Orthopaedic Sports Medicine Fellowship Directors Are Predominantly White Men With a High Degree of Research Productivity

Focus areas and methodological characteristics of North American-based health disparity research in sports medicine: a scoping review

OBJECTIVE

Health disparities are widely prevalent; however, little has been done to examine and address their causes and effects in sports and exercise medicine (SEM). We aimed to summarise the focus areas and methodology used for existing North American health disparity research in SEM and to identify gaps in the evidence base.

DESIGN

Scoping review.

DATA SOURCES

Systematic literature search of PubMed, Scopus, SPORTDiscus, CINAHL Plus with Full Text, Web of Science Core Collection and Cochrane Central Register of Controlled Trials.

ELIGIBILITY CRITERIA

Full-text, peer-reviewed manuscripts of primary research, conducted in North America; published in the year 2000 or after, in English; and focusing on organised sports were included.

RESULTS

103 articles met inclusion criteria. Articles were classified into five focus areas: access to and participation in sports (n=45), access to SEM care (n=28), health-related outcomes in SEM (n=24), provider representation in SEM (n=5) and methodology (n=1). Race/ethnicity (n=39), socioeconomic status (n=28) and sex (n=27) were the most studied potential causes of health disparities, whereas sexual orientation (n=5), location (rural/urban/suburban, n=5), education level (n=5), body composition (n=5), gender identity (n=4) and language (n=2) were the least studied. Most articles (n=74) were cross-sectional, conducted on youth (n=55) and originated in the USA (n=90).

CONCLUSION

Health disparity research relevant to SEM in North America is limited. The overall volume and breadth of research required to identify patterns in a heterogeneous sports landscape, which can then be used to inform positive change, need expansion. Intentional research focused on assessing the intersectionality, causes and consequences of health disparities in SEM is necessary.

Most Faculty Members at the Top Orthopaedic Sports Medicine Fellowship Programs Trained at Many of the Same Programs

Purpose

To determine the proportion of faculty members at the top orthopaedic sports medicine fellowship programs who completed a fellowship at one of these programs themselves, how many remained at their fellowship training programs as an attending (institutional loyalty), where they most commonly completed residency and medical school, and to characterize their research productivity.

Methods

The fellowship programs of current orthopaedic sports medicine fellowship faculty members at each of the top 10 orthopaedic sports medicine fellowship programs (based on a recent study) were determined by searching program websites or contacting program coordinators. For each program, we determined the proportion of faculty members who completed fellowship at one of these top 10 programs and the proportion who remained at their fellowship program as an attending. Residency and medical school information was found for faculty members on their professional websites. To determine research output, each faculty member's name was searched within the Scopus database and the number of publications was recorded.

Results

Data were obtained from each of the top 10 sports medicine fellowship programs. Fifty-eight of 82 (70.7%) fellowship faculty members completed fellowship at a top 10 program. Regarding institutional loyalty, 36 of 82 (43.9%) fellowship faculty members remained at the program where they trained, with one program led entirely by alumni. The average number of publications per faculty member was 130.6, with a range among the 10 programs of 23-355.8.

Conclusions

Most orthopaedic sports medicine fellowship faculty at the top perceived training programs completed a fellowship at one of these same programs and maintain high research productivity.

Clinical Relevance

Orthopaedic surgery trainees who wish to become faculty members at one of the top orthopaedic sports medicine training programs should aim to match into one of these top programs when applying for fellowship.

Demographics and Characteristics of Orthopaedic Surgery Residency Program Directors

To date, there has been a paucity of research evaluating the demographics, characteristics, and surgical training of orthopaedic residency program directors (PDs).

Gender disparities in shoulder and elbow publications

HYPOTHESIS/BACKGROUND

Female representation in orthopedics, and specifically shoulder and elbow surgery, lags behind other surgical subspecialities. There has been a growing interest in recent years to better characterize, and address, gender disparities in the field. The purpose of this investigation was to characterize gender trends in authorship in the shoulder and elbow literature from 2002 to 2020.

METHODS

Articles published from January 2002 to December 2020 in 15 clinical orthopedic and shoulder- and elbow-specific journals were extracted from the online PubMed database. Articles that included the first name of the first and senior authors and contained keywords related to the shoulder and elbow subspecialty were included. The Genderize algorithm was used to determine each author's gender. Gender-based publication trends from 2002 to 2020 were analyzed using descriptive and significance testing as well as logistic regression.

RESULTS

34,695 articles met inclusion criteria and 52,497 unique authors were identified. Of these unique authors, 10,175 (19.4%) were female and 42,322 (80.6%) were male. On average, each unique female author published 1.7 ± 0.1 manuscripts since 2002 and each male author published 2.5 ± 0.2 (P < .001). Female representation in shoulder and elbow publications began at 10.2% in 2002 and rose to 15.9% in 2020 (P < .001). Female representation in the lead author position began at 4.1% in 2002 and rose to 5.8% in 2020 (P = .009). Female representation in the senior author position began at 6.0% in 2002 and rose to 9.1% in 2020 (P < .001).

CONCLUSION

Although female representation in first, senior, and general authorship lags behind male representation in the shoulder and elbow literature, female authorship has significantly increased since 2002. The same men tend to publish more frequently while the number of unique female authors surpasses the annual representation of female authorship. Efforts to improve female representation in the field of orthopedic surgery should include efforts directed at improving female representation in academic literature.

Orthopaedic Shoulder and Elbow Fellowship Directors in the United States Have Substantial Research Output but Lack Diversity

Purpose

To investigate the characteristics of shoulder and elbow fellowship directors (FDs).

Methods

FDs for shoulder and elbow fellowship programs in the United States were identified. Demographic, educational, and professional background data were collected from available curricula vitarum, institutional biographies, and the Scopus database. Data collected included age, sex, race/ethnicity, training locations, graduation years, advanced degrees, current institutional information, and personal research H-index.

Results

Thirty current orthopaedic shoulder and elbow FDs were identified. The mean Scopus H-index was 25.5. The mean age of FDs was 52.1 years. In total, 29 FDs (96.7%) were male and 1 (3.3%) was female. In addition, 25 of the 30 (83.3%) were White (83.3%), 4 were Asian, and 1 (3.3%) was Hispanic. Two (6.7%) had a military affiliation. Mean time from fellowship training graduation to FD appointment was 13.5 years. Mean number of years as FD was 6.1 years, whereas the number of years tenure with an FD-affiliated institution was 13.0 years. Mean calendar years for completion of orthopaedic residency training and fellowship training were 1998 and 2000, respectively. The residencies that produced the most future FDs were Hospital of the University of Pennsylvania (n = 2) and University of Nebraska Medical Center/Creighton University Health Foundation (n = 2). The fellowship that produced the most future FDs was Columbia University (n = 6). Moderate correlation was found between age and Scopus H-index (r = 0.48; P = .04) and years as FD and Scopus H-index (r = 0.42; P = .03).

Conclusions

Women and minorities are under-represented in leadership positions in shoulder and elbow surgery. Shoulder and elbow FDs have the highest H-index of any subspecialty reported in the orthopaedic literature. Research productivity is an important qualification when considering the characteristics of shoulder and elbow FDs.

Clinical Relevance

Fellowship directors can have a profound influence on current and future orthopaedic surgeons. It is important to identify the traits that characterize current fellowship directors to have a better understanding of who we choose as leaders in our field.

Investigation of Fellowship Leadership in Orthopaedic Musculoskeletal Oncology

Introduction:

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Conclusion: