Research Activity Among Foot and Ankle Surgery Fellows: A Systematic Review

Predicting academic productivity among American Shoulder and Elbow Surgeons fellowship faculty from publications acquired before and during surgical training

BACKGROUND

Orthopedic residency and fellowship applicants with a strong research record are highly valued for their potential in continuing academic excellence. Despite this, the association between research productivity during training and future academic productivity as an attending orthopedic surgeon is not well-established. We assess the effects of research output during different periods of surgical training as well as residency location on long-term academic productivity as an attending shoulder and elbow surgeon.

METHODS

A search of the 2022-2023 American Shoulder and Elbow Surgeons Fellowship Directory was conducted to identify a list of orthopedic shoulder and elbow fellowship faculty members. Each surgeon's residency, fellowship and current institution of practice were determined and stratified by geographic location. Total publication counts acquired before residency, during residency, during fellowship, and after fellowship were collected for each faculty member. Attending publication rates and H-indices were calculated. A multivariate linear regression model was created, and significance was set at a P value <.05.

RESULTS

A total of 149 shoulder and elbow fellowship faculty members representing 34 fellowship programs were identified. The average number of total publications per surgeon was 88.8 ± 102. The average attending publication rate was 5.29 ± 6.89 publications per year. The average H-index for included surgeons was 27.8 ± 24.4. The number of publications acquired before residency (β = 0.293; P < .001), during residency (β = 0.110; P = .025) and during fellowship (β = 0.593; P < .001) were significantly associated with an increased attending publication rate, but no association was observed with the H-index [before residency (β = -0.221; P = .574), during residency (β = 0.045; P = .866), during fellowship (β = 0.198; P = .678)]. There were no significant differences in total publication count (P = .397), attending publication rate (P = .237), or H-index (P = .364) based on location of residency training.

DISCUSSION

Research output before and during surgical training is predictive of continued academic productivity as a shoulder and elbow surgeon. In particular, greater productivity during surgical fellowship was most predictive of academic output as an attending. While long-term academic productivity does not seem to be influenced by the geographic location of residency training, attending surgeons practicing in the Midwest had significantly greater total publication counts and H-indices but similar annual publication rates.

AI-Assisted Sentiment Analysis of ACFAS Fellowship-Trained Foot and Ankle Surgeon Online Reviews

Online physician ratings and reviews prove useful among patients when selecting a provider. Analyzing such reviews across medical and surgical specialties to determine their emotional tone through sentiment analysis yielded varying levels of positivity, negativity, and neutrality. To provide insight into what patients are saying, this study similarly analyzes the sentiment of physician ratings and reviews among foot and ankle surgeons. Healthgrades ratings and reviews, entered as of February 2024, were collected among the American College of Foot and Ankle Surgeons (ACFAS) fellows along with each surgeon's demographic information. ChatGPT was used to perform a sentiment analysis to describe the positivity, negativity, and neutrality of online physician reviews. Ratings and review sentiment were described among the sample and between sexes. Among 268 fellows, men received higher average rating scores than women (p = .02), From the 2339 reviews, women received a greater proportion of negative reviews compared to men (p < .001). The overall sentiment scores among men were higher than women (p < .001). There existed a very weak inverse relationship between ratings and years in practice (R = -0.16; p = .01). Fellowship-trained foot and ankle surgeons received predominantly positive reviews. When comparing sexes, males received higher ratings with higher sentiment scores. As patients place high credence in online reviews when selecting their provider, surgeons should remain mindful of and monitor or manage their online reputation.

Intellectual Property and Royalty Payments Among Foot and Ankle Surgery Fellowship Faculty

Faculty of the American College of Foot and Ankle Surgeons and American Orthopedic Foot and Ankle Society fellowship programs are uniquely positioned to provide advanced clinical and surgical training to fellows. One aspect of this training may include product design and mentorship through the associated intellectual property (IP) and patent timeline. This study describes the payments received and IP held among foot and ankle surgery fellowship faculty. A review of foot and ankle surgeons with royalties or license payments disclosed on the CMS Open Payments Database from 2014 to 2020 was conducted. Members with payments were then cross-referenced with the US Patent Full-Text Database to identify patents held. Fellowship affiliation, practice location, patent office, number of patents, citations, patent h-index, type of patent, and yearly payment values were recorded. Among the 2801 surgeons, 53 fellowship affiliates and 46 nonaffiliates maintained at least 1 patent and royalty/license payment. A total of 576 patents and 19,191 citations were assessed. The median number of patents and citations held by fellowship faculty was 3 and 60, respectively, while the median total payment value reached $165,197.09. Fixation devices comprised most of the patents and citations. Payment value positively correlated with number of patents held (p = .01), citations (p = .007), and patent h-index (p = .01) among fellowship-affiliated surgeons. Foot and ankle surgery fellowship faculty payments for IP are associated with the number and citability of patents held. While a small proportion of faculty were paid for intellectual property, the number of patents held and citations was comparable to other specialties.

Post-Fellowship Foot and Ankle Surgeon Research Productivity: A Systematic Review

Though foot and ankle surgery fellowships have been around for decades, contributing factors for long-term research productivity remain unreported. Along with enhancing surgical training, the American College of Foot and Ankle Surgeons (ACFAS) tasked programs with fostering research in effort to continue post-fellowship investigations. As the number of fellowship programs and fellows continues to increase, this study attempts to identifies factors associated with postfellowship research success. A PubMed search of peer-reviewed literature authored by ACFAS recognized 1-year fellowship graduates from 2000-2018 was conducted. Demographic data including current practice type and location was collected. Research activity at the 3, 5, and 10-year postfellowship period was investigated between publication history and current practice type. Statistical significance was set at p ≤ .05. Among the 37 fellowships assessed, 132 fellows were eligible for analysis. Most fellows maintained hospital-based employment 46 (34%) followed by private 44 (33%) and orthopedic group 30 (22%) practices. The proportion of fellows that published 5 and 10 years postfellowship was associated with research productivity 3 and 5 years postfellowship (p ≤ .03). The odds of publishing 3 years post-fellowship in orthopedic groups and university-based practices were 1.62 and 4.42 times higher compared to hospital-based graduates, respectively. The odds of publishing 5 years post-fellowship in orthopedic group and university based practices were 3.5 and 6.63 times higher than hospital-based practices, respectively. Despite the growing number of fellowships, a small proportion of fellows continue publishing postfellowship. These findings support the need to provide resources to engage graduates if retaining young practitioners in scholarly activity is desired.