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Leape CP, Hawken JB, Geng X, Wright MA, Murthi AM. An investigation into gender bias in the evaluation of orthopedic trainee arthroscopic skills. J Shoulder Elbow Surg 2022; 31:2402-2409. [PMID: 35788056 DOI: 10.1016/j.jse.2022.05.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 05/20/2022] [Accepted: 05/30/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND Women surgeons receive lower compensation, hold fewer academic positions, and hold fewer leadership positions than men, particularly in orthopedic surgery. Gender bias at the trainee level has been demonstrated in various surgical subspecialties, but there is a lack of information on gender bias within the orthopedic training environment. This study investigated whether implicit gender bias is present in the subjective evaluation of orthopedic trainee arthroscopic skills. METHODS After institutional review board approval, a web-based survey was sent to American Shoulder and Elbow Surgeons (ASES) members via the society's email listserve. Study participants were informed that the study was being done to develop a systematic evaluation method for trainees. The survey randomized participants to view and evaluate a prefellowship and a postfellowship video of "Rachel" (she/her) or "Charles" (he/him) performing a 15-point diagnostic shoulder arthroscopy. The videos for Rachel and Charles were identical except for the pronouns used in the video. Participants evaluated the trainee's skill level using questions from the Arthroscopic Surgical Skill Evaluation Tool (ASSET). Blinded and deidentified additional comments regarding the trainee's skill were classified as positive, negative, or neutral. Statistical analyses were used to compare scores and comments between Rachel and Charles. RESULTS Of 1115 active ASES members, 181 ASES members started the survey and 106 watched both videos and were included in the analysis. Of the 106 participants completing the survey, 96 (91%) were men and 10 (9%) were women with a median (interquartile range) age of 44 (38-51). A teaching role was reported by 84 of 106 participants (79%). There was no significant difference between prefellowship scores (P = .87) or between postfellowship scores (P = .84) for the woman and man fellow. The numbers of comments classified as positive, negative, or neutral were not significantly different between the man and woman fellow (P = .19). Participants in teaching roles gave significantly lower scores to both fellows at both time points (P = .04), and participants who had fellow trainees were more likely to give negative comments to both fellows (P = .02). DISCUSSION Trainee gender did not influence the ratings and comments participants gave for trainee arthroscopic skills, suggesting that gender bias may not play a major role in the evaluation of arthroscopic skill during orthopedic training.
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Affiliation(s)
| | - Jessica B Hawken
- Department of Orthopedic Surgery, MedStar Union Memorial Hospital, Baltimore, MD, USA
| | - Xue Geng
- Department of Biostatistics, Georgetown University, Washington, DC, USA
| | - Melissa A Wright
- Department of Orthopedic Surgery, MedStar Union Memorial Hospital, Baltimore, MD, USA; Department of Orthopedic Surgery, Georgetown University School of Medicine, Washington, DC, USA
| | - Anand M Murthi
- Department of Orthopedic Surgery, MedStar Union Memorial Hospital, Baltimore, MD, USA; Department of Orthopedic Surgery, Georgetown University School of Medicine, Washington, DC, USA.
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Webber CRJ, Davie R, Herzwurm Z, Whitehead J, Paré DW, Homlar KC. Is There Unconscious Bias in the Orthopaedic Residency Interview Selection Process? JOURNAL OF SURGICAL EDUCATION 2022; 79:1055-1062. [PMID: 35241397 DOI: 10.1016/j.jsurg.2022.02.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 09/28/2021] [Accepted: 02/06/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVE Orthopaedic surgery has historically been a white male-dominated field. Given the diverse patient population presenting to providers with musculoskeletal pathology, it is thought that it would be beneficial for the orthopaedic workforce to more closely mirror this patient population. This study aims to elucidate whether unconscious bias may have an effect on the scoring of applications for residency interview selection. DESIGN Applications for the 2019-2020 residency match cycle were initially reviewed and scored by faculty members. Applications were then redacted of all information suggestive of race or gender and returned to evaluators for rescoring after at least 6 months. The pre and post-redaction data was compared using ANOVA and student's two-tailed t tests. SETTING Department of Orthopaedic Surgery, Medical College of Georgia at Augusta University. PARTICIPANTS Thirteen attending surgeons scored 320 2019-2020 Electronic Residency Application System (ERAS) applications, unblinded and blinded of applicant identifying information. RESULTS Interviewed applicants were similar to the non-interviewed group in all measured variables except for higher pre-redaction scores (8.73-7.81; p = 0.02) which was expected (Table 2). Minority applicants had significant differences in Step 1 scores (243 vs 247; p < 0.01), Step 2 scores (251 vs 254; p = 0.01), articles (5.9 vs 3.8; p < 0.01), posters (5.9 vs 3.5; p < 0.01), and pre-redaction scores (7.44 vs 8.07; p = 0.01) compared to white applicants (Table 4). There was no relationship noted between step score and number or type of research items (Table 5). Pre-redaction and post-redaction scores were significantly different in white applicants who experienced a negative change (8.07-7.88; p = 0.03 (Table 6)). Males had statistically significant differences compared to females in Step 1 score (246 vs 243; p = 0.01) (Table 7). CONCLUSIONS This study was unable to prove unconscious bias based on a lack of statistically significant change of score when blinded, however the direction in change of scores was unlikely to be accounted for exclusively by objective differences between applicants, suggesting a trend toward unconscious bias. It remains unclear how influential subjective portions of the ERAS application such as personal statements, Letters of Recommendation, hobbies, and activities are on the overall assessment of an applicant and whether or not unconscious bias manifests in these subjective portions. Further investigation is needed in this area. Until then, residency programs should take immediate measures to mitigate potential implicit bias in the residency interview selection process. Actions can include implicit bias training for all faculty members involved in resident selection, standardization of application scoring and possibly redacting all or portions of the ERAS application so that only objective academic markers are presented to evaluators. Gaining a better understanding of these barriers is not only essential for their removal, but also allows for better preparation of applicants for success in the match with the ultimate goal being to correct the persistent disparity in the field of orthopaedic surgery.
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Affiliation(s)
- Colton R J Webber
- Department of Orthopaedic Surgery, Medical College of Georgia at Augusta University, Augusta, Georgia.
| | - Ryann Davie
- Medical College of Georgia at Augusta University, Augusta, Georgia
| | - Zachary Herzwurm
- Department of Orthopaedic Surgery, Medical College of Georgia at Augusta University, Augusta, Georgia
| | - Jonathon Whitehead
- Department of Orthopaedic Surgery, Medical College of Georgia at Augusta University, Augusta, Georgia
| | - Daniel W Paré
- Medical College of Georgia at Augusta University, Augusta, Georgia
| | - Kelly C Homlar
- Department of Orthopaedic Surgery, Medical College of Georgia at Augusta University, Augusta, Georgia
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Future of women orthopaedists: signs of optimism in a 3-year follow-up survey. CURRENT ORTHOPAEDIC PRACTICE 2021. [DOI: 10.1097/bco.0000000000001032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Amos AJ, Lee K, Sen Gupta T, Malau-Aduli BS. Systematic review of specialist selection methods with implications for diversity in the medical workforce. BMC MEDICAL EDUCATION 2021; 21:448. [PMID: 34429084 PMCID: PMC8385860 DOI: 10.1186/s12909-021-02685-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 04/16/2021] [Indexed: 06/13/2023]
Abstract
PURPOSE There is growing concern that inequities in methods of selection into medical specialties reduce specialist cohort diversity, particularly where measures designed for another purpose are adapted for specialist selection, prioritising reliability over validity. This review examined how empirical measures affect the diversity of specialist selection. The goals were to summarise the groups for which evidence is available, evaluate evidence that measures prioritising reliability over validity contribute to under-representation, and identify novel measures or processes that address under-representation, in order to make recommendations on selection into medical specialties and research required to support diversity. METHOD In 2020-1, the authors implemented a comprehensive search strategy across 4 electronic databases (Medline, PsychINFO, Scopus, ERIC) covering years 2000-2020, supplemented with hand-search of key journals and reference lists from identified studies. Articles were screened using explicit inclusion and exclusion criteria designed to focus on empirical measures used in medical specialty selection decisions. RESULTS Thirty-five articles were included from 1344 retrieved from databases and hand-searches. In order of prevalence these papers addressed the under-representation of women (21/35), international medical graduates (10/35), and race/ethnicity (9/35). Apart from well-powered studies of selection into general practice training in the UK, the literature was exploratory, retrospective, and relied upon convenience samples with limited follow-up. There was preliminary evidence that bias in the measures used for selection into training might contribute to under-representation of some groups. CONCLUSIONS The review did not find convincing evidence that measures prioritising reliability drive under-representation of some groups in medical specialties, although this may be due to limited power analyses. In addition, the review did not identify novel specialist selection methods likely to improve diversity. Nevertheless, significant and divergent efforts are being made to promote the evolution of selection processes that draw on all the diverse qualities required for specialist practice serving diverse populations. More rigorous prospective research across different national frameworks will be needed to clarify whether eliminating or reducing the weighting of reliable pre-selection academic results in selection decisions will increase or decrease diversity, and whether drawing on a broader range of assessments can achieve both reliable and socially desirable outcomes.
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Affiliation(s)
- Andrew James Amos
- Director of Training in Psychiatry for North Queensland, Queensland Health, Townsville, Australia.
- College of Medicine and Dentistry, James Cook University, Townsville, Australia.
| | - Kyungmi Lee
- College of Science and Engineering, James Cook University, Cairns, Australia
| | - Tarun Sen Gupta
- College of Medicine and Dentistry, James Cook University, Townsville, Australia
| | - Bunmi S Malau-Aduli
- College of Medicine and Dentistry, James Cook University, Townsville, Australia
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Katz SJ. The Influence of Applicant and Reviewer Gender on Resident Selection for Internal Medicine. JOURNAL OF MEDICAL EDUCATION AND CURRICULAR DEVELOPMENT 2021; 8:23821205211016502. [PMID: 34104786 PMCID: PMC8150434 DOI: 10.1177/23821205211016502] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Accepted: 04/16/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND While gender bias in medicine, including physician training, has been well described, less is known about gender bias in the selection process for post graduate residency training programs. This analysis reviews the potential role of gender on resident selection for an internal medicine residency program. METHODS File review and interview overall and component scores were analyzed based on the gender of the applicant. File review scores were further analyzed based on the reviewer's gender. RESULTS Women applicants scored higher than men applicants on their file review. There were no differences in any one component score except for leadership in art. Women file reviewers scored applicants higher than men file reviewers, but there was no difference between gender scores. There was no difference in overall or component interview scores between men or women applicants. Scoring did not impact the expected rank performance of applicants based on gender at any stage of the selection process. CONCLUSIONS While higher scores were observed in women applicants upon their file review, and women reviewers provided higher file review scores, this did not appear to impact the expected number of women and men applicants at each stage of the applicant process. This suggests a potential lack of gender bias at these stages of applicant selection.
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Affiliation(s)
- Steven J Katz
- Steven J Katz, University of Alberta, 8-130 Clinical Sciences Building, Edmonton, AB T6G 2G3, Canada.
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Halim UA, Elbayouk A, Ali AM, Cullen CM, Javed S. The prevalence and impact of gender bias and sexual discrimination in orthopaedics, and mitigating strategies. Bone Joint J 2020; 102-B:1446-1456. [PMID: 33135433 DOI: 10.1302/0301-620x.102b11.bjj-2020-0982.r1] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS Gender bias and sexual discrimination (GBSD) have been widely recognized across a range of fields and are now part of the wider social consciousness. Such conduct can occur in the medical workplace, with detrimental effects on recipients. The aim of this review was to identify the prevalence and impact of GBSD in orthopaedic surgery, and to investigate interventions countering such behaviours. METHODS A systematic review was conducted by searching Medline, EMCARE, CINAHL, PsycINFO, and the Cochrane Library Database in April 2020, and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to which we adhered. Original research papers pertaining to the prevalence and impact of GBSD, or mitigating strategies, within orthopaedics were included for review. RESULTS Of 570 papers, 27 were eligible for inclusion. These were published between 1998 and 2020. A narrative review was performed in light of the significant heterogeneity displayed by the eligible studies. A total of 13 papers discussed the prevalence of GBSD, while 13 related to the impact of these behaviours, and six discussed mitigating strategies. GBSD was found to be common in the orthopaedic workplace, with all sources showing women to be the subjects. The impact of this includes poor workforce representation, lower salaries, and less career success, including in academia, for women in orthopaedics. Mitigating strategies in the literature are focused on providing female role models, mentors, and educational interventions. CONCLUSION GBSD is common in orthopaedic surgery, with a substantial impact on sufferers. A small number of mitigating strategies have been tested but these are limited in their scope. As such, the orthopaedic community is obliged to participate in more thoughtful and proactive strategies that mitigate against GBSD, by improving female recruitment and retention within the specialty. Cite this article: Bone Joint J 2020;102-B(11):1446-1456.
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Affiliation(s)
- Usman A Halim
- Trauma and Orthopaedic Surgery Department, North Manchester General Hospital, Manchester, UK
| | - Abdulrahman Elbayouk
- Trauma and Orthopaedic Surgery Department, North Manchester General Hospital, Manchester, UK
| | - Adam M Ali
- Trauma and Orthopaedic Surgery Department, London North West University Healthcare NHS Trust, London, UK
| | - Clare M Cullen
- Trauma and Orthopaedic Surgery Department, Burnley General Hospital, Burnley, UK
| | - Saqib Javed
- Trauma and Orthopaedic Surgery Department, North Manchester General Hospital, Manchester, UK
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Halim UA, Elbayouk A, Ali AM, Cullen CM, Javed S. The prevalence and impact of gender bias and sexual discrimination in orthopaedics, and mitigating strategies. Bone Joint J 2020:1-11. [PMID: 32951434 DOI: 10.1302/0301-620x.102b9.bjj-2020-0982.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS Gender bias and sexual discrimination (GBSD) have been widely recognized across a range of fields and are now part of the wider social consciousness. Such conduct can occur in the medical workplace, with detrimental effects on recipients. The aim of this review was to identify the prevalence and impact of GBSD in orthopaedic surgery, and to investigate interventions countering such behaviours. METHODS A systematic review was conducted by searching Medline, EMCARE, CINAHL, PsycINFO, and the Cochrane Library Database in April 2020, and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to which we adhered. Original research papers pertaining to the prevalence and impact of GBSD, or mitigating strategies, within orthopaedics were included for review. RESULTS Of 570 papers, 27 were eligible for inclusion. These were published between 1998 and 2020. A narrative review was performed in light of the significant heterogeneity displayed by the eligible studies. A total of 13 papers discussed the prevalence of GBSD, while 13 related to the impact of these behaviours, and six discussed mitigating strategies. GBSD was found to be common in the orthopaedic workplace, with all sources showing women to be the subjects. The impact of this includes poor workforce representation, lower salaries, and less career success, including in academia, for women in orthopaedics. Mitigating strategies in the literature are focused on providing female role models, mentors, and educational interventions. CONCLUSION GBSD is common in orthopaedic surgery, with a substantial impact on sufferers. A small number of mitigating strategies have been tested but these are limited in their scope. As such, the orthopaedic community is obliged to participate in more thoughtful and proactive strategies that mitigate against GBSD, by improving female recruitment and retention within the specialty.
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Affiliation(s)
- Usman A Halim
- Trauma and Orthopaedic Surgery Department, North Manchester General Hospital, Manchester, UK
| | - Abdulrahman Elbayouk
- Trauma and Orthopaedic Surgery Department, North Manchester General Hospital, Manchester, UK
| | - Adam M Ali
- Trauma and Orthopaedic Surgery Department, London North West University Healthcare NHS Trust, London, UK
| | - Clare M Cullen
- Trauma and Orthopaedic Surgery Department, Burnley General Hospital, Burnley, UK
| | - Saqib Javed
- Trauma and Orthopaedic Surgery Department, North Manchester General Hospital, Manchester, UK
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Abstract
BACKGROUND Orthopaedics is the least gender-diverse medical specialty. Research suggests that the use of gendered language can contribute to workforce disparity and that gender-neutral language supports the inclusion and advancement of women, but the degree to which gender-neutral language is used by academic departments in what typically is a department's highest position (department chair) has not been characterized. QUESTIONS/PURPOSES (1) Is the proportion of department websites that use the term chairman (as opposed to chair) greater in orthopaedics than in five other surgical and medical specialties? (2) Are departments led by chairs who are women less likely to use "chairman" than those led by men, and does this vary by specialty? METHODS Seven hundred fourteen official websites of orthopaedic, neurosurgery, general surgery, internal medicine, pediatrics, and obstetrics and gynecology departments affiliated with 129 allopathic medical schools were screened. Any use of the term chairman on title pages, welcome messages, and faculty profile pages was identified using a Boyer-Moore string-search algorithm and terms were classified based on their location on the site. The overall use of the term chairman was compared by specialty and gender of the chair. RESULTS Sixty percent of orthopaedic department websites (71 of 119) used the term chairman at least once, a proportion higher than that of pediatrics (36% [46 of 128]; OR 0.38; 95% CI, 0.23 to 0.63; p < 0.001), internal medicine (31% [38 of 122]; OR 0.030; 95% CI, 0.18 to 0.53; p < 0.001), and obstetrics and gynecology (29% [37 of 126]; OR 0.28; 95% CI, 0.17 to 0.48; p < 0.001), but no different than that of neurosurgery (57% [54 of 94]; OR 0.91; 95% CI, 0.52 to 1.6; p = 0.74) and general surgery (55% [69 of 125]; OR 0.83; 95% CI, 0.50 to 1.4; p = 0.48). Across disciplines, departments whose chairs were women were much less likely to use the term chairman than departments whose chairs were men (14% [17 of 122] versus 50% [297 of 592]; OR 0.16; 95% CI, 0.09 to 0.28; p < 0.001). CONCLUSIONS The frequent use of the term chairman in orthopaedics, coupled with the preference of women to use the term chair, suggests considerable room for growth in the use of gender-equal language in orthopaedics. CLINICAL RELEVANCE Our current efforts to increase the number of women in orthopaedics may be undermined by gendered language, which can create and reinforce gendered culture in the field. Electing to use gender-neutral leadership titles, while a relatively small step in the pursuit of a more gender-equal environment, presents an immediate and no-cost way to support a more inclusive culture and counteract unconscious gender bias. Future studies should explore the individual attitudes of chairs regarding the use of gendered titles and identify additional ways in which biases may manifest; for example, the use of gendered language in interpersonal communications and the presence of unconscious bias in leadership evaluations. Continued efforts to understand implicit bias in orthopaedics can guide actionable strategies for counteracting gendered stereotypes of the specialty, in turn aiding initiatives to recruit and promote women in the field.
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CORR Insights®: Chair Versus Chairman: Does Orthopaedics Use the Gendered Term More Than Other Specialties? Clin Orthop Relat Res 2020; 478:1590-1592. [PMID: 31688212 PMCID: PMC7310433 DOI: 10.1097/corr.0000000000001026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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10
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Lin JS, Lattanza LL, Weber KL, Balch Samora J. Improving Sexual, Racial, and Ethnic Diversity in Orthopedics: An Imperative. Orthopedics 2020; 43:e134-e140. [PMID: 32003842 DOI: 10.3928/01477447-20200129-04] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Accepted: 02/07/2019] [Indexed: 02/03/2023]
Abstract
Orthopedics is the least diverse medical specialty. From residents to faculty, the representation of women and underrepresented minorities lags behind that of all other specialties. The crux of the disparity stems from the pipeline, as medical students who are female and are underrepresented minorities are simply not applying to orthopedic surgery. Grassroots efforts providing early exposure to orthopedics have led to a considerable proportion of alumnae pursuing science majors and eventually medical school. Institutions with a stated commitment to diversity have successfully produced residency classes with greater diversity. The culture should be one that combats biases, dispels misconceptions about orthopedics, and prioritizes recruiting/retaining diverse providers. [Orthopedics. 2020;43(3):e134-e140.].
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Summers MA, Matar RN, Denning JR, Dixon TL, Ramalingam WG, Asghar FA, Grawe BM. Closing the Gender Gap. JBJS Rev 2020; 8:e0211. [DOI: 10.2106/jbjs.rvw.19.00211] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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12
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Ruzycki SM, Earp M, Ma IWY. Applicant gender and matching to first-choice discipline: a cross-sectional analysis of data from the Canadian Resident Matching Service (2013-2019). CMAJ Open 2020; 8:E346-E351. [PMID: 32381685 PMCID: PMC7207035 DOI: 10.9778/cmajo.20190029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Previous studies examining potential sex and gender bias in the Canadian Resident Matching Service (CaRMS) match have had conflicting results. We examined the results of the CaRMS match over the period 2013-2019 to determine the potential association between applicants' gender and the outcome of matching to their first-choice discipline. METHODS In this cross-sectional analysis, we determined the risk of matching to one's first-choice discipline in CaRMS by applicant gender and year, for all Canadian medical students who participated in the first iteration of the R-1 match for the years 2013 to 2019. We analyzed data in 3 categories of disciplines according to CaRMS classifications: family medicine, nonsurgical disciplines and surgical disciplines. We excluded disciplines with fewer than 10 applicants. RESULTS Match results were available for 20 033 participants, of whom 11 078 (55.3%) were female. Overall, female applicants were significantly more likely to match to their first-choice discipline (relative risk [RR] 1.03, 95% confidence interval [CI] 1.02-1.04). After adjustment for match year and stratification by discipline categories, we found that female applicants were more likely to match to family medicine as their first choice (RR 1.04, 95% CI 1.03-1.05) and less likely to match to a first-choice surgical discipline (RR 0.95, 95% CI 0.91-1.00) than their male peers. There was no significant difference between the genders in matching to one's first-choice nonsurgical discipline (RR 1.01, 95% CI 0.99-1.03). INTERPRETATION These results suggest an association between an applicant's gender and the probability of matching to one's first-choice discipline. The possibility of gender bias in the application process for residency programs should be further evaluated and monitored.
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Affiliation(s)
- Shannon M Ruzycki
- Division of General Internal Medicine, Department of Medicine (Ruzycki, Ma), Department of Community Health Sciences (Ruzycki) and Department of Oncology (Earp), Cumming School of Medicine, University of Calgary, Calgary, Alta.
| | - Madalene Earp
- Division of General Internal Medicine, Department of Medicine (Ruzycki, Ma), Department of Community Health Sciences (Ruzycki) and Department of Oncology (Earp), Cumming School of Medicine, University of Calgary, Calgary, Alta
| | - Irene W Y Ma
- Division of General Internal Medicine, Department of Medicine (Ruzycki, Ma), Department of Community Health Sciences (Ruzycki) and Department of Oncology (Earp), Cumming School of Medicine, University of Calgary, Calgary, Alta
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13
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Nasreddine AY, Gallo R. Applying to Orthopaedic Residency and Matching Rates: Analysis and Review of the Past 25 Years. J Bone Joint Surg Am 2019; 101:e134. [PMID: 31567661 DOI: 10.2106/jbjs.18.00371] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The competitiveness of orthopaedics and recent changes in the residency application process have resulted in increased costs to both applicants and programs. Our purpose was to investigate changes in the orthopaedic residency application process between 1992 and 2017. Also, we aimed to determine an ideal number of applications that each student can submit without jeopardizing his or her probability of matching into an orthopaedic residency slot while concurrently reducing the excessive number of applications that are received by program selection committees. METHODS Retrospective data from both the Electronic Residency Application Service (ERAS) and the National Resident Matching Program (NRMP) were collected and analyzed for changes in the characteristics of applications, applicants, and programs over the study period. Using these data, the probability of matching into orthopaedics through the years was calculated and compared in order to propose an ideal number of applications for a medical student to submit to match into an orthopaedic residency. RESULTS Over the study period of 25 years, there has been an increase in the number of residency positions offered and a decrease in the number of applicants per offered position among U.S. senior medical students. Nonetheless, the average number of submitted applications per applicant significantly increased from 1992 to 2017, from 28 to 80 applications (p < 0.001). As a result, the overall costs to apply and review applications also have increased. There was no association between the increased number of submitted applications and the match rate. Our analysis showed that 50 applications per student offer is the most effective option without compromising the overall applicant match rate. CONCLUSIONS Based on these data, we suggest encouraging students to limit the number of applications that they submit. This limit could reduce the cost for both applicants and programs while likely maintaining the current match rate and competitiveness of the specialty.
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Affiliation(s)
- Adam Y Nasreddine
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, Connecticut.,Penn State Hershey College of Medicine, Hershey, Pennsylvania
| | - Robert Gallo
- Penn State Hershey College of Medicine, Hershey, Pennsylvania.,Penn State Hershey Medical Center, Bone and Joint Institute, Hershey, Pennsylvania
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Okike K, Phillips DP, Swart E, O'Connor MI. Orthopaedic Faculty and Resident Sex Diversity Are Associated with the Orthopaedic Residency Application Rate of Female Medical Students. J Bone Joint Surg Am 2019; 101:e56. [PMID: 31220032 DOI: 10.2106/jbjs.18.00320] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The representation of women in orthopaedics in the United States remains among the lowest in all fields of medicine, and prior research has suggested that this underrepresentation may stem from lower levels of interest among female medical students. Of the many proposed reasons for this lack of interest, the male-dominated nature of the field is one of the most commonly cited. The purpose of this study was to determine the degree to which the representation of women among orthopaedic faculty and residents influences female medical students at that institution to apply for a residency in orthopaedics. METHODS Using data provided by the Association of American Medical Colleges, we identified all U.S. medical schools that were affiliated with an orthopaedic surgery department and an orthopaedic surgery residency program (n = 107). For each institution, data on the representation of women among the orthopaedic faculty and residents from 2014 through 2016 were collected, as well as data on the proportion of female medical school graduates who applied to an orthopaedic residency program from 2015 through 2017. The association between institutional factors and the female medical student orthopaedic application rate was assessed. RESULTS Of 22,707 women who graduated from medical school during the 3-year study period, 449 (1.98%) applied to an orthopaedic surgery residency program. Women who attended medical school at institutions with high orthopaedic faculty sex diversity were more likely to apply for a residency in orthopaedics (odds ratio [OR], 1.30; 95% confidence interval [CI], 1.04 to 1.64; p = 0.023), as were women who attended medical school at institutions with high orthopaedic resident sex diversity (OR, 1.30; 95% CI, 1.05 to 1.61; p = 0.019). CONCLUSIONS In this study, we found that increased sex diversity among orthopaedic faculty and residents was associated with a greater likelihood that female medical students at that institution would apply for an orthopaedic residency. These results suggest that at least some of the factors currently impeding female medical student interest in orthopaedics may be modifiable. These findings may have important implications for efforts to improve the sex diversity of the field of orthopaedics going forward.
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Affiliation(s)
- Kanu Okike
- Department of Orthopaedics, Kaiser Permanente Moanalua Medical Center, Honolulu, Hawaii
| | - Donna P Phillips
- Department of Orthopaedic Surgery, NYU Langone Orthopedic Hospital, New York, NY
| | - Eric Swart
- Department of Orthopaedic Surgery and Rehabilitation, University of Massachusetts, Worcester, Massachusetts
| | - Mary I O'Connor
- Center for Musculoskeletal Care, Yale School of Medicine, New Haven, Connecticut
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Poon S, Kiridly D, Brown L, Wendolowski S, Gecelter R, Vetere A, Kline M, Lane L. Evaluation of Sex, Ethnic, and Racial Diversity Across US ACGME-Accredited Orthopedic Subspecialty Fellowship Programs. Orthopedics 2018; 41:282-288. [PMID: 30168833 DOI: 10.3928/01477447-20180828-03] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Accepted: 07/12/2018] [Indexed: 02/03/2023]
Abstract
In recent years, there has been an increasing trend toward subspecialization in orthopedic surgery via fellowships. This study sought to characterize sex, ethnic, and racial representation within each fellowship program and to examine their changes over time to identify trends and/or gaps. Demographic data were obtained from the National Graduate Medical Education Census. Diversity was assessed using proportions of minority and female trainees. The trends in racial, ethnic, and sex diversity from 2006 to 2015 for orthopedics as a whole and within each subspecialty were analyzed. Of 3722 orthopedic fellows, 2551 identified as white (68.5%), 648 as Asian (17.4%), 175 as Hispanic (4.7%), 161 as black (4.3%), 8 as Native Hawaiian/Pacific Islander (0.21%), and 3 as American Indian/Alaskan Native (0.08%). Further, 479 identified as female (12.9%). Racial and ethnic minority representation among orthopedic fellows did not increase over time. Female representation did increase proportionally with female residents. Asian fellows preferred reconstructive adult and spine, whereas white fellows preferred sports medicine, hand surgery, and trauma. Female fellows preferred pediatrics, hand surgery, and musculoskeletal oncology. Although sex diversity among orthopedic fellows has increased in the past 10 years, racial and ethnic minority representation lacked similar growth. Asian and female fellows preferred specific subspecialties over others. These data are presented as an initial step in determining factors that attract minority groups to different orthopedic subspecialties. Further research should define specific factors and identify ways to increase minority distribution among fellowship programs. [Orthopedics. 2018; 41(5):282-288.].
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The Orthopaedic Surgery Residency Application Process: An Analysis of the Applicant Experience. J Am Acad Orthop Surg 2018; 26:537-544. [PMID: 29870416 DOI: 10.5435/jaaos-d-16-00835] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION Orthopaedic surgery residency positions are highly sought after. The purpose of this survey study was to report the following components of the applicant experience: (1) the number of programs to which applicants applied and interviewed, (2) the performance criteria associated with receiving interviews, (3) the way applicants respond to e-mail interview offers, (4) the pre- and post-interview communication between applicants and programs, (5) the importance of interview day activities and the determinants of the applicant rank order list (ROL), and (6) the financial cost of the application process. METHODS An online survey was administered and entirely completed by a representative sample of 100 orthopaedic surgery residency applicants for the 2015 to 2016 cycle during the 3-week period between the last interview of the application season and the deadline for ROL certification. The survey included 45 questions: 7 for background, 7 for competitiveness, 15 for the interaction between applicants and programs, 15 for the importance of interview day experience and the determinants of the applicant ROL, and 1 for the cost of attending each interview. RESULTS Students applied to 83 ± 27 programs, received 17 ± 10 interviews, and attended 12 ± 5 interviews. Interview offers correlated with, in descending order, Alpha Omega Alpha status, Step 2 Clinical Knowledge, and Step 1. The mean time to reply of interview offer was 17 minutes, yet 25% of the applicants lost at least one interview despite having at least one other person monitor the applicant's e-mail account. Applicants and programs frequently contacted each other to express interest. Although evaluating current residents was the most valuable aspect of interview day to applicants, the strongest determinants for applicants' ROLs were location and surgical experience, with research the least important factor. The cost of interview season was >$7,000 per applicant, excluding away externships. CONCLUSION Applying to orthopaedic surgery residency is a complex, competitive, and costly experience for applicants. The application process may benefit from better expectation management of applicant candidacy and a more prohibitive communication policy between applicants and programs after the interview day.
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Roberts C, Khanna P, Rigby L, Bartle E, Llewellyn A, Gustavs J, Newton L, Newcombe JP, Davies M, Thistlethwaite J, Lynam J. Utility of selection methods for specialist medical training: A BEME (best evidence medical education) systematic review: BEME guide no. 45. MEDICAL TEACHER 2018; 40:3-19. [PMID: 28847200 DOI: 10.1080/0142159x.2017.1367375] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
BACKGROUND Selection into specialty training is a high-stakes and resource-intensive process. While substantial literature exists on selection into medical schools, and there are individual studies in postgraduate settings, there seems to be paucity of evidence concerning selection systems and the utility of selection tools in postgraduate training environments. AIM To explore, analyze and synthesize the evidence related to selection into postgraduate medical specialty training. METHOD Core bibliographic databases including PubMed; Ovid Medline; Embase, CINAHL; ERIC and PsycINFO were searched, and a total of 2640 abstracts were retrieved. After removing duplicates and screening against the inclusion criteria, 202 full papers were coded, of which 116 were included. RESULTS Gaps in underlying selection frameworks were illuminated. Frameworks defined by locally derived selection criteria, and heavily weighed on academic parameters seem to be giving way to the evidencing of competency-based selection approaches in some settings. Regarding selection tools, we found favorable psychometric evidence for multiple mini-interviews, situational judgment tests and clinical problem-solving tests, although the bulk of evidence was mostly limited to the United Kingdom. The evidence around the robustness of curriculum vitae, letters of recommendation and personal statements was equivocal. The findings on the predictors of past performance were limited to academic criteria with paucity of long-term evaluations. The evidence around nonacademic criteria was inadequate to make an informed judgment. CONCLUSIONS While much has been gained in understanding the utility of individual selection methods, though the evidence around many of them is equivocal, the underlying theoretical and conceptual frameworks for designing holistic and equitable selection systems are yet to be developed.
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Affiliation(s)
- Chris Roberts
- a Primary Care and Medical Education, Sydney Medical School , University of Sydney , New South Wales , Australia
| | - Priya Khanna
- b The Royal Australasian College of Physicians , New South Wales , Australia
| | - Louise Rigby
- c Health Education and Training Institute , New South Wales , Australia
| | - Emma Bartle
- d School of Dentistry , University of Queensland , Queensland , Australia
| | - Anthony Llewellyn
- e Hunter New England Local Health District , New Lambton , Australia
- f Health Education and Training Institute, University of Newcastle , Newcastle Australia
| | - Julie Gustavs
- b The Royal Australasian College of Physicians , New South Wales , Australia
| | - Libby Newton
- b The Royal Australasian College of Physicians , New South Wales , Australia
| | | | - Mark Davies
- h Royal Brisbane and Women's Hospital , Queensland , Australia
| | - Jill Thistlethwaite
- i School of Communication , University of Technology Sydney , New South Wales , Australia
| | - James Lynam
- j Calvary Mater Newcastle, University of Newcastle , New South Wales , Australia
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Abstract
BACKGROUND Orthopaedic surgery now has the lowest percentage of women in residency programs of any surgical specialty. Understanding factors, particularly those related to the medical school experience, that contribute to the specialty's inability to draw from the best women students is crucial to improving diversity in the profession. QUESTIONS/PURPOSES (1) Does required medical school exposure to orthopaedic surgery increase the proportion of women choosing the specialty? (2) Do negative perceptions deter women from choosing orthopaedic surgery? (3) What proportion of orthopaedic faculty members are women, and what proportion of residents are women? (4) To what degree has gender bias been identified in the application/interview process? METHODS Two PubMed searches of articles between 2005 and 2015 were performed using a combination of medical subject headings. The first search combined "Orthopaedics" with "Physicians, women" and phrases "women surgeons" or "female surgeons" and the second combined "Orthopedics" with "Internship & Residency" or "exp Education, Medical" and "Sex Ratio" or "Sex Factors", resulting in 46 publications of which all abstracts were reviewed resulting in 11 manuscripts that were related to the research questions. The Google Scholar search of "women in orthopaedic surgery" identified one additional publication. These 12 manuscripts were read and bibliographies of each reviewed with two additional publications identified and included. RESULTS Required exposure to orthopaedics was found to be positively associated with the number of women applicants to the field, whereas negative perceptions have been reported to deter women from choosing orthopaedic surgery. Orthopaedics has the lowest percentage of women faculty and women residents (14%) compared with other specialties; this suggests that same gender mentorship opportunities are limited. For women applying to orthopaedics, gender bias is most evident through illegal interview questions, in which women are asked such questions more often than men (such as family planning questions, asked to 61% of women versus 8% of men). CONCLUSIONS Successful recruitment of women to orthopaedic surgery may be improved by early exposure and access to role models, both of which will help women students' perceptions of their role in field of orthopaedic surgery.
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Bauer JM, Holt GE. National Orthopedic Residency Attrition: Who Is At Risk? JOURNAL OF SURGICAL EDUCATION 2016; 73:852-857. [PMID: 27216301 DOI: 10.1016/j.jsurg.2016.03.010] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/29/2015] [Revised: 02/23/2016] [Accepted: 03/14/2016] [Indexed: 06/05/2023]
Abstract
BACKGROUND National U.S. orthopedic resident attrition rates have been historically low, but no literature exists as to the characteristics of those who leave nor the circumstance of the departure. We aimed to determine factors that may place a resident at higher risk for attrition. Additionally, we planned to determine whether the 2003-work hour restriction affected attrition rate. MATERIALS AND METHODS All orthopedic surgery residency program directors in the United States were surveyed on demographic data for their current resident class, the number of residents who left the program, as well as demographic description for each of the residents who left their program from 1998 to 2013. Exclusion criteria included military programs and those younger than 3 years. All data were deidentified and compared to the Accreditation Council for Graduate Medical Education Data Resource book to protect against sample error in respondents. RESULTS Of 146 programs included, the overall response rate was 54% of residency directors, representing 51% of orthopedic residents. The respondent demographic make-up of 13.7% female, and average program size of 22.3 residents, compared similarly to the Accreditation Council for Graduate Medical Education national average of 13% female and 23-resident program size. Compared to all respondents, residents who left their program were more likely to be female (27%, p = 0.0018), single (51%, p = 0.0028), and without children (80%, p = 0.0018). There was no statistical difference based on minority status or 2003-instituted work hour restriction. Of those who left, 45% transferred to another specialty, 34% were dismissed, 14% voluntarily withdrew or cited personal reasons, and 6% transferred to another orthopedic program. The most common specialties to transfer into were radiology (30%), emergency medicine (25%), and anesthesia (18%). CONCLUSIONS Orthopedic residents who are female, single, or without children are statistically more likely to undergo attrition. Consideration could be given to targeted mentoring of these resident groups.
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Affiliation(s)
| | - Ginger E Holt
- Vanderbilt University Medical Center, Nashville, Tennessee
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Martinez M, Lopez S, Beebe K. Gender Comparison of Scholarly Production in the Musculoskeletal Tumor Society Using the Hirsch Index. JOURNAL OF SURGICAL EDUCATION 2015; 72:1172-1178. [PMID: 26232946 DOI: 10.1016/j.jsurg.2015.06.020] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Accepted: 06/29/2015] [Indexed: 06/04/2023]
Abstract
OBJECTIVE Despite an increase in the proportion of female medical school graduates, the number of women in orthopedic surgery remains low. To examine the presence of gender disparities in scholarly production, the authors used the Hirsch index (h-index) to assess members of the Musculoskeletal Tumor Society (MSTS), a well-defined subspecialty of orthopedic surgery. DESIGN Using the MSTS Membership Directory, the authors assessed those practicing at an academic institution in the United States. Members׳ sex and rank was obtained from their department's website, and their h-index and years since initial publication was collected from the Scopus database. SETTING Research was performed at New Jersey Medical School, an institution, using online databases. PARTICIPANTS A total of 247 members of the MSTS were eligible, of whom 125 practiced at a US academic medical center and were included in the study. RESULTS The MSTS is composed of 247 members, 28 (11%) of whom are women. Within US academic medical centers, there are 125 members, including 17 (14%) women. Mean h-indices increased with rising academic rank from 5.42 for assistant professors to 19.28 for professors. Publication ranges showed an increase from 11.03 years for assistant professors to 29.52 years for professors. The h-index and publication years of chairpersons were nearly equal to those of professors. Using the h-index, it was found that men outproduce women-13.4:7.9. Men outnumber women at every rank, increasingly so at higher ranks. The authors found that there was a significant difference in productivity between ranks (p < 0.01) and between sexes (p = 0.035), but not between sexes at the assistant professor, associate professor, or professor levels (p = 0.147, 0.581, and 0.263, respectively). CONCLUSIONS The h-index shows differing production among the sexes and ranks in the MSTS. No significant difference exists between the sexes when members are organized by academic title.
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Affiliation(s)
- Maximilian Martinez
- Department of Orthopaedic Surgery, Rutgers-New Jersey Medical School, Newark, New Jersey.
| | - Santiago Lopez
- Department of Orthopaedic Surgery, Rutgers-New Jersey Medical School, Newark, New Jersey
| | - Kathleen Beebe
- Department of Orthopaedic Surgery, Rutgers-New Jersey Medical School, Newark, New Jersey
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21
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Bernstein J. Male practice: gender inequality in orthopaedic surgery. Clin Orthop Relat Res 2013; 471:1754-7. [PMID: 23595511 PMCID: PMC3706651 DOI: 10.1007/s11999-013-2978-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2013] [Accepted: 03/29/2013] [Indexed: 01/31/2023]
Affiliation(s)
- Joseph Bernstein
- Department of Orthopaedic Surgery, University of Pennsylvania, 424 Stemmler Hall, Philadelphia, PA 19104 USA
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Affiliation(s)
- Valerae Olive Lewis
- Section of Orthopaedic Oncology, The University of Texas, MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030, USA.
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Van Heest AE, Agel J. The uneven distribution of women in orthopaedic surgery resident training programs in the United States. J Bone Joint Surg Am 2012; 94:e9. [PMID: 22258016 DOI: 10.2106/jbjs.j.01583] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Although women represented 58% of undergraduate students and 48% of medical students in the U.S. in the 2008-2009 academic year, only 13% of orthopaedic residents and only 4% of American Academy of Orthopaedic Surgeons (AAOS) Fellows in 2009 were women. Are all orthopaedic surgery programs in the U.S. equal in their ability to attract female medical students and train female orthopaedic surgeons? This study was undertaken to test the hypothesis that all Accreditation Council for Graduate Medical Education (ACGME)-accredited orthopaedic surgery residency programs in the U.S. train a similar number of female residents. METHODS Data for all ACGME-accredited orthopaedic surgery residency training programs in the U.S. for five academic years (2004-2005 through 2008-2009) were collected with use of the Graduate Medical Education (GME) Track database. RESULTS Orthopaedic residency programs in the U.S. do not train women at an equal frequency. In the academic years from 2004-2005 through 2008-2009, forty-five programs had no female residents during at least one of the five academic years reviewed, and nine programs had no female residents during any of the years. More than fifty orthopaedic residency programs in the U.S. had an average of <10% female trainees over the five-year period, and more than ten programs had an average of >20%. There was no significant change in the distribution among these categories over the five years examined (p = 0.234). CONCLUSIONS Significant differences in the representation of women exist among orthopaedic residency training programs in the U.S. Further examination of the characteristics of orthopaedic residency programs that are successful in attracting female residents, particularly the composition of their faculty as role models, will be important in furthering our understanding of how orthopaedic surgery can continue to attract the best and the brightest individuals. Changes in the cultural experiences in programs that have not trained female orthopaedic surgeons, such as an increased number of female faculty, and policies that emphasize diversity may provide a greater opportunity for our orthopaedic profession to attract female medical students.
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Affiliation(s)
- Ann E Van Heest
- Department of Orthopaedic Surgery, University of Minnesota, 2450 Riverside Avenue, Suite R200, Minneapolis, MN 55454
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Baldwin K, Namdari S, Bowers A, Keenan MA, Levin LS, Ahn J. Factors affecting interest in orthopedics among female medical students: a prospective analysis. Orthopedics 2011; 34:e919-32. [PMID: 22146211 DOI: 10.3928/01477447-20111021-17] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The field of orthopedics has a limited ability to recruit high-quality female applicants. The purpose of this study was to determine whether early exposure to the field affects a woman's decision to pursue orthopedics. We performed a prospective, nonrandomized cohort study between academic years 2005 and 2009 and compared interest in orthopedic surgery among female (n=271) and male (n=71) medical students at 2 urban teaching institutions. Elective lectures and orthopedic literature were distributed via e-mail to the study participants. These materials included articles published in the medical literature, materials produced and distributed by the American Academy of Orthopaedic Surgeons, and Web sites providing educational materials. The primary outcome was the likelihood of application for orthopedic residency. We studied the influence of demographics, exposure, and attitudes on interest in pursuing an orthopedic career. Men had a significantly higher baseline level of interest in orthopedic surgery than women (P=.005). Younger age (P<.001) and personal (P<.001), independent (P<.001), and school (P=.023) exposures to orthopedics were significantly related to interest among women. At final follow-up, total personal exposures (P=.003) and total independent exposures (P<.001) in the form of our literature and lectures were correlated with final interest in women. Female interest was decreased by the long hours, physical demands, and predominantly male nature of the field. Early exposure to orthopedic educational resources may be useful in generating female interest. Perceptions and attitudes regarding orthopedic surgery must to be changed to attract the best and brightest minds, regardless of sex.
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Affiliation(s)
- Keith Baldwin
- Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
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Abstract
Multiple studies have attempted to determine which attributes are predictive of success during residency as well as the optimal method of selecting residents who possess these attributes. Factors that are consistently ranked as being important in the selection of candidates into orthopaedic residency programs include performance during orthopaedic rotation, United States Medical Licensing Examination (USMLE) Step 1 score, Alpha Omega Alpha Honor Medical Society membership, medical school class rank, interview performance, and letters of recommendation. No consensus exists regarding the best predictors of resident success, but trends do exist. High USMLE Step 1 scores have been shown to correlate with high Orthopaedic In-Training Examination scores and improved surgical skill ratings during residency, whereas higher numbers of medical school clinical honors grades have been correlated to higher overall resident performance, higher residency interpersonal skills grading, higher resident knowledge grading, and higher surgical skills evaluations. Successful resident performance can be measured by evaluating psychomotor abilities, cognitive skills, and affective domain.
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Brustman LE, Williams FL, Carroll K, Lurie H, Ganz E, Langer O. The effect of blinded versus nonblinded interviews in the resident selection process. J Grad Med Educ 2010; 2:349-53. [PMID: 21976082 PMCID: PMC2951773 DOI: 10.4300/jgme-d-10-00051.1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2010] [Revised: 06/18/2010] [Accepted: 07/09/2010] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE To evaluate whether resident applicants' academic performance biases the assessment of nonacademic qualities. METHODS In this prospective, descriptive study, 2 blinded (personal statement only) and 1 nonblinded (application) 30-minute interviews were compared for candidates ranking into Top 10, Upper Third, Middle Thirds, Lower Third, and Do Not Rank classes. RESULTS A total of 234 candidates were interviewed from 2005 to 2007. The association between blinded interviewers for the categories was 87%, 63%, 68%, 73%, and 90% (P = .0000), respectively. Comparing blinded to nonblinded interviewers showed an association of 75% (63%), 71% (86%), 68% (58%), 66% (79%), and 72.7% (82%) (P = .0000), respectively. A strong degree of agreement (Cohen κ, 0.75) for the 2 ranking scores resulted in 90% agreement for Top 10 and Upper Third and 85% for Middle Third and Lower Third categories. No correlation was found between United States Medical Licensing Examination scores and final ranking; moderate agreement was found between ranking and deans' letters (Cohen κ, 0.59, P = .0000). CONCLUSION Candidate rankings on nonacademic attributes were not affected by interview type.
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Affiliation(s)
- Lois E. Brustman
- Corresponding author: Lois Brustman, MD, Department of Obstetrics and Gynecology, St. Luke's-Roosevelt Hospital Center, 1000 Tenth Avenue, Suite 10C, New York, NY 10019, 212.523.8366,
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Nguyen L, Amin NH, Vail TP, Pietrobon R, Shah A. Editorial: a paucity of women among residents, faculty, and chairpersons in orthopaedic surgery. Clin Orthop Relat Res 2010; 468:1746-8. [PMID: 19844769 PMCID: PMC2882013 DOI: 10.1007/s11999-009-1125-y] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Affiliation(s)
- Lam Nguyen
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC USA
| | - Nirav H. Amin
- Department of Orthopedic Surgery, Drexel University College of Medicine, Philadelphia, PA USA
| | - Thomas P. Vail
- Department of Orthopaedic Surgery, University of California San Francisco, San Francisco, CA USA
| | - Ricardo Pietrobon
- Department of Surgery, Duke University Medical Center, DUMC 3094, Durham, NC 27710 USA
| | - Anand Shah
- Department of Surgery, Duke University Medical Center, DUMC 3094, Durham, NC 27710 USA
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA USA
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28
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Pico K, Gioe TJ, VanHeest A, Tatman PJ. Do men outperform women during orthopaedic residency training? Clin Orthop Relat Res 2010; 468:1804-8. [PMID: 20333491 PMCID: PMC2881995 DOI: 10.1007/s11999-010-1318-4] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Orthopaedic surgery residency has one of the lowest percentages of women (13.1%) of all primary surgical specialties. There are many possible reasons for this, including bias during the selection process. QUESTIONS/PURPOSES We therefore asked whether performance during residency might adversely bias the selection of future female orthopaedic residents by researching whether males and females perform equally in orthopaedic surgery residency. METHODS Ninety-seven residents enrolled in our residency between 1999 and 2009; six males and one female left the program, leaving 90 residents (73 males, 17 females) as the study cohort. Resident performance was compared for OITE scores, ABOS results, faculty evaluations, and in a resident graduate survey. RESULTS Males and females had similar faculty evaluations in all ACGME competency areas. Males and females had similar mean OITE scores for Years 2-5 of residency, although males had higher mean scores at Years 3 through 5. Males and females had similar mean ABOS Part 1 scores and ABOS Part 1 pass rates; however, fewer males than females took more than one attempt to pass. Males and females had similar Part 2 pass rates or attempts. For the 45 resident graduates surveyed, females pursued fellowships equally to males, worked slightly less hours in practice, and reported higher satisfaction with their career choice. CONCLUSIONS For the 90 residents at one residency program, we observed no differences between males' and females' performance. Although females pursue orthopaedic residency less frequently than males, performance during residency should not bias their future selection.
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Affiliation(s)
- Katharine Pico
- Department of Orthopaedic Surgery, University of Minnesota, 2450 Riverside Avenue, Suite R200, Minneapolis, MN 55454 USA
| | - Terence J. Gioe
- Department of Orthopaedic Surgery, University of Minnesota, 2450 Riverside Avenue, Suite R200, Minneapolis, MN 55454 USA ,Minneapolis Veterans Affairs Medical Center, Minneapolis, MN USA
| | - Ann VanHeest
- Department of Orthopaedic Surgery, University of Minnesota, 2450 Riverside Avenue, Suite R200, Minneapolis, MN 55454 USA
| | - Penny J. Tatman
- HealthEast Education and Research Department, St Paul, MN USA
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Are away rotations critical for a successful match in orthopaedic surgery? Clin Orthop Relat Res 2009; 467:3340-5. [PMID: 19582529 PMCID: PMC2772936 DOI: 10.1007/s11999-009-0920-9] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2008] [Accepted: 05/21/2009] [Indexed: 01/31/2023]
Abstract
Surveys have suggested one of the most important determinants of orthopaedic resident selection is completion of an orthopaedic clerkship at the program director's institution. The purpose of this study was to further elucidate the significance of visiting externships on the resident selection process. We retrospectively reviewed data for all medical students applying for orthopaedic surgery residency from six medical schools between 2006 and 2008, for a total of 143 applicants. Univariate and multivariate regression analyses were used to compare students who matched successfully versus those who did not in terms of number of away rotations, United States Medical Licensing Examination scores, class rank, and other objective factors. Of the 143 medical students, 19 did not match in orthopaedics (13.3%), whereas the remaining 124 matched. On multiple logistic regression analysis, whether a student did more than one home rotation, how many away rotations a student performed, and United States Medical Licensing Examination Step 1 score were factors in the odds of match success. Orthopaedic surgery is one of the most competitive specialties in medicine; the away rotation remains an important factor in match success.
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Bucknall V, Pynsent PB. Sex and the orthopaedic surgeon: a survey of patient, medical student and male orthopaedic surgeon attitudes towards female orthopaedic surgeons. Surgeon 2009; 7:89-95. [PMID: 19408801 DOI: 10.1016/s1479-666x(09)80023-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To ascertain whether perceived negative attitudes regarding female orthopaedic surgeons impact on female medical student career choice of orthopaedic surgery and determine to what extent these perceptions hold true among orthopaedic surgeons and patients. SUBJECTS AND METHODS A structured questionnaire, distributed to three study cohorts; 311 medical students, 182 patients and 54 orthopaedic surgeons from two specialist orthopaedic hospitals, asked questions pertaining to views regarding female orthopaedic surgeons. Binary questions and 5-point Likert scale statements were scored. Analysis was undertaken using Fisher's exact test and the trend test for proportions. Qualitative responses were categorised into themes and reported. Significance levels were set at < or = 0.05. RESULTS Only 24% of female students would consider orthopaedic surgical careers, differing significantly from male students (p = < 0.01). The reasons given included disinterest and male domination. Significantly greater female students had been exposed to negative attitudes regarding female surgeons (p = < 0.01), of which 62% would not consider surgery. Most patients (89%) had no sex-preference for orthopaedic surgeon. Seventy-five percent believed women are surgically as skilled as men and 4% of the patients stated they had more confidence in female orthopaedic surgeons compared to males. Fifty-eight percent of the surgeons had never encountered negative attitudes. Of those that had, skill and family responsibilities were questioned. All agreed there is a place for women in orthopaedic surgical careers and welcomed diversity. CONCLUSION Rumoured negative attitudes regarding female orthopaedic surgeons still exist among some orthopaedic surgeons, but not patients, influencing the undergraduate teaching experience and ultimate career choice in orthopaedic surgery.
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Affiliation(s)
- V Bucknall
- University of Birmingham Medical School, Birmingham, B29 2TT, UK.
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Thordarson DB, Ebramzadeh E, Sangiorgio SN, Schnall SB, Patzakis MJ. Resident selection: how we are doing and why? Clin Orthop Relat Res 2007; 459:255-9. [PMID: 17415012 DOI: 10.1097/blo.0b013e31805d7eda] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Selection of the best applicants for orthopaedic residency programs remains a difficult problem. Most quantifiable factors for residency selection evaluate test-taking ability and grades rather than other aspects, such as patient care, professionalism, moral reasoning, and integrity. Four current department members on our resident selection committee ranked four consecutive classes of orthopaedic residents interviewed for residency. We ranked incoming residents in order of best to least qualified and compared those rankings with rank lists by the same faculty on completion of residency. Rankings also were compared with the residents' United States Medical Licensing Examination (USMLE) Part I scores, American Board of Orthopaedic Surgery (ABOS) Part I scores, and fourth-year Orthopaedic-in-Training Examination (OITE) scores. We found fair or poor correlations between the residents' initial rankings, rankings on graduation, and their USMLE, ABOS, and OITE scores. The only relatively strong correlation found was between the OITE and ABOS scores. Despite the faculty's consensus regarding selection criteria, interviewers did not agree in their rankings of residents on graduation. Additional work is necessary to refine the inexact yet important science of selecting residency applicants.
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Affiliation(s)
- David B Thordarson
- Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA.
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Abstract
Women and underrepresented minorities make up smaller proportions of orthopaedic residency programs than their numbers in medical school would predict, according to our evaluation of self-reported orthopaedic residency data from 1998 and 2001, as well as information on medical students published in 2002. Based on race, ethnicity, and sex, comparisons were made between students entering and graduating from medical school and those in orthopaedic residency programs. With few exceptions, the percentages of women and underrepresented minorities were statistically significantly lower among those training in orthopaedic residency programs compared with those same groups entering and graduating from medical school. The percentage of women and minorities in orthopaedic residency programs remained constant between 1998 and 2001. Further study is necessary to determine whether fewer students of color and women apply to orthopaedic residency programs because of lack of interest, lack of appropriate mentoring and role models, or other factors.
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Eidt JF, Chaikof E, Sidawy AN. Characteristics of the applicant pool to vascular surgery residency programs. J Vasc Surg 2005; 42:519-23. [PMID: 16171600 DOI: 10.1016/j.jvs.2005.05.011] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2005] [Accepted: 05/01/2005] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Based on the significant number of unfilled vascular fellowship positions in the 2004 National Residency Matching Program (NRMP) and the perception of program directors that the quality of candidates is deteriorating, the Issues Committee of the Association of Program Directors in Vascular Surgery (APDVS) explored the characteristics and the trend of the applicant pool to develop recommendations for improvement. METHODS The Electronic Residency Application Service (ERAS) database was queried for the total number of applicants, medical school, gender, and age, among other characteristics. The vascular surgery applicant pool was compared to the applicant pool for general surgery; the applicant pool for all fellowship positions, including a variety of medical subspecialties; the applicant pool for all residency positions; and the applicant pool for colorectal surgery, the only other surgical subspecialty participating in ERAS in 2004. NRMP data was used prior to 2004. The chi(2) test was used for statistical analysis, with significance set at P < .05. RESULTS In the 2004 match for June 2005 positions, there were 100 applicants for 110 first-year vascular surgery positions in 90 programs. In 1989, there were 123 applicants for 56 positions in 49 programs. In 1989, 55% of vascular surgery applicants did not match; whereas in 2004, only 7% were unmatched. Although the overall number of vascular surgery applicants has remained relatively stable, the number of United States applicants has decreased from 89% in 1990 to 68% in 2004 (P < .01). There was a significant geographic variation: 34% of those in the applicant pool came from the state of New York, but 23 states did not contribute a single applicant to the pool. In addition, vascular surgery, like other fellowships, attracts fewer female applicants. CONCLUSIONS The data from the ERAS database support the impression held by many in the vascular surgery education community that the size of the applicant pool for vascular surgery fellowship positions has remained stagnant, while the number of positions has significantly increased. Strategies to increase the size and quality of the applicant pool are needed.
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Affiliation(s)
- John F Eidt
- University of Arkansas for Medical Sciences, 72205, USA.
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Bajaj G, Carmichael KD. What Attributes are Necessary to Be Selected for an Orthopaedic Surgery Residency Position: Perceptions of Faculty and Residents. South Med J 2004; 97:1179-85. [PMID: 15646754 DOI: 10.1097/01.smj.0000136233.60966.f2] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Orthopaedic surgery has an extremely competitive residency selection process. The authors discuss which attributes of an orthopaedic surgery residency applicant are the most important in obtaining a position. A comparison of applicants' opinions to those of faculty was also done. Anonymous questionnaires were filled out by orthopaedic surgery residency applicants and faculty orthopaedists at teaching institutions. The most important attributes to obtaining a residency were performance on a local rotation (externship), class rank, and interview performance according to faculty. Applicants thought performance on local rotation, United States Medical Licensing Examination Step 1 scores, and letters of recommendation were the three most important. Both groups ranked research participation, gender, and race as the three least important attributes.
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Affiliation(s)
- Gurpreet Bajaj
- University of Texas Medical Branch School of Medicine, Department of Orthopaedics and Rehabilitation, Galveston, TX, USA
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Bernstein AD, Jazrawi LM, Elbeshbeshy B, Della Valle CJ, Zuckerman JD. Orthopaedic resident-selection criteria. J Bone Joint Surg Am 2002; 84:2090-6. [PMID: 12429773 DOI: 10.2106/00004623-200211000-00026] [Citation(s) in RCA: 68] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Adam D Bernstein
- Department of Orthopedic Surgery, New York University Medical Center, Hospital for Joint Diseases Orthopaedic Institute, 301 East 17th Street, New York, NY 10003, USA.
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Affiliation(s)
- M A Simon
- Section of Orthopedic Surgery and Rehabilitation Medicine, The University of Chicago, Illinois 60637, USA
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