Orthopaedic Surgery Residency Research Articles

Use of Mixed Reality Technologies by Orthopedic Surgery Residents: A Cross-Sectional Study of Trainee Perceptions

Introduction Recently within surgical education, the development of extended reality (XR) devices has become a topic of interest to improve trainees’ surgical technique outside of the operating room. There is a growing body of literature which supports the use of XR, and it is important to understand the perceptions of orthopedic surgery trainees on the use of XR as an adjunct during training. Purpose Understand the perceptions of orthopedic trainees on the use of XR as an adjunctive surgical training tool. Methods An internally validated 18-question survey was sent to all US orthopedic residency program coordinators with the intent for distribution to each program’s respective residents. Responses with ≥ 70% completion were considered complete. Results Overall, 33% and 18% of residents agreed XR is needed, and all programs should offer XR, respectively. There was overall agreement (67%) for XR’s ability to improve procedural confidence and improve skill progression (65% agreed). Only 25% of respondents felt XR could accurately simulate orthopedic procedures and 36% agreed it could effectively model patient-specific anatomy for preoperative planning. Regarding XR’s ability to reduce intraoperative navigational error, 45% of respondents agreed. However, responses were more neutral for XR’s ability to reduce inpatient length of stay (40%) and ability to improve the accuracy of hardware/prosthetic placement (31%). Finally, 53% of respondents agreed that the largest barrier to integration of XR is cost, while 35% felt that a lack of dedicated time to use the technology during their training program was a major barrier. Conclusion The need for adjunctive surgical training outside of the operating room is clearly demonstrated from our results. Although it is unclear if XR will become a standard tool across all residency programs, orthopedic surgery residents do feel that the technology is useful in terms of skills progression and operative confidence. Thus, this study provides a preliminary framework which suggests a potential role for XR in orthopedic surgery training and the need for further study to address barriers to widespread integration.

Challenges of minimally- invasive orthopaedic surgery practice in Nigeria - a national survey of residents’ perceptive

Background: Minimally invasive orthopaedic surgery (MIOS) practice globally has been on a gradual increase, however the current state in Nigeria is not same. Objectives: To determine the challenges of minimally invasive orthopaedic surgery (MIOS) practice in Nigeria and proffer realistic suggestions to improve the current state in Nigeria. Methodology: A descriptive cross-sectional online survey conducted among senior orthopaedic surgery residents across all specialist hospitals in Nigeria. Data was analysed with the SPSS software version 20. Significance was set at p<0.05. Mean and S.D scores were calculated for responses with Likert scales of 1-5 (5- strongly agree). Results: 48 residents completed and submitted the questionnaire, response rate of about 70.6%.The results showed that the most significant factors affecting minimally invasive orthopaedic surgery practice in Nigeria were lack of funds (72.9% of respondents), unavailability of equipment and implants (60.4%), limited number of trainers and fellows skilled in minimal access surgery (54.2%). The narrowest Standard deviation reflecting closest precisions in perspectives of the challenges was a S.D of 0.794, Mean 4.02, which stated that there are very few courses on training of MIOS procedures. Conclusion: Funds, training, equipment availability were the major challenges of minimally invasive orthopaedic surgery practice in Nigeria. Keywords: Minimally- invasive orthopaedic surgery; residents’ perceptive; Nigeria.

Assessing students' perception of gender as a barrier in Orthopedic residency matching: A pilot survey study

BackgroundGender disparity in orthopedic residency programs is evident. Limited research investigates if gender attitudes deter women from applying to orthopedic surgery residency programs. MethodsA questionnaire was distributed to a single medical school which explored medical students' perceptions regarding their gender's influence on matching into orthopedic surgery residency, alongside motivators and barriers for applying. Descriptive statistics and chi-square tests analyzed potential association and trends using SPSS computation with alpha set at 0.05. Results202 medical students completed the questionnaire. Women respondents were found to be 10.6 times more likely to report their own gender as a barrier to matching to orthopedic surgery residency compared to men. ConclusionA significant proportion of women perceive their gender as a barrier to matching. Dismantling gender stereotypes may increase consideration of women medical students of orthopedic surgery as a career option.

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

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

Higher Grit Scores Are Associated With Greater Scholarly Productivity Among Orthopaedic Surgery Residents

Introduction: Scholarly research is a core component of resident education, designed to advance the orthopaedic field while facilitating an evidence-based approach to patient care. Grit, defined as trait-level perseverance, has been shown in prior studies to predict clinical performance, burnout rates, and residency match rates. No previous study has investigated the relationship between grit and research productivity. Study Description: This study is a cross-sectional survey of orthopaedic surgery residents from the American Academy of Orthopaedic Surgeons. Residents were assessed via online survey of scholarly productivity and the 12-item grit scale. Methods: Surveys distributed to the Academy of Orthopaedic Surgeons residents assessed the number of peer-reviewed publications, presentations, first author publications, book chapters, and articles. Respondents were also evaluated through the 12-item grit scale, with scores ranging from 1 (minimum grit) to 5 (maximum grit). Residents were divided into low (score ≤3.4), medium (score: 3.5 to 3.9), and high grit (score ≥4.0) cohorts. Analysis of variance analysis compared the cohorts regarding the scholarly productivity metrics. Linear regression models analyzed grit score as a continuous variable. Findings were statistically significant at P < 0.05. Results: The mean grit score was 3.8. The high grit cohort was more likely to have increased publications, presentations, articles, and first authorship (P < 0.0001). Analyzed as a continuous variable, increased grit positively correlated with increased publications, presentations, articles, first authorship, and book chapters (P < 0.0001). Conclusions: The results suggest that higher grit scores are associated with scholarly productivity.

Professional Behavior Assessment During Residency Training: Can We Identify Outliers?

The American Board of Orthopaedic Surgery (ABOS) Knowledge, Skills, and Behavior (KSB) project sets up a framework for competency-based medical education for orthopaedic surgery residency training. The Behavior aspect of KSB includes use of the American Board of Orthopaedic Surgery Behavior Tool (ABOSBT) to assess 5 domains of professional behavior. The purpose of this study was to analyze the results of 2 years of ABOSBT assessments and to characterize the low score ratings. All ABOSBT assessments from January 1, 2022, to December 31, 2023, were reviewed totaling 51,678 completed assessments with 48,648 (94%) assessments from a 360° process and 3,030 (6%) as end-of-rotation assessments. Distribution of 51,678 ABOSBT assessments with 258,390 scores demonstrated low scores (disagree or strongly disagree) in 0.9% of assessments. All 5 domains identified low scores in a small percentage at all years-in-training with the greatest number in second- and third-year residents. Comparison of scores from 360° vs. end-of-rotation requests demonstrated a higher percentage of low scores given during the 360° process (p < 0.0001). Three thousand seven hundred seven unique evaluators completed ABOSBT assessments, with attending physicians as the most frequent evaluator type (44%); inpatient nurses assessed residents with low ABOSBT scores more frequently (4.5%) than any other evaluator type. Residents with 2 or more low scores by 2 or more different evaluators were analyzed for each of the 5 domains; low scores were most frequently observed in the reliability domain. The ABOSBT was originally validated 5 years ago in 18 programs with 9,892 assessments; this article updates results using the ABOSBT across 95 programs assessing 2,397 residents with 3,707 evaluators. The ABOSBT demonstrates that most residents demonstrate professional behavior across 5 domains of assessment; the ABOSBT identifies residents with low scores. A strength of KSB is the ability to identify professionalism deficiencies while residents are in training and can focus on individualized educational improvement. Tracking residents with low scores on the ABOSBT assessment over time will help determine its effectiveness in identifying unprofessional behavior.

Orthopaedic surgery residents with a mentor report greater self-assessed theoretical and practical preparedness than residents without a mentor.

The purpose of the study was to investigate the effect of mentorship on self-perceived theoretical and practical skill levels of German-speaking residents affiliated to a scientific society with a focus on sports medicine. It was hypothesized that orthopaedic surgery residents with a mentor would report higher subjective theoretical and practical skills and less apprehension towards performing surgeries unsupervised compared to those without mentors. A 35-item questionnaire was distributed among resident members of AGA-Society for Arthroscopy and Joint-Surgery. The survey explored the current status of mentoring and self-assessed theoretical and practical skill levels as well as apprehension towards performing surgeries unsupervised (1-10 scale with higher values indicating higher skill level or greater apprehension). In total, 115 residents were included, of which 46 (40.0%) had a mentor. The majority of residents without a mentor (65.7%) reported the desire to have a mentor. Residents with a mentor reported significantly higher self-assessed theoretical (p = 0.003) and practical skill levels (p < 0.001) and less apprehension towards performing surgeries unsupervised (p < 0.001) compared to residents without a mentor. The presence of formal mentorship programs increased the likelihood of having a mentor significantly (odds ratio [OR] 7.17, p < 0.001). Male and female participants did not differ significantly in self-assessed skill level or apprehension towards performing surgeries unsupervised. Residents with a mentor reported greater subjective skill levels and stated less apprehension towards performing surgeries unsupervised compared to residents without a mentor. The majority of residents without a mentor stated that they would like to have a mentor. This may be achieved by establishing more formal mentorship programs as they facilitate mentorship. Level IV, cross-sectional study.

Assessing the Accuracy and Reliability of the Fluoroscopic Ruler for Comminuted Femur Fractures: A Cadaveric Study.

Fixation of comminuted femur fractures may result in limb length discrepancy. Intraoperative fluoroscopic measurement of the contra-lateral femur with a ruler is commonly performed to establish a reference for femoral length. No evidence regarding the reliability and accuracy of this technique exists. This study aimed to assess the accuracy and interrater reliability of a fluoroscopic ruler in obtaining correct femoral length in a comminuted femoral shaft fracture model. Approximately 5 cm of bone was removed from the left femoral diaphyses of 8 cadavers. Seven orthopedic surgery residents and 2 attendings measured the length of the intact contralateral femur using a ruler under fluoroscopy. The ruler was then applied to the "fractured" femur with manual traction applied until femoral length matched the measured length of the contralateral femur. The resulting gap in the "fractured" femur was compared with the length of bone that had been resected. Data were analyzed using means, SDs, and intraclass correlation coefficients (ICCs). Fifty-seven measurements were collected. The mean difference between the measured fracture gap and the length of bone removed was 8.0±5.8 mm (range, 0-22 mm). Femoral length was accurate to 5 mm in 40% of cases, 10 mm in 70%, 15 mm in 81%, 20 mm in 98%, and 25 mm in 100%. The overall interrater reliability was poor (ICC, 0.11; 95% CI, 0.001-0.44). Despite poor interrater reliability, the fluoroscopic ruler resulted in a mean leg length discrepancy of 8.0±5.8 mm in this cadaveric study. [Orthopedics. 202x;4x(x):xx-xx.].

Peer-Reviewed Publications by Successfully Matched Orthopedic Surgery Residency Applicants in the 2022-2023 Match.

The Orthopaedic Surgery Match is highly competitive, with more applicants than residency spots. With the Step 1 Exam moving to a pass/fail result, residency programs and applicants have fewer objective data to determine applicants' relative competitiveness. Through this study, we sought to provide the mean number of accepted publications on PubMed a successfully matched orthopedic surgery applicant has by the time of submission of their application. Orthopedic surgery residency programs participating in the National Resident Matching Program were identified by their ranking on the Doximity Residency Navigator. Each program's intern class and their medical schools were identified. Their names were searched in PubMed and Scopus and articles with their name and affiliations were recorded. In total, 877 orthopedic surgery interns published a mean of 3.30±5.27 articles each on PubMed. They were first or second author on 1.44±2.58, and 1.96±3.89 publications were related to orthopedic surgery. There were no statistical differences between degree, sex, or residency program rank from the Doximity Residency Navigator. The mean number of publications from a successful applicant was approximately 3. There was a great range in the number of publications, and 27.3% of successful applicants did not have a single publication. Future applicants and programs can use this number to gauge relative research output. [Orthopedics. 202x;4x(x):xx-xx.].

Evaluating the 2023 Standardized Letter of Recommendation Form in Applications to Orthopaedic Surgery Residency.

Successfully matching into orthopaedic surgery residency is a challenging endeavor due to the limited number of available positions. Implementation of the Standard Letter of Recommendation (SLOR) in 2017 was intended to allow better comparisons between applicants; however, the form suffered from notable rank inflation ultimately requiring introduction of an updated SLOR for the 2023 to 2024 application cycle. The purpose of this study was to evaluate whether the 2023 SLOR improves on deficiencies of the 2017 SLOR. Applications submitted to our institution during the 2023 to 2024 orthopaedic surgery residency application cycle were analyzed. Applicant objective metrics were collected, including US Medical Licensing Exam scores, clerkship grades, AΩA status, and research productivity. Scores for each domain of the 2023 SLOR forms were recorded. Mean scores were calculated for each question, and cumulative scores per SLOR were determined. Intraclass correlation coefficients were determined per applicant and evaluator. The Spearman rank correlation coefficient was calculated for comparison of SLOR cumulative scores and objective metrics. Three hundred sixty-eight applications were reviewed, and 743 2023 SLORs were submitted in conjunction with these applications. Most of the 2023 SLORs (n = 399, 53.70%) had cumulative scores placing applicants in at least the 90th percentile. Furthermore, 267 evaluators (72.36%) consistently gave scores of 99s and 10s for each question. Intraclass correlation coefficients were rated as fair to moderate agreement between evaluators for each applicant. Objective applicant metrics did not meaningfully correlate with SLOR cumulative scores. The 2023 SLOR demonstrated notable rank inflation with only 22.7% of applicants receiving a score of less than 7 on any domain. By contrast, 69.9% of applicants received a score of "rare, perfect gem" on at least one domain of the form. We encourage the American Orthopaedic Association Council of Orthopaedic Residency Director to continue to improve the form and provide guidance to residency program leadership on proper use of the grading system.

Sex diversity in spine surgery fellowship training: analysis of recent trends and program characteristics associated with increased diversity

BACKGROUND CONTEXTSex diversity in the spine surgery workforce remains limited. Accelerated efforts to recruit more female trainees into spine surgery fellowship training may help promote diversity and inclusion in the emerging spine surgery workforce. PURPOSEThis study assessed the representation of female trainees in spine surgery fellowship training and program factors associated with greater sex diversity among fellows. Study Design/SettingThis was a cross-sectional analysis of spine surgery fellows in the United States during the 2016–2017 to 2022–2023 academic years. PATIENT SAMPLEN/A. OUTCOME MEASURESRepresentation (%) and participation-to-prevalence ratios (PPRs) defined as the participation of female trainees in spine surgery fellowship training divided by the prevalence of female trainees in previous training cohorts. PPR values <0.8 indicated underrepresentation. METHODSSex diversity was assessed among spine surgery faculty, spine surgery fellows, orthopaedic surgery residents, neurosurgery residents, and allopathic medical students. Fellowship program characteristics associated with increased sex diversity were calculated with chi square tests. RESULTSThere were 693 spine surgery fellows and 41 were female (5.9%). Sex diversity in spine surgery fellowship training decreased over the study period (6.4% vs. 4.1%, p=.025). Female trainee representation in spine surgery fellowship training was less than that in orthopaedic surgery residency (14.2%, PPR=0.42), neurosurgery residency (17.1%, PPR=0.35), and allopathic medical school (47.6%, PPR=0.12) training (p<.001). There were 508 faculty at 78 spine surgery fellowships and 25 were female (4.9%). There were 3 female fellowship program directors (3.8%). Fellowship program characteristics associated with increased sex diversity included the presence of female faculty (p=.020). Additional program characteristics including geographic region, accreditation status, number of faculty and fellows were not associated with sex diversity (p>.05). CONCLUSIONSFemale representation in spine surgery fellowship training decreased over the study period and remains underrepresented relative to earlier stages of medical and surgical training. There was a positive association between female faculty and increased sex diversity among fellows. Greater efforts are needed to create training environments that promote diversity, equity, and inclusion in spine surgery fellowship training.

Innovating Flexor Tendon Repair Training with a Three-dimensional Printed Model.

Flexor tendon repair is a technically demanding procedure, with functional outcome directly proportional to skillful execution. A repair must be strong to manage early mobilization and precise to allow for gliding through the tendon sheath. As a result, junior residents face a steep learning curve that may be mitigated by exposure to surgical simulators. To facilitate flexor tendon repair training, a surgical training device and accompanying instructional video were developed. Simulation workshops were held for junior orthopedic and plastic surgery residents (n = 11). To objectively assess validity of the curriculum, study participants performed cadaveric flexor tendon repairs before and after the workshop. Anonymous recordings of these repairs were graded by two certified hand surgeons. Additionally, a tensometer was used to measure strength of repair. Model realism, educational utility, and overall usefulness rated high: 4.6 ± 0.52 95% confidence interval (CI) for realism, 4.9 ± 0.42 95% CI for device, 4.7 ± 0.96 95% CI for video, and 4.9 ± 0.66 95% CI overall. Subjective confidence increased after the training session (73% ranked "moderately" or "extremely"). Likewise, scores given by the surgeons grading the repairs improved for overall quality and time of repair (pre: 2.77 ± 0.61, post: 4.22 ± 0.56, P= 0.0002). Strength of repair did not change (P = 0.87). The proposed three-dimensional surgical simulator for flexor tendon repair is realistic and useful, with improved surgical technique and improved confidence demonstrated after use. This design can be three-dimensionally printed en masse and provide value to hand surgery training curriculum.

Wrist and Hand Arthroscopy Procedure Volume Is Low Among Graduating Orthopaedic Surgery Residents

Wrist and Hand Arthroscopy Procedure Volume Is Low Among Graduating Orthopaedic Surgery Residents

International medical graduates in orthopaedic surgery: An opportunity to improve diversity and inclusion?

Background/aimsRacial and ethnic minorities are under-represented in orthopaedic surgery despite efforts to promote diversity and inclusion in the specialty. The purpose of this study was to determine the proportion of international medical graduates (IMGs) in the surgical workforce and future residency pipeline. We further analyze IMG applicant qualifications relative to their US-based counterparts to assess the viability of recruiting IMG candidates as one strategy to advance diversity and inclusion in orthopaedic surgery. MethodsPhysician workforce data from the American Medical Association and residency match data from the National Resident Match Program were analyzed for Orthopaedic Surgery. Trends in the proportion of IMG applicants were compared with those from other specialties. Qualifications of applicants were compared including board exam scores, number of abstracts/publications, and additional graduate degrees. ResultsIn 2020, orthopaedic surgery had the lowest percentage of IMGs relative to otolaryngology (5.8 %, p < 0.001), neurosurgery (12.1 %, p < 0.001), obstetrics & gynecology (14.0 %, p < 0.001), and general surgery (19.1 %, p < 0.001). From 1986 to 2021, IMG Graduates who matched into orthopaedic surgery increased from 1 (0.3 %) to 8 (0.9 %). Compared to other surgical specialties, orthopaedic surgery had among the lowest annual rates of incoming IMG residents. In 2021, most respondents to the orthopaedic surgery residency program directors survey reported never selecting IMG applicants for interview (74 % for non-US IMG applicants and 53 % for US IMG applicants). From 2020 to 2021, non-US IMG applicants (17 %) and US IMG applicants (26 %) had lower match rates than DO Senior (74 %) and MD Senior (80 %) applicants (p < 0.001). In 2020, matched non-US IMGs had similar board scores as matched US MD Senior applicants, but more abstracts/publications. ConclusionThe recruitment of IMGs into orthopaedic surgery residency remains limited and lower than other surgical specialties. IMGs have similar board scores and more abstracts/publications, thus representing a potential pipeline for workforce diversity. More research is needed to understand the special needs of IMGs in the orthopaedic surgery match.

The Impact of Diversity, Equity, and Inclusion Scholarships for Acting Interns on the Diversity of Orthopaedic Surgery Residency Programs

Background Improving diversity, equity, and inclusion (DEI) in orthopaedic surgery is a priority as statistics continue to demonstrate it as the least diverse surgical subspecialty. DEI scholarships for Acting Interns have been recently developed to recruit more diverse candidates. Objective To determine the impact of DEI scholarships on the orthopaedic surgery residency application process. Design An anonymous survey was distributed to program directors at ACGME accredited orthopaedic residencies that offered DEI scholarships for visiting medical students. The survey inquired about factors involved in scholarship implementation, source of funding, number of scholarship applications received, factors considered in selecting recipients, number of DEI scholarships awarded, program results in the 2023 Match, demographics of incoming first-year residents, and program directors’ observations following implementation. Results Of the 49 programs with known DEI scholarships, 16 (32.7%) completed the survey. During the 2023 Match cycle, respondents matched an average of 5 residents (SD 0.5, Range 3 – 8) consisting of 36.7% female (SD 31.7%, Range 0 – 100%) and 36.9 (SD 28.2%, Range 0 – 100%) underrepresented minority (URM) residents. Following scholarship implementation, most program directors (56.2%) observed a rise in URM student rotators with an associated 18.8% increase in the number of URM residents. Additionally, 18.8% of programs claimed that scholarship recipients either matched at their program or another orthopaedic residency program. Respondents reported that 68.8% (SD 41.5%, Range 0 – 100%) of scholarship recipients received an invitation to interview at the awarding program. Of the three programs (18.8%) that claimed recipients matched at their program, two (13.3%) reported they matched one DEI scholar, while the other (6.7%) stated that five DEI scholars matched into their program. Conclusion DEI scholarships may be an effective strategy for promoting diversity in orthopaedics. However, longitudinal data and increased institutional GME funding are required to increase the proportion of orthopaedic residency programs that offer these scholarships for visiting students.

Factors Affecting Choice of Subspecialisation amongst Orthopaedic Surgery Residents in Southern Nigeria

Abstract Background: As the field of surgery continues to evolve, subspecialty training is fast becoming integral to surgical education. Presently, orthopaedic surgery residents have opportunities to subspecialise in different areas. Objectives: The aim of this study was to determine the factors affecting the choice of desired subspecialties amongst orthopaedic surgery residents in southern Nigeria. Materials and Methods: This study was a cross-sectional study conducted amongst senior orthopaedic surgery residents in southern Nigeria. A well-structured questionnaire designed using the free software Google Forms was electronically distributed to senior orthopaedic residents in Nigeria through online forums (WhatsApp, email, and Telegram). Data obtained were analysed using IBM Statistical Product and Service Solutions version 26. The odds ratio and the associated 95% confidence interval were used to assess outcomes, and a P value &lt;0.05 defined that the difference was statistically significant. Results: At the end of the study period, 53 orthopaedic surgery senior residents completed and submitted the questionnaire with a response rate of 73.6%; 50.9% were married with children and 49.1% were single. The most agreed key factor influencing the choice of orthopaedic surgery subspecialisation from the study was lifestyle considerations (79.2%). Other major factors considered to be also very important were the needs of the region (73.6%), active mentorship (71.7%), ergonomics (64.6%), rotation experiences (47.2%), cost of acquiring the training (41.5%), and salary and financial privileges (37.7%). Overall, 24.5% of respondents chose spine surgery as their desired subspecialty, 18.9% arthroplasty, 17% arthroscopy, 17% paediatrics, 13.2% reconstructive orthopaedics, 5.7% musculoskeletal oncology, and 4.7% hand and foot surgery. Our study revealed a significant statistical relationship between having children and choice of a subspecialty (Fischer’s = 0.032; χ2 = 0.033), as the married female residents tend to have more family considerations in their final choice of subspecialisation. Conclusion: The choice of orthopaedic surgery subspecialisation amongst orthopaedic surgery residents in southern Nigeria is affected by different factors, such as mentorship, needs of region, desire to work in academic settings, and ergonomics.

Accessibility and Characterization of Parental Leave Policies for Orthopaedic Surgery Residency Training in the United States.

This study assesses the accessibility and nature of parental leave policies during orthopaedic surgery residency training after implementation of the Accreditation Council for Graduate Medical Education (GME) mandate for 6 weeks of paid parental leave effective July of 2022. An audit of orthopaedic surgery residency and affiliated GME websites was conducted to assess the accessibility of parental leave policies during the 2023-2024 academic year. Details on length of leave and nature of renumeration during the leave were recorded. Bivariate analyses were conducted to determine residency program characteristics associated with the accessibility of a parental leave policy. Results were compared with a previous analysis during the 2017-2018 academic year. A total of 200 residency programs were evaluated, and 152 had parental leave policies (76.0%). Compared with 2017 to 2018, a similar percentage of parental leave policies were accessible on residency program websites (3.0% vs. 2.0%, P = 0.777) but fewer were accessible on GME websites (55.5% vs. 80.7%, P < 0.001). More contemporary policies were obtained from program coordinators (18.5% vs. 7.2%, P = 0.003), and more were not available (24.0% vs. 9.0%, P < 0.001). Most policies offered renumeration (86.7%) and leave for 6 weeks in length (75.0%). A higher prevalence of parental leave policy accessibility was found among orthopaedic residency programs with university affiliation (P < 0.001), more faculty members (P = 0.008) and residents (P = 0.017), a higher percentage of female faculty (P = 0.008), affiliation with a top 50 ranked National Institutes of Health-funded orthopaedic surgery department, and accreditation achieved before 2017 to 2018 (P = 0.004). Most orthopaedic surgery residency programs do not have accessible parental leave policies on their websites. The new Accreditation Council for GME mandate will require orthopaedic residency programs to provide residents with 6 weeks of paid parental leave during residency training. Accessible policies may be useful to applicants interested in child rearing during orthopaedic residency training.

ChatGPT, Bard, and Bing Chat are large language processing models that answered OITE questions with a similar accuracy to first-year orthopaedic surgery residents.

PurposeTo assess ChatGPT, Bard, and BingChat’s ability to generate accurate orthopaedic diagnosis or corresponding treatments by comparing their performance on the Orthopaedic In-Training Examination (OITE) to orthopaedic trainees. MethodsOITE question sets from 2021 and 2022 were compiled to form a large set of 420 questions. ChatGPT (GPT3.5), Bard, and BingChat were instructed to select one of the provided responses to each question. The accuracy of composite questions was recorded and comparatively analyzed to human cohorts including medical students and orthopaedic residents, stratified by post-graduate year. ResultsChatGPT correctly answered 46.3% of composite questions whereas BingChat correctly answered 52.4% and Bard correctly answered 51.4% of questions on the OITE. Upon excluding image-associated questions, ChatGPT, BingChat, and Bard’s overall accuracies improved to 49.1%, 53.5%, and 56.8%, respectively. Medical students and orthopaedic residents (PGY1-5) correctly answered 30.8%, 53.1%, 60.4%, 66.6%, 70.0%, and 71.9%, respectively. ConclusionChatGPT, Bard, and BingChat are AI models that answered OITE questions with an accuracy similar to that of first-year orthopaedic surgery residents. ChatGPT, Bard, and BingChat achieved this result without using images or other supplementary media that human test takers are provided.

The Impact of the Dobbs v. Jackson Supreme Court Decision on Orthopaedic Residency Programs: A Collaborative Orthopaedic Education Research Group (COERG) Survey.

Recent changes inreproductive health care policy have now led to state-specific differences in abortion care access across the United States. Members of the medical community in particular have issued concerns regarding these new policies and their potential impact on graduate medical training. Objectives: The purpose of this study was to sample orthopaedic surgery residency programs to gauge their perceptions of the Dobbs decision and its impact on residency training. Materials and methods:A 25-item questionnaire was developed toassess the attitudes of orthopaedic surgery residency programs on the Dobbs v. Jackson Women's Health Organization decision. Our survey-based study was first endorsed by and then distributed amongst members of the Collaborative Orthopaedic Education Research Group (COERG). A total of 24 representatives from 24 Accreditation Council for Graduate Medical Education (ACGME) accredited orthopaedic surgery residency programs agreed to participate in the study. Results: Twenty-four of 24 program correspondents completed the survey (100%). Of the 15 programs (68.2%) who reported that their institution does not have a contingency plan in place, only five (33.3%) see a need for one. Eighteen programs (75.0%) agreed that the ACGME should have a policy protecting residents or significant others needing reproductive care. Ten (41.7%) respondents indicated that the Dobbs decision will impact how students rank residency programs; however, none (0%) believe it will impact their ability to attract a diverse applicant pool. Conclusion: Although some programs surveyed have a contingency plan in place, the majority believe the ACGME should develop a policy that addresses the reproductive needs of residents. Given the higher rate of pregnancy complications experienced by women training in orthopaedic surgery it is paramount to have policies that protect residents seeking reproductive care.

Where are the women in spine surgery? A demographic study of the range of gender disparity in academic spine hospitals in the United States

BACKGROUND CONTEXTThere is a paucity of women in the field of academic spine surgery. In 2022, 20% of orthopedic surgery residents and 24% of neurosurgery residents were women, the lowest and third lowest of all medical specialties respectively. There exists a significant discrepancy in the number of women employed as adult spine surgeons at academic hospitals. PURPOSETo quantify the number of female attending spine surgeons at academic hospitals and identify institutions that based on faculty diversity are demonstrating inequity. STUDY DESIGNDescriptive. METHODSDemographic data was collected utilizing the 2023 to 2024 NASS Fellowship Directory in combination with publicly available information on faculty profiles from January 1, 2024 to January 30, 2024. Data collected included gender and training institutions (medical school, residency, and fellowship). Adult spine fellowship-trained orthopedic surgeons and neurosurgeons who perform adult spine surgery were included. RESULTSThere are 943 neurosurgical and orthopedic adult spine surgeons employed at 73 academic hospitals. The breakdown of orthopedic spine surgeons versus neurosurgeons is roughly equivalent, at 453 and 490, respectively. Among orthopedic spine surgeons, 19 out of 453 (4%) are female. Among neurosurgeons, 44 out of 490 (9%) are female. The number of female academic spine surgeons who are neurosurgeons is more than double that of orthopedic surgeons. Twelve out of the 19 (63%) female orthopedic spine surgeons, and 16 out of the 44 (36%) female neurosurgeons are employed at the program where they trained. Out of 45 larger academic spine hospitals with >10 faculty members, there were 15 without any female faculty. There is 1 academic hospital with ≥ 20 spine faculty, and zero women. CONCLUSIONThe number of women pursuing academic spine careers continues to lag behind present day demographics of training programs. These continued trends should prompt both individuals and institutions to support progress in gender disparity research.