Orthopaedic Surgery Faculty Research Articles

Race, Ethnicity, and Gender Representation Among US Academic Spine Surgeons.

Although diversity has improved across certain orthopaedic subspecialties, enhancing diversity within spine surgery has remained a challenge. We aimed to investigate the current state of sex, racial, and ethnic diversity among academic orthopaedic spine surgeons in the United States. In January 2024, a cross-sectional analysis of orthopaedic spine surgery faculty in the United States was conducted using the Doximity database to identify eligible surgeons. Fellowship-trained orthopaedic spine surgeons (professor, associate professor, and assistant professor) who graduated residency between 1990 and 2022 were included. Race, sex, academic rank, residency year of graduation, and H-Index scores were recorded using publicly available information from faculty profile pages and the Doximity database. Four hundred fifty-two spine faculty were included in the analysis: 95.1% men and 4.84% women. Across race and ethnicity, 315 surgeons (69.7%) were White, 111 (24.6%) Asian, 15 (3.32%) Black or African American, and 11 (2.43%) Hispanic or Latino or of Spanish origin. Of the 101 professor-level surgeons, 3 (2.97%) were Black men. Among female professors, none were Black, Asian, or Hispanic/Latino. No Hispanic or Latino female professors, associate professors, or assistant professors were identified. The sex and race/ethnicity demographics that have increased in percentage over time include White women (0.92% to 6.08%), Asian men (11.0% to 26.5%), Asian women (0% to 1.66%), and Hispanic/Latino men (1.83% to 3.87%). The surgeon demographic groups that demonstrated minimal fluctuations over time included Black men, Black women, and Hispanic/Latino women. Our findings demonstrate that underrepresentation among academic spine surgeons remains an ongoing challenge that warrants increased attention. Enhancing the representation of Black and Hispanic men, as well as Black, Asian, and Hispanic women, in spine surgery requires a deliberate effort at every level of orthopaedic training.

Sex Diversity and Equity Among Fellows of the American Orthopaedic Association.

We hypothesized that women are underrepresented among fellows of the American Orthopaedic Association (AOA) relative to their prevalence among faculty at departments of orthopaedic surgery. Clinical faculty at departments of orthopaedic surgery that are affiliated with residency training programs were analyzed for AOA membership. Participation-to-prevalence ratios (PPRs) were calculated for men and women with AOA membership relative to their prevalence among orthopaedic surgeon faculty. A PPR of <0.8 or >1.2 indicated under- or overrepresentation, respectively. PPR values between 0.8 and 1.2 indicated equivalent representation. Sex disparities in AOA membership were explored by academic rank and orthopaedic subspecialty. There were 4,310 orthopaedic surgery faculty, and 998 (23.2%) had AOA membership. Overall, women formed the minority of members in the AOA study cohort (11.4%), but they had equivalent representation relative to their prevalence among faculty (10.0%, PPR = 1.14, p = 0.210). In the AOA study cohort, women were the minority at each academic rank, including assistant professor (20.2% versus 79.8%, p < 0.001), associate professor (16.8% versus 83.2%, p < 0.001), and full professor (7.0% versus 93.0%, p < 0.001). However, women had greater representation in the AOA study cohort at each academic rank than would be expected based on their prevalence among faculty, including the assistant (PPR = 1.45), associate (PPR = 1.56), and full (PPR = 1.27) professor levels. Similarly, in the AOA study cohort, women were the minority in each orthopaedic subspecialty, but were only underrepresented in pediatric orthopaedics (PPR = 0.74). Women had greater representation in the AOA study cohort than would be expected by their prevalence among faculty in hand surgery (PPR = 1.51) and orthopaedic sports medicine (PPR = 1.33). In contrast, men had equivalent representation in each orthopaedic subspecialty. Women form a minority group in the AOA, but they exhibit greater representation in the AOA than would be expected based on their prevalence among faculty at each academic rank, and they have greater representation than men, who exhibit equivalent representation across all academic ranks. Collectively, these results disproved our hypothesis, and suggest that women are participating in the AOA at rates that are greater than their prevalence among faculty. Equitable participation of women in orthopaedic surgery is necessary to promote diversity and inclusion in the specialty. The AOA may be an important catalyst for future positive diversity and inclusion efforts within orthopaedic surgery.

Improving clinical reasoning and communication during handover: An intervention study of the BRIEF-C tool

BackgroundExisting handover communication tools often lack a clear theoretical foundation, have limited psychometric evidence, and overlook effective communication strategies for enhancing diagnostic reasoning. This oversight becomes critical as communication breakdowns...

CORR Insights®: A Shadow of Doubt: Is There Implicit Bias Among Orthopaedic Surgery Faculty and Residents Regarding Race and Gender?

CORR Insights®: A Shadow of Doubt: Is There Implicit Bias Among Orthopaedic Surgery Faculty and Residents Regarding Race and Gender?

A Shadow of Doubt: Is There Implicit Bias Among Orthopaedic Surgery Faculty and Residents Regarding Race and Gender?

Orthopaedic surgery continues to be one of the least diverse medical specialties. Recently, increasing emphasis has been placed on improving diversity in the medical field, which includes the need to better understand existing biases. Despite this, only about 6% of orthopaedic surgeons are women and 0.3% are Black. Addressing diversity, in part, requires a better understanding of existing biases. Most universities and residency programs have statements and policies against discrimination that seek to eliminate explicit biases. However, unconscious biases might negatively impact the selection, training, and career advancement of women and minorities who are underrepresented in orthopaedic surgery. Although this is difficult to measure, the Implicit Association Test (IAT) by Project Implicit might be useful to identify and measure levels of unconscious bias among orthopaedic surgeons, providing opportunities for additional interventions to improve diversity in this field. (1) Do orthopaedic surgeons demonstrate implicit biases related to race and gender roles? (2) Are certain demographic characteristics (age, gender, race or ethnicity, or geographic location) or program characteristics (geographic location or size of program) associated with the presence of implicit biases? (3) Do the implicit biases of orthopaedic surgeons differ from those of other healthcare providers or the general population? A cross-sectional study of implicit bias among orthopaedic surgeons was performed using the IAT from Project Implicit. The IAT is a computerized test that measures the time required to associate words or pictures with attributes, with faster or slower response times suggesting the ease or difficulty of associating the items. Although concerns have been raised recently about the validity and utility of the IAT, we believed it was the right study instrument to help identify the slight hesitation that can imply differences between inclusion and exclusion of a person. We used two IATs, one for Black and White race and one for gender, career, and family roles. We invited a consortium of researchers from United States and Canadian orthopaedic residency programs. Researchers at 34 programs agreed to distribute the invitation via email to their faculty, residents, and fellows for a total of 1484 invitees. Twenty-eight percent (419) of orthopaedic surgeons and trainees completed the survey. The respondents were 45% (186) residents, 55% (228) faculty, and one fellow. To evaluate response biases, the respondent population was compared with that of the American Academy of Orthopaedic Surgeons census. Responses were reported as D-scores based on response times for associations. D-scores were categorized as showing strong (≥ 0.65), moderate (≥ 0.35 to < 0.65), or slight (≥ 0.15 to < 0.35) associations. For a frame of reference, orthopaedic surgeons' mean IAT scores were compared with historical scores of other self-identified healthcare providers and that of the general population. Mean D-scores were analyzed with the Kruskal-Wallis test to determine whether demographic characteristics were associated with differences in D-scores. Bonferroni correction was applied, and p values less than 0.0056 were considered statistically significant. Overall, the mean IAT D-scores of orthopaedic surgeons indicated a slight preference for White people (0.29 ± 0.4) and a slight association of men with career (0.24 ± 0.3), with a normal distribution. Hence, most respondents' scores indicated slight preferences, but strong preferences for White race were noted in 27% (112 of 419) of respondents. There was a strong association of women with family and home and an association of men with work or career in 14% (60 of 419). These preferences generally did not correlate with the demographic, geographic, and program variables that were analyzed, except for a stronger association of women with family and home among women respondents. There were no differences in race IAT D-scores between orthopaedic surgeons and other healthcare providers and the general population. Gender-career IAT D-scores associating women with family and home were slightly lower among orthopaedic surgeons (0.24 ± 0.3) than among the general population (0.32 ± 0.4; p < 0.001) and other healthcare professionals (0.34 ± 0.4; p < 0.001). All of these values are in the slight preference range. Orthopaedic surgeons demonstrated slight preferences for White people, and there was a tendency to associate women with career and family on IATs, regardless of demographic and program characteristics, similar to others in healthcare and the general population. Given the similarity of scores with those in other, more diverse areas of medicine, unconscious biases alone do not explain the relative lack of diversity in orthopaedic surgery. Implicit biases only explain a small portion of the lack of progress in improving diversity, equity, inclusion, and belonging in our workforce and resolving healthcare disparities. Other causes including explicit biases, an unwelcoming culture, and perceptions of our specialty should be examined. Remedies including engagement of students and mentorship throughout training and early career should be sought.

Educating residents in spine surgery: A study of Entrustable professional activities in neurosurgery and orthopedic surgery.

Surgery for spinal disorders represents some of the commonest surgical procedures performed in many countries worldwide, carried out by neurosurgeons and orthopedic surgeons. Residency training is shifting to competency-based medical education, which requires setting standards for graduating residents and their assessments. However, gaps exist in the literature regarding the parameters used for assessment and the mastery levels expected of graduating residents in the performance of common spinal procedures as defined in Entrustable Professional Activities (EPAs). The objectives of the study were to describe the assessment parameters used for residents, identify the standard of performance expected of graduating residents of EPAs of spinal procedures, and identify factors predicting the expected standard of competent performance of graduating residents. The survey was sent to neurosurgery and orthopedic surgery Faculty requesting their recommendations on parameters of assessment and the expected standard competence performance for EPAs related to spinal procedures using our entrustment scale (A-E). Based on total responses, the recommended number of assessments and assessors for each EPA was 5 and 2, respectively. Regarding each specialty, there was no significant difference in the recommended number of assessments for each EPA. However, neurosurgery Faculty recommended higher number of assessors(n = 3) than orthopedic surgery Faculty(n = 2) for both posterior spinal decompression EPA(PSD) (p = 0.01) and spinal instrumentation EPA(SI) (p = 0.04). Based on total responses, 83% felt PSD was appropriate to the general practice, 86.8% considered it not too broad, and 62.3% expected entrustment level E as a graduation target. The proportions of these ratings were slightly lower for SI at 58.5%, 71.7% and 56.6%, respectively. Both specialties indicated that the EPAs were not too broad. In contrast, neurosurgery Faculty were more likely to consider these EPAs appropriate for general practice than orthopedic surgery Faculty for both PSD (94.7% vs 53.3%, p = 0.0003) and SI (68.4% vs 33.3%, p = 0.02). Moreover, neurosurgery Faculty had a higher expected standard of performance as a graduation target for both PSD (Level E 76.3% vs 26.7%, p = 0.001) and SI (Level E 65.8% vs 33.3%, p = 0.03) than orthopedic surgery Faculty. Expectations of entrustment level E for PSD was associated with the belief that the current EPA was appropriate for the general practice of their specialty with an odds ratio of 8.35 (p = 0.01, 95%CI 1.53-45.67). A difference exists in parameters of assessment and expected standard competence performance of spine procedures among spinal surgery specialties. In our opinion, there should be efforts to develop consensus between specialties for the sake of uniform delivery of high-quality care for patients regardless of the specialty of their surgeon. Our results will be particularly valuable to certification bodies in the assessment of spinal milestones. This study has important implications for the design of residency and fellowship education in spinal surgery internationally.

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

The Effect of Underrepresented Minority Mentorship on Orthopaedic Spine Surgery Recruitment and Diversity: A 20-Year Analysis at a Single Institution.

Despite national efforts to increase diversity and inclusion, underrepresented minority (URM) representation among orthopaedic spine surgery faculty remains low. Research has shown that URM trainees are more likely to pursue surgical careers when they have access to URM mentors. The purpose of this study was to explore the influence of URM representation among spine faculty on the rate of URM orthopaedic residents pursuing spine surgery fellowships. From 2004 to 2023, data were collected from each residency class at our academic institution: residency year, number of residents per class (total and URM), and number of residents applying to spine surgery fellowships. These ethnicities were considered URM: Black or African American, Hispanic or Latino, and Native American. In 2018, two African American spine faculty were hired. Data were compared between Before and After their arrival. A subanalysis was done to include a period of increasing URM recruitment (2012 to 2018). Binary logistic regression analysis evaluated associations between appointment of URM faculty and fellowship choice of URM residents. Two hundred fifty-six residents were included. Thirty-one total URM residents were in the program during the study period (12.1%). Overall, URM representation in the program increased over time [OR: 1.1, 95% CI: 1.1 to 1.2], whereas residents applying to spine surgery fellowships did not change [OR: 1.0, 95% CI: 1.0 to 1.1]. Comparing Before-2012 and 2012 to 2018 groups with the After-2018 group demonstrated a significant difference in the proportion of URM residents applying to spine surgery fellowships after the hiring of URM spine faculty (0.0% versus 23.1% versus 74.1%; P = 0.001). This retrospective study provides empirical evidence of the importance of URM representation among orthopaedic spine surgery faculty and the potential effect on URMs pursuing orthopaedic fellowships. Institutions should consider prioritizing the representation of URM faculty in spine surgery to address the lack of current and future diversity in the field. III.

The Majority of Orthopaedic Surgery Residency Faculty in the United States are Allopathic Males

Introduction There is a paucity of information regarding the demographic characteristics of faculty at Accreditation Council for Graduate Medical Education (ACGME) orthopaedic surgery residency programs. The purpose of this study was to determine the demographics and education training of all current orthopaedic surgery residency program faculty members. We hypothesized that there would be a sex discrepancy among orthopaedic surgery faculty, and that there would be fewer DO (Doctor of Osteopathic Medicine) than MD (Medical Doctor) orthopaedic surgeons in academic medicine. Methods The Fellowship and Residency Electronic Interactive Database was used to identify all orthopaedic surgery residency programs in the United States. The following information was collected from each program website: faculty sex, degree, academic role, administrative title, and subspecialty. Faculty roles, titles, and subspecialties were compared across type of institution, degree earned, and sex using Chi squared and Analysis of Variance (ANOVA). Results Of the 4,325 faculty members identified, 3,893 were male (90%) and 4,033 were MDs (93%). The most common subspecialty was sports medicine (789, 18%). While traditional ACGME programs still had more MD faculty (3,728, 97.5%) (p&lt;0.001), the majority of faculty at traditional American Osteopathic Association (AOA) programs were also MDs (305, 61%). There were more male DOs than male MDs (95.6% vs. 89.3%, p&lt;0.001). More DOs practiced general orthopaedics (14.8% vs. 4.1%), whereas more MDs practiced upper extremity and orthopaedic oncology (p&lt;0.001). More male faculty practiced adult reconstruction (616, 15.8%), trauma (489, 12.6%), spine (471, 12.1%), and sports medicine (719, 18.5%), whereas more female faculty practiced pediatrics (135, 31.3%), upper extremity (100, 23.1%), and oncology (33, 7.6%). More male faculty held titles as chair of orthopaedic surgery (145, 3.7%) and fellowship director (111, 2.9%) than females (5, 1.2% and 5, 1.2%). Males were also listed as assistant professor (1057, 27.2% vs 188, 43.5%), associate professor (636, 16.3% vs 86, 19.9%), and professor (618, 15.9% vs 41, 9.5%) more commonly than females. Conclusion The current faculty of orthopaedic surgery residency programs is heavily male dominated, holding higher academic roles and administrative titles than women. There is also a high prevalence of MDs with higher academic roles and administrative titles than DOs.

Evaluation of the National Institutes of Health–supported relative citation ratio among American orthopedic spine surgery faculty: A new bibliometric measure of scientific influence

BackgroundPublication metrics have been traditionally used to compare research productivity amongst academic faculty. However, traditional bibliometrics lack field-normalization and are often biased towards time-dependent publication factors. The National Institutes of Health (NIH) has developed a new, field-normalized, article-level metric, known as the “relative citation ratio” (RCR), that can be used to make accurate self, departmental, and cross-specialty comparisons of research productivity. This study evaluates the use of the RCR amongst academic orthopedic spine surgery faculty and analyzes physician factors associated with RCR values. MethodsA retrospective data analysis was performed using the iCite database for all fellowship trained orthopedic spine surgery (OSS) faculty associated with Accreditation Council for Graduate Medical Education (ACGME)-accredited orthopedic surgery residency program. Mean RCR, weighted RCR, and total publication count were compared by sex, career duration, academic rank, and presence of additional degrees. A value of 1.0 is the NIH-funded field-normalized standard. Student t-tests were used for two-group analyses whereas the analysis of variance tests (ANOVA) was used for between-group comparisons of three or more subgroups. Statistical significance was achieved at P < 0.05. ResultsA total of 502 academic OSS faculty members from 159 institutions were included in the analysis. Overall, OSS faculty were highly productive, with a median RCR of 1.62 (IQR 1.38-2.32) and a median weighted RCR of 68.98 (IQR 21.06-212.70). Advancing academic rank was associated with weighted RCR, career longevity was associated with mean RCR score, and male sex was associated with having increased mean and weighted RCR scores. All subgroups analyzed had an RCR value above 1.0. ConclusionsAcademic orthopedic spine surgery faculty produce impactful research as evidenced by the high median RCR relative to the standard value set by the NIH of 1.0. Our data can be used to evaluate research productivity in the orthopedic spine community.

H-Index Predicts Academic Rank Among Full-time Academic Orthopaedic Trauma Surgeons Affiliated with Fellowship Programs

Objectives: The purpose was to investigate the association between Hirsch index (H-index) and academic rank among orthopaedic trauma surgeons affiliated with Orthopaedic Trauma Association (OTA) and Accreditation Council for Graduate Medical Education (ACGME) fellowship programs with academic appointments. Additional variables investigated included total number of publications and training program affiliation. Design: Database review. Participants: Orthopaedic trauma surgery faculty members at OTA and ACGME orthopaedic trauma surgery fellowship. Main outcome measurement: H-index, total number of publications, academic rank, and fellowship training pedigree. Results: The H-indices of 273 orthopaedic traumatologists from 57 fellowship programs were organized and calculated. There are strong correlations among total number of publications, citations, and H-index. Overall, there is a strong association with number of publications, number of citations, and H-index with higher academic rank. Overall, H-index was a stronger predictor of academic rank than total number of publications and citations. Appointment to the same program as an individual’s fellowship training program and orthopaedic subspeciality fellowship outside of traumatology were not associated with academic rank. Level of Evidence: IV, case series Key words: trauma, fellowship, academic rank, H-index

The Effect of Salary Compensation for Time Spent Teaching in an Orthopaedic Residency Program: An Analysis of Teaching Performance Reviews.

Although there has been a recent emphasis on standardized resident assessments within Accrediation Council for Graduate Medical Education programs, assessments of faculty teaching performance and effectiveness are less frequent. Our purpose was to compare the teaching performance of orthopaedic surgery faculty receiving compensation for time spent teaching with faculty without compensation. For this prospective investigation, we collected anonymous resident reviews of 23 orthopaedic faculty within a rural, academic orthopaedic residency program over 2 academic years. Performance reviews of the faculty used a validated assessment of clinical teaching effectiveness with nine domains (faculty knowledge, organization, enthusiasm, rapport, involvement in learning experiences, feedback, clinical skill, accessibility, and overall effectiveness). A composite teaching effectiveness score was determined by adding each of the scores from the individual domains. We compared reviews for faculty members with and without compensation for time spent teaching. A total of 202 performance reviews for 23 orthopaedic faculty were analyzed. Most of the faculty were male (91%), and 61% received compensation for teaching. No demographic differences were observed between the two faculty groups. Notable differences between the groups were noted in three domains: enthusiasm, ability to establish rapport as well as direction, and feedback. Faculty compensated for teaching demonstrated a markedly higher composite teaching effectiveness score than those without compensation. These data suggest that orthopaedic faculty compensated for teaching responsibilities provide a better educational experience for resident trainees compared with faculty without compensation for teaching. Future studies should aim to assess varying compensation models for teaching responsibilities across different departments.

Leadership in Orthopaedic Surgery: A Survey of the Value of Leadership Development for Orthopaedic Surgery Faculty.

Introduction:The purpose of this study was to survey current orthopaedic department chairs at ACGME-accredited orthopaedic surgery programs in the United States to determine whether department chairs valued the importance of formal leadership training and, if so, to understand the leadership development opportunities available along with the benefits of these program for their orthopaedic faculty.Methods:An anonymous online, voluntary, self-administered questionnaire containing 27 questions was distributed to current orthopaedic department chairs at ACGME-accredited orthopaedic surgery programs in the United States.Results:Thirty-eight responses were received for a response rate of 27.1%. Twenty-three of 38 (60.5%) department chairs believed leadership training is very important for their orthopaedic faculty. Thirty-six of 38 (94.7%) department chairs did not believe that all their current faculty have strong leadership skills. Twenty-eight of 38 (73.6%) respondents have specific training programs for leadership development at their institution.Discussion:Most department chairs (92.1%) viewed leadership training for their orthopaedic faculty as either important or very important. Seventy-four percent of orthopaedic surgery department chairs surveyed indicated that they had a leadership development program in place, with 59.1% being developed within the past 10 years. Benefits of these programs included improved listening and communication skills and management of staff.

Publication Productivity Among Academic Orthopaedic Surgeons in Canada

ObjectiveThe Hirsch Index (h-index) and m-index are often utilized to assess academic productivity and have been widely found to have a positive association with academic promotion and grant selection. The aim of this study was to assess the relationship between these indices and academic ranks among Canadian orthopaedic surgery faculty members.MethodsFive hundred and sixty-seven Canadian orthopaedic surgery faculty members associated with residency training programs were included in the study. H-indices of individual faculty members were obtained through Elsevier’s Scopus database. Faculty members’ year of residency graduation was recorded from their respective licensing body database and was utilized as a surrogate for the start of their academic career to determine career duration and calculate the m-index. Faculty members were divided based on their academic rank (assistant, associate and full professors) and subspecialty.ResultsIncreased h-index, m-index and long career duration were associated with increased academic rank, while gender did not demonstrate an association. Overall, males had a significantly higher h-index compared to females, but no significant difference was observed when comparing the m-index between genders. The m-index varied between subspecialties among senior faculty, but not among junior-ranked faculty.ConclusionBibliometric academic productivity using h-index and m-index is associated with academic ranking among Canadian orthopaedic surgeons at training institutions. Although these indices may provide insight into the academic merits of faculty members, caution must be taken about utilizing it indiscriminately and their limitations must be strongly considered.

Lack of Additional Advanced Graduate Training by Orthopaedic Surgeons in Academic Practice: Current Employment and Recruitment Trends.

Background:Orthopaedic surgery is ever changing and depends on diverse technical and intellectual skill sets. The purpose of the current study was to evaluate the percentage of academic orthopaedic surgeons with additional graduate degrees in the United States.Methods:Data including advanced degree(s) (eg, PhD, MS, MBA, MPH, JD, and DVM), academic rank, leadership position, subspecialty, years since training completion, and sex were collected from websites for all academic orthopaedic surgery departments in the United States. Univariate analyses were performed to evaluate for differences in demographic data based on the advanced degree status. Data from the National Resident Matching Program (NRMP) were used to characterize graduate degree-holding US senior medical students who ranked orthopaedic surgery first relative to peers without additional advanced degrees and to applicants who ranked other specialties first.Results:Of 4,519 faculty at 175 academic orthopaedic surgery departments in the United States, 7.1% held a graduate degree in addition to a medical doctorate. There was no difference in the percentage of faculty who held departmental leadership positions (P = 0.62) or who were full professors (P = 0.66) based on holding an additional graduate degree. Of 678 US senior applicants who ranked orthopaedic surgery first and successfully matched into the specialty in 2018, 12.5% held an additional graduate degree and 1.3% were MD-PhDs. Orthopaedic surgery had the second lowest percentage of matched medical students with additional advanced degrees, which was significantly lower than the top 10 specialties (range 16.1% to 21.6%; P < 0.05). Orthopaedic surgery recruited 1.6% of all MD-PhD applicants in 2018.Discussion:Few academic orthopaedic surgery faculty and admitted orthopaedic residency candidates have additional graduate school training. The low percentage of orthopaedic faculty and trainees with additional advanced degrees relative to other specialties may represent a missed opportunity to recruit individuals with diverse skills to advance the field of orthopaedic surgery.

Orthopaedic Surgery Faculty: An Evaluation of Gender and Racial Diversity Compared with Other Specialties.

Background:The American Academy of Orthopaedic Surgeons has adopted the strategic goal of evolving its culture and governance to become more strategic, innovative, and diverse. Given the charge to increase diversity, a focus on assessing and increasing diversity at the faculty level may help this cause. However, an analysis of gender and racial diversity among orthopaedic faculty has not been performed. The purpose of this study was to evaluate faculty appointments for underrepresented minority (URM) and female orthopaedic surgeons. We also aim to draw comparisons between orthopaedic surgery and other specialties.Methods:Data on gender, race, and faculty rank (clinical instructor, assistant professor, associate professor, and professor) of academic faculty for 18 specialties from 1997 to 2017 were obtained from the Association of American Medical Colleges (AAMC) Faculty Roster. Assistant professors were designated as junior faculty, whereas associate professor and professor were considered senior faculty. URMs were defined using the AAMC definition—groups having lower representation than in the general population. Regression analysis was used to evaluate and compare the change over time and to compare the change across different specialties.Results:Over the 20-year study period, the number of female faculty increased (8.8% pts) but represents a lower proportion than other specialties (13.9% pts) (p = 0.029). Female orthopaedic senior faculty grew slower (7.3% pts) than other specialties (14.7% pts) (p < 0.001). There was no difference in the growth of URM faculty positions (2.0% pts) compared with all other specialties (2.4% pts) (p = 0.165). The proportion of orthopaedic URM senior faculty increased less (0.5% pts) than other specialties (2.5% pts) (p < 0.001), whereas more orthopaedic URM junior faculty were added than other specialties (2.2% pts) (p = 0.012).Conclusions:Although orthopaedic surgery has increased the representation of female and URM faculty members, it continues to lag behind other specialties. In addition, fewer female and URM orthopaedic faculty members obtained senior faculty status than other specialties. To address the differences seen in faculty diversity, a concerted effort should be made to recruit and promote more diverse faculty, given similar qualifications and capabilities.Level of Evidence:Prognostic Level IV.

Indications and associated outcomes for platelet-rich plasma injections performed in an academic orthopaedic-specific hospital: A patient satisfaction survey

Background: Platelet-rich plasma (PRP) is an autologous biologic product that has become widely used in orthopaedic centers and at so-called “regenerative medicine” or “pain” clinics. Although food Drug Administration (FDA)-approved indications for use of PRP in orthopaedics are for applications in which it is mixed with autograft or allograft bone, attention and clinical research have focused on its off-label uses for treatment of osteoarthritis, musculotendinous disorders, or joint pain. The present study aimed to document indications for PRP used by orthopaedic surgery faculty in an academic orthopaedic-specific hospital between 2011 and 2016, characterize demographics of patients receiving these injections, and assess associated 1-year or greater outcomes for these patients. Methods: With institutional review board approval, this study retrospectively identified 148 patients with osteoarthritis, augmentation surgical treatments, tendon or ligament pathology, and sacroiliac joint pain as indications for PRP treatment. Results: For respondents (n=60), 78.3% (47 of 60) reported PRP-related improvement in symptoms, with mean duration of effect of 800 days and an overall level of satisfaction with their PRP treatment of 67.9% (range, 1-100%). Factors that negatively influenced successful outcomes in the present study included patient age older than 45 yr and use of leukocyte-rich PRP, while degree of improvement and return to full activity positively influenced patient satisfaction with PRP treatment. Conclusions: The results of the present study suggest that PRP can be used to treat a variety of musculoskeletal conditions commonly diagnosed at an academic orthopaedic-specific hospital, with expectations for 78% of patients reporting improvement and an overall patient satisfaction level of 68%. Level of Evidence: Level IV.

The Influence of Mentors in Orthopedic Surgery.

The importance of mentorship in medicine has been established. However, little is known regarding the influence of mentors in orthopedic surgery. This study sought to (1) determine the prevalence of mentoring relationships in orthopedic surgery, (2) assess the influence of mentors in specialty and subspecialty selection, and (3) evaluate the importance of gender in orthopedic mentoring relationships. An electronic survey was distributed to 358 orthopedic surgeons at academic residency programs. Participants were asked to report mentoring relationships and their attitudes toward mentors, including gender preferences. A total of 117 (95 males and 22 females) surveys were returned. The majority of respondents (66.7%, n=78) had at least one mentor in their career, and the majority of respondents (66.7%, n=52) were satisfied with their mentoring experience. Residency was the most common time to have a mentor, and 73.3% (n=44) of respondents indicated their mentor was influential in determining their subspecialty. Although only 50% of respondents indicated they had a mentor in medical school, 84.2% (n=32) believed their mentor was influential in selecting an orthopedic surgery residency. The majority (79.4%, n=62) of respondents did not have a preference on the gender of their mentor. Many orthopedic surgeons have a mentor at some point in their career who influenced their specialty or subspecialty decision. Mentoring experiences are less prevalent in medical school, and female medical students may lack accessibility to mentoring opportunities. Future efforts should focus on opportunities that connect medical students to orthopedic surgery faculty to further diversify the field and close the gender gap. [Orthopedics. 2020; 43(1):e37-e42.].

Physician Burnout and Associated Factors: Orthopaedics vs Anesthesia

Background: Physician burnout has garnered increased attention in recent studies. It is attributed to the intrinsic stresses of medical practice and affects the quality of patient care. Previous studies have reported roughly half of orthopedic surgery and anesthesiology faculty and residents suffer symptoms of burnout.&#x0D; Objective: The purpose of this study is to determine if there is a significant difference in burnout rates among orthopedic surgeons and anesthesiologists, between faculty and residents in both specialties, and possible associated factors that may predispose participants to experience burnout. &#x0D; Methods: Data was gathered using the Maslach Burnout inventory survey (42 questions), which was distributed during the spring/summer of 2017 to orthopaedic surgery and anesthesiology residents and attending physicians, anesthesiology residents, orthopedic surgery faculty, and orthopedic surgery residents from various programs in the northeastern United States.&#x0D; Results: Survey Response rate was 238/666 = 38% response. As compared to attendings, residents scored: worse on Emotional Exhaustion; worse on Depersonalization and worse on Personal Accomplishment. When comparing specialties; for Emotional Exhaustion, Orthopaedic surgery scored better as compared with Anesthesiology. On Personal Accomplishment, Orthopaedic surgery scored better as compared with Anesthesiology. Residents had higher levels of burnout compared to attendings. Regarding specialty, Orthopaedic surgery scored significantly lower with regard to Emotional Exhaustion and Personal Accomplishment. It was also discovered that Orthopaedic surgeons overall have more social events, and more residents have mentors.&#x0D; Conclusion: Residents consistently demonstrated higher levels of burnout than attendings in both anesthesiology and orthopaedic surgery. Having a mentor and more interdepartmental social events may protect against burnout.

Intraoperative Point of View Video Capture and Surgical Segmentation in Carpal Tunnel Release: A Feasibility Analysis

The purpose of this study was to (1) examine the feasibility of intraoperative point of view video while performing open and endoscopic carpal tunnel release (CTR), (2) define surgical segments of CTR, and (3) describe the duration of various surgical steps of open versus endoscopic CTR in a teaching setting. Fellowship trained hand surgeons reached consensus on surgical segments for CTR. Adult patients 18 and older previously indicated for CTR in clinic were eligible. Head-mounted point-of-view cameras were worn during endoscopic and open CTR by resident surgeons. Video was reviewed to determine segment duration. Independent sample t tests were used for comparison of duration by technique with statistical significance set as p < 0.05. University of Iowa Hospitals and Clinics; 200 Hawkins Dr, Iowa City, IA 52242; Tertiary Academic Medical Center. Orthopedic Surgery Residents and Orthopedic Surgery Faculty. Surgical segments were defined as incision, dissection of superficial soft tissue structures, transection of the carpal ligament, and surgical incision closure. Twelve of 14 video capture events yielded data. In the teaching setting, the average duration of endoscopic CTR was 609.5 seconds (±111.07) versus 547.75 seconds (±82.06) for open with p value = 0.406. No surgical segments were significantly different. Transition time from dissection to ligament transection differed significantly (p = 0.004) between endoscopic (46.88 seconds ± 19.19) and open (9.0 seconds ± 7.90) CTR. Transition time between ligament transection and closure was significantly different (p = 0.029) among endoscopic (50.5 seconds ± 15.0) and open (26.25 seconds ± 2.99) CTR. Point-of-view video capture is feasible for the capture of video during a common hand surgery procedure. A method for managing device battery power is necessary for future applications. CTR can be defined as, and described in, individual procedure segments potentially useful for surgical education as well as efficiency improvements. Identification of surgical segments may aid the development of better objective tools for the assessment of surgeon skill and competency for common orthopedic procedures.