninety-one percent of matched applicants matched at a program they signaled. Sixty-three percent of matched applicants performed an away rotation at their matched programs. Forty-five percent of applicants felt that signaling incentivized reducing the programs they applied to, and applicants gave signaling a high favorability rating of 4/5. Applicants with Alpha Omega Alpha status received more interviews per application (0.18 ± 0.11 vs. 0.10 ± 0.10, p &lt; 0.001) and more interviews from programs they did not signal (74% of interviews from signaled programs vs. 90% of interviews from signaled programs, p &lt; 0.001). Higher Step 1 and Step 2 scores were associated with more interviews per application (Step 1: 0.16 ± 0.12 vs. 0.12 ± 0.08, p = 0.032) (Step 2: 0.16 ± 0.11 vs. 0.12 ± 0.09, p = 0.032). Conclusion: Orthopaedic residency applicants received most of their interviews from programs that they signaled, with an overwhelming majority matching at signaled program. Alpha Omega Alpha status and high USMLE scores were associated with more interviews granted per application, regardless of signaling status. Signaling seems to be a favorable option for orthopaedic applicants. Data from future application cycles will help further evaluate signaling's impact on the orthopaedic match.

Recent trends in hand surgery fellowship applicants and programs

BackgroundHand surgery is a competitive fellowship that draws applicants from orthopedic, plastic, and general surgery. In 2010, recommendations from the American Academy of Orthopaedic Surgeons (AAOS) Board of Specialty Societies Match Oversight Committee and the American Society of Plastic Surgeons (ASPS) Plastic Surgery Workforce Task Force led to significant reforms to their respective workforces and training. This study characterizes trends in hand fellowship applicants and programs since these recommendations (2010–2023). Materials and methodsWe queried hand fellowship applicant and program data from the American Society for Surgery of the Hand (ASSH), the National Resident Matching Program (NRMP), and the Accreditation Council for Graduate Medical Education (ACGME). Results, discussion and conclusionsFrom 2010 to 2023, the number of ACGME-accredited hand fellowship programs increased across specialties (orthopedic surgery, 58 to 74 (27.6 % increase, R = 0.97, p < 0.001); plastic surgery, 14 to 19 (35.7 % increase, R = 0.91, p < 0.001); general surgery, 1 to 2 (50 % increase, R = 0.71, p = 0.004). The number of available fellowship positions commensurately increased by 38.8 % over the same time period. The number of applicants did not significantly change between 2010 (155 applicants) and 2023 (198 applicants) (R = 0.32, p = 0.27). The ratio of applicants-to-positions significantly decreased from 2010 (1.12 applicants per position) to 2023 (1.04 applicants per position) (R = -0.74, p = 0.003). Yet, applicants ranked nearly twice as many programs in 2023 (14.9 programs per applicant) compared to in 2010 (7.5 programs per applicant) (R = 0.98, p < 0.001). In light of the American Orthopaedic Association endorsing signal preferencing in the 2022–2023 residency Match, strategies to optimize rank lists in the fellowship application process should be further explored.

The 2023 Austrian-Swiss-German Fellowship.

The Austrian-Swiss-German Fellowship was set up in 1978 to facilitate a program through which surgeons from the German-speaking countries of Austria, Switzerland, and Germany could visit the United Kingdom, Canada, and the United States of America. In 2023, surgeons Brian Mullis and Satish Kutty, representing the American Orthopaedic Association and the British Orthopaedic Association, respectively, visited centers in Austria, Switzerland, and Germany over the course of 4 weeks. This article describes their journey and experiences.

An analysis of 32 orthopaedic society costs and benefits

Background: Many orthopaedic surgeons belong to specialty groups or societies at the local, state, and national levels. We sought to understand costs and benefits of orthopaedic society memberships. Methods: We collected data on the cost of membership and benefits for 32 different orthopaedic societies in 2020 and 2021 by using website information and contacting the society’s administration. We grouped benefits into distinct categories: annual conference, continuing education, educational resources, leadership opportunities, career job listings, research grants, mentorship program, resident/fellow resources, medical student resources, and journal affiliation. Results: On average, attending surgeons pay $460 and residents/fellows pay $300 for a single annual membership. However, some organizations, such as the American Academy of Orthopaedic Surgeons (AAOS), the American Orthopaedic Association (AOA), and the Hip Society have higher annual dues ($1,115, $1,100, and $1,500, respectfully). Over 20 years, a physician belonging to both the AOA and the AAOS pay $44,300 in fees at the current cost. All 32 societies offer an annual conference, continuing education credit opportunities, other educational resources, leadership opportunities, and journal affiliations. Conclusions: Membership fees vary and benefits are often difficult to assess without becoming a member. The COVID-19 pandemic has moved society activities online, decreasing opportunities for in-person networking and education, with some societies considering reduced fees. The pandemic has also strained hospital budgets resulting in loss of funds for many physicians at academic organizations that would normally be used toward membership fees. Perhaps increased opportunities for resource pooling, with group access to educational opportunities and mentorship, should be considered. Level of Evidence: Level V.

AOA Critical Issues: Perceptions on the State of Diversity, Equity, and Inclusion in Orthopaedic Surgery: A Survey of the AOA Membership.

Orthopaedic surgery continues to trail other specialties in increasing diversity among its physician workforce. Various efforts have been and are currently being made to not only increase diversity, but also promote equity and inclusion in the field. The purpose of this study was to survey members of the American Orthopaedic Association (AOA) to determine how leaders in orthopaedics view diversity, equity, and inclusion (DEI) at the present time and to understand their perspective while moving into the future. An anonymous 11-question survey was disseminated online to AOA members in May 2022. These individuals were identified by the AOA membership directory and the email ListServe. The survey included free-response and multiple-choice questions. Demographic information was self-identified, and both qualitative and quantitative data were collected. Of the 1,657 AOA members who were provided the survey, 262 (15.8%) responded. Approximately 29.5% (77) and 45.6% (119) of the surveyed population ranked "retention of underrepresented populations in orthopaedic residency (women, URiM)" as "very important" or "absolutely essential," respectively. The answers to the free-response questions identified multiple core themes that responders were passionate about, namely resident and attending physician recruitment and retention, as well as resident selection. Leaders in the field of orthopaedic surgery desire for action to be taken in the field of DEI. The findings of this survey denote positive attitudes even though many inequalities still pervade the field of orthopaedics. Through mentorship, objective evaluation, transparency, and continued intentional action, orthopaedic surgery is well-positioned to continue to move forward with DEI.

Analysis of Academic Accomplishments and Demographics for Elected Presidents of National Orthopedic Surgery Organizations in the United States.

This study analyzed the academic accomplishments and demographics of elected presidents of the American Academy of Orthopaedic Surgeons (AAOS), American Orthopaedic Association (AOA), and American Board of Orthopaedic Surgery (ABOS). Curriculum vitae and internet-based resources were reviewed to collect demographics, training characteristics, bibliometrics, and National Institutes of Health (NIH) research funding of contemporary presidents (1990-2020). Eighty presidents were included. Most presidents were men (97%), and 4% of presidents were non-White (3% Black and 1% Hispanic). Few had an additional graduate degree (4% MBA, 3% MS, 1% MPH, 1% PhD). Ten orthopedic surgery residency programs trained 47% of these presidents. Most had fellowship training (59%), and the top three were hand surgery (11%), pediatric orthopedics (11%), and adult reconstruction (10%). Twenty-nine presidents (36%) participated in a traveling fellowship. The mean age at appointment was 58±5 years, which was 27 years since residency graduation. The mean h-index was 36±23, resulting from 150±126 peer-reviewed manuscripts. Orthopedic surgery presidents had more peer-reviewed manuscripts (150±126) than chairs (73±81) and program directors (27±32) (P<.001). AOA presidents had the highest mean h-index (42±21) compared with AAOS (38±27) and ABOS (25±16) presidents (P=.035). Nineteen presidents had NIH funding (24%). More presidents had NIH funding in the AOA (39%) and AAOS (25%) than the ABOS (0%) (P=.007). Orthopedic surgery presidents possess high levels of scholarly output. AOA presidents had the highest h-index values and prevalence of NIH funding. Females and racial minorities remain underrepresented at the highest levels of leadership. [Orthopedics. 2024;47(1):e45-e51.].

Effect of Lawsuits on Professional Well-Being and Medical Error Rates Among Orthopaedic Surgeons.

Orthopaedic surgery is one of the most cited specialties among legal claims. Malpractice lawsuits are financially burdensome, increase defensive practices, and incur a notable emotional toll on defendants. We sought to determine the effect of malpractice lawsuits on professional well-being and self-reported medical errors among orthopaedic surgeons. We surveyed 305 members of the American Orthopaedic Association to collect information on experiences with medical malpractice lawsuits, demographic and practice characteristics, professional well-being on the Professional Fulfillment Index, and self-reported medical errors. Multivariable logistic regression identified predictors of malpractice lawsuits, professional well-being, and self-reported medical errors. Seventy-three percent (224 of 305) respondents had been involved in a medical malpractice lawsuit. The odds of experiencing a malpractice lawsuit increased by seven percent with each year in practice (OR=1.07, 95% CI: 1.04 to 1.10, P < 0.001) and with specialization in spine surgery. Respondents with a lawsuit in 2 years before the survey reported comparable professional well-being and medical error rates with those without a lawsuit. However, compared with respondents without a lawsuit, respondents with a lawsuit more than 2 years in the past were less likely to report burnout (OR=0.43, 95% CI: 0.20 to 0.90, P = 0.03) and more likely to report a medical error in the past year, which resulted in patient harm (OR=3.51, 95% CI: 1.39 to 8.91, P = 0.008). While malpractice lawsuits negatively affect professional well-being, this effect resolves with time. The effect on medical errors may be more permanent; orthopaedic surgeons who have experienced a lawsuit reported greater rates of medical errors even after these legal issues have been settled. Among orthopaedic surgeons dealing with lawsuits, supportive interventions to protect professional well-being and mitigate the factors which lead to greater medical errors are needed. Prognostic Level III.

AOA Critical Issues Symposium: Shaping the Impact of Artificial Intelligence within Orthopaedic Surgery.

Artificial intelligence (AI) is a broad term that is widely used but inconsistently understood. It refers to the ability of any machine to exhibit human-like intelligence by making decisions, solving problems, or learning from experience. With its ability to rapidly process large amounts of information, AI has already transformed many industries such as entertainment, transportation, and communications through consumer-facing products and business-to-business applications. Given its potential, AI is also anticipated to impact the practice of medicine and the delivery of health care. Interest in AI-based techniques has grown rapidly within the orthopaedic community, resulting in an increasing number of publications on this topic. Topics of interest have ranged from the use of AI for imaging interpretation to AI-based techniques for predicting postoperative outcomes.The highly technical and data-driven nature of orthopaedic surgery creates the potential for AI, and its subdisciplines machine learning (ML) and deep learning (DL), to fundamentally transform our understanding of musculoskeletal care. However, AI-based techniques are not well known to most orthopaedic surgeons, nor are they taught with the same level of insight and critical thinking as traditional statistical methodology. With a clear understanding of the science behind AI-based techniques, orthopaedic surgeons will be able to identify the potential pitfalls of the application of AI to musculoskeletal health. Additionally, with increased understanding of AI, surgeons and their patients may have more trust in the results of AI-based analytics, thereby expanding the potential use of AI in clinical care and amplifying the impact it could have in improving quality and value. The purpose of this American Orthopaedic Association (AOA) symposium was to facilitate understanding and development of AI and AI-based techniques within orthopaedic surgery by defining common terminology related to AI, demonstrating the existing clinical utility of AI, and presenting future applications of AI in surgical care.

Orthopedic Surgery Residencies: The Leap to Social Media.

Social media has been previously shown to influence applicants' perception of plastic surgery residencies and increase their likelihood to apply, interview, and rank the program. We wanted to analyze this hypothesized trend in the context of orthopedic surgery residency while also characterizing the content of orthopedic surgery residency program accounts. A current list of US orthopedic residency programs was acquired from the American Orthopaedic Association and cross-referenced with the Accreditation Council for Graduate Medical Education webpage of all orthopedic surgery residencies. Forty-five of 185 (24%) residencies had residency-specific Instagram accounts. We analyzed the number of followers, the number of posts, and the date of the first post for each account. We characterized content by categories including science education, recruitment or hospital promotion, resident highlight, news coverage, events, and community building posts. We analyzed the "social currency" of each post and program, tracking the number of likes, comments, and followers. Twenty-seven of 45 (60%) active residency Instagram pages were created in 2020, with 13 of 45 (29%) pages created in June 2020 alone. Residency programs are increasingly turning to Instagram to showcase the residents at their programs, their lifestyles, and program strengths. Sixty percent of all orthopedic residency Instagram accounts were created in 2020 alone, likely precipitated by travel concerns from COVID-19 forcing programs to conduct online interviews and cancel away rotations this application cycle. Going forward, residency programs will continue using Instagram to recruit potential residents, leaving programs without social media accounts at a relative disadvantage in terms of visibility and their ability to recruit qualified applicants. [Orthopedics. 2023;46(5):e281-e286.].

The More Things Change, the More They Stay the Same: Residents Perspectives on Learning to Teach Over 7 Years.

Data were collected during the American Orthopaedic Association's resident-only engagement activity known as the C. McCollister Evarts Resident Leadership Forum (RLF). A total of 997 of 1,050 RLF participants responded from 2015 to 2021. Residents perceived themselves as having a strong influence on medical students' education more so than any other teacher. However, less than one third are provided with any formal instruction from their institutions to support their teaching, and nearly 3 quarters of participants felt there was room for improvement in their teaching effectiveness. For the most part, resident perspectives have stayed relatively consistent over time. Residents are keen and willing to invest time into developing their teaching effectiveness. There may be a need for improved advocacy to program directors to increase the presence and availability of formal Residents-as-Teachers programs to support residents in their roles as teachers. We offer suggestions for the composition of such programs for consideration.

Effect of Faculty Diversity on Minority Student Populations Matching into Orthopaedic Surgery Residency Programs.

The American Orthopaedic Association's Orthopaedic Residency Information Network database was used to collect demographic data on 172 US residency programs. Linear regression analyses were performed to determine the relationship between the proportion of female or URiM attendings at a program and the proportion of female, URiM, or IMG residents or top-ranked applicants (≥25 rank). URiM was defined as "racial and ethnic populations that are underrepresented in the medical profession relative to their numbers in the general population." A mean of 13.55% of attendings were female and 14.14% were URiM. A larger fraction of female attendings was a positive predictor of female residents (p < 0.001). Similarly, a larger percentage of URiM attendings was a positive predictor of URiM residents (p < 0.001), as well as of URiM (p < 0.001) and IMG (p < 0.01) students being ranked highly. There was no significant association between URiM attendings and female residents/overall top-ranked applicants, or vice versa. Residency programs with more female attendings were more likely to match female residents, and programs with more URiM attendings were more likely to highly rank URiM and IMG applicants as well as match URiM residents. Our findings indicate that orthopaedic surgery residencies may be more likely to rank and match female or URiM students at similar proportions to that of their faculty. This may reflect minority students preferentially applying to programs with more diverse faculty because they feel a better sense of fit and are likely to benefit from a stronger support system. III.