Orthopaedic Residency Applicants Research Articles

How Prominent Are Gender Bias, Racial Bias, and Score Inflation in Orthopaedic Surgery Residency Recommendation Letters? A Systematic Review.

Letters of recommendation are considered an important factor in the holistic ranking of orthopaedic residency applications. The standardized letter of recommendation (SLOR) was introduced in 2017 in response to the inherent bias and limited comparative value of traditional LORs. It includes standardized questions about an applicant's orthopaedic qualifications, designed to enable fair comparisons among candidates. However, disparate and inconsistent findings have made it difficult to draw meaningful conclusions from individual studies on the SLOR and narrative letter of recommendation. In this systematic review we asked: (1) What is the distribution of applicant SLOR rating among nine domains and summative scores? (2) Are there applicant characteristics associated with SLOR ratings? (3) Is there gender and racial bias in the SLOR and narrative letter of recommendation? PubMed, EBSCO, and Google Scholar electronic databases were queried on March 20, 2023, to identify all studies evaluating SLOR and narrative letter of recommendations between January 1, 2017, and March 20, 2023. Articles that evaluated orthopaedic SLOR or narrative LORs were included. Systematic reviews, case reports, duplicate studies between databases, and grey literature such as abstracts and articles on preprint servers were excluded. Eight studies including 6179 applicants and 18,987 letters of recommendation were included in the final analysis. The applicant classes ranged from years 2014 to 2020. Two reviewers independently evaluated the quality of the included studies using the Joanna Briggs Institute (JBI) tool for cross-sectional studies. The mean JBI score of included studies was 7.4 out of a maximum of 8, with higher scores indicating better quality. The primary outcome was to determine the distribution of applicant SLOR rankings in their summative score. Summative scores were separated into ranked to match, top one-third, middle one-third, lower one-third, and not a fit. Four studies reported the summative SLOR scores of applicants. Our secondary study goal was to assess applicant characteristics associated with SLOR summative scores and assess any bias present in the SLOR or narrative recommendation. Five studies compared SLOR ratings across applicant characteristics including gender, race, USMLE Step 1 score, USMLE Step 2 score, Alpha Omega Alpha (AΩA) membership, clerkship grades, and publications. Gender and racial bias were also assessed across five studies. Four studies utilized a linguistic analysis software to search letters of recommendation for differences in word category use by gender and race. Studies consistently found that a higher percentage of candidates were identified in the top percentile blocks than is mathematically possible. For example, the two studies that tallied the proportion of candidates ranking in the top 10% of applicants found that 36% and 42% were rated as being in the top 10%. Similarly, articles found more than 87% of applicants scored in the top one-third. Studies had mixed results, but in general, they suggested that AΩA status, higher Step 1 scores, and more research publications have a slightly positive association with increased SLOR scores. We found no evidence of gender bias against women, and in fact, most studies evaluating word choices found word choices for women candidates generally were stronger. Similarly, no consistent disparities were identified in word categories utilized in SLORs based on applicant race. Most notably, a mathematically impossible proportion of applicants were counted in the top percentiles in letters of recommendation. This compromises readers' abilities to differentiate candidates. Factors like AOA status and research publications displayed a modest positive correlation with SLOR scores. Gender bias against women or candidates from racial minority groups was not evident. We suggest that group SLOR authorship, with a consensus assessment by clerkship or residency directors, should be considered. We also recommend the incorporation of mean and SD scores for each letter writer (or group) alongside their letters. Furthermore, studies indicate that submitting all four SLOR letters can substantially improve an applicant's chances of success. We advise students to choose strategically and submit the maximum allowable number of SLORs.

Preference Signaling in the Orthopaedic Surgery Match: Applicant and Residency Program Attitudes, Behaviors, and Outcomes.

The orthopaedic surgery match has experienced a consistent increase in both the number of applicants and applications submitted per applicant. Preference signaling was implemented during the 2022 to 2023 application cycle in part to curtail the rising application burden on both applicants and residency programs. Our aim was to explore the impact of the preference signaling system on applicant and residency program leader attitudes, behaviors, and outcomes. We distributed surveys to American Orthopaedic Association/Council of Orthopaedic Residency Directors member program leaders (program directors, assistant program directors, and program coordinators) and applicants registered for the Electronic Standardized Letter of Recommendation after Universal Interview Offer Day 2022 (Fall Survey) and Match Day 2023 (Spring Survey). The surveys contained multiple-choice and numeric response questions on attitudes, behaviors, and outcomes that were analyzed and reported as percentages and medians, respectively. Open-text responses were reviewed for dominant themes. One hundred program leaders and 378 applicants (47%) completed the Fall Survey, and 146 program leaders and 290 applicants (36%) completed the Spring Survey. A majority of applicants (71%) and program leadership (91%) support the continued use of signaling. Applicants reported a 16% reduction in the number of programs to which they applied. Program directors largely used signaling as a tool for screening applications (75%), with few programs using signaling in the ranking process (20%). Applicants reported that 81% of their interviews were from programs they signaled. Slightly more than half of programs (53%) reported filling their last slot at a higher rank order position than the average of the previous 5 years. Qualitative analysis suggests a need for more transparency in the use of signals, consideration of application and/or interview caps, and reconsideration of the other components of the application. Preference signaling in the orthopaedic surgery match was met with positive feedback and led to a reduction in the number of applications. Future research will examine the continued impact of preference signaling and assess alterations for optimizing the match process.

Predicting academic productivity among American Shoulder and Elbow Surgeons fellowship faculty from publications acquired before and during surgical training

Orthopedic residency and fellowship applicants with a strong research record are highly valued for their potential in continuing academic excellence. Despite this, the association between research productivity during training and future academic productivity as an attending orthopedic surgeon is not well-established. We assess the effects of research output during different periods of surgical training as well as residency location on long-term academic productivity as an attending shoulder and elbow surgeon. A search of the 2022-2023 American Shoulder and Elbow Surgeons Fellowship Directory was conducted to identify a list of orthopedic shoulder and elbow fellowship faculty members. Each surgeon's residency, fellowship and current institution of practice were determined and stratified by geographic location. Total publication counts acquired before residency, during residency, during fellowship, and after fellowship were collected for each faculty member. Attending publication rates and H-indices were calculated. A multivariate linear regression model was created, and significance was set at a P value <.05. A total of 149 shoulder and elbow fellowship faculty members representing 34 fellowship programs were identified. The average number of total publications per surgeon was 88.8±102. The average attending publication rate was 5.29±6.89 publications per year. The average H-index for included surgeons was 27.8±24.4. The number of publications acquired before residency (β=0.293; P<.001), during residency (β=0.110; P=.025) and during fellowship (β=0.593; P<.001) were significantly associated with an increased attending publication rate, but no association was observed with the H-index [before residency (β=-0.221; P=.574), during residency (β=0.045; P=.866), during fellowship (β=0.198; P=.678)]. There were no significant differences in total publication count (P=.397), attending publication rate (P=.237), or H-index (P=.364) based on location of residency training. Research output before and during surgical training is predictive of continued academic productivity as a shoulder and elbow surgeon. In particular, greater productivity during surgical fellowship was most predictive of academic output as an attending. While long-term academic productivity does not seem to be influenced by the geographic location of residency training, attending surgeons practicing in the Midwest had significantly greater total publication counts and H-indices but similar annual publication rates.

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

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. 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. 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 < 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 < 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). 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.

Understanding the Match: The Effect of Signaling, Demographics, and Applicant Characteristics on Match Success in the Orthopaedic Residency Application Process.

As of the 2022 to 2023 match cycle, orthopaedic residency programs began offering applicants 30 signals as part of a preference signaling program. Many have assumed that signals would become powerful tools in the match process, yet no objective data currently exist analyzing their effect. This study aims to provide such analysis while also offering comparisons with other factors affecting match success. Self-reported survey data on applicants and applications from 2017 to 2023 from the Texas Seeking Transparency in Application to Residency database were queried. Variables associated with receiving interviews and match success were analyzed using two-sided Student t -tests, chi-squared tests, variance ratio testing, and receiver operating characteristic analysis. Compared with 2017 to 2022, 2023 applicants submitted fewer applications (61.8 versus 78; P < 0.001), received fewer interview offers (11.6 versus 13.8; P < 0.001), and interview offers were spread more evenly among applicants (SD, 6.82 versus 9.10; P < 0.001). For 2023 applications, odds of securing an interview were increased most by away rotations (odds ratios [OR] 61.8; P < 0.001), use of a signal (OR, 9.61; P < 0.001), and geographic connection (OR, 4.70; P < 0.001). Female applicants received more interview offers from signaled programs than their male counterparts (11.2 versus 8.94; P = 0.003). Applicant variables most predictive of match success in 2023 were interview offers (area under the receiver operating characteristic curve [AUC] = 0.802), step 2 CK score (AUC = 0.673), and step 1 score (AUC = 0.648). The preference signaling program seems to be accomplishing its goals of reducing applications and more evenly distributing interviews. Away rotations, signals, and geographic connections represent the strongest predictors of applications resulting in a successful match. Applicants must use their signals carefully to maximize their chance of success. Level III.

Analysis of Research Productivity of Orthopedic Surgery Residency Applicants.

Background Orthopedic surgery has become an increasingly competitive specialty. With a pass-fail Step 1, an even greater emphasis on research has been placed to allow candidates to better distinguish themselves. This study analyzes the scholarly activity of accepted orthopedic residency applicants during medical school, assessing what factors, including the novel altmetric attention score, may be associated with greater research productivity. Methods A list of orthopedic residency programs was obtained from the Electronic Residency Application Service (ERAS). A total of 688 orthopedic residents from 180 programs who matriculated in 2020 from allopathic medical schools were identified.Resident demographic information and bibliometric data (total publications, orthopedic-related publications, h-index, and altmetric score)of publications published from July 1, 2016, toSeptember 1, 2020, were collected. Descriptive statistics were calculated. Kruskal-Wallis tests analyzed the association between medical school characteristics and research productivity using Stata® 17.0 (StataCorpLLC, College Station, Texas). Results Postgraduate-Year-3 orthopedic residents (N=688) published 2,600 articles during medical school, averaging 3.8 articles per resident. The residents from a top 25 medical school for research had publication counts, altmetric scores, and h-indices, on average, that were higher than those from non-top 25 medical schools for research. Over 150 residents had no publications, and ~10 residents had more than 30 publications. Conclusions The results illustrate that medical school research status influences the research productivity of applicants. Also, given the average number of publications, most research listed on applications are abstracts and presentations. Utilization of the altmetric score may not yet be the best way of examining research experience because orthopedic applicants do not appear to use social networks for academic research.

Reimagining the Path of an Unmatched Orthopaedic Residency Application: A Survey of Program Directors.

Few evidence-based suggestions are available to help applicants and mentors improve reapplication outcomes. We sought to provide program directors' (PDs) perspectives on actionable steps to improve reapplicants' chances for a match. The PDs were asked to rank positions unmatched applicants can pursue, steps these applicants can take for the next application cycle, and reasons why reapplicants do not match. Responses from 66 of 123 PDs were received (53.6% response rate). Obtaining new recommendation letters and rotating with orthopaedics were the highest 20 ranked steps unmatched applicants can take. No curriculum vitae (CV) improvement, poor interview, and poor letters of recommendation were the most important reasons hindering applicants from matching when reapplying. Steps reapplicants could prioritize include obtaining new recommendation letters, rotating in orthopaedics, and producing new research items. CV strengthening and improving interview skills address the 2 main reasons why unmatched applicants failed in subsequent attempts. Level IV.

CORR Insights®: What Are the Trends in Research Publication Misrepresentation Among Orthopaedic Residency and Fellowship Applicants From 1996 to 2019? A Systematic Review.

1Oregon Health and Science University, Department of Orthopaedics and Rehabilitation, Portland VA Medical Center, Operative Care Division, Portland, OR, USA K. R. Gundle, Oregon Health and Science University, Department of Orthopaedics and Rehabilitation, 3181 SW Sam Jackson Park Road, OP31, Portland, OR 97239, USA, Email: [email protected] This CORR Insights® is a commentary on the article “What are the Trends in Research Publication Misrepresentation Among Orthopaedic Residency and Fellowship Applicants From 1996 to 2019? A Systematic Review?” by Burkhart and colleagues available at: DOI: 10.1097/CORR.0000000000002549. The author certifies that there are no funding or commercial associations (consultancies, stock ownership, equity interest, patent/licensing arrangements, etc.) that might pose a conflict of interest in connection with the submitted article related to the author or any immediate family members. All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research® editors and board members are on file with the publication and can be viewed on request. The opinions expressed are those of the writer, and do not reflect the opinion or policy of CORR® or The Association of Bone and Joint Surgeons®.

Career Choice Disclosure and Clerkship Grades Among Orthopaedic Residency Applicants

Objective Medical student clerkship evaluations are susceptible to preceptor bias. Students interested in orthopaedics may choose not to disclose their career path during clerkships to avoid bias. The purpose of this study was to identify factors that may lead to grading bias, including career choice disclosure, among medical students interested in a career in orthopaedic surgery. Design A cross-sectional survey was performed by distributing an anonymous electronic survey. Respondents were asked if they disclosed an interest in orthopaedic surgery during core clerkships and whether or not they believed it impacted their grade. The relationship between demographic variables including age, gender, race, ethnicity, and geographical location were also collected and compared. Setting Multiple institutions in different geographic locations in the US. Participants Medical students in orthopaedic interest groups or those who completed an orthopaedic surgery rotation. Results Of 149 responses, 90 (60.1%) of students chose to disclose an interest in orthopaedics during all clerkships. Over 50% of students were able to achieve honors in core clerkships except for OB/Gyn (41/112, 36.6% honors) and emergency medicine (17/59, 28.8% honors). On average, 7.9% of students believed disclosure had a negative impact on their grade, but in internal medicine and OB/Gyn, those that disclosed were able to achieve honors more often than those that did not. Males (38/50, 76%) were given honors more often than females (11/24, 45.8%) in their surgery clerkship and those that identified as “other” race (1/6, 16.7%) achieved fewer honors in surgery and pediatrics compared to White, Black, Asian, Indian, and Hispanic students (48/68, 70.6%). Conclusion Some students believe disclosing an interest in orthopaedics may negatively impact their grade, but the opposite may be true. Other potential areas of bias include gender and race. More research is needed to improve the clerkship evaluation process given an increasingly competitive application process.

Preference Signaling for Orthopaedic Surgery Applicants: A Survey of Residency Program Directors

On March 30, 2022, the American Orthopaedic Association's Council of Orthopaedic Residency Directors announced its endorsement for a preference signaling program (PSP) for the 2022 to 2023 orthopaedic residency application cycle. The purpose of our study was to assess orthopaedic surgery residency program director (PD) perceptions of the PSP and analyze potential effects of the PSP on the residency application process. A 19-question survey was distributed to 98 PDs (40.8% response rate). Contact information was obtained from a national database. Most programs plan to participate in the PSP (87.5%). Preference signaling is highly regarded for residency selection, with PDs ranking its relative importance just below away rotation performance and personal knowledge of the applicant. Most PDs agreed that applicants will have increased chances of receiving interviews at programs they send a preference signal (65%). Most PDs also do not think that the PSP will help improve diversity (42.5%) and combat the overapplication phenomenon (67.5%). A majority think that an application cap limiting the total number of applications submitted should be initiated in future application cycles (85%). Preference signaling will be one of the most important factors considered during orthopaedic residency selection. A signal will likely improve applicants' chance of receiving an interview. Thus, students should be selective about where they send their preference signals and invest time in creating strong, personal connections with a few, select programs to increase their success in the orthopaedic residency match.

Social Media and the Orthopaedic Surgery Residency Application Process.

Introduction: Social media use in the residency application process has been on the rise, yet applicant and program director (PD) perspectives in orthopaedic residency have not been explored in depth. Our objective is to evaluate perspectives of orthopaedic residency applicants and PDs on social media usage and its impact on the residency application process.Methods: Cross-sectional survey study conducted in 2021 with two related, anonymous surveys sent to residency applicants and PDs. One hundred thirteen of 562 (20.1%) applicants to our institution and 29 of 148 (19.6%) PDs listed on the Accreditation Council for Graduate Medical Education (ACGME) website responded to our survey and were included in the analysis.Results: Applicants reported learning about residency programs through Instagram (69.2%), the program website (58.9%), and Doximity (29.9%). Thirty-four percent of applicants reported social media influencing their rank list, with non-training-related posts being the most impactful. PDs reported that 97% of their programs have an official web page, 41% have an active Instagram site, 27% have a Twitter account but none regularly update Doximity. Just over 48% of PDs reported institutional support for online content creation. Financial investment varied, with 35% reporting no spending, and 24% spending over $2501. In response to coronavirus disease 2019 (COVID-19) restrictions, 79% of PDs reported generating increased social media content.Discussion: Social media provides a low-cost but far-reaching opportunity for PDs to recruit residents and highlight their respective programs. Social media content should display the culture and lifestyle of the program, with consistency in content creation. PDs should also ensure accuracy on external sites such as Doximity.

Supplemental Essays for Residency Applications: The Modern Day Typewriter

The purpose of this study is to evaluate one institution's use of a supplemental essay and its effect on the total number and demographics of applicants as compared to previous years. A retrospective cohort review of candidates applying to our institution's Orthopedic Surgery residency program in the 2020 to 2021 cycle was performed. All applicants were presented a prompt for a short supplemental essay. Only candidates who completed the essay were considered for an invitation to interview. Differences in proportions of female and under-represented minority (URM) applicants associated with the year of application and with essay completion were evaluated. A similar analysis was also performed to assess differences in demographics of interviewees between years. A single academic medical center providing tertiary care. All orthopedic residency applicants from the 2019 to 2020 and 2020 to 2021 cycles. Of 863 applicants in 2021, 506 (59%) completed the supplemental essay. URM status was significantly associated with application year and essay completion. However, demographics of eligible applicants and interviewees were not significantly associated with the application year, nor were the proportion of female or URM candidates offered an interview. Our analysis based on use of the supplemental essay in one application cycle demonstrated that it was effective in reducing the application review burden by approximately 41.4% without adversely affecting the demographics of the interviewee pool.

Orthopaedic Residency Applicants' Perspective on Program-Based Social Media.

Background:Social media and online resources have been used in graduate medical education for years. In addition to an official residency program website, many orthopaedic surgery programs have an established social media presence to interact, educate, and engage with prospective applicants. The role of social media in orthopaedic surgery has significantly expanded in recent years. Despite its increasing use, the specific impact of social media on orthopaedic surgery residency applicants remains unknown.Methods:Applicants to the home institution's orthopaedic surgery residency program were sent an optional online survey during the 2020 to 2021 application cycle. No incentive was provided in exchange for participation.Results:Of 812 orthopaedic surgery applicants, 650 (80%) completed the survey. Program-based social media is widely accessed by applicants. Instagram is used by most applicants (61.9%), and nearly a third (28.7%) rely on it as their main resource when researching prospective residency programs. The majority (66.9%) agreed that social media can be successfully used to inform and interact with applicants. Most of the applicants (60.6%) also reported that social media had a positive impact on their perception of the associated program. Only 5.7% of respondents indicated that social media had a negative influence. The most effective uses of social media seem to be in allowing a program to display its culture and transparency.Conclusion:Social media plays a substantial role in the orthopaedic surgery residency application process, and its use continues to grow. Programs can use it to effectively engage with and inform prospective applicants. The impact of social media is positive on most of the applicants. Instagram is the preferred social media platform used by applicants, and nearly one-third rely on it as their main resource when researching programs. Investing time and resources into a social media presence seems to be a worthwhile pursuit for orthopaedic surgery programs as an important piece to a well-rounded recruitment effort of modern orthopaedic surgery applicants.

Incidence of Research Gap Years in Orthopaedic Residency Applicants: The New Standard?

Introduction:The purpose of this study was to (1) determine the incidence of a research gap year (RGY) in orthopaedic residency applicants at a single institution over a seven-year span; (2) compare applicant characteristics between applicants who did a RGY with those who did not, and (3) report variables associated with match success for RGY applicants.Methods:Applicants who reported taking a year out from medical school to pursue research on their Electronic Residency Application Service to a single institution from 2014 to 2015 through 2020 to 2021 were reviewed.Results:A strong positive correlation was noted between the percentage of applicants who participated in a RGY and time (Pearson correlation: r = 0.945 [95% confidence interval (CI), 0.666­0.992], P = 0.001). Over the study period, 11% of applicants had done a RGY, most commonly after their third year of medical school (82.7%). Most RGY applicants matched orthopaedics (72.8%) and 19.4% matched at the same institution they did their RGY.Conclusion:The percentage of RGY applicants to the study institution nearly doubled between 2014 to 2015 and 2020 to 2021. RGY applicants had a higher match rate than nationally published match rates. Further study is needed on a national level.

Impacts of COVID‐19 on orthopaedic surgery residency / spine trainee application trends

BackgroundThe COVID-19 pandemic has had widespread impact across medical educational sectors, including cancellations and delays of board exams, interruptions in clinical rotations and electives, altered processes for away rotations, and conversion to virtual interviews. These changes, combined with applicant and program uncertainty, may affect the 2021 residency application cycle for competitive fields such as orthopaedic surgery. In consideration of spine trainees and the spine fellow application pipeline, the current study aims to evaluate for deviations in trends found in applications to an orthopaedic surgery residency program from the 2021 cycle compared to six years prior. MethodsAfter institutional review board approval, applications to a single orthopaedic surgery residency program from application cycles 2015 to 2021 were evaluated in the Electronic Residency Application System (ERAS) and analyzed for trends. Supplementary information was taken from publicly available ERAS statistics. ResultsCompared to existing trends, the ERAS 2021 cycle had a greater number of applicants, more research items, and lower rates of USMLE Step 2 test administration. Of the 4,965 applications analyzed, no deviations in trends were found in number of female applicants, Black and Hispanic applicants, applicants from medical schools outside the US, DO applicants, applicants with interruptions in their training, or USMLE scores. ConclusionsThe orthopaedic surgery applicant pool increased amidst the COVID-19 pandemic and applicants had more research items than previous years. No significant deviations in the demographics of the applicant pool were noted. This is thought to be reassuring about the integrity of the orthopaedic residency application process / spine fellow application pipeline and should continue to be observed in the coming years.

Does Removing the Photograph and Name Change the Reviewer's Perception of Orthopaedic Residency Applicants?

Orthopaedic surgery remains the least diverse field in medicine regarding female and minority representation. Scarce literature exists evaluating the role of implicit bias in the residency application process. We hypothesized that applicants perceived as underrepresented minorities in orthopaedic surgery (URMs) based on their photograph or name would have a decreased likelihood of being invited to interview. Data from the 2018 to 2019 orthopaedic residency application cycle were collected from a single institution. Applications were classified URM or non-URM. After the application cycle was completed, the URM applications were propensity matched with non-URM applicants. Photographs and names were removed, and the applications were rereviewed by the Residency Applicant Review committee. Rank-in-group and the likelihood of being invited for an interview were compared. Four hundred eleven applications were included with 27.5% URM and 72.5% non-URM. During the regular application cycle, 34.7% of those invited to interview were URM and 50% of those who were ranked-to-match range were URM. After propensity matching, 90 matched pairs were rereviewed with their photograph and name removed. In the regular application cycle, the URM applicant was 3.8 times more likely to get an interview than the matched non-URM applicant (odds ratio, 3.8, 95% confidence interval, 1.7 to 8.8, P = 0.0014). In the "blinded" condition, the URM candidate was 2.5 times more likely to get an interview than the non-URM candidate (odds ratio, 2.5, 95% confidence interval, 1.1 to 6.2 P = 0.034). In the unblinded condition, the URM candidate had a higher ranking within their group than the corresponding non-URM applicant (P = 0.0005). Contrary to our initial hypothesis, URM applicants were invited to interview at a higher rate than non-URM applicants, both in the regular application cycle and in the propensity-matched "blinded" condition. This suggests that implicit bias based on the picture or name is not negatively affecting URM students during the application review process at our institution. 3.

Cost Analysis of Medical Students Applying to Orthopaedic Surgery Residency: Implications for the 2020 to 2021 Application Cycle During COVID-19.

Introduction:Although studies have evaluated the economic burden to medical students desiring an orthopaedic residency broadly, no study has evaluated in detail the application costs, away rotation costs, interview costs, and total costs. Given that the Association of American Medical Colleges and the American Orthopaedic Association's Council of Orthopaedic Residency Directors have recommended orthopaedic surgery residency programs for the 2021 residency application cycle cancel away rotations and in-person interviews, our objective was to evaluate the cost savings to medical students applying during this time and the potential implications.Methods:Using the 2019 to 2020 Texas STAR Dashboard database, we queried responses from applicants applying to orthopaedic surgery residency. The dashboard was queried to record the application costs, away rotation costs, interview costs, and total costs for medical school seniors applying to orthopaedic surgery residency. Demographic information for applicants was also recorded. Mean and median costs were reported with percentile distributions and geographic comparisons. A Kruskal-Wallis H test was used to determine whether there were statistically significant differences in mean costs by medical school region.Results:The 2019 to 2020 Texas STAR Dashboard database had 473 responses from applicants to orthopaedic surgery residency. The mean application costs were $1,990, away rotation costs were $3,182, interview costs were $3,129, and total costs were $8,205. The mean total costs for applicants from Midwest schools were significantly less than Western schools ($7,410/applicant vs. $9,909/applicant) (p = 0.008). There was no significant difference between the mean application fees between regions. Away rotation costs for applicants from schools in the Midwest ($2,413/applicant) were significantly less compared with Northeast ($3,279/applicant), South ($3,343/applicant), and West ($3,913/applicant) (all p < 0.002). Interview costs for applicants from schools in the Northeast ($2,891/applicant) were less than applicants from Western US schools ($3,831/applicant) (p = 0.038).Conclusion:In the COVID-19 era, orthopaedic residency applicants could save on average $6,311 through the use of virtual interviews and lack of away rotations. There are geographic implications, with applicants from Western US medical schools potentially saving most.

Current Orthopaedic Residency Letters of Recommendation Are Not Biased by Gender of Applicant.

Background:Letters of recommendation (LORs) are highly influential in the residency selection process. Differences in language and length of LORs by gender have been demonstrated for applicants applying to surgical residencies and fellowships. This had yet to be studied in orthopaedic surgery. Given the gender disparity in the field, we sought to investigate the impact of gender on orthopaedic residency applicant LORs. We hypothesized that differences in length and language would be present for women applicants as compared to men.Methods:LORs for 2019 to 2020 applicants who applied to a single academic institution were selected for review. Female and male applicants were matched by medical school attended and United States Medical Licensing Examination Step 1 score. LORs were analyzed using both qualitative and quantitative analyses. Letters were evaluated for their word count, presence of language terms, and frequency of language terms. A similar subgroup language analysis was performed for standardized LORs (SLORs).Results:Six hundred fifty-six applicants met the initial screening criteria—126 women and 530 men. After matching, 71 female applicants were paired with 111 male applicants. Word count was, on average, longer for female applicants. LORs for female applicants were more likely to contain language terms that characterized their ability, achievement, participation in athletics, awards received, fit, leadership, and personality traits. Of these terms, ability and participation in athletics were also found more frequently in LORs written for women. In addition, language characterizing technical skills was found more frequently in LORs of female applicants. Similar codes were found to be statistically significant in the SLOR subgroup analysis.Conclusion:This study highlights that current orthopaedic surgery residency LORs do not appear to be biased by applicant gender. LORs were longer for female applicants and described them more positively. Future female orthopaedic residency applicants should be assured that current female candidates are applying with at least similar if not greater subjective qualifications to their male counterparts based on the findings of this study.

The Role of Social Media on Orthopaedic Residency Application Process during the COVID-19 Pandemic

Background: With the COVID-19 pandemic, the medical community saw many changes to practices and policies including medical education and the residency application process. Traditionally medical students in their fourth year of their training are allotted time for away rotations at an institution of their choosing. As a result of COVID-19, many medical schools were forced to eliminate away rotations from their curriculum due to concerns about student safety. This led to the advent of social media outlets designed for the specific purpose of providing medical students with information about residency programs in an effort to recruit interested candidates. With virtual meetings, online communications, and social media platforms all becoming a cornerstone in management of day-to-day hospital functioning this seemed the most appropriate way of adapting to the pandemic while still finding a way to communicate with medical students interested in orthopaedic surgery (9). We hypothesize that the advent of social media accounts during the COVID-19 pandemic would play a role in the orthopaedic residency application process. Question/Purpose: Our question was to determine the role of social media on the orthopaedic surgery residency application process during the COVID-19 era. Patients/Methods: An electronic survey consisting of 12 multiple-choice questions was created to query medical students applying to the field of orthopaedics about the role of social media on their application process. The survey link was emailed to all orthopaedic residency applicants available through the ERAS system. Conclusion: Based on our results it appears applicants may be using social media accounts as a tool to get onto a residency program’s “radar” rather than to obtain meaningful information about a program. Medical students do however find zoom meetings and open houses to be meaningful and provide valuable insight for their application process.

The Outcomes of "Submitted" Publications From Applicants to Orthopaedic Surgery Residency Programs: A Retrospective Review of 1303 Residency Applications.

Purpose:To evaluate research listed as “Submitted” on orthopaedic surgery residency applications for eventual publication rates and quality.Significance:As the orthopaedic surgery residency selection process becomes increasingly competitive, the number of research publications listed on applications continually increases. However, the utility of using publications listed as “Submitted” in the applicant evaluation process remains unknown.Methods:Demographic and publication data were retrospectively collected from 1303 applications to an orthopaedic surgery residency program. The PubMed database was used to verify “Submitted” publications for (1) publication fruition or (2) publication mismatch, defined as discordance between the listed journal of submission and the eventual journal of publication.Results:A total of 594 applications (45.6%) listed ≥1 publication as “Submitted.” Out of 1636 “Submitted” publications, 565 were unverifiable (32.5%). Of the 1071 verified publications, 362 (33.8%) experienced publication mismatch. Within this subgroup, a significant difference existed between the mean impact factors of the listed journal of submission and the eventual journal of publication (1.5 ± 2.7 versus 3.0 ± 2.5, P < 0.01). Demographic data were not predictive of having an unverified publication.Conclusion:Publications listed as “Submitted” in orthopaedic surgery residency applications frequently remain unpublished or are published in less impactful journals than originally intended.