Orthopaedic Leaders Research Articles

Exploring Impact and Variability of Research Productivity Among Academic Orthopaedic Leaders.

Assessing scholarly contributions in academic orthopaedic surgery remains challenging, despite the importance of publication productivity in evaluating academic leaders. The Hirsch (h)-index and its derivative, the m-index, offer objective measures to compare and evaluate publication productivity. The primary aims of this study were to compare h- and m-indices of department chairs and residency program directors of orthopaedic training programs in the United States and assess the association between h-index and program rank. A publicly available Doximity report was used to identify and rank orthopaedic surgery residency programs in the United States. Internet-based searches of institution-specific websites were performed to confirm current department chairs and residency program directors as of January 2024. H-index data were collected from a publicly available database known as Scopus. The m-index was calculated as the quotient of h-index and years in practice. Gender and years in practice were obtained through available biographies on institution-specific websites. Department chairs had significantly higher h- and m-indices at both the career and 5-year time intervals compared with program directors. Upon subgroup analysis, department chairs and program directors at top-10 ranked programs had significantly higher h- and m-indices compared with the entire population of department chairs and program directors. Linear regression analyses demonstrated a direct linear association between department chair/program director h- and m-indices and program rank. Publication productivity was higher for department chairs than residency program directors. Orthopaedic leaders at top-10 institutions had higher publication productivity compared with those at institutions outside of the top 10, per Doximity rankings. Finally, there is substantial variation in publication productivity of orthopaedic surgeons in leadership roles at academic institutions in the United States. This study highlights the publication productivity of orthopaedic surgery department chairs and residency program directors and describes the linear association between publication productivity of academic orthopaedic leaders and program rank. This information can be utilized by those interested in learning more about the publication productivity among academic orthopaedic surgeons across different institutions and can assist those who are involved in the hiring and promotion process at these academic institutions.

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.

American Orthopaedic Association’s (AOA) Council of Orthopaedic Residency Directors (CORD) 2021 Summer CORD Conference: Top 10 Abstracts

In a continuing collaboration between the American Orthopaedic Association's (AOA) Council of Orthopaedic Residency Directors (CORD) and the JBJS, the following 10 abstracts highlight the scientific research presented at AOA's virtual annual national meeting held in June 2021. 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 Accreditation Council for Graduate Medical Education (ACGME)-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.

Formal leadership training among orthopaedic surgeons in leadership positions

PurposeTo determine what formal leadership training orthopaedic leaders had pursued to develop the leadership skills necessary to be in their current leadership roles, and what perceptions they have on including formal leadership training in medical education.MethodsAn anonymous survey was distributed via email to 255 orthopaedic surgeons in leadership positions. Statistical analysis focused on differences in leadership training between different demographic groups, their formal leadership experience, and perception about the importance of formal leadership training.ResultsThe survey was distributed to 247 potential recipients, of which 76 responded (response rate = 30.8%). Sixty-five of 76 (85.5%) current orthopaedic surgeons in leadership positions have received formal leadership training. The three most common types of leadership training included: institutional leadership training (n = 36; 54.5%); AOA Kellogg Leadership Series (n = 25; 37.9%); and AOA Emerging Leaders Program (n = 13; 19.7%). 77% of respondents agreed that this training helped prepare them to become a more effective leader. 79.7% of respondents agreed that formal leadership training should be incorporated, with the majority (50.8%), indicating that they believed it should be included during medical school, orthopaedic residency, and fellowship.ConclusionThe majority of orthopaedic surgeons in leadership positions have received formal leadership training and believe that this helped them become a more effective leader. Providing formal leadership opportunities for a more diverse set of surgeons could catalyze an increase in minority representation. Informal leadership training, such as mentoring throughout medical school and residency, could also be beneficial, especially for minorities.

Evidence-based quality leadership in orthopaedics.

There is a paucity of literature analysing the importance of leadership within trauma and orthopaedics. However, such skills are essential to make an orthopaedic surgeon proficient in their various roles. This literature review on leadership within orthopaedics enables an understanding of current issues. A narrative literature review was conducted using Pubmed, Medline and The National Centre for Biotechnology databases. The search string used to conduct the narrative literature review was (orthopaedic) and (leadership[Title]). The articles were screened by title, abstract and full text. A reference search was subsequently conducted on these papers using the same inclusion and exclusion criteria. The papers then underwent a thematic analysis to understand the issues surrounding leadership in orthopaedics. The critical themes recognised were quality improvement, training, women in leadership, inequality and traits of a leader. Through reviewing the themes in this article, a framework was developed to identify the current issues and potential avenues of advancing orthopaedic leadership. This narrative literature review has demonstrated a paucity of research in orthopaedic leadership. Further work would create a robust evidence base, outline ideal orthopaedic leadership and standardise training to create better orthopaedic leaders.

Five Years In: The AAOS Resident Assembly, "Bidirectional Communication," and Early Career Involvement in Orthopaedic Leadership.

Established in 2014, the American Academy of Orthopaedic Surgeons (AAOS) Resident Assembly (RA) has served as a mode of "bidirectional communication" between AAOS and a combined resident body. Training and education initiatives relevant to the current issues facing residency training can be passed up to and directly addressed by the leadership of AAOS, whereas AAOS recruitment and membership initiatives can be disseminated to the full resident body through the RA. Since its inception in 2014, the RA has grown markedly, with representation from most MD and DO residency programs in the United States and Canada. It also has included an increasing number of medical students from Orthopaedic Surgery Interest Groups to directly take part in RA activities. For the past half decade, the RA has served as a partner for the AAOS in addition to a valuable recruitment tool to engage the broadest diversity of potential orthopaedic leaders at their earliest stages of training. This work is a review of the development of the RA over its first half decade, as well as a discussion of its future goals in line with AAOS priorities.

What Do Orthopaedists Believe is Needed for Incorporating Patient-reported Outcome Measures into Clinical Care? A Qualitative Study.

Patient-reported outcome measures (PROMs) are increasingly promoted for use in routine orthopaedic care with the expectation that if they are made available during encounters, they will be incorporated into clinical practice. We investigated an initiative in which PROMs were systematically collected and provided via the electronic health record but were infrequently used. In a qualitative study, we asked: (1) Why are PROM results not being used in clinical care when they are available to surgeons? (2) What aspects of PROMs are seen as useful for clinical care? (3) How are PROMs generally perceived by surgeons and orthopaedic leaders? A cross-sectional qualitative study was conducted in a single health system in an urban setting using semistructured interviews with a purposive sample of orthopaedic surgeons and leaders who would have substantial knowledge of and experience with the organization's PROM system, which was embedded in the electronic health record and developed for use in clinical care but was not being used. We included surgeons whose practices consisted of at least 90% patients with osteoarthritis, including surgical and nonsurgical management, and thus their patients would be completing PROMs surveys, or surgeons who were leaders in one of the three orthopaedic divisions in the health plan. The senior research manager for orthopaedics identified 14 potential participants meeting these criteria, 11 of whom agreed to study participation. Participants included nine surgeons and two orthopaedic leaders; the majority were men, with a median of 13 years of clinical practice. Study interviews were conducted by an experienced interviewer not known to participants, in private conference rooms in the healthcare setting, and a median (range) of 27 minutes (16 to 40) in length. A content analysis approach was employed for data analysis, with thematic inductive saturation reached in the analysis and attention to trustworthiness and rigor during the analytic process. Interviewees reported that PROM scores are not being used in patient clinical care because of logistical barriers, such as access and display issues and the time required, and perceptual barriers, such as concerns about patient understanding and the validity and reliability of measures. Surgeons preferred talking with patients about the personal outcomes patients had identified as important; most patients preferred to assess progress toward their own goals than PROMs scores for other people. Surgeons also identified changes that could facilitate PROM use and reduce barriers in clinical care, including pushing PROM scores to physicians' inboxes, developing inserts for physician notes, using easy-to-understand graphical displays, and engaging patients about PROMs earlier in the care process. Participants all agreed that PROMs in aggregate use are valuable for the organization, department, and individual surgeons, but individual patient scores are not. Despite the availability of PROMs, there are important barriers to incorporating and using PROMs in clinical care. Providing access to PROM scores without clearly understanding how and why surgeons may consider using or incorporating them into their clinical practice can result in expensive and underused systems that add little value for the clinician, patient, or organization. Involving front-line orthopaedic surgeons and leaders in shaping the design and structure of PROM systems is important for use in clinical care, but these interviewees seemed to see aggregate data as more valuable than individual patient scores.

American Orthopaedic Association's (AOA) Council of Orthopaedic Residency Directors (CORD) 2020 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 virtual annual national meeting held this past June 2020. 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 that this education-related research will inspire further inquiry to advance the development of future orthopaedic surgeons.

The AOA: A Comprehensive House with Compassionate Leaders. Presidential Address to the AOA, June 15, 2020: AOA Critical Issues.

The American Orthopaedic Association (AOA) is the world's oldest orthopaedic association and it has been responsible for the founding of many prominent organizations as well as The Journal of Bone & Joint Surgery. While the AOA has traditionally focused on academic orthopaedic leadership, the time has come to expand our horizons and look to include all orthopaedic leaders from the wide variety of leadership roles in which they currently serve.Orthopaedic surgeons who demonstrate compassionate leadership will find that they create stronger, more successful teams. Compassionate leadership is a skill that can be learned, and investing the energy to develop this skill will have a profound impact on our success as orthopaedic surgeons and leaders.

American Orthopaedic Association's (AOA) Council of Orthopaedic Residency Directors (CORD) 2019 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 that was held in June 2019 in San Diego, California. 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 that this education-related research will inspire further inquiry to advance the development of future orthopaedic surgeons.

Quality Improvement and Patient Safety: How Leadership Can Create a Culture of Safety: AOA Critical Issues Symposium.

Orthopaedic leaders need to create a shared vision and must establish trust, open lines of communication, and buy-in from all team members in order to establish a culture that is supportive of quality improvement. Leaders should encourage teams to follow evidence-based guidelines, reduce variation, take an active role in supply chain processes, and develop new ideas to improve quality and safety of care. With rapidly changing medical and surgical advancements, orthopaedic leaders must continually adapt in the face of evolving challenges.

American Orthopaedic Association's (AOA) Council of Orthopaedic Residency Directors (CORD) Summer 2018 Conference: Top Abstracts.

This article is a continuation of the collaboration between the American Orthopaedic Association's (AOA) Council of Orthopaedic Residency Directors (CORD) and JBJS to highlight selected abstracts presented at the CORD Conference held at the AOA's annual national meeting in June 2018. These abstracts are representative in advancing CORD's purpose and mission:"The American Orthopaedic Association 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 effectively teach residents in orthopaedic programs." The following studies were presented at the 2018 Summer CORD Conference in Boston, Massachusetts. They exemplify education-related research and are offered to inspire further inquiry to advance the development of future orthopaedic surgeons.

Academic Orthopaedic Leadership: Current Challenges and Lessons Learned

Health-care reform, market competition, cost containment, and pressure for productivity have dramatically impacted the practice of orthopaedic surgery and academic surgical training. Orthopaedic leaders and training programs are striving to identify and solve these contemporary challenges. Herein, we focus on 4 areas that currently pose important challenges to modern orthopaedic surgical departments and academic hospital systems, including the demanding and evolving skill sets that are required of physician leaders, the effects of the changing medical-legal environment on academic medicine, the impact of increased clinical productivity emphasis on surgical education, and departmental leadership transitions.

The Role of Mentoring in the Development of Successful Orthopaedic Surgeons.

Mentoring plays an integral role in orthopaedic surgeons' career development and personal growth. Effective mentors are committed to their roles, provide skilled instructional support, model continuous learning, and communicate optimism. Numerous obstacles impede productive mentoring relationships in medicine, including reluctance to ask for help, time constraints due to extensive work obligations, lack of institutional support, relational difficulties, and lack of mentoring skills. Effective partnerships require a concerted effort to establish behaviors conducive to mentoring, such as sharing knowledge and providing constructive feedback. Given that women represent only 13% of orthopaedic surgery residents and racial/ethnic minorities account for 3% to 10% of US orthopaedic surgeons, mentoring may help diversify the workforce by providing early exposure and professional support to physicians from underrepresented demographic groups. Orthopaedic leaders must embrace their professional obligation to cultivate and inspire the next generation of orthopaedic surgeons.

American Orthopaedic Association’s (AOA) Council of Orthopaedic Residency Directors (CORD) Summer 2017 Conference: Top Abstracts

This article is the first in a collaboration between the American Orthopaedic Association’s (AOA) Council of Orthopaedic Residency Directors (CORD) and JBJS to highlight selected abstracts presented at the Summer CORD Conference. These abstracts all serve to support the purpose and mission of CORD:“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 effectively teach residents in orthopaedic programs.” The following abstracts were presented at the Summer 2017 CORD Conference in Charlotte, North Carolina. They are excellent examples of education-related research and will hopefully inspire more investigation into this much-needed area.

The 2016 American Orthopaedic Association-Japanese Orthopaedic Association Traveling Fellowship.

The American Orthopaedic Association-Japanese Orthopaedic Association (AOA-JOA) Traveling Fellowship, which began in 1992 as a collaborative effort between the 2 orthopaedic communities, is aimed at fostering leadership among early-career surgeons through clinical, academic, and cultural exchange. Over 3 weeks, we experienced an extraordinary journey that led us across nearly 800 miles of the picturesque Japanese countryside, with stops at 6 distinguished academic centers. The opportunity to become personally acquainted with orthopaedic leaders in Japan, learn from their experiences, and immerse ourselves in the ancient and storied culture of a beautiful country was one that we will not soon forget. Along the way, we accumulated a wealth of information while enjoying the legendary hospitality of the Japanese people. There is a ubiquitous challenge in delivering cost-effective, accessible health care while maintaining a commitment to education and research. The U.S. orthopaedic community may take solace in the fact that our Japanese colleagues stand with us as partners in this pursuit, and our relationship with them continues to grow stronger through endeavors such as the AOA-JOA Traveling Fellowship. We look forward to honoring our Japanese colleagues in 2017 when we host them in the United States.

Hiring your next partner: AOA critical issues.

Hiring a new partner into an orthopaedic department or group can be a daunting task. A recent American Orthopedic Association symposium sought to address three major aspects of hiring that affect orthopaedic leaders: (1) when to hire-the chairperson's role; (2) generational issues that affect hiring; and (3) the development of an initial compensation package.How does the chairperson recruit new physicians? Hiring a new partner into the academic setting requires a good deal of foresight. There must be an established game plan. Advertising and interviews need to be orchestrated. Chairpersons can find information about candidates from many unique sources. Fit within the department and community is important and must be cultivated. Spouses and families need special attention. Research candidates have individual needs. Perhaps the most important aspect of recruitment is the development of a realistic business plan. This paper provides an overview of factors to consider in managing a new hire.Generational issues are intriguing. Should they affect our hiring practices? It seems clear to established physicians that the new generation of graduates is different from their predecessors. Is this really true? Most everyone is familiar with the terms "Silent Generation," "Baby Boomers," "Generation X," and "Generation Y." Is there anything to be gained by categorizing an applicant? Is it important to hire a replica of one's self? This paper provides a thoughtful overview of generational issues as they apply to hiring new partners.Most department chairpersons are not trained as negotiators. Some preparation and experience are helpful in guiding the process of making an initial offer to a candidate. It is not all about pay. The package includes the guarantee period, expectations for the new hire, mentorship, and resources. How much should new orthopaedic academic hires be paid? Recent benchmark data from the Academic Orthopaedic Consortium suggest a mean income of $282,667 for physicians who have just finished a fellowship. New hires are concerned about call frequency and available time free from work. How much work should be expected from an academic surgeon? Recent survey data from the American Orthopaedic Consortium suggest a mean of 9200 relative value units per year. This article offers some guidelines for the chairperson who needs to formulate an initial offer for a new hire.There is a lot involved in hiring a new partner, as times are changing. This paper offers considerable food for thought about hiring.

Managing Stress in the Orthopaedic Family

Stress is a double-edged sword. When managed appropriately, it can lead to peak performance in high-pressure professions, while the potential negative effects of stress are well documented, being directly related to seven of the ten leading causes of death in industrialized nations1,2. A major psychological manifestation of stress is burnout. Validated assessment tools, such as the Maslach Burnout Inventory, can be utilized to quantify the three components of burnout: emotional exhaustion, depersonalization, and a decreased sense of personal accomplishment3,4. Early signs of burnout, described by Quick et al., include declining professional performance and morale, physical and somatic symptoms, and behavioral changes. More advanced signs include self-medication and serious self-doubt1. In 2006, the results of a national survey of orthopaedic leaders (past, current, and acting chairs of orthopaedic departments, in addition to program directors) were presented to the American Orthopaedic Association (AOA) by Saleh et al.5. Numerous job stressors were identified, and the impact of these stressors was rated as moderate to severe in 70% of the leaders responding. High levels of emotional exhaustion and depersonalization were noted. A number of disturbing trends were identified. Only 15% were satisfied with their personal-professional life balance, and the percent dissatisfied with their job was increasing with time. Thirty-seven percent stated that they were moderately, very, or extremely likely to step down from their chair position within two years5. Stress and burnout have a substantial impact on patient care, especially an increase in medical errors. Fifty percent of physicians and 70% of the public believe that overwork, stress, and fatigue contribute to medical errors6. A recent survey of members of the American College of Surgeons assessed burnout among 7905 responding surgeons, 700 (8.9%) of whom reported committing a …

Predictors of prolonged hospital stays following hip and knee arthroplasty

Orthopaedic leaders face extraordinary pressures in a world of diminishing resources, aging baby boomers and escalating demands for hip and knee replacement surgeries. Never has the need for focused, proactive care to improve outcomes and avoid unnecessary hospital days been greater. In this study, risk factors associated with prolonged length of stay (LOS) were investigated for hip and knee arthroplasty patients. An Arthroplasty Optimization Risk Screening Tool (AORST) was designed by an interdisciplinary team to detect patients at risk for prolonged hospital stays. One hundred and fifty patients completed the AORST prior to surgery. A chart audit was done postoperatively to investigate reasons for prolonged stay. Logistic regression statistics were employed to examine predictive associations between the risk variables and LOS. Age over 80, living alone, two or more comorbidities and language barriers were factors associated with prolonged stays. These factors help inform program focus. Interventions can be targeted to address preventable risks early in the pre-surgical phase, so that patients arrive for surgery better prepared and in optimal condition for a smooth recovery. The prevalence of these factors may also help explain variances in LOS among hospital sites, providing a better understanding of the catchment population and the resources required.

Editorial: A Paucity of Women Among Residents, Faculty, and Chairpersons in Orthopaedic Surgery

Editorial: A Paucity of Women Among Residents, Faculty, and Chairpersons in Orthopaedic Surgery