Orthopaedic Surgery Residency Programs Research Articles

A Linguistic Analysis of United States Navy Orthopaedic Surgery Applicant Personal Statements.

Despite the importance of linguistic analysis, no systematic research has been explored in the form of linguistic analysis on personal statements for military orthopedic surgery residency programs. This study was conducted to analyze U.S. Navy (USN) orthopedic surgery applicants' personal statements using an automated textual analysis program to assess personal statements for linguistic styles. A retrospective analysis of USN orthopedic applicant personal statements from application years 2016 to 2019 was performed utilizing the Linguistic Inquiry and Word Count (LIWC) software. LIWC analyzed the text for summary variables: analytical thinking, clout, authenticity, and emotional tone. We compared this analysis with Step 1 and Step 2 scores and determined whether an applicant matched. A total of 94 personal statements (60,230 words) were analyzed using LIWC. The average word count was 640.7, with an average of 23 words per sentence. The average-matched applicant USMLE Step 1 and Step 2 scores were 240 and 250, respectively. When examining summary traits utilizing multiple logistic regression analysis, only analytical thinking demonstrated a statistically significant difference in matched versus unmatched applicants with a P = .011 (OR = 1.10). As the USMLE Step 1 exam transitions from a scoring system to Pass/Fail grading, programs will look at other characteristics to determine who would likely succeed in residency. From a linguistic analysis standpoint, matched applicants' personal statements demonstrated higher analytical thinking, clout, affiliation, power, and risk focus than unmatched applicants. Unmatched applicants demonstrated higher authenticity than matched applicants.

Very Few ACGME-accredited Orthopaedic Surgery Residency Programs Have Web-accessible Leave Policies Dedicated to Parental Leave for Residents, Despite ACGME Requirements.

The Accreditation Council for Graduate Medical Education (ACGME) requires that all graduate medical education (GME) programs provide at least 6 paid weeks off for medical, parental, and caregiver leave to residents. However, it is unclear whether all orthopaedic residency programs have adapted to making specific parental leave policies web-accessible since the ACGME's mandate in 2022. This gap in policy knowledge leaves both prospective and current residents in the dark when it comes to choosing residency programs, and knowing what leave benefits they are entitled to when having children during training via birth, surrogacy, adoption, or legal guardianship. (1) What percentage of ACGME-accredited orthopaedic surgery residency programs provide accessible parental leave policies on their program's website, their GME website, and through direct contact with their program's administration? (2) What percentage of programs offer specific parental leave policies, generic leave policies, or defer to the Family and Medical Leave Act (FMLA)? As indicated in the American Medical Association's 2022 Freida Specialty Guide, 207 ACGME-accredited orthopaedic residency programs were listed. After further evaluation using previous literature's exclusion criteria, 37 programs were excluded based on osteopathic graduate rates. In all, 170 ACGME-accredited allopathic orthopaedic surgery residency programs were identified and included in this study. Three independent reviewers assessed each program website for the presence of an accessible parental leave policy. Each reviewer accessed the program's public webpage initially, and if no parental leave policy was available, they searched the institution's GME webpage. If no policy was found online, the program administrator was contacted directly via email and phone. Available leave policies were further classified into five categories by reviewers: parental leave, generic leave, deferred to FMLA, combination of parental and FMLA, and combination of parental and generic leave. Our results demonstrated that 6% (10 of 170) of orthopaedic residency programs had policy information available on their program's main orthopaedic web page. Fifty nine-percent (101 of 170) of orthopaedic residency programs had a clearly stated policy on their institution's GME website. The remaining 35% (59 of 170) had no information on their public website and required direct communication with program administration to obtain policy information. After directly contacting program administration, 12% (21 of 170) of programs responded to researchers request with a PDF explicitly outlining their policy. Twenty-two percent (38 of 170) of programs did not have an accessible policy available. Of the programs that had available policies, a total of 53% (70 of 132) of programs were categorized as offering explicit parental leave policies, 9% (12 of 132) were categorized as offering general leave policies, and 27% (36 of 132) deferred to FMLA. Seven percent (9 of 132) offered combined parental leave policies with FMLA, and 4% (5 of 132) offered combined general leave policies with FMLA. Although most ACGME-accredited allopathic orthopaedic surgery residency programs met the ACGME requirement of written parental leave policies in 2023, a small minority of programs have clear, accessible parental leave policies provided on their webpage. Parental leave policies should be easily accessible to prospective and current trainees and should clearly state compensation and length of leave. Ensuring orthopaedic surgery residency programs provide accessible and transparent parental leave policies is important for maintaining diversity in prospective applicants and supporting the work-life balance of current residents.

Is Program Director Gender Associated With Gender Diversity Among Orthopaedic Surgery Residency Programs?

Is Program Director Gender Associated With Gender Diversity Among Orthopaedic Surgery Residency Programs?

Orthopaedic Surgery Attrition Before Board Certification: A National-Cohort Study of US MD Graduates in Orthopaedic Surgery Residency Programs.

Little is known about attrition before American Board of Orthopaedic Surgery (ABOS) board certification for orthopaedic residents training in Accreditation Council for Graduate Medical Education (ACGME)-accredited orthopaedics programs. This national-cohort study examined orthopaedic surgery attrition, associated risk factors, and specialties pursued by residents who left orthopaedics. From August 2022 through July 2023, we analyzed deidentified, individual-level data from the Association of American Medical Colleges for 129,860 US MD-granting medical-school matriculants in academic years 1993 to 1994 through 2000 to 2001. Graduates with records of training ≥1 year in orthopaedic surgery during GME and of board certification as of May 2020 were included. Retention was defined as being ABOS-certified; attrition was defined as being certified by another specialty board and not ABOS. We identified variables independently associated with attrition from orthopaedics using multivariable logistic regression analysis and reported adjusted odds ratios (OR) and 95% confidence intervals (CI). Of 4,319 US medical-school graduates from 1997 to 2009 with ≥1 year of orthopaedic surgery GME, 4,085 (94.6%) obtained ABOS board certification (retention) and 234 did not (attrition). Women (OR 2.8, 95% CI 2.0-3.9), first-generation college graduates (OR 1.6, 95% CI 1.1-2.2), Asians (OR 1.9, 95% CI 1.4-2.7), and residents who placed greater importance on innovation/research in choosing medicine as a career (OR 1.4, 95% CI 1.1-1.7) and completed ≥1 year of research during GME (OR 2.4, 95% CI 1.7-3.5) were more likely to leave orthopaedics. Overall, 121 trainees who left orthopaedics selected surgical specialties for board certification, most commonly plastic surgery (n = 66) and general surgery (n = 45). The increased risk of attrition among women, Asians, first-generation college graduates, and trainees endorsing higher importance of innovation/research in choosing medicine and participating in research during GME raises concerns about the potential loss of underrepresented groups among orthopaedic surgeons and surgeon-scientists. Efforts to mitigate attrition among residents in high-risk groups are warranted.

The Sex or Race of Program Directors May Not Play a Significant Role in Impacting Diversity Among Orthopaedic Surgery Residents

PurposeTo identify residency program characteristics, including the presence of underrepresented minority in medicine (URiM) and/or female Program Director’s influence on the race and sex distribution of Orthopaedic Surgery Residency trainees. MethodsAll active and ACGME-accredited orthopaedic surgery residency programs from 2017-2021 that reported usable information on the Residency Explorer Tool were included. Data collected included program characteristics, faculty and resident sex distribution, ethnicity, race, and demographic characteristics. The program director’s (PDs) specific sex, ethnicity, race, and demographic characteristics were collected utilizing residency program websites. The prevalence of factors in programs with the top quartile of female and underrepresented residents were compared with the lower three quartiles. ResultsData were obtained from 148/200 ACGME-accredited programs (n=3,694 residents). The 52 excluded programs had no usable information on the Residency Explorer Tool or an identifiable program website. Overall, 15.9% of residents were female and 14% were underrepresented minorities in Orthopaedic surgery residency programs. Female PDs made up 12.4% and chairs 6.9% while URiM PDs and chairs were 8.3% and 4.6%, respectively. Programs with more female residents were not associated with a female PD (p=0.79) or with URiM PDs (p=0.48). Programs with a greater percentage of URiM residents were not associated with URiM PDs (p=0.16). No correlation was found with higher percentages of underrepresented residents and female PDs (p=0.76). Larger (p = 0.021) and university-based programs (p=0.048) had a greater percentage of female residents. Orthopaedic residency programs with Visa Sponsorship had a greater percentage of URiM residents (p = 0.017). ConclusionPrograms with a higher percentage of female or URiM residents did not show a significant association with having female or URiM program directors. Larger programs and university-affiliated programs were more likely to have a larger percentage of female residents, while programs that offered visa sponsorship had a higher percentage of URiM residents.

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.

Gender Diversity in Orthopaedic Surgery Residencies Does Not Translate to Accreditation Council for Graduate Medical Education-Accredited Fellowships.

Gender representation among orthopaedic surgery applicants and residents has increased over the past two decades. The aims of this study were to evaluate trends of female fellows in ACGME-accredited orthopaedic subspecialties between 2007 and 2021, and to compare the fellowship trends of female representation to those of ACGME-accredited orthopaedic residencies. We conducted a retrospective review of publicly available ACGME-accredited fellowship demographic data from 2007 to 2021. The distribution of genders (male vs. female) across subspecialties and orthopaedic surgery residency programs was compared. Chi-square, Spearman correlation, and logistic regression tests were performed to analyze the relationships between year, gender, and fellowship. Chi-square analysis demonstrated a significant relationship between gender and year for orthopaedic residency (p < 0.001), but not for any fellowship. There was a significant negative Spearman correlation between the two variables for hand (r(1844) = -0.06, p = 0.02) and sports medicine (r(2804) = -0.05, p = 0.01) fellowships. The negative Spearman correlation for pediatrics (r(499) = -0.09, p = 0.054) approached but did not reach statistical significance. Logistic regression analysis revealed that, holding year constant and comparing to orthopaedic residency, the odds of male participation increased by 173% (95% CI, 1.8-4.1) in spine, increased by 138% (95% CI, 1.7-3.3) in adult reconstruction, increased by 51% (95% CI, 1.3-1.7) in sports medicine, decreased by 41% (95% CI, 0.5-0.7) in hand, decreased by 36% (95% CI, 0.5-0.9) in foot and ankle, decreased by 48% (95% CI, 0.4-0.7) in musculoskeletal oncology, and decreased by 68% (95% CI, 0.3-0.4) in pediatrics. Although the percentage of female orthopaedic residents in ACGME-accredited programs increased significantly from 2007 to 2021, this has not translated to ACGME-accredited fellowship positions. Future research optimizing methods to improve the representation of females in orthopaedic surgery should be considered. III.

Analysis of variability and trends in medical school clerkship grades

BackgroundMedical school clerkship grades are used to evaluate orthopedic surgery residency applicants, however, high interinstitutional variability in grade distribution calls into question the utility of clerkship grades when evaluating applicants from different medical schools. This study aims to evaluate the variability in grade distribution among medical schools and look for trends in grade distribution over recent years. MethodsApplications submitted to Rush University's orthopedic surgery residency program from 2015, 2019, and 2022 were collected from the Electronic Residency Application Service. Applications from the top 100 schools according to the 2023–2024 U.S. News and World Report Research Rankings were reviewed. The percentage of “honors” grades awarded by medical schools for the surgery and internal medicine clerkships were extracted from applicants' Medical Student Performance Evaluation letters. ResultsThe median percentage of honors given in 2022 was 36.0 % (range 10.0–82.0) for the surgery clerkship and 33.0 % (range 6.7–80.0) for the internal medicine clerkship. Honors were given 6.6 % more in the surgery clerkship in 2022 compared to 2015. There was a negative correlation between a higher (worse) U.S. News and World Report research ranking and the percentage of honors awarded in 2022 for the surgery and internal medicine clerkships. ConclusionThere is substantial interinstitutional variability in the rate that medical schools award an “honors” grade with evidence of grade inflation in the surgery clerkship. Residency programs using clerkship grades to compare applicants should do so cautiously provided the variability demonstrated in this study.

Orthopedic Surgery Residency Program Rankings and Gender Diversity.

Background Orthopedic surgery residency programs are some of the least gender-diverse specialty programs in medicine. Despite strong representation at the undergraduate and medical school levels and increased applications to orthopedic surgery residency programs by women, there is still a substantial gender gap at the resident level. This study explores the relationship between the gender diversity of orthopedic surgery residency programs and program rankings. Methodology Program rank, program director gender identity, and gender diversity data were collected for the top 100 programs by reputation in Doximity. Gender diversity was measured as the proportion of female residents in the program and alumni. Results The greatest percentage of women in a program was 33% and the smallest was 3%. After linear regression analysis, we found that there was a statistically significant positive correlation between program rank and the proportion of women. The higher ranked a program was, the greater the proportion of women. There was no significant correlation between program director gender, appointment year, and program rank. Conclusions These results suggest that, although there is still a long way to go before closing the gender gap in orthopedic surgery residency programs, higher-ranked programs are associated with greater gender diversity than their lower-ranked counterparts.

Orthopedic Surgery Matched Applicants Are Publishing More: A Bibliometric Analysis of Research Output.

Introduction This studyanalyzed the number of peer-reviewed publications submitted by matriculants prior to applying for the orthopedic surgery residency. The graduating residency classes of 2023 and 2027 were included in the study to understand the trend of publications, to inform aspiring orthopedic surgeons. Methods The top, middle, and bottom 10 orthopedic surgery residency programs were identified on the Doximity online website. Matriculants were searched on PubMed and Google Scholar for publication contributions. Variables including number of publications, orthopedic publications, first-author authorship, and H-index were analyzed. A logistic regression model was created, and a t-test was conducted to statistically compare the 2027 and 2023 graduating classes. Results Matriculants of the 2023 match had higher numbers of publications, orthopedic surgery-specific publications, first authorships, and h-indices than the matriculants of the 2018 match. Conclusion The average number of publications has been observed to increase over four years, indicating an increase in competition to match into orthopedic surgery residency. Publishing in higher numbers may be a good indicator of an applicant's success in not only matching but also matching into a higher-tier program.

Discrepancies in Publication Volume Per Matched-Applicant Between Sex, Geographic Regions and Program Affiliation in the 2023 Orthopaedic Surgery Residency Match

Objective: This study aims to examine potential gender-based publication disparities among 2023 orthopaedic surgery matched-applicants, investigate variations in research emphasis based on program affiliation and assess publication differences across different geographic regions. Methods: Orthopaedic surgery residency programs participating in the 2023 NRMP with a publicly available incoming resident class were identified using the NRMP database. Each resident was searched using PubMed and ORCID identifiers for publications. Each program was designated as “university-based”, “community-based”, “community-based/university affiliated” or “other” using the American Medical Association’s FRIEDA database. Results: In total, 763 residents were identified with a mean and median number of publications of 6.1 (SD=10.0) and 3.0 (IQR=1.0-7.0) respectively. There was no significant difference in the median number of publications between males (2.0) and females (3.0, p=0.2315). Those who matched to “community-based/university affiliated” (median=2.0) programs had a lower median number of publications than those who matched to “university-based” (median=3.0, p&lt;0.0001) or “other” (median=6.0, p=0.0006). Geographically, applicants in the West-South Central region (median=1.0) had the lowest publication median compared to those in the New England (median=4.0, p=0.0010) or Pacific (median=4.0, p=0.0015) regions. Conclusion: There lies a perceived increase in significance of research publications for competitiveness in the orthopaedic surgery match. This largely follows the elimination of objective Step-1 scoring to help stratify potential applicants. Research remains an objective manner to stratify applicants; however, new data lacks on recent analysis of the 2023 match pool. There was not a significant difference in the number of publications between male vs female matched-applicants. The program category “other” and the New England and Pacific regions had the highest median number of publications. Keywords: Orthopaedics; Medical Residency; Graduate Medical Education; Medical School; Residency Match; Orthopaedic Education; Orthopaedic Residency

Orthopaedic surgery residency program ranking and the current state of leadership: what are the characteristics of the leaders in the “Top-tier” programs?

Background: Orthopaedic surgery residency program ranking and leadership can influence applicant and program decision-making. The study objective was to evaluate the relationship between program rankings and characteristics of their leadership. Methods: The Accreditation Council for Graduate Medical Education, Doximity, and program-specific websites were queried, identifying 193 programs and 426 leaders for analysis. Leadership positions evaluated included: Chairs, Vice Chairs, Program Directors, and Assistant Program Directors. Residency programs were categorized into tiers based on 2022-2023 Doximity reputation ranking. Program ranking was stratified as follows: Tier 1 (rank 1-50, highest-ranking programs), Tier 2 (rank 51-100), Tier 3 (rank 101-150), and Tier 4 (rank 151-201, lowest-ranking programs). Leaders were described according to demographics, training, research productivity, and experience. Results: A total of 426 leaders at 193 programs were included. The average number of leadership positions per program was 2.2±1.0. Higher-tier programs had more leadership positions and were more likely to have chairpeople (P&lt;0.001). They also had a larger proportion of women leaders (P=0.023), although only 11.2% of leaders overall were women. Residency training outside the US did not vary across tiers (P=0.881). Higher-tier leaders were more likely to complete fellowship (P&lt;0.001) and specialize in pediatrics, oncology, and spine (P&lt;0.032), although trauma was the most common specialty among leaders regardless of ranking. Program rank correlated strongly with program size (number of residents) (r2=−0.69) and weakly with leadership h-index (r2=−0.33) and research documents (r2=−0.40). Rank did not correlate with years in practice (r2=0.06), years until attaining a leadership position (r2=0.06), or years in present leadership position (r2=0.07). Conclusions: Program ranking correlated with the number of leaders and residents, as well as research productivity, but not with years of experience or training within the US. Top-tier programs have a higher proportion of women leaders, although the overall number is still low.

Correlation between research productivity during and after orthopaedic surgery training

BackgroundResearch experience is mandatory for all Orthopaedic Surgery residency programs. Although the allocation of required protected time and resources varies from program to program, the underlying importance of research remains consistent with mutual benefit to both residents and the program and faculty. Authorship and publications have become the standard metric used to evaluate academic success. This study aimed to determine if there is a correlation between the research productivity of Orthopaedic Surgery trainees and their subsequent research productivity as attending Orthopaedic Surgeons. MethodsUsing the University of Mississippi Orthopaedic Residency Program Research Productivity Rank List, 30 different Orthopaedic Surgery Residency Programs were analyzed for the names of every graduating surgeon in their 2013 class. PubMed Central was used to screen all 156 physicians and collect all publications produced by them between 2008 and August 2022. Results were separated into two categories: Publications during training and Publications post-training. ResultsAs defined above, 156 Surgeons were analyzed for publications during training and post-training. The mean number of publications was 7.02 ± 17.819 post-training vs. 2.47 ± 4.313 during training, P < 0.001. The range of publication post-training was 0–124 vs. 0–30 during training. Pearson correlation between the two groups resulted in a value of 0.654, P < 0.001. ConclusionHigher research productivity while training correlates to higher productivity post-training, but overall Orthopaedic surgeons produce more research after training than during. With the growing importance of research, more mentorship, time, and resources must be dedicated to research to instill and foster greater participation while in training.

Use of Social Media in Orthopaedic Surgery Training and Practice: A Systematic Review.

Social media use has grown across healthcare delivery and practice, with dramatic changes occurring in response to the coronavirus (COVID-19) pandemic. The purpose of this study was to conduct a comprehensive systematic review to determine the current landscape of social media use by (1) orthopaedic surgery residencies/fellowship training programs and (2) individual orthopaedic surgeons and the change in use over time. We searched 3 electronic databases (PubMed, MEDLINE, and Embase) from their inception to April 2022 for all studies that analyzed the use of social media in orthopaedic surgery. Two reviewers independently determined study eligibility, rated study quality, and extracted data. Methodology was in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Twenty-eight studies were included, of which 11 analyzed social media use by orthopaedic surgery residency and fellowship training programs and 17 examined its use by individual orthopaedic surgeons. Among residency and fellowship programs, Instagram was identified as the most common platform used, with 42% to 88% of programs reporting program-specific Instagram accounts, followed by Twitter/X (20%-52%) and Facebook (10%-38%). Social media was most commonly used by programs for recruitment and information dissemination to prospective residency applicants (82% and 73% of included studies, respectively). After the start of the COVID-19 pandemic, there was a 620% and 177% increase in the number of training programs with Instagram and Twitter/X accounts, respectively. Individual use of social media ranged from 1.7% to 76% (Twitter/X), 10% to 73% (Facebook), 0% to 61% (Instagram), 22% to 61% (LinkedIn), and 6.5% to 56% (YouTube). Instagram, Twitter/X, and Facebook are the premier platforms that patients, residency applicants, and institutions frequent. With the continued growth of social media use anticipated, it will be critical for institutions and individuals to create and abide by guidelines outlining respectful and professional integration of social media into practice. Level IV.

Orthopaedic Journal Clubs are More Effective with Variety and Debates

Objective: To analyze the opinions of orthopaedic surgery faculty and residents on thecharacteristics that improve journal club effectiveness, engagement, and value.&#x0D; Design: Journal club series with 10 monthly meetings at a single ACGME orthopaedic surgeryresidency program during the 2022-2023 academic year with variable formats based onleadership style, themes, types and number of articles, and debates.&#x0D; Setting: Single ACGME orthopaedic surgery residency program.&#x0D; Participants: Sixteen faculty surgeons and 25 residents participated in the journal club seriesand 37 individuals completed the survey with 14 faculty surgeons and 23 residents.&#x0D; Intervention: A 12-question anonymous survey and free text section at the conclusion of theseries&#x0D; Main Outcome Measurements: Survey responses regarding effective attributes of journal clubmeetings, primarily use of debates and secondarily leadership style.&#x0D; Results: Faculty ranked a hybrid format (71%) with resident presentations and debates (86%)first. Residents were relatively more divided and overall ranked a hybrid format (52%) withattending presentations and debates (56%) first. Both faculty and residents ranked a debate orhybrid format among the top three formats (69 vs. 77%). Within the program, a debate or hybridformat was ranked first by 65% of respondents and among the top three formats by 74%.Conclusion: Faculty preferred that residents lead and present articles or debate topics whileapproximately half of residents preferred that faculty debate. The optimal journal club seriescombines multiple components and can be improved with variety, debates, and continuedopportunity for residents to demonstrate critical appraisal of how articles influence practice.&#x0D; Key Words: journal club, debate, ACGME, residency&#x0D; Level of Evidence: III, cohort

Perceptions of Preference Signaling in Orthopaedic Surgery: A Survey of Applicants and Program Directors.

To improve transparency between candidates and training programs, a preference signaling program (PSP) was implemented before the 2022 to 2023 orthopaedic surgery match. The PSP allows applicants to 'signal' up to 30 programs, informing the program of the applicant's particular interest in interviewing for their available position(s). This study reports the perspectives of orthopaedic surgery residency applicants and program directors (PDs) on the effects of preference signaling on the orthopaedic match. Electronic surveys were distributed to PDs and applicants. Almost all programs participated in the PSP (90%), and most of the applicants (97.6%) used 25 to 30 of their allotted preference signals. Most of the applicants (67.2%) thought that their likelihood of obtaining an interview was improved at 'signaled' programs but decreased at programs without a 'signal' designation (85.3%). Both applicants and PDs considered preference signaling to be one of the three most important factors for interview selection, along with Step 2 CK score and letters of recommendation. The applicants did not think that their likelihood of matching would improve with fewer allotted signaling tokens (35.2%), and 55.2% of PDs believed 21 to 30 tokens were optimal. Preference signaling is highly regarded by applicants and PDs. Signaling a program will likely improve an applicant's chance to interview. The optimal number of signaling tokens remains unknown, although both groups favored a larger allotment of tokens than has been seen in other specialties. Universal guidelines and recommendations for applicants and PDs would improve the utility of preference signaling.

Technology-Assisted Hip and Knee Arthroplasty in Orthopaedic Residency Training: A National Survey.

The adoption of technology-assisted total joint arthroplasty (TA-TJA) is increasing; however, the extent to which TA-TJA is used among orthopaedic trainees is unknown. The purpose of this study was to assess the current use of TA total knee arthroplasty (TKA) and total hip arthroplasty (THA) by orthopaedic residents and to evaluate resident perceptions toward TA-TJA in their surgical training. In this cross-sectional study, an anonymous electronic survey was sent to all Accreditation Council for Graduate Medical Education-accredited orthopaedic surgery residency program coordinators to distribute to their PGY-2 to PGY-5 residents. The survey consisted of 24 questions, including resident demographics, utilization of TA-TJA in their training, and perceptions regarding TA-TJA. A total of 103 orthopaedic residents completed the survey, of whom 68.0% reported using TA-TJA at their institution. Of the residents using TA-TJA, 28.6% used TA for total TKA only, 71.4% used TA for both TKA and THA, and none used TA solely for THA. One-third of residents (33.3%) use TA for more than half of all TKAs conducted, whereas 57.0% use TA for <10% of all THAs conducted. Approximately half of all residents (49.5%) thought that training in TA-TJA should be required during residency, with no significant differences between junior and senior level residents ( P = 0.24). Most (82.0%) thought that trainees should be required to learn conventional TJA before learning TA-TJA. 63.0% thought that technology had a positive effect on their primary TJA training experience; however, 26.0% reported concern that their training conducting conventional TJA may be inadequate. This study demonstrates that most orthopaedic residents currently conduct TA-TJA and highlights notable differences in TJA training experiences. These results provide a platform for future work aimed at further optimizing TJA training in residency, particularly as technology continues to rapidly evolve and utilization of TA-TJA is projected to grow exponentially. N/A, survey-based study.

Assessing Gender Differences in Technical Skills and Confidence in Orthopaedic Surgery Residency Applicants.

Variations in confidence for procedural skills have been demonstrated when comparing male and female medical students in surgical training. This study investigates whether differences in technical skill and self-reported confidence exist between male and female medical students applying to orthopaedic residency. All medical students (2017 to 2020) invited to interview at a single orthopaedic residency program were prospectively evaluated on their technical skills and self-reported confidence. Objective evaluation of technical skill included scores for a suturing task as evaluated by faculty graders. Self-reported confidence in technical skills was assessed before and after completing the assigned task. Scores for male and female students were compared by age, self-identified race/ethnicity, number of publications at the time of application, athletic background, and US Medical Licensing Examination Step 1 score. Two hundred sixteen medical students were interviewed, of which 73% were male (n = 158). No gender differences were observed in suture task technical skill scores or mean difference in simultaneous visual task scores. The mean change from pre-task and post-task self-reported confidence scores was similar between sexes. Although female students trended toward lower post-task self-reported confidence scores compared with male students, this did not achieve statistical significance. Lower self-reported confidence was associated with a higher US Medical Licensing Examination score and with attending a private medical school. No difference in technical skill or confidence was found between male and female applicants to a single orthopaedic surgery residency program. Female applicants trended toward self-reporting lower confidence than male applicants in post-task evaluations. Differences in confidence have been shown previously in surgical trainees, which may suggest that differences in skill and confidence may develop during residency training.

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.].

The Value of Signaling an Orthopaedic Surgery Program: A Survey to Orthopaedic Surgery Programs.

A new system was implemented by the Association of American Medical Colleges called the preference signaling program for the 2022 to 2023 orthopaedic surgery residency match. Applicants were able to signal 30 orthopaedic surgery programs to indicate high interest in a specific program. The purpose of this study was to address how important signaling was to an orthopaedic surgery program this 2022 to 2023 application cycle. A five-question survey was sent to orthopaedic surgery residency programs participating in the Electronic Residency Application Service this application cycle. Contact information was gathered through the Accreditation Council for Graduate Medical Education residency website and program websites. Responses were obtained from 69 of the 151 programs (46%) contacted. The average number of applicants per program was 727 (range, 372 to 1031, SD 155). Thirty-four of 61 respondents (56%) stated that 100% of their interviewees signaled their program. Fifty-five of 61 respondents (90%) indicated that their interviewee pool consisted of 75% or more applicants who signaled. Applicants who signaled had a 24.4% (range, 12.77 to 47.41, SD 8.04) chance of receiving an interview. Applicants who did not signal had just a 0.92% (range, 0 to 13.10, SD 2.08) chance of receiving an interview. Fifty-four of the 63 applicants (86%) answered that signaling played an important role in considering an applicant for an interview. Over half of the responding programs only interviewed applicants who signaled their program, and over 90% of programs' interview lists consisted of at least 75% of signaling applicants. Eighty-six percent of programs indicated that signaling played an important role in considering an applicant for an interview. Applicants who signaled were 26.5 times more likely to receive an interview than those who did not (P < 0.0001). With this information, applicants can narrow down their list of programs to apply to, knowing that their signal to a program will give them a better chance at receiving an interview.