Sports Medicine Fellowship Research Articles

Comprehensive Evaluation of Primary Care Sports Medicine Fellowship Websites

Objective:To evaluate the comprehensiveness of primary care sports medicine fellowship websites and identify potential areas of improvement.Design:Cross-sectional analysis of fellowship program websites using quantitative and descriptive statistics.Setting:Internet.Participants:A total of 192 primary care sports medicine fellowship websites listed on the Electronic Residency Application Service (ERAS) website.Independent Variables:Program Specialty and Program Region.Main Outcome Measures:The presence or absence of 19 predetermined criteria on primary care sports medicine fellowship websites.Results:The average number of criteria that was included on each website was 9.8 (SD 3.5) (51.6%) of the possible 19. Programs had as few as 2 of the 19 (10.5%) criteria included on their website, and others had as many as 17 of the 19 (89.4%) criteria. Of the 192 primary care sports medicine fellowships, only 5 (2.6%) addressed at least 80% of the 19 different criteria. No primary care sports medicine fellowship website included all 19 criteria.Conclusions:Most primary care sports medicine fellowship websites do not offer comprehensive information about their programs for prospective applicants.

Surgeon Applications of Patient Preferences in Treatment Decision Making for First-Time Anterior Shoulder Dislocation.

Background:Treatment of a first-time anterior shoulder dislocation (FTASD) is sensitive to patient preferences. The operative or nonoperative management debate provides an excellent opportunity to learn how surgeons apply patient preferences in treatment decisions.Purpose:To determine how patient preferences (repeat dislocation risk, recovery difficulties, fear of surgery, treatment costs) and surgeon factors influence a surgeon’s treatment plan for FTASD.Study Design:Cross-sectional study.Methods:Eight clinical vignettes of hypothetical patients with FTASD (including age, sex, and activity level) were presented to members of the Magellan Society. A second set of matched vignettes with patient preferences and clinical variables were also presented. The vignettes represented scenarios in which evidence does not favor one treatment over another. Respondents were asked how they would manage each hypothetical case. Respondents also estimated the risk of redislocation for the nonoperative cases for comparison with the published rates. Finally, respondents completed a Likert-scale questionnaire to determine their perceptions on factors influencing their decisions.Results:A total of 103 orthopaedic surgeons completed the survey; 48% practiced in an academic hospital; 79% were in practice for 10 years or longer; and 75% had completed a sports medicine fellowship. Patient preferences were the single most important factor influencing treatment recommendation, with activity type and age also important. Just 62% of the surgeon estimates of the risk of redislocation were consistent with the published rates. The inclusion of patient preferences to clinical variables changed treatment recommendations in 62.5% of our hypothetical cases. Respondents rated patient treatment preference as the leading factor in their treatment decision making.Conclusion:Patient preferences were important when deciding the appropriate treatment for FTASD. Respondents were inconsistent when applying evidence in their decision making and estimates of recurrent instability. Decision support tools that deliver patient preferences and personalized evidence-based outcome estimates improve the quality of decision making at the point of care.

Factors Considered in Ranking Orthopaedic Trauma Fellowship Applicants: A Survey of Program Directors.

More than 90% of orthopaedic surgery graduates pursue fellowship training after residency. Previous investigations have examined factors considered important by orthopaedic sports medicine and hand surgery fellowship program directors (PDs). This study sought to identify which factors orthopaedic trauma fellowship PDs deem most important when evaluating applicants. A web-based survey was sent to all 59 orthopaedic trauma fellowship PDs. PDs were given a list of 12 factors, which they ranked in order of importance. A weighted score for each factor was calculated. PDs could also write-in additional factors they considered important when ranking applicants. The overall response rate was 83% (49/59 PDs). Forty-five percent of responding PDs listed the interview as the most important factor when ranking applicants. Other factors considered most important included letters of recommendation, personal connections to the applicant and/or letter writers, and the applicant's background in trauma. Results of the weighted score calculation again identified the interview as the most important factor when ranking applicants, followed by letters of recommendation, personal connections to the applicant/letter writers, the applicant's residency program, strength of the applicant's background in trauma, and research experience. Orthopaedic trauma fellowship PDs consider the interview, letters of recommendation, and personal connections to the applicant/letter writers to be the most important factors when ranking fellowship applicants.

Orthopaedic Surgery Sports Medicine Fellows See Substantial Increase in Hip Arthroscopy Procedural Volume With High Variability From 2011 to 2016

To analyze the trends in operative experience, specifically procedures of the shoulder, hip and knee, of fellows graduating from Accreditation Council for Graduate Medical Education orthopaedic sports medicine fellowships between 2011 and2016. The 2011-2016 Accreditation Council for Graduate Medical Education orthopaedic surgery sports medicine fellow case logs were retrieved for analysis. Trends in the mean case volume for procedures of the shoulder, hip, and knee were analyzed. Linear regression was used to identify significant changes in trends over time for each surgical case/procedure. Variation in case volume between fellows in the lowest (10th) and highest (90th) centile was assessed for first and last year of the study. The average number of total procedures per fellow minimally decreased by 3.5% from 2011 to 2016 (726 to 701 cases) (P < .001). The mean total number of hip procedures significantly increased by 155% from 24.9 to 63.5 (P= .049). There were no significant differences in the mean total number of shoulder (P= .88) and knee procedures (P= .54). Arthroscopic hip procedures had the largest increase from 2011 to 2016 (14.1 to 57.8 [+310%], P= .049). There was greater than 2-fold difference in total procedural volume between fellows in the 10th and 90th percentile for 2011 and 2016, with the greatest variation (64-fold) for arthroscopic hip procedures. In this study there was a 2.6-fold increase in hip procedures, largely driven by a 310% rise in arthroscopic hip cases. The average procedural volume per fellow minimally decreased, with no change in the mean number of shoulder and knee procedures. Understanding variability in case exposure among orthopaedic sports medicine fellowships is important for programs to ensure that fellows are appropriately exposed to all facets of sports medicine procedures.

The Learning Curve for Hip Arthroscopic Surgery: A Prospective Evaluation With 2-Year Outcomes in Patients With Femoroacetabular Impingement

Background:The use of hip arthroscopic surgery in the treatment of femoroacetabular impingement (FAI) is increasing, but it is universally known as a technically demanding procedure with a “steep” learning curve. There are limited data investigating the correlation between surgeon experience and patient-reported outcomes (PROs) as well as procedure and traction times.Purpose:To prospectively evaluate the relationship between surgeon experience and PROs after hip arthroscopic surgery for the treatment of FAI.Study Design:Cohort study; Level of evidence, 2.Methods:A total of 190 patients undergoing primary hip arthroscopic surgery for FAI were prospectively enrolled during a sports medicine fellowship–trained surgeon’s first 36 months of practice. A radiographic evaluation as well as PRO surveys including the 12-Item Short Form Health Survey (SF-12), the modified Harris Hip Score (mHHS), and the Hip disability and Osteoarthritis Outcome Score (HOOS) were administered preoperatively and at 2 years postoperatively. Logistic regression as well as analysis of variance was performed to evaluate for correlations between surgical experience and PROs, procedure time, and traction time.Results:Of the 190 patients, 168 (88%; mean age, 35.3 ± 9.6 years; mean body mass index, 25.07 ± 3.98) completed a 2-year follow-up and were included for analysis. The mean procedure time was 91.5 ± 23.9 minutes, and the mean traction time was 54.0 ± 17.7 minutes. Patients demonstrated significant improvements at 2 years after surgery for all PRO scores (mHHS, HOOS, and SF-12 physical component summary; P < .001), except the SF-12 mental component summary, which had no change (P = .43). The procedure time significantly decreased after 70 cases, while the traction time continued to decrease until 110 cases (R 2 = 0.99; P < .0001). There was no correlation between increasing case volume and 2-year PRO scores (P > .2 for mHHS, HOOS, and SF-12). There was also no difference with increasing case volume and amount of improvement from preoperative to 2-year postoperative PRO scores for the SF-12 and HOOS. Case volume did not affect the complication rate, as this cohort experienced 4 minor cases of neurapraxia.Conclusion:Surgical efficiency in hip arthroscopic surgery for the treatment of FAI was maximized after 110 cases in this cohort. However, significant PRO improvements can be achieved early in a surgeon’s practice prior to maximizing surgical efficiency.

Factors Influencing Fellowship Decision Making During Physical Medicine & Rehabilitation Residency.

Previous surveys have demonstrated an increasing trend among graduating physiatry residents who desired to pursue a subspecialty fellowship. There has been sparse information on whether residents start their training with a subspecialty interest in mind and what factors influenced them to choose a fellowship. This article describes a prospective survey in the 2019-2020 academic year in which 175 responses were collected representing 65 (78.3%) of the 83 physical medicine and rehabilitation programs with graduating residents. Nearly 3 in 4 (73.7%, 129/175) reported matching into a fellowship, and among those, 79.8% (103/129) had matched into a pain, spine, or sports medicine fellowship. At the start of residency, 62.3% (109/175) were planning to pursue a fellowship, with 54.9% (96/175) planning to focus on either pain, sports, or spine medicine. Most respondents (72.2%) did not change their initial subspecialty focus during their residency training. Forty-six percent agreed that their anticipated subspecialty influenced their choice of residency program. The results of this survey demonstrate that most graduating residents are matriculating into fellowship training with pain, spine, and/or sports medicine being among the top choices. These results underscore the importance of subspecialty interests of trainees at the start of their residency and how training may influence their subspecialty interest.

Does Surgeon Subspecialty Training Affect Outcomes in the Treatment of Displaced Supracondylar Humerus Fractures in Children?

The effect of the treating surgeon's subspecialty training on the outcomes of managing displaced supracondylar humerus fractures in the pediatric cohort remains under debate. The objective of this study was to examine patient outcomes and treatment variables for these injuries based on the surgeon subspecialty training. A retrospective study of children who had undergone primary closed reduction and percutaneous fixation for displaced supracondylar humerus fractures was done from January 2012 through May 2019. The following four groups with differing orthopaedic subspecialty training were evaluated: (1) pediatric fellowship trained (2) trauma fellowship trained, (3) sports medicine fellowship trained, and (4) all others. Outcomes examined included time to surgery, surgical time, fluoroscopy usage, postoperative follow-up protocols, radiographic measurements of alignment, and complications between surgeon groups. Two hundred thirty-one cases were included (mean age 6 ± 2 years). Pediatric fellowship-trained surgeons took patients to surgery in a more delayed fashion (>12 hours, P = 0.02). Surgical time and fluoroscopy usage were significantly shorter for pediatric fellowship-trained surgeons (P < 0.001). No statistical difference was noted in pin configuration constructs between the groups. Pediatric fellowship-trained surgeons, on average, saw patients two times postoperatively within a year with most patients being within 30 days. Complications were not statistically different between the groups. Pediatric fellowship-trained orthopaedic surgeons provide more efficient care on a more delayed basis for displaced supracondylar humerus fractures than other subspecialty-trained orthopaedic surgeons. However, if barriers exist that limit the practicality or availability of these specialists, nonpediatric fellowship-trained surgeons achieve similar and satisfactory outcomes. Level III retrospective cohort study.

Identifiable Factors Associated With Acceptance Into Sports Medicine Fellowship Programs: A Brief Report.

To identify factors associated with entry into primary care sports medicine (PCSM) fellowship programs. Primary care sports medicine fellowship directors (FDs) and fellowship faculty were surveyed regarding preferences for accepting applicants into their programs. Survey study. Primary care sports medicine FDs and fellowship faculty. Questions were designed to delineate factors [clinical experience, letters of recommendation (LOR), scholarship, service commitment, interview performance, etc] perceived to be associated with entry into PCSM fellowship (1-10 scale; 10 = highest value). Weighted mean ± SD were calculated for each question. Determination of most valued factors for entry into PCSM fellowship. Responses were provided by 242/2332 (10.4%) of the American Medical Society for Sports Medicine members, including 77 of 175 (44%) FDs. The top 3 factors for entry into PCSM fellowships for all respondents were as follows: interview performance (9.17 ± 1.13), LOR from SM fellowship faculty (8.20 ± 1.67), and high school game/event coverage (7.83 ± 1.70). Musculoskeletal ultrasound experience (4.50 ± 2.23) and residency training in pediatrics (4.58 ± 2.54), internal medicine (4.48 ± 2.44), emergency medicine (4.44 ± 2.59), and physical medicine and rehabilitation (4.40 ± 2.83) received the lowest scores. Applicants seeking entry into SM fellowships should prioritize performance during interviews, LOR from SM fellowship faculty, and team game/event coverage experiences.

An update on graft-tunnel mismatch in anterior cruciate ligament reconstruction: A survey of the experts in the field of orthopedic sports medicine demonstrates no clear consensus in management

BackgroundThe purpose of this study was to identify and report on the rate at which leaders in orthopaedic surgery are encountering GTM, their treatment methods and to identify whether these clinicians’ demographics or techniques correlate with their GTM incidence and/or treatment algorithms. MethodsA survey was sent to identify the rate at which member orthopaedic surgeons of the American Orthopaedic Society for Sports Medicine (AOSSM), the National Football League Physicians Society (NFLPS), and the Herodicus Society are encountering GTM in ACL reconstruction with BTB graft and to establish what methods are most commonly utilized. ResultsIn total, 260 orthopaedic surgeons completed the survey. Respondents most frequently reported GTM in 1–5% of cases, with GTM most often between 5 and 10 mm. For lower levels of GTM, surgeons are most frequently recessing the femoral bone plug and adding a cortical suspensory device or outside–in fixation. Higher degrees of GTM are most commonly supplemented with a screw/post on the tibia. Those with >15 years of experience were more commonly using a transtibial femoral drilling with lower tibial tunnel angulation, and lower incidences of GTM than their less experienced counterparts. ConclusionThere is tremendous variability in the incidence and management of GTM in ACL reconstruction with BTB graft with no clear consensus among experts. Differences are seen in ACL reconstruction techniques and means of correcting GTM when evaluating based on years of surgical experience and Sports Medicine Fellowship completion.

Variation in technique and postoperative management of the Latarjet procedure among orthopedic surgeons

The Latarjet procedure has become a treatment of choice for glenohumeral instability in the setting of large glenoid osseous defects (>20%) and for prior failed soft tissue repairs. However, surgical techniques and postoperative rehabilitation protocols vary among expert shoulder surgeons. The purpose of this survey study was to characterize the variation in current practice patterns amongfellowship-trained orthopedic shoulder surgeons and identify factors related to variation. A 9-question survey was created (SurveyMonkey, San Mateo, CA, USA) and distributed to orthopedic surgeons who are active members of the American Shoulder and Elbow Surgeons or American Orthopaedic Society for Sports Medicine. The survey asked questions regarding surgeon experience with the Latarjet procedure, fellowship training, open vs. arthroscopic approach, method of coracoid-to-glenoid fixation, period of sling use postoperatively, and time before clearance to return to sport. Subgroup analysis was performed to determine whether further variation was evident between surgeons who completed sports medicine vs. shoulder and elbow fellowship training. In total, 242 surgeons completed the survey. Of these, 55% indicated performing a sports medicine fellowship and 39% indicated completing a shoulder and elbow fellowship. Amongall surgeons, the classic open Latarjet procedure was the strongly preferred technique (79%), followed by the open congruent-arc (17%) and all-arthroscopic (3%) techniques. With respect to fixation, 98% used screw fixation and only 1% indicated cortical button use. With respect to the postoperative course, >85% of surgeons preferred immobilization for 3-6 weeks after the procedure and 42% of respondents stated they waited ≥6 months prior to clearing their patients to return to sport. Subgroup analysis revealed that surgeons who completed a shoulder and elbow fellowship performed the classic open technique 89% of the time compared with 63% of those who completed a sports medicine fellowship (P < .001). The results of our survey study indicate an overall strong preference for the open classic Latarjet technique as well as an overall strong preference for screw fixation of the coracoid graft to the glenoid among all surgeons. Shoulder and elbow fellowship-trained surgeons are significantly more likely to perform open surgery with a classic technique compared with sports medicine fellowship-trained surgeons. Furthermore, the significant variation in postoperative sling use and return to sport suggests that further research is needed to develop an evidence-based postoperative Latarjet rehabilitation protocol.

Pilot study: undergraduate sports & exercise medicine conferences: what role do they play?

ObjectivesSports & exercise medicine (SEM) is a specialty encompassing the management of medical problems and injuries related to physical activity through means such as exercise advice and prescription. The field...

Factors Used by Program Directors in the Orthopedic Sports Medicine Fellowship Match

Background: Obtaining an orthopedic sports medicine fellowship position is becoming more difficult, as the number of residents seeking post-graduate training continues to increase. Objective: To identify factors that orthopedic surgery sports medicine fellowship program directors deem valuable in selecting applicants. Methods: A web-based questionnaire was sent to all ACGME accredited sports medicine fellowship program directors in the United States in 2016. The questionnaire was designed to identify the most important criteria in selecting applicants for an interview, and ranking candidates to match into their program. Results: Thirty-five of ninety-one program directors responded. The criteria for offering an applicant an interview were quality of recommendation letter, technical competence, and residency program reputation. Letters of recommendation that held the highest value were from the chief of sports medicine and another sports medicine surgeon in the department. The most important features of the interview were the applicant’s ability to articulate thoughts, the maturity of the applicant, and the ability of the applicant to listen well. The attributes deemed most important in high ranking a candidate included the applicant’s commitment to hard work, quality of the interview, and quality of letters of recommendation. Conclusion: There are identifiable factors considered important by sports medicine fellowship directors when selecting candidates for an interview and ranking them in the match process. With increasing costs of the application process and competition among applicants, this information can be valuable to medical students and residents considering a career in orthopedic sports medicine.

Surgical treatment for recurrent shoulder instability: factors influencing surgeon decision making

The optimal surgical approach for recurrent anterior shoulder instability remains controversial, particularly in the face of glenoid and/or humeral bone loss. The purpose of this study was to use a contingent-behavior questionnaire (CBQ) to determine which factors drive surgeons to perform bony procedures over soft tissue procedures to address recurrent anterior shoulder instability. A CBQ survey presented each respondent with 32 clinical vignettes of recurrent shoulder instability that contained 8 patient factors. The factors included(1) age, (2) sex, (3) hand dominance, (4) number of previous dislocations, (5) activity level, (6) generalized laxity, (7) glenoid bone loss, and (8) glenoid track. The survey was distributed to fellowship-trained surgeons in shoulder/elbow or sports medicine. Respondents were asked to recommend either a soft tissue or bone-based procedure, then specifically recommend a type of procedure. Responses were analyzed using a multinomial-logit regression model that quantified the relative importance of the patient characteristics in choosing bony procedures. Seventy orthopedic surgeons completed the survey, 33 were shoulder/elbow fellowship trained and 37 were sports medicine fellowship trained; 52% were in clinical practice ≥10 years and 48% <10 years; and 95% reported that the shoulder surgery made up at least 25% of their practice. There were 53% from private practice, 33% from academic medicine, and 14% in government settings. Amount of glenoid bone loss was the single most important factor driving surgeons to perform bony procedures over soft tissue procedures, followed by the patient age (19-25 years) and the patient activity level. The number of prior dislocations and glenoid track status did not have a strong influence on respondents' decision making. Twenty-one percent glenoid bone loss was the threshold of bone loss that influenced decision toward a bony procedure. If surgeons performed 10 or more open procedures per year, they were more likely to perform a bony procedure. The factors that drove surgeons to choose bony procedures were the amount of glenoid bone loss with the threshold at 21%, patient age, and their activity demands. Surprisingly, glenoid track status and the number of previous dislocations did not strongly influence surgical treatment decisions. Ten open shoulder procedures a year seems to provide a level of comfort to recommend bony treatment for shoulder instability.

Does the position of interference screw in tibial tunnel effect anatomic orientation in single bundle anterior cruciate ligament reconstruction?

Background/objectiveThe purpose of the study was to evaluate the change in orientation of the reconstructed ACL with the change in position of the interference screw in the tibial tunnel. MethodIt was a retrospective review of Magnetic Resonance Imaging (MRI) in which 51 normal and 61 MRI of patients who had undergone ACL reconstruction at our institute were evaluated. Postoperative ACL reconstruction group MRI studies were obtained and evaluated by two sports medicine fellows independently to assess the position of interference screw, distance of the graft from the anterior cortex of tibia and inclination of the graft. The data was collected and compared with MRI data of normal ACL patients. ResultsThere were total 61 patients with ACL reconstruction. 32 patients had anterior screw placement and 29 patients had posterior screw placement in the tibial tunnel. The distance of the graft from the anterior cortex was 39.18% in ACL intact group, 50.35% in anterior screw group and 41.64% in posterior screw group. The inclination angle was 44.49⁰ in intact group, 49.69° and 42.20° in anterior and posterior screw group respectively. The difference between intact group and anterior screw group was statistically significant. ConclusionPosterior position of interference screw in tibial tunnel increases graft obliquity than anterior position and decreases its distance from the anterior tibial cortex. This increased graft obliquity and distance from the anterior tibial cortex is similar to the native ACL.

Sports Ultrasound Training During a Pandemic: Developing a "Hands-on" Skill Through Distance Learning.

ABSTRACTSports ultrasound (US) training is required in sports medicine fellowships. US is taught through a combination of self-directed learning, didactic lectures, and “in-person” training sessions. “Hands-on” formal instruction is thought to be a vital component of US skill acquisition. However, during a pandemic and social distancing practices, “in-person” ultrasound training sessions are not possible. Display of ultrasound machine image and probe positioning can be shared in real time through virtual platforms, which allows for direct instructor education and feedback. This virtual method of US teaching may be complementary to traditional US teaching methods in the future.ABSTRACT“Hands-on” teaching is an important part of sports ultrasound (US) education in sports medicine fellowships. However, physical distancing requirements during a global pandemic have resulted in cancellation and/or postponement of “in-person” educational sessions, US conferences, and clinical diagnostic and interventional US cases that enhance US training. In order for “hands-on” sports US teaching to continue during these uncertain times, the educational model must be adapted. The use of virtual meeting platforms to display US images is possible, and this not only allows for instructor demonstration, but also gives the instructor an opportunity to observe the learner scanning and provide direct feedback in real-time. Moving forward, virtual US teaching methods will likely continue to be of educational value, as they provide increased access to individualized instruction from skilled instructors and eliminate travel time and cost of conferences and instructional sessions.

Sports Medicine Fellowship Training Improves Sport-related Concussion Evaluation.

Evaluating acute sport-related concussion (SRC) differs among providers, who apply international consensus and national guidelines variably. Retrospective medical record review was completed for 889 outpatients aged 7 to 18 years, diagnosed with SRC from 2014 to 2017. Associations between board-certified sports medicine fellowship (SMF) training status and assessment of concussion-specific history and physical examination items were tested using nonparametric χ tests. Differential odds (by fellowship training status) of using history and physical examination items were assessed using multivariable logistic regression modeling. Each SRC history and physical examination items were assessed in higher proportions by SMFs, as compared with non-SMFs, statistically significant for all tested items with the exception of headache history. SMFs demonstrated higher odds of detailed neurologic examinations and clinical cognitive testing compared with non-SMFs, after adjusting for patient and physician characteristics. Physicians caring for concussed patients should seek continuing education opportunities aligning them with training provided to sports medicine fellows.

Current Practice Trends in the Surgical Management of Patellofemoral Instability: A Survey of the Pediatric Research in Sports Medicine (PRiSM)Society

Current Practice Trends in the Surgical Management of Patellofemoral Instability: A Survey of the Pediatric Research in Sports Medicine (PRiSM)Society

The Impact of COVID-19 on the Sports Medicine Fellowship Class of 2020

Background:In response to the COVID-19 pandemic, many US health systems suspended elective surgery at the recommendation of the US Surgeon General. This dramatically decreased case volumes for orthopaedic sports medicine fellows at academic institutions.Purpose:To describe how the COVID-19 pandemic has affected the education of the sports medicine fellowship class of 2020 as well as the subsequent effects on their career plans and psychological well-being.Study Design:Cross-sectional study.Methods:A 33-item survey was distributed via email to all American Orthopaedic Society for Sports Medicine (AOSSM) 2020 fellow members on April 22, 2020. Frequencies are presented as raw totals and percentages of respondents. The Fisher exact test was used to determine statistical significance between nominal variables, with significance set at P < .05.Results:Of 210 registered fellows, 101 (48.1%) responded. Before the COVID-19 outbreak, the typical case volume per week for most fellows (47.5%) was 11 to 15 cases. From the enactment of COVID-19 mitigation policies to the date of survey completion, 90.1% of fellows had performed fewer than 20 cases. A total of 32 fellows were presented with redeployment options by their fellowship program, with 10 redeployed mandatorily to other hospital departments. Fellows reported that web-based didactics (n = 100) and web-based journal clubs (n = 72) were utilized as alternative supplements in the absence of clinical education. There were 8 respondents who had either their prior contract or job offer rescinded, while 1 had a signed contract voided. As a result, 6 fellows now plan to matriculate into a previously unplanned fellowship. Also, 10 respondents’ intended practice start date was being delayed by their employer. Respondents whose postfellowship plans were affected were statistically more likely to experience doubts about readiness for practice (58.8% vs 20.3%, respectively; P = .005), anxiety about future career plans (94.4% vs 63.8%, respectively; P = .01), anxiety about their financial situation (86.7% vs 50.8%, respectively; P = .018), stress in personal relationships (58.8% vs 29.9%, respectively; P = .045), and signs or symptoms of depression (41.2% vs 11.1%, respectively; P = .007) compared with those whose plans were not affected.Conclusion:This survey illustrates that during the early stages of the COVID-19 pandemic and the subsequent suspension of elective surgery, there have been downstream effects to this group’s education, careers, board certification timeline, and potentially their social and/or emotional well-being.

Accuracy Of The Limb-lead Electrocardiogram In Identifying Conditions Associated With Sudden Cardiac Death

The best screening strategy to prevent sudden cardiac death (SCD) in athletes remains unknown. Using the electrocardiogram (ECG) as a part of a pre-participation examination remains controversial due to the cost and rate of false positives. Screening athletes can be both time intensive and costly. Our previous study demonstrated that using a limb-lead ECG is faster than using a 12-lead ECG. However, the utility and accuracy of limb-leads alone in identifying cardiac abnormalities associated with SCD have never been studied. PURPOSE: To assess agreement and diagnostic accuracy in the interpretation of limb lead v. 12-lead ECG in identifying cardiac abnormalities associated with SCD. METHODS: This study compared the interpretation accuracy of 4 physicians evaluating publicly available ECGs of the most common cardiac conditions associated with SCD in athletes. 4 Medical Sports Medicine fellows participated in the study and each interpreted a total of 100 ECGs: 50 normal ECGs (25 limb lead and 25 12-lead) and 50 abnormal ECGs (25 limb lead and 25 12-lead). The agreement between limb lead and 12-lead ECGs was assessed by Cohen’s kappa coefficient and the accuracy of identifying an abnormal ECG was compared across limb lead and 12-lead ECGs using a chi-squared test. Inter-rater and intra-rater reliability were assessed by estimating the Fleiss’s kappa coefficient. RESULTS: Preliminary data of 150 interpreted ECGs showed an accuracy of 77.8% and 82.1% in identifying abnormal from normal ECGs using 12-lead v. limb-lead, respectively (p = 0.513). Based on the readings of the physicians in this study, the sensitivity of limb-lead was 97.2% and 12-lead was 89.5%. The specificity of limb-lead was 69.1% and 12-lead was 64.7%. CONCLUSIONS: There was no significant difference in the accuracy of physicians’ interpretations of limb lead ECGs compare to standard 12-lead ECGs in identifying cardiac conditions associated with SCD.

Assessing Knowledge And Confidence In Musculoskeletal Medicine Among Primary Care Specialties

Prior studies suggest primary care clinicians lack knowledge and confidence in how to diagnose and treat musculoskeletal (MSK) disorders. One showed 64% of academic primary care attendings scored <70% on an MSK knowledge exam, while another noted that primary care residents scored an average of 56% on an MSK competency exam. Few studies examine differences among Family Medicine, Internal Medicine, and Pediatrics in knowledge and confidence in diagnosing and treating MSK conditions. PURPOSE: To determine if a significant difference exists between primary care specialties for both residents and non-fellowship trained attendings in knowledge and confidence in diagnosing MSK conditions. To assess whether a focused lecture series can increase resident knowledge and confidence in diagnosing MSK disorders. METHODS: An anonymous shoulder, hip, knee, and ankle survey was emailed to Pediatric, Internal Medicine, and Family Medicine residents and attendings at a local teaching hospital. Sports Medicine Fellows lectured Internal Medicine and Pediatrics residents, focusing on exam and common conditions for each joint. Family Medicine was excluded from the lectures, as MSK education is a part of their ACGME requirement. Pre and post lecture surveys with 5 knowledge questions and two 5-point Likert scale confidence measures were administered to Pediatric and Internal Medicine residents. Two-tailed t-tests were used with a p value set at <0.05. RESULTS: Pediatric residents showed a significant increase in shoulder knowledge scores (60% vs 72.8%, p=0.04), shoulder confidence scores (2.2 vs. 3.11; 2.13 vs. 2.94; p<0.001), and confidence in doing an appropriate knee exam post lecture (2.6 vs. 3.4, p=0.03). There was no significant difference between Family Medicine, Internal Medicine, or Pediatrics regarding general MSK knowledge and confidence. There was no significant difference for Internal Medicine between pre and post lecture scores for all joints. There was no significant difference for pre and post lecture scores on the hip and ankle for Pediatrics. CONCLUSION: Dedicated lectures related to the MSK exam and common MSK conditions can increase the knowledge and confidence among primary care residents, but further studies with a greater number of subjects are needed.