Mentorship in Orthopedics: A National Survey of Orthopedic Surgery Residents

The experiences of culturally and linguistically diverse health practitioners in dominant culture practice: a scoping review

Increasing the proportion of culturally and linguistically diverse (CALD) health practitioners is identified as one strategy to address healthcare disparities that individuals from minority or under-represented backgrounds experience. However, professional and institutional cultures and structures are known to contribute to the challenges for CALD practitioners who work in dominant culture practice contexts. This scoping review used the theory of Legitimate Peripheral Participation to describe and interpret literature about the experiences of CALD health practitioners in view of informing strategies to increase their representation. A systematised search was conducted across four allied health, medicine and nursing databases. Following abstract and full text screening, articles which fit the inclusion criteria (n = 124) proceeded to data extraction. Categories relating to the experiences of practitioners were extracted, and three themes were identified that were subsequently theoretically interpreted: Discrimination, Consequences and Hierarchy. Discrimination functioned as a barrier to CALD practitioners being legitimised and able to participate equally in healthcare practice, retaining their position at the periphery of the practice community; Consequences reinforced this peripheral position and further impeded legitimation and participation; and Hierarchy was maintained through structures that reinforced and reproduced these barriers. The findings summarise how these barriers are reinforced through the intersections of professional and racial hierarchies, and highlight a need for strategies to address discrimination and structures that marginalise CALD practitioners' identity, practices and participation in their health professional communities.

Disparities in Mentorship and Implications for US Surgical Resident Education and Wellness

Importance

Many surgeons cite mentorship as a critical component of training. However, little evidence exists regarding factors associated with mentorship and the influence of mentorship on trainee education or wellness.

Objectives

To evaluate factors associated with surgical trainees' perceptions of meaningful mentorship, assess associations of mentorship with resident education and wellness, and evaluate programmatic variation in mentorship.

Design, Setting, and Participants

A voluntary, anonymous survey was administered to clinically active residents in all accredited US general surgery residency programs following the 2019 American Board of Surgery In-Service Training Examination. Data were analyzed from July 2019 to July 2022.

Exposure

Residents were asked, "Do you have a mentor who genuinely cares about you and your career?"

Main Outcomes and Measures

Resident characteristics associated with report of meaningful mentorship were evaluated with multivariable logistic regression. Associations of mentorship with education (clinical and operative autonomy) and wellness (career satisfaction, burnout, thoughts of attrition, suicidality) were examined using cluster-adjusted multivariable logistic regression controlling for resident and program factors. Residents' race and ethnicity were self-identified using US census categories (American Indian or Alaska Native, Asian, Black or African American, Native Hawaiian or Other Pacific Islander, and White), which were combined and dichotomized as non-Hispanic White vs non-White or Hispanic.

Results

A total of 6956 residents from 301 programs completed the survey (85.6% response rate); 6373 responded to all relevant questions (2572 [40.3%] female; 2539 [39.8%] non-White or Hispanic). Of these, 4256 (66.8%) reported meaningful mentorship. Non-White or Hispanic residents were less likely than non-Hispanic White residents to report meaningful mentorship (odds ratio [OR], 0.81, 95% CI, 0.71-0.91). Senior residents (postgraduate year 4/5) were more likely to report meaningful mentorship than interns (OR, 3.06; 95% CI, 2.59-3.62). Residents with meaningful mentorship were more likely to endorse operative autonomy (OR, 3.87; 95% CI, 3.35-4.46) and less likely to report burnout (OR, 0.52; 95% CI, 0.46-0.58), thoughts of attrition (OR, 0.42; 95% CI, 0.36-0.50), and suicidality (OR, 0.47; 95% CI, 0.37-0.60) compared with residents without meaningful mentorship.

Conclusions and Relevance

One-third of trainees reported lack of meaningful mentorship, particularly non-White or Hispanic trainees. Although education and wellness are multifactorial issues, mentorship was associated with improvement; thus, efforts to facilitate mentorship are needed, especially for minoritized residents.

A systematic review of the prevalence of burnout in orthopaedic surgeons

INTRODUCTION

Professional burnout is a syndrome of emotional exhaustion, depersonalisation and low sense of personal achievement related to the workplace. Orthopaedic surgeons train and practise in highly demanding environments. Understanding up-to-date trends in burnout, particularly following the COVID-19 pandemic, is vital. For this reason, we carried out a systematic review on this topic.

METHODS

A scoping literature review of two databases was conducted. Two authors independently screened articles and conflicts were resolved by panel discussion. Articles pertaining to orthopaedic surgeons that used validated scales and were peer reviewed research were included. Non-English or abstract-only results were excluded.

RESULTS

A total of 664 papers were identified in the literature search and 34 were included in the qualitative review. Among 8,471 orthopaedic surgeons, the mean burnout prevalence was 48.9%. The wide range in rate of burnout between the studies (15-90.4%) reflected the variety in setting, subspecialty and surgeon grade. Common protective factors comprised dedicated mentorship, surgeon seniority, sufficient exercise and family support. Substance abuse, malpractice claims, financial stress and onerous on-call responsibilities were risk factors. Burnout prevalence during the COVID-19 pandemic was not noticeably different; there were a number of pandemic-associated risk and protective factors.

CONCLUSIONS

Nearly one in two orthopaedic surgeons are burnt out. There is a paucity of data on the short and long-term impact of COVID-19 on burnout. Burnout has deep organisational, personal and clinical implications. Targeted organisational interventions are required to prevent burnout from irrevocably damaging the future of orthopaedic surgery.

The Mentee Perspective: Evaluating Mentorship of Medical Students in the Field of Orthopaedic Surgery

INTRODUCTION

Mentorship is an invaluable facet of medical education. The purpose of this study was to analyze medical student perspectives of mentorship they received and the influence this has on their participation in the field of orthopaedic surgery.

METHODS

We conducted a cross-sectional study of medical students interested in pursuing orthopaedic surgery through an 18-question survey distributed through social media and e-mail.

RESULTS

Two hundred fifteen students completed this survey, with over 50% of students reporting that they have a mentor in orthopaedic surgery while 34% were actively seeking one. Most students found mentors through research opportunities (25%) and cold e-mails (20%). Common hurdles to mentorship were access (38%) and finding common time (30%). Peer mentorship had a higher mean satisfaction score in all domains, except facilitating matching, and there was a significant difference between groups (e.g., peer mentor versus program director; P < 0.001). Sex, race, and degree type were not significantly related to students' access to or their evaluation of mentors (P > 0.05 for all).

CONCLUSION

Overall, this study demonstrates that medical students across the nation rely on mentorship to guide them on their path to becoming an orthopaedic surgeon.

AOA Critical Issues Symposium: Leadership and Education During and After COVID-19: Back to the Future or a New Normal

ABSTRACT

The devastating impact of COVID-19 has reshaped how we lead and train our future surgeons in the field of orthopaedics. Overnight, leaders in our field had to dramatically shift their mindset to continue to lead a hospital, department, journal, or residency or fellowship program in the face of an unprecedented level of adversity in the history of the United States. This symposium discusses the role of physician leadership during and after a pandemic, as well as the adoption of technology for training surgeons in the field of orthopaedics.

Medical Student Mentorship in the COVID-19 Era

Background

The Covid-19 pandemic led to a reduction of in-person, guided mentorship due to social distancing and an emphasis on virtual meetings. The effect of these changes on medical students' experiences and specialty choice has yet to be studied in a large-scale manner.

Objective

To determine the perspective of third- and fourth-year medical students regarding the impact of the COVID-19 pandemic on mentorship.

Design

The authors distributed a modified Likert scale questionnaire (score: 1-10) to assess responses.

Participants

Third- and fourth-year medical students at two large US allopathic medical schools.

Main Measures

Responses to each survey item were analyzed to characterize the impact of the COVID-19 pandemic on mentorship relationships in medical school. A score of 1-5 was considered "disagree" and a score of 6-10 was considered "agree."

Key Results

A total of 144 responses were collected with a response rate of 16.2%. Overall, 80.6% (n = 116) of respondents agree that the COVID-19 pandemic has had a negative impact on their medical school experience. Nearly half (41.0%, n = 59) expressed concern over the lack of mentorship opportunities, and 66.0% (n = 95) reported that the pandemic has made it more difficult to form or maintain connections with their mentors. Importantly, 43.6% (n = 61) of respondents reported that having close mentoring relationships reduced the impact of the pandemic on their medical training. While many respondents (79.9%, n = 114) did not change career plans due to the pandemic, most students are concerned about evaluating prospective residency programs (88.9%, n = 128). Notably, M3s have much lower confidence than M4s in their ability to choose a specialty (5.9 vs. 8.2, p = 6.43e - 08).

Conclusions

This investigation illustrates the concerns that medical students have regarding access to mentorship opportunities due to the COVID-19 pandemic. We hope that these findings encourage medical schools to evaluate and expand their current mentorship programs.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40670-023-01838-4.

The Changing Environment in Postgraduate Education in Orthopedic Surgery and Neurosurgery and Its Impact on Technology-Driven Targeted Interventional and Surgical Pain Management: Perspectives from Europe, Latin America, Asia, and The United States

Personalized care models are dominating modern medicine. These models are rooted in teaching future physicians the skill set to keep up with innovation. In orthopedic surgery and neurosurgery, education is increasingly influenced by augmented reality, simulation, navigation, robotics, and in some cases, artificial intelligence. The postpandemic learning environment has also changed, emphasizing online learning and skill- and competency-based teaching models incorporating clinical and bench-top research. Attempts to improve work-life balance and minimize physician burnout have led to work-hour restrictions in postgraduate training programs. These restrictions have made it particularly challenging for orthopedic and neurosurgery residents to acquire the knowledge and skill set to meet the requirements for certification. The fast-paced flow of information and the rapid implementation of innovation require higher efficiencies in the modern postgraduate training environment. However, what is taught typically lags several years behind. Examples include minimally invasive tissue-sparing techniques through tubular small-bladed retractor systems, robotic and navigation, endoscopic, patient-specific implants made possible by advances in imaging technology and 3D printing, and regenerative strategies. Currently, the traditional roles of mentee and mentor are being redefined. The future orthopedic surgeons and neurosurgeons involved in personalized surgical pain management will need to be versed in several disciplines ranging from bioengineering, basic research, computer, social and health sciences, clinical study, trial design, public health policy development, and economic accountability. Solutions to the fast-paced innovation cycle in orthopedic surgery and neurosurgery include adaptive learning skills to seize opportunities for innovation with execution and implementation by facilitating translational research and clinical program development across traditional boundaries between clinical and nonclinical specialties. Preparing the future generation of surgeons to have the aptitude to keep up with the rapid technological advances is challenging for postgraduate residency programs and accreditation agencies. However, implementing clinical protocol change when the entrepreneur-investigator surgeon substantiates it with high-grade clinical evidence is at the heart of personalized surgical pain management.

How to Be a Mentee: Getting the Most of Your Mentorship

Mentorship is a key part of the development of knowledge and skills in orthopedics. Mentorship at each of these different phases is important to preparing and enabling a competent, knowledgeable, and well-rounded surgeon. Although the mentor is generally the one in a senior position, experienced in their field, the mentee is the protégé or the trainee engaged in a relationship with the person with expertise. There should be mutual responsibility on both sides to develop a collaborative relationship in order to optimize value in the relationship for both parties.

What Program Characteristics Are Associated with Resident Racial Diversity in Orthopaedic Surgery? An Analysis of Association of American Medical Colleges Data

In orthopaedic surgery, there are fewer Black or African American (4%) and Hispanic or Latino (4%) residents compared with general surgery, internal medicine, family medicine, and pediatrics (5%-7% Black residents and 7%-9% Hispanic/Latino residents, respectively). There are also fewer underrepresented in medicine minority (URiM) faculty in orthopaedic surgery (6.1%) compared with general surgery (8.9%), otolaryngology (7.8%), internal medicine (9.7%), and obstetrics and gynecology (15.6%). Identifying program characteristics that are associated with the percentage of URiM residents could reveal strategies for improving diversity.

Methods

Using Association of American Medical Colleges orthopaedic resident and faculty race/ethnicity data from 2007 to 2016, we analyzed the racial diversity of 166 of 207 residency programs. The primary outcome was program racial diversity, measured as the percentage of URiM residents per program. The top quartile of programs was compared with the other quartiles. Characteristics analyzed included percentage of URiM faculty, affiliation with a university/top 40 medical school/top 40 orthopaedic hospital, geographic region, city type, and city size. We used a multivariable linear regression model to evaluate program characteristics associated with diversity and a linear mixed-effects model with program-specific random effects to evaluate time trends.

Results

The mean percentage of URiM residents per program was 9.3% (SD = 10.5%). In the top quartile of programs, URiM residents composed 20.7% ± 2.5% of the program compared with 5.8% ± 0.3% in other quartiles (p < 0.001). After adjusting for program and faculty size, the only factor associated with the number of URiM residents per program was the number of URiM faculty. For every 5 additional URiM faculty members, there was an associated increase in the number of URiM residents per program by 3.6 (95% confidence interval [CI]: 2.3-5.0). There was a small but statistically significant annual increase in the percentage of URiM residents per program of 0.207 (95% CI: 0.112-0.302) percentage points during the study period.

Conclusion

URiM representation remains low among orthopaedic residents. Efforts to increase the URiM faculty base represent a potential strategy for programs to increase URiM representation among residents by attracting more diverse applicants.

Resident Burnout and Well-being in Otolaryngology and Other Surgical Specialties: Strategies for Change

OBJECTIVE

To perform a literature review on burnout prevalence, factors that affect burnout and well-being, and solutions to address burnout in otolaryngology-head and neck surgery (OTO-HNS) residents and residents in other surgical specialties.

DATA SOURCES

Ovid Medline, Embase, and article reference lists.

REVIEW METHODS

A literature search was performed to identify articles on resident burnout, distress, wellness, well-being, and quality of life. Articles deemed outside the scope of the current work were excluded. Search was limited to the past 5 years.

CONCLUSIONS

Moderate to high burnout has been reported in 35% to 86% of OTO-HNS residents. Among other surgical specialties, resident burnout ranges between 58% and 66% in plastics, 11% and 67% in neurosurgery, 38% and 68% in urology, and 31% and 56% in orthopedics. Highest burnout rates were seen in postgraduate year 2 residents. Factors significantly associated with burnout included hours worked (>80 h/wk), level of autonomy, exercise, and program support. Reported resident work hours have steadily increased: 8% of OTO-HNS residents in 2005 vs 26% in 2019 reported averaging >80 h/wk. Practical implications of resident burnout include decreased empathy, moral distress and injury, poor health, decreased quality of life, increased attrition, decreased desire to pursue fellowship, and increased likelihood of medical errors. Structured mentorship programs, wellness initiatives, and increased ancillary support have been associated with lower burnout rates and improvements in resident well-being across specialties.

IMPLICATIONS FOR PRACTICE

Addressing burnout, which is prevalent in OTO-HNS residents, is critical to improving patient care and physician well-being. Surgical specialties can share strategies to effectively address resident burnout through institutional interventions, which can be essential quality improvement initiatives, to promote well-being.

Influence of COVID-19 on Tertiary Orthopaedic Centres

Coronavirus disease 2019 (COVID-19) is a highly contagious lethal infection that has successfully spread all across the world. The novel coronavirus that is behind the menace and spread of COVID-19, is the next in the lineage of the Coronaviridae family of viruses, which had previously given two deadly viruses with limited geographical extent. After sustaining for more than two years, the virus is still active and keeps on mutating to evade human immunity. The impact of COVID-19 is felt not only by patients of COVID-19 who go through the trauma but also by non-COVID-19 patients due to the non-pharmacological interventions (NPIs) enforced. Patients in the orthopedic departments suffered a huge blow as their rehabilitation practices were stalled due to a lack of health professionals and also restrictions imposed. But to soften the blow, usage of telemedicine was done in some instances so that the essential therapies can continue despite the movement restrictions imposed. COVID-19 has disrupted many aspects of human life including clinical practices and this endeavor is to review those aspects and provide conclusions if any. The aim of the study is to review the available resources regarding Indoor orthopedic practice during the COVID-19 pandemic and draw a conclusion that can help further research on the aforementioned topic.

Coaching, Separate from Mentoring, May Provide Skill Acquisition, Improved Well-Being, and Career Advancement in Orthopaedic Surgery: AOA Critical Issues

Coaching is separate from mentoring, and can include life coaching, skills coaching, and behavior coaching. Life coaching can focus on purpose, work-life balance, well-being, and career path. Skills coaching encourages mastery and promotes autonomy. Behavior coaching may be mandated for a disruptive surgeon. Coaching has been shown to reduce burnout and promote well-being and can potentially advance a surgeon's career trajectory and leadership skills.

The impact of mentoring in trauma and orthopaedic training: a systematic review

INTRODUCTION

Trauma and orthopaedics is renowned for being a challenging yet rewarding career. The value of mentorship in medical and surgical training is known to be beneficial; however, the prevalence and quality of mentorship opportunities in orthopaedics are less well studied. Identifying the strengths and weaknesses of mentoring programmes in orthopaedic training and recognising barriers to effective mentorship are key to unlocking the full potential of future orthopaedic surgeons.

METHODS

A comprehensive search of PubMed, Medline, EMBASE and the Cochrane Library was performed. All studies published in the English language that reported data on mentorship programmes in orthopaedic training were included.

FINDINGS

A total of 23 studies met the inclusion criteria. These studies demonstrated that formal mentorship programmes in orthopaedics are lacking but are sought after, with a positive influence on satisfaction and future career choice/subspecialty selection identified. Several barriers to mentoring in the field were recognised including the difficulty faced by female trainees, the availability of mentors and time constraints. The opportunity to choose a mentor, a mentor with the same interests, regular meetings and the option of gender congruent mentorship were all identified as crucial requirements for effective mentorship.

CONCLUSION

Mentorship opportunities must be more accessible to all orthopaedic trainees alike and should aim to incorporate the attributes identified to provide the highest calibre of training to prospective orthopaedic surgeons.

Mentorship Interest in Breast Imaging: Survey Results From the Society of Breast Imaging

OBJECTIVE

This study assessed mentorship interest within the breast radiologist community to guide development of a mentorship program through the Society of Breast Imaging (SBI).

METHODS

A 19-question survey developed by the SBI mentorship committee was distributed electronically to its members March 16, 2021, to May 7, 2021, to gauge interest in forming a society-sponsored mentorship program. Responses were analyzed, with subgroups compared using chi-square analysis.

RESULTS

There was an 18% response rate (598/3277), and 65% (381/588) professed interest in an SBI-sponsored mentorship. Respondents were evenly distributed between academic (241/586, 41%) and private practice (242/586, 41%). Most were breast imaging fellowship-trained (355/593, 60%) and identified as female (420/596, 70%). For practice years, 50% (293/586) were late career (11+ years) with the remainder early-mid career (201/586, 34%) or trainees (92/586, 16%). For mentorship content areas, work/life balance was the most popular choice (275/395, 70%) followed by leadership (234/395, 59%). Most respondents were not currently mentors (279/377, 74%) or mentees (284/337, 84%). Those interested in a mentorship relationship were statistically younger (<45 years old, 234/381, 61% vs 31/207, 15%, P < 0.00001), female (289/381, 76% vs 123/207, 59%, P = 0.00003), academics (189/381, 50% vs 48/207, 23%, P < 0.00001), identified as a racial/ethnic minority (138/381, 64% vs 121/297, 15%, P < 0.00001), and fellowship-trained (262/381, 69% vs 88/207, 43%, P < 0.00001).

CONCLUSION

There is demand, especially among the society's young and minority members, for an SBI-sponsored mentorship program. Work/life balance and leadership were the most popular choices for guidance.

MedFTs' Role in the Recruitment and Retention of a Diverse Physician Population: A Conceptual Model

Recruitment and retention of a diverse physician population across stages of medical education is essential for the success of the healthcare system. MedFTs have a unique role to play in advocacy and intervention related to the recruitment and retention of these physicians at all stages of their education and career. As MedFTs expand their influence in healthcare systems, they must ground into their fundamental theories, like systems theory and the Four World View, all while advancing in their professional competencies to attune their skills and those whom they are entrusted in training. The conceptual model, MedFTs’ Role in the Recruitment and Retention of a Diverse Physician Population, provides a framework for MedFTs to use their influence to enact change related to diversity and equity in the healthcare system. In addition, the model provides avenues for intervention and advocacy on the part of the MedFT related to each of the four worlds and their specific role(s) in the health care.

A Review of Mentorship in Urology: Are We Satisfied?

PURPOSE OF REVIEW

To evaluate the state of mentorship in the field of urology.

RECENT FINDINGS

Mentorship has been shown to decrease burnout, increase recruitment of underrepresented minority groups, and have a positive influence on the career trajectory of mentees. Approximately half of surgical residency programs have mentorship programs. The current literature supports the idea that formal mentorship programs are successful based on level 1 satisfaction scores. However, studies are sparse and of low quality. Mentorship program success is rarely objectively measured. Structured mentorship programs appear to be beneficial, but require serious planning, evaluation, and ongoing support without which the programs can fail. Future research should be focused on objective and measurable metrics of success.

Use of an Individualized Development Plan to Identify Career Development Needs in Prospective Orthopaedic Sports Medicine Fellows

Background

Mentorship is a key aspect of leadership development for orthopaedic surgeons, but there are few formalized mentorship programs in medical training. The individualized development plan (IDP) is a tool that potentially improves mentorship opportunities through identifying specific competency deficiencies and facilitating communication with mentors.

Purpose

To assess the views of prospective orthopaedic surgery sports medicine fellows on the skills necessary for career development and the utility of an IDP for longitudinal career mentorship during a sports medicine fellowship.

Study Design

Cross-sectional study.

Methods

Candidates who interviewed for an orthopaedic surgery sports medicine fellowship voluntarily completed an anonymous IDP as well as a survey to assess their perceptions of the IDP tool to define their career goals and its use for longitudinal mentorship. The IDP included quantitative and qualitative responses for the self-assessment of multiple skill domains (general research, teaching, professional, interpersonal, leadership, and management) using a 5-point Likert scale (1 = needs improvement, 5 = highly proficient). Quantitative results were analyzed using analysis of variance and Student t test.

Results

A total of 25 candidates completed the IDP and survey. The mean ± standard deviation composite score of all skill domains was 3.62 ± 0.91. The candidates' greatest deficit was in grant writing (2.28 ± 0.94; P < .01), while their greatest strength was getting along with others (4.52 ± 0.65; P < .01). Candidates identified, as short-term goals, obtaining a fellowship training position, completion of research/academic projects, and improvement of surgical skills; their common long-term goals included having a role in an academic institution, professional society, and/or research and innovation environment. The majority of participants agreed that the IDP is a valuable tool to characterize career and personal goals (74%) and facilitate longitudinal fellowship mentorship (83.3%).

Conclusion

The majority of candidates valued the IDP for their short- and long-term goals. Program implementation of an IDP could be beneficial in allowing trainees to effectively identify areas of weakness and strengths while facilitating efficient communication of these needs to mentors.

Current Resident and Faculty Mentorship Satisfaction and Important Mentee Functions in Orthopedic Surgery: An American Orthopedic Association North American Traveling Fellowship Project

OBJECTIVE

While mentorship remains important in orthopedic training, few studies have delineated specific priorities for creating successful mentorship programs and reciprocal satisfaction among contemporary trainees and faculty. The purpose of this study was to define beneficial mentor qualities along with specific mentee characteristics to facilitate improved mentoring relationships in orthopedic surgery.

DESIGN

This is a cross-sectional study with a 16 multi-item self-reported survey.

SETTING

This study was conducted at 11 tertiary orthopedic surgery training programs during the 2017 American Orthopaedic Association (AOA) North American Traveling Fellowship Tour.

PARTICIPANTS

Eighty orthopedic resident trainees and 90 academic faculty members completed the survey.

RESULTS

Around 55.0% of residents and 48.9% of faculty acknowledged a formal mentorship program at their institution. Furthermore, 61.3% of residents and 61.1% of faculty reported having a current mentor. The top 3 qualities valued by residents were a mentor who modeled work-life balance, remained in touch with contemporary issues in training, and provided timely counseling. Faculty valued a mentor who accepted their goals and priorities, provided counseling, and enhanced exposure in their subspecialty. Surveyed faculty were more satisfied than their corresponding residents with how their mentor promoted them, enhanced their exposure, was a friend, and protected them from exploitative collaborations. Mentee participation was considered the most important variable for a successful mentor relationship, while mentee acknowledgement of their mentors was the least prioritized quality.

CONCLUSIONS

Faculty had a higher overall satisfaction with their mentoring relationships in orthopedic surgery. Residents reported more favorable results when their mentor was a role model of work-life balance. For optimal success, mentors identified active participation and openness to feedback as the most important quality for a mentee to display. These qualities contribute to a heightened sense of satisfaction among mentors and mentees and can be utilized to further guide development of both formal and informal programs for residents and faculty.

Delirium Reduction by Analgesia Management in Hip Fracture surgery (DRAM-HF): Exploration of perceived facilitators and barriers

OBJECTIVES

In tandem with the implementation of a multidisciplinary protocol which was successful in reducing delirium after hip fracture surgery (DRAM-HF), we sought to investigate enablers and barriers to same.

METHODS

Single-centre, prospective, before-and-after questionnaire targeted at health-care professionals involved in DRAM-HF. We assessed respondent-reported enablers and barriers to the multidisciplinary protocol, using 0-100 agreement scales and free-text responses.

RESULTS

A total of 134 preintervention and 124 postintervention responses were collated (out of 200, response rates 67% and 62%, respectively). Preintervention support for DRAM-HF was 100% (n = 130) and postintervention 95.9% (n = 116). Study design was well received with a mean score of 76.7 (SD 19.7) for being easy to understand. Support for additional computer alert systems was also high (mean 73.6, SD 23.9). Free-text responses emphasised the need for integration of ward pharmacists into medication optimisation (n = 31) and upskilling nurse practitioners (n = 23).

CONCLUSION

Whilst generally supported, DRAM-HF implementation may be streamlined by optimising electronic delivery, offering targeted education and expanding roles.

Medical Student Mentorship in Orthopaedic Surgery

Mentorship is a key aspect of medical education, but the availability and quality of mentorship varies considerably between institutions. The lack of standardization results in information asymmetry and creates notable inequities. This disparity is particularly important for students interested in pursuing competitive specialties, such as orthopaedic surgery. The purpose of this study was to (1) demonstrate the importance of mentorship in orthopaedics, (2) provide a framework for orthopaedic surgeon mentors, and (3) guide medical students interested in activating and expanding their networks.

Online Information and Mentorship: Perspectives From Orthopaedic Surgery Residency Applicants

INTRODUCTION

Applying to orthopaedic surgery residency is competitive. Online information and mentorship are important tools applicants use to learn about programs and navigate the process. We aimed to identify which resources applicants use and their perspectives on those resources.

METHODS

We surveyed all applicants at a single residency program for the 2018 to 2019 application cycle (n = 610) regarding the importance of online resources and mentors during the application process. We defined mentorship as advice from faculty advisors or counselors, orthopaedic residents, medical school alumni, or other medical students. We also assessed their attitudes about the quality and availability of these resources. Applicants were asked to rank resources and complete Likert scales (1 to 5) to indicate the relative utility and quality of options. Descriptive statistics were used to summarize data for comparisons.

RESULTS

The response rate was 42% (259 of 610 applicants). Almost 50% of applicants reported that they would have likely applied to fewer programs if they had better information. Applicants used program websites with the highest cumulative frequency (96%), followed by advice from medical school faculty/counselors and advice from orthopaedic residents at home institution (both 82%). The next two most popular online resources were a circulating Google Document (78%) and the Doximity Residency Navigator (73%). On average, the quality of online resources was felt to be poorer than mentorship with advice from orthopaedic residents receiving the highest quality rating (4.16) and being ranked most frequently as a top three resource (122 votes). Mentorship comprised three of the top five highest mean quality ratings and three of the top five cumulative rankings by usefulness.

CONCLUSION

Applicants reference online resources frequently, despite valuing mentorship more. If the orthopaedic community fostered better mentorship for applicants, they may not feel compelled to rely on subpar online information. Both online information and mentorship can be improved to create a more effective application experience.

Parenthood Among Orthopedic Surgery Residents: Assessment of Resident and Program Director Perceptions on Training

Orthopedic residency training overlaps with common childbearing ages. The purpose of this study was to describe factors affecting male and female residents' family-planning decisions and attitudes of program directors (PDs) toward parenthood during residency. In 2018, using an anonymous survey model, residents and PDs in Accreditation Council for Graduate Medical Education-accredited orthopedic surgery programs were asked about their perceptions of parenthood on training, the availability of family-oriented services at their programs, and the effect of residency culture and policies on their decision to have children. This survey occurred in 2018. Three hundred forty-nine (76.2%) of 458 resident respondents were male and 109 (23.8%) were female. Two hundred four (49.9%) of 409 residents were unsure of their program's parental leave policy. Male residents reported taking an average of 0.8 weeks (95% CI, 0.0-4.0 weeks) of parental leave and females an average of 4.6 weeks (95% CI, 2.0-6.5 weeks) (P<.001). Female residents were more likely to report delaying having children during residency (56.73% vs 38.71%, P=.001) and were more likely to cite reputational concerns (57.63% vs 0.76%, P<.001) and effects on career opportunities (42.37% vs 7.57%, P<.001) as reasons for delaying parenthood. The most commonly cited negative effect of parenthood on residency training by PDs was reduction in off-duty educational time (15 of 29, 51.72%). Twenty-four (80%) of 30 PDs believe that training may need to be extended based on amount of maternity/paternity leave time taken off. Although parenthood during orthopedic training is common, both male and female residents reported delaying parenthood because of residency-related factors. Improved clarification of leave policies and establishment of clear guidelines for parenthood in residency may improve resident wellness. [Orthopedics. 2021;44(2):98-104.].

Residents' Perceptions of Faculty Behaviors and Resident Burnout: a Cross-Sectional Survey Study Across a Large Health Care Organization

BACKGROUND

Data suggests the learning environment factors influence resident well-being. The authors conducted an assessment of how residents' perceptions of faculty-resident relationships, faculty professional behaviors, and afforded autonomy related to resident burnout.

METHODS

All residents at one organization were surveyed in 2019 using two items from the Maslach Burnout Inventory and the faculty relationship subscale of the Johns Hopkins Learning Environment Scale (JHLES, range 6 to 30). Residents were also asked about faculty professional behaviors (range 0 to 30), and satisfaction with autonomy across various clinical settings.

RESULTS

A total of 762/1146 (66.5%) residents responded to the survey. After adjusting for age, gender, postgraduate year, and specialty, lower (less favorable) JHLES-faculty relationship subscale score (parameter estimate, - 3.08, 95% CI - 3.75, - 2.41, p < 0.0001), fewer observed faculty professional behaviors (parameter estimate, - 3.34, 95% CI - 4.02, - 2.67, p < 0.0001), and lower odds of satisfaction with autonomy in the intensive care settings (OR 0.46, 95% CI 0.30, 0.70, p = 0.001), but not other care settings, were reported by residents with burnout in comparison to those without. Similar relationships were observed when emotional exhaustion and depersonalization were analyzed separately as continuous variables.

CONCLUSION

In this cohort, resident perceptions of faculty relationships, faculty professional behaviors, and satisfaction with autonomy in the intensive care unit were associated with resident burnout. Additional longitudinal studies are needed to elucidate the direction of these relationships and determine if faculty development can reduce resident burnout.

The Use of Personality Assessment in Mentoring and to Aid in Self-reflection in Orthopaedic Surgery Residency Programs

Personality plays an important role in performance in medical education and mentorship. Personality assessment can aid in the ability to identify strengths and areas for development by understanding how one's personality influences their learning and interpersonal relationships. We sought to evaluate personality assessment as an effective tool in mentoring during orthopaedic residency in this prospective, cross-sectional study from two orthopaedic surgery residency programs using the Hogan Personality Inventory (HPI). Participants completed a survey regarding their experience with the assessment. Descriptive statistics were calculated, and two-sample t-tests were used to examine differences between groups. In total, thirty-four individuals completed the survey. Our results showed 82.4% reported that the HPI very accurately represented them and 58.8% reported better understanding potentially perceived strengths and weaknesses. In total, 75.7% and 72.7% were satisfied with their mentorship about development as a clinician and researcher, respectively. Significant differences were seen between participants who did and did not re-review their results, and participants who did and did-not believe their results profile was accurate. We conclude that personality assessments can be valuable in promoting introspection and strengthening relationships within orthopaedic surgery, particularly when they are valued and emphasized by the user. Our results suggest that use of the HPI provided participants with a better understanding of their perceived strengths and weaknesses as they progress through their orthopaedic residency training.

Mentorship Effectiveness in Cardiothoracic Surgical Training

BACKGROUND

Mentoring is an essential component of cardiothoracic surgery training, yet trainees report varied experiences despite substantial efforts to enhance mentorship opportunities. This study aimed to evaluate mentorship effectiveness and identify gaps in mentorship education.

METHODS

A survey was distributed to cardiothoracic surgical trainees in Accreditation Council for Graduate Medical Education-accredited programs (n = 531). Responses to 16 questions concerning trainee experiences, expectations, and perspectives on mentorship were collected. An 11-component mentorship effectiveness tool generated a composite score (0 to 55), with a score of 44 or lower indicating less effective mentorship.

RESULTS

Sixty-seven residents completed the survey (12.6%), with most (83.6%) reporting a current mentor. Trainees with mentors cited "easy to work with and approachable" (44 of 58; 75.9%) as the major criterion for mentor selection, whereas trainees without a mentor reported an inability to identify one who truly reflected the resident's needs (6 of 11; 45.5%). Resident age, gender, race or ethnicity, marital status, family status, postgraduate year, and training program type or size were not associated with having a mentor (P = .15 to .73). The median mentorship effectiveness score was 51 (interquartile range, 44, 55). More than one-third of residents (25 of 67) had either no mentor (n = 6) or less effective mentorship (n = 16), or both (n = 3). Resident and program characteristics were not associated with mentorship effectiveness (P = .39 to .99). Finally, 61.2% of residents had not received education on effective mentorship, and 53.8% did not currently serve as a mentor.

CONCLUSIONS

Many resident respondents have either no mentor or less effective mentorship, and most reported not having received education on mentorship. Addressing these gaps in mentorship training and delivery should be prioritized.

Implementation of a Longitudinal Mentorship Program for Quality of Life, Mental Health, and Motivation of Brazilian Medical Students

OBJECTIVES

Mentoring has been used as a strategy for mental health prevention and the promotion of quality of life in medical students, with mixed results. The aim of this study was to compare the levels of mental health, quality of life, and academic motivation of medical students after implementation of a longitudinal curricular mentoring program relative to those students without mentoring in their curricula.

METHOD

The results of the mentoring program were assessed by comparing two classes of 2nd-year students of a school of medicine (one that had received mentoring since admission and another which had no exposure to the method during the course). Self-report questionnaires were used to collect data on sociodemographics, quality of life (WHOQOL-BREF), mental health (DASS-21), and academic motivation (Academic Motivation Scale-AMS).

RESULTS

A total of 95 medical students were included: 55 received the mentoring program and 40 did not receive the program. The Multivariate GLM regression model revealed no significant main effect of mentoring on domains of the WHOQOL-BREF (Wilks's Lambda = 0.938, F = 1.427, p < 0.232); the DASS-21 (Wilks's Lambda = 0.051, p < 0.985); or the AMS (Wilks's Lambda = 0.957, F = 0.628, p < 0.708). Likewise, the Univariate GLM regression showed no significant main effect of mentoring on medical students' perceived health (F = 0.585; d.f. = 1; p = 0.446).

CONCLUSION

Mentoring promoted no significant changes in the students of this Brazilian institution. These results highlight the challenges faced in structuring, maintaining, and assessing an effective mentoring program for students on medicine courses.

Orthopaedic Resident Burnout: A Literature Review on Vulnerability, Risk Factors, Consequences and Management Strategies

Introduction: Orthopaedic surgery is physically demanding. Surgeons may have to work long unpredictable hours especially during residency training. This arduous task comes with the risk of burnout leading to negative repercussions to the surgeon and the patient. In view of strategising peer support, we intend to review the literature and analyse whether orthopaedic resident burnout is a global issue. We also intend to derive common strategies to tackle burnout at individual and organisational levels. Materials and Methods: A literature search was carried out in the databases including PubMed, Scopus, SciELO, and Google Scholar to shortlist studies dealing with orthopaedic residency and related burnout. Those studies that used the Maslach Burnout Inventory (MBI) for quantifying burnout were collectively interpreted. Other studies were reviewed to analyse the vulnerability, risk factors, consequences and management strategies related to burnout. Results: Among a total of 72 titles shortlisted, eight studies independently reported burnout among orthopaedic surgery residents/trainees and used MBI as a tool for assessing burnout. Based on the three subscales of MBI, 37.2% had high degree of emotional exhaustion (EE), 48% had high degree of depersonalisation (DP) and 33.1% perceived low personal accomplishment. This signifies the high prevalence of burnout among orthopaedic residents/trainees. Conclusion: Burnout among orthopaedic surgery residents seems to be a universal problem. Risk factors could be multifactorial, influenced by clinical competency and work-home environment. This can be tackled at the individual level by being aware of burnout syndrome, involving in adequate physical activity and spending quality social time; and at the organisational level by duty hour limitation, professional appreciation and mentorship programme.

A Systematic Scoping Review of Ethical Issues in Mentoring in Surgery

BACKGROUND

Mentoring is crucial to the growth and development of mentors, mentees, and host organisations. Yet, the process of mentoring in surgery is poorly understood and increasingly mired in ethical concerns that compromise the quality of mentorship and prevent mentors, mentees, and host organisations from maximising its full potential. A systematic scoping review was undertaken to map the ethical issues in surgical mentoring to enhance understanding, assessment, and guidance on ethical conduct.

METHODS

Arksey and O'Malley's methodological framework was used to guide a systematic scoping review involving articles published between January 1, 2000 and December 31, 2018 in PubMed, Embase, Scopus, ERIC, ScienceDirect, Mednar, and OpenGrey databases. Braun and Clarke's thematic analysis approach was adopted to compare ethical issues in surgical mentoring across different settings, mentee and mentor populations, and host organisations.

RESULTS

A total of 3849 abstracts were identified, 464 full-text articles were retrieved, and 50 articles were included. The 3 themes concerned ethical lapses at the levels of mentor or mentee, mentoring relationships, and host organisation.

CONCLUSIONS

Mentoring abuse in surgery involves lapses in conduct, understanding of roles and responsibilities, poor alignment of expectations, and a lack of clear standards of practice. It is only with better structuring of mentoring processes and effective support of host organisation tasked with providing timely, longitudinal, and holistic assessment and oversight will surgical mentoring overcome prevailing ethical concerns surrounding it.

Oral and Maxillofacial Surgery Program Websites Under-Report Content Related to Resident Recruitment and Education

PURPOSE

Prospective applicants use residency program websites (PWs) to evaluate programs when deciding where to apply, interview, and rank. The purpose of this study was to evaluate the content of oral and maxillofacial surgery (OMS) PWs.

MATERIALS AND METHODS

This is a cross-sectional study of all OMS programs accredited by the Commission on Dental Accreditation. PWs were identified through the American Association of Oral and Maxillofacial Surgeons Program Directory (AAOMS-PD) and a secondary internet search. The predictor variables were program characteristics (federal service, medical school curriculum, program size, and viability of AAOMS-PD link). The outcome variables were 22 content items related to resident recruitment and resident education and 4 content items related to medical school commitment. Content was recorded as present or absent without judgment on the quality or accuracy. Descriptive statistics were calculated for all outcome variables, and Student t tests were used to compare program characteristics with the amount of content reported.

RESULTS

Ninety-six of 101 programs had dedicated PWs. On average, programs included 39% (range, 0 to 77%) of the recruitment and education items assessed. Most programs did not address crucial aspects of training, such as faculty research interests (22%), resident selection criteria (22%), alumni rosters (19%), surgical case load (13%), and dedicated scholarly time (8.8%). Less than half the 6-year programs discussed a tuition responsibility (44%) or tuition assistance (21%). Four-year programs provided significantly less recruitment content (P < .01) and 4-year (P < .01) and federal (P < .01) programs reported significantly less resident education content.

CONCLUSIONS

As a whole, OMS PWs are under-reporting content related to resident recruitment and resident education. Program directors should update their PWs to provide adequate information for prospective applicants.