Orthopaedic Program Directors Research Articles

Factors influencing the selection criteria of Saudi board orthopedic surgery applicants: a national survey of program directors

BackgroundAnnually, medical students vie to secure a seat with an orthopedic residency program. This rigorous competition places orthopedic surgery as one of the most competitive specialties in the medical field. Although several international studies have been published regarding the factors that influence program directors when choosing their ideal applicant, the data for Saudi Arabia in that regard is absent.MethodsIn this cross-sectional study, we aimed to survey all orthopedic program directors regarding the factors that influence them when choosing their ideal orthopedic surgery applicant. A survey was sent to all program directors via email during the month of August 2022. A reminder was sent 2 weeks later to maximize the response rate. The survey was completed by 22 out of 36 orthopedic program directors, which gave us a response rate of 61.11%.ResultsIn this study, 22 orthopedic surgery program directors responded to our survey. When program directors were asked to rank the factors of residency selection criteria, the top ranked factors were good impression on interviews; prior experience in orthopedic surgery with, for example, electives; and performance on ethical questions during interviews, with means of 9.18, 8.95, and 8.82 out of 10, respectively. Furthermore, program directors preferred letters of recommendation from recommenders that they personally know, clinical experience such as electives taken at the program director’s institution, and the quality of publications as the most important aspects of research. Most program directors (90.9%) relied on their residents’ and fellows’ opinions when selecting candidates, and 77.3% did not think gender has an influence on selection of applicants.ConclusionBy providing comprehensive data regarding the factors that influence and attract program directors of orthopedic surgery when choosing residency candidates. With the data provided by this study, applicants for orthopedic surgery have the advantage of early planning to build a strong application that may help persuade program directors to choose them.

Matching into Orthopedic Surgery in the U.S. Navy: A Review of Applicant Selection Criteria.

The U.S. Navy offers an attractive opportunity for residency training in orthopedic surgery. The factors that Navy orthopedic residency program leadership finds important in applicant selection for training have not been reported. Additionally, data regarding the academic competitiveness of recently matched applicants have not been previously published. This study presents the results of two surveys administered to all navy orthopedic program directors and department chairmen, as well as data for United States Medical Licensing Examination (USMLE) Steps 1 and 2, medical school class percentile, leadership responsibilities, research endeavors, and letters of recommendation of both matched and unmatched applicants. Two anonymous surveys were administered to all program directors and department chairmen at Navy orthopedic residency training programs with questions designed to gauge perceived importance of various application factors when selecting for the match. The results were compiled, and mean levels of importance were reported. Deidentified data were collected on all applicants to Navy orthopedic residency programs from 2015 to 2019. Data points specific to USMLE Step 1 and 2 board scores, medical school class percentile, research, leadership, and letters of recommendation were analyzed using single and multiple logistic regression analyses, and odds ratios for each variable were calculated. Navy leadership unanimously expressed that clerkship performance at the individual program director's institution was most important, followed by Steps 1 and 2 licensing examination scores. Single logistic regression analyses showed that Step 1 score and clinical, leadership, and recommendation scores were statistically significant. When controlled for Step 1 score, only academic performance and leadership scores maintained statistical significance. Applicants to Navy orthopedic surgery residency programs should strive to be competitive in all aspects of their application, with specific emphasis placed on outstanding performance during orthopedic clerkships, demonstration of leadership characteristics, and academic excellence. With transition to a pass/fail grading system for Step 1, there will be more emphasis on other measures of academic success, such as Step 2 scores and clinical clerkship grades.

Variability of the Orthopaedic Away Rotation: A Survey of Orthopaedic Program Directors.

Introduction:With the increasing interest and pursuit of away rotations by orthopaedic surgery applicants, program directors (PDs) must use information from the 4-week performance to determine who is good fit for their program. For students, despite the increasing cost and time, they are faced with a variable experience from program to program. The purpose of this study was to survey PDs from Accreditation Council of Graduate Medical Education–accredited orthopaedic residency programs to better understand how programs approach the away rotation process.Methods:An anonymous online survey was distributed to PDs of all 164 accredited allopathic orthopaedic surgery residency programs in the United States. The survey included questions regarding PD demographics, away rotations structure, and the process of interviewing rotating students. The data were aggregated, and an analysis was done.Results:A total of 61 of 164 (37%) surveys were completed. There was variability regarding the number of away students that a program accepted over the course of a year, and the number of students that a program will accept at one time. Fifty-two of 55 (94%) programs evaluated medical students immediately after their rotation. Visiting students were most commonly evaluated by the program's residents, followed by attendings they rotated with, and only 46% of PDs. Furthermore, PDs placed the most emphasis on work ethic and social interaction when evaluating students compared with surgical skills and orthopaedic knowledge. Only 38.5% of programs reported that visiting students were guaranteed an interview. If granted an interview, 80% of programs require that the students return for interview day.Conclusions:The visiting rotation has become increasingly more valuable for students; however, there is notable variability in the process between programs. Creating a more standardized away rotation could decrease the variability and facilitate a more beneficial experience to the student and program.

Orthopaedic surgery resident consultations at a level I trauma center

Background: The responsibilities of an on-call orthopaedic surgery resident has been minimally described in the literature. The most common diagnoses, procedures, and surgical cases that occur during an on-call shift would be of interest to an incoming resident. This study was designed to provide insight as to the knowledge and skills necessary to be a competent orthopaedic surgery resident on call. Methods: An electronic databank was created for the on-call residents to prospectively log inpatient and emergency department consultations at a level I trauma center over a 3-month period. Pertinent information was gathered about each consultation such as the diagnosis, treatment required in the emergency department or formal operative suite, type of anesthetic used to complete a reduction or procedure if necessary, duration of consultation, and more. Results: Over 500 consults were recorded during the collection period. The top three most common diagnoses included distal radial and/or distal ulnar fracture (8.2%), hand laceration (8.0%), and compression, burst, transverse process, or fracture dislocation of the spine (5.7%). The top three most common procedures or reductions performed in the emergency department included closed reduction of a fracture (38.9%), irrigation and debridement (24.0%), and closed reduction of a fracture dislocation or isolated dislocation (15.7%). Conclusions: This is the first study to evaluate the most common diagnoses and procedures encountered by orthopaedic residents on call at a level I trauma center. The results of the study can be utilized by orthopaedic program directors and department chairs, residents in training, and medical students.

ACGME Core Competencies: Where Are We?

Beginning in July 2002, the Accreditation Council for Graduate Medical Education (ACGME) instructed all residency programs to require their residents to demonstrate competency in 6 core areas: patient care, interpersonal and communication skills, medical knowledge, professionalism, practice-based learning, and systems-based practice. The goal was to have objective markers of performance that would serve as a gauge to determine a program's accreditation. To determine the experiences of orthopedic residency programs with regard to the ACGME's core competencies, a national survey was administered to orthopedic program directors and selected orthopedic residents. Of those orthopedic programs that responded, most appeared to be complying with the ACGME requirements. Both directors and residents thought patient care and medical knowledge ranked most important, while practice-based learning and systems-based practice were assigned the lowest ranks. Barriers to implementation of the core competencies included low priority compared with clinical duties, lack of faculty or resident education, and lack of formal orthopedic core competencies. Residents and program directors agreed that their programs would benefit from a definition of each of the core competencies, including a greater commitment to the processes involved in surgical procedures. This study demonstrated a commitment to the core competencies by the programs that responded. The survey also suggested this commitment would be aided by improved definitions of some of the competencies for the orthopedic resident.

1. Communication skills training in orthopaedics

Communication skills have been identified as a key component of medical education by the CanMEDS Project. The objectives of this study were to identify the perceived key components of communication skills from the perspectives of both orthopaedic residents and their program directors, and to understand how these skills are currently taught.
 This study utilized a mixed methods design. Quantitative data was collected using a 30-item questionnaire, which was distributed to all Canadian orthopaedic residents. Qualitative data was collected through focus groups with orthopaedic residents and semi-structured interviews with orthopaedic program directors. 
 One hundred and nineteen out of three hundred and twenty-five questionnaires were completed (response rate = 37%), twelve residents participated in two focus groups, and 9/16 program directors from across the country were interviewed. The questionnaire reliability had an internal consistency of Cronbach’s alpha = 0.72. An ANOVA of the questionnaire data showed gender and International vs. Canadian medical graduate status to be independent variables to several item responses (P < 0.01). The factor analysis produced a five-factor model accounting for 50% of the variance.
 Both program directors and residents identified communication skills as being the accurate and appropriate use of language (ie, content skills), not how the communication was presented (ie, process skills). Perceived barriers to communication included time constraints and the need to adapt to the many personalities and types of people encountered daily in the hospital. Residents lack explicit communication skill training, but value developing communication skills in the clinical environment through experiential learning and role modeling. Resident education should focus on developing residents’ process skills in communication. Care should be taken to avoid large-group didactic teaching sessions, which are perceived as ineffective.

The Effect of Work Hour Restrictions on the Education of Orthopaedic Surgery Residents

In 2005 the Academic Leadership Group of the American Orthopaedic Association surveyed orthopaedic program directors, chairs, and members of the Resident Leadership Forum to gather information about the effect of the Accreditation Council for Graduate Medical Education work-hour restrictions on resident education. We compared these results with a similar survey performed 2 years ago. Ninety-four program directors and chairs and 59 senior residents responded to this survey. Overall, the respondents thought the duty hour restrictions had a negative impact on orthopaedic residency education but less so than in the previous survey. This conclusion was based on perceived negative effects on professionalism, resident operative experience, continuity of care, and increased workload for the faculty. Senior residents who worked before and after the work-hour limitations were instituted were more concerned about the negative effects than junior residents. Residents did seem more rested and content but not better prepared or necessarily more attentive. Respondents were not of the opinion resident performance had improved as measured by perceptions of performance on standardized tests. Orthopaedic departments had adapted to the work-hour limitations by scheduling night float rotations, converting in-house call to home call, and by hiring additional personnel in the form of physician extenders.

Orthopaedic resident-selection criteria.

Flynn, John M. MD; Sarwark, John F. MD; Waters, Peter M. MD; Bae, Donald S. MD; Powers Lemke, Laura MD Author Information