Current Trends in Orthopaedic Surgery Residency Applications and Match Rates

How Did Black and Hispanic Orthopaedic Applicants and Residents Compare to General Surgery Between 2015 and 2022?

BACKGROUND

Despite the heavy demand for and knowledge of the benefits of diversity, there is a persistent lack of racial, ethnic, and gender diversity in orthopaedic surgery. Since the implementation of diversity initiatives, data have shown that general surgery has been one of the top competitive surgical fields and has demonstrated growth in racial, ethnic, and gender diversity, making general surgery a good point of reference and comparison when analyzing racial and ethnic growth in orthopaedic surgery.

QUESTIONS/PURPOSES

(1) What were the growth rates for Black and Hispanic orthopaedic residency applicants and residents between 2015 and 2022? (2) How did the growth rates of Black and Hispanic individuals in orthopaedic surgery compare with those of general surgery? (3) How did applicant recruitment and resident acceptance differ between Black and Hispanic people in orthopaedic surgery?

METHODS

Applicant data were obtained from historical specialty-specific data from the Association of American Medical Colleges Electronic Residency Application Service Statistics database between 2018 and 2022, and resident data were obtained from the Accreditation Council of Graduate Medical Education Data Resource Book between 2015 and 2021. Between 2018 and 2022, the number of residency applicants totaled 216,677, with 17,912 Black residency applicants and 20,413 Hispanic residency applicants. Between 2015 and 2021, the number of active residents totaled 977,877, with 48,600 Black residents and 62,605 Hispanic residents. Because the applicant and resident data do not overlap throughout all years of observation, a sensitivity analysis of overlapping years (between 2018 and 2021) was conducted to ensure observed trends were consistent and valid throughout the study. All datasets obtained were used to establish the different racial and ethnic proportions of Black and Hispanic residency applicants and residents in four nonsurgical primary care specialties and four surgical subspecialties. A reference slope was created using data from the Association of American Medical Colleges and Accreditation Council of Graduate Medical Education to represent the growth rate for total residency applicants and residents, independently, across all residency specialties reported in each database. This slope was used for comparison among the resident and applicant growth rates for all eight selected specialties. Datapoints were placed into a scatterplot with regression lines, using slope equations to depict rate of growth and R2 values to depict linear fit. Applicant growth corresponded to applicant recruitment and resident growth corresponded to resident acceptance. Chi-square tests were used to compare residents and residency applicants for the Black and Hispanic populations, separately. Two-way analysis of variance with a time-by-specialty interaction term (F-test) was conducted to determine differences between growth slopes.

RESULTS

There was no difference in the growth rate of Black orthopaedic surgery applicants between 2018 and 2022, and there was no difference in the growth rate of Hispanic orthopaedic surgery applicants (R2 = 0.43; p = 0.23 and R2 = 0.63; p = 0.11, respectively). However, there was a very slight increase in the growth rate of Black orthopaedic surgery residents between 2015 and 2021, and a very slight increase in the growth rate of Hispanic orthopaedic surgery residents (R2 = 0.73; p = 0.02 and R2 = 0.79; p = 0.01, respectively). There were no differences in orthopaedic and general surgery rates of growth for Black applicants between 2018 and 2022 (0.004 applicants/year versus -0.001 applicants/year; p = 0.22), and no differences were found in orthopaedic and general surgery rates of growth for Black residents between 2015 and 2021 (0.003 residents/year versus 0.002 residents/year; p = 0.59). Likewise, Hispanic orthopaedic applicant growth rates did not differ between 2018 and 2022 from the rates of general surgery (0.004 applicants/year versus 0.005 applicants/year; p = 0.68), and there were no differences in orthopaedic and general surgery rates of growth for Hispanic residents (0.007 residents/year versus 0.01 residents/year; p = 0.35). Furthermore, growth rate comparisons between Black orthopaedic applicants and residents between 2018 and 2021 showed applicant growth was larger than resident growth, illustrating that the recruitment of Black applicants increased slightly more rapidly than resident acceptance. Growth rate comparisons between Hispanic applicants and residents showed a larger rate of resident growth, illustrating Hispanic resident acceptance increased slightly faster than applicant recruitment during that time.

CONCLUSION

We found low acceptance of Black residents compared with the higher recruitment of Black applicants, as well as overall low proportions of Black and Hispanic applicants and residents. Future studies might explore the factors contributing to the higher acceptances of Hispanic orthopaedic residents than Black orthopaedic residents.

CLINICAL RELEVANCE

We recommend that more emphasis should be placed on increasing Black and Hispanic representation at the department level to ensure cultural considerations remain at the forefront of applicant recruitment. Internal or external reviews of residency selection processes should be considered, and more immersive, longitudinal orthopaedic surgery clerkships and research mentorship experiences should be targeted toward Black and Hispanic students. Holistic reviews of applications and selection processes should be implemented to produce an increased racially and ethnically diverse applicant pool and a diverse residency work force, and implicit bias training should be implemented to address potential biases and diversity barriers that are present in residency programs and leadership.

Identification of Factors Associated with Orthopaedic Surgery Residency Programs That Preferentially Match Students Who Performed an Elective Rotation Before the Interview Process

Introduction

The role of elective rotations in the orthopaedic residency selection process varies between programs. Our study aims to identify factors associated with residency programs that interview and match a greater proportion of applicants who have completed an elective rotation with their program.

Methods

Data were collected through the American Orthopaedic Association's Orthopaedic Residency Information Network database. Bivariate correlations and multivariate regression models were used to identify independent predictors of programs with a greater proportion of interviewees or residents who completed an elective rotation at the respective program.

Results

One hundred seventy-eight of the 218 existing residency programs were included in this study. Programs that offered fewer interviews and more away rotation positions per year were associated with a greater odds of its interviewees (OR = 0.36, p = 0.01; OR = 4.55, p < 0.001, respectively) and residents (OR = 0.44, p = 0.04; OR = 4.23, p < 0.001, respectively) having completed an elective rotation with the program. In addition, programs with fewer attendings (OR = 0.39, p = 0.03) and in-person interviews (OR = 3.04, p = 0.04) matched a greater proportion of their rotators. However, programs that interviewed applicants during the elective rotation were less likely to match their rotators (OR = 0.35, p = 0.04).

Conclusion

Certain program characteristics independently predict the likelihood of a program interviewing and matching their rotators. These findings may provide information for applicants and programs regarding the rotation process.

Level of Evidence

III.

Osteopathic Students Have Decreased Match Rates in Orthopaedic Surgery Compared with Allopathic Students

Introduction

Orthopaedic surgery continues to be one of the most competitive specialties to match into as a medical student, particularly for osteopathic medical students. Therefore, in this study, we sought to examine the prevalence of osteopathic students (DO) matching into orthopaedic surgery at traditional Accreditation Council for Graduate Medical Education (ACGME) accredited programs (former allopathic residency programs) in recent years.

Methods

A retrospective review of National Residency Match Program annual reports and Association of American Medical Colleges's Electronic Residency Application Service Statistic reports were performed to determine the number of applications and match rates among osteopathic (DO) and allopathic (MD) medical students into orthopaedic surgery from 2019 to 2023. Data on the degree type of current residents at all ACGME-accredited residency programs were identified.

Results

During the analyzed study period of 2019 to 2023, there were 3,473 (74.5%) allopathic students and 571 (59.9%) osteopathic students who successfully matched into orthopaedic surgery. This match rate for allopathic students was 74.5% compared with 59.9% for osteopathic students. Of the 3,506 medical students who hold postgraduate orthopaedic surgery positions at former allopathic programs over the past 5 years, only 58 (1.7%) hold an osteopathic degree. Of the 560 medical students who hold postgraduate orthopaedic surgery positions at former osteopathic programs over the past 5 years, 47 (8.4%) hold an allopathic degree. The match rate of allopathic students at former osteopathic programs is significantly higher than the match rate of osteopathic students at former allopathic programs.

Conclusions

Osteopathic students continue to match into orthopaedic surgery at lower rates than their allopathic counterparts. In addition, there remains a consistent and low number of osteopathic students matching into former allopathic programs. Allopathic students also have a higher likelihood of matching into former osteopathic programs when compared with osteopathic students matching into previous allopathic orthopaedic surgery programs.

Understanding the Match: The Effect of Signaling, Demographics, and Applicant Characteristics on Match Success in the Orthopaedic Residency Application Process

INTRODUCTION

As of the 2022 to 2023 match cycle, orthopaedic residency programs began offering applicants 30 signals as part of a preference signaling program. Many have assumed that signals would become powerful tools in the match process, yet no objective data currently exist analyzing their effect. This study aims to provide such analysis while also offering comparisons with other factors affecting match success.

METHODS

Self-reported survey data on applicants and applications from 2017 to 2023 from the Texas Seeking Transparency in Application to Residency database were queried. Variables associated with receiving interviews and match success were analyzed using two-sided Student t -tests, chi-squared tests, variance ratio testing, and receiver operating characteristic analysis.

RESULTS

Compared with 2017 to 2022, 2023 applicants submitted fewer applications (61.8 versus 78; P < 0.001), received fewer interview offers (11.6 versus 13.8; P < 0.001), and interview offers were spread more evenly among applicants (SD, 6.82 versus 9.10; P < 0.001). For 2023 applications, odds of securing an interview were increased most by away rotations (odds ratios [OR] 61.8; P < 0.001), use of a signal (OR, 9.61; P < 0.001), and geographic connection (OR, 4.70; P < 0.001). Female applicants received more interview offers from signaled programs than their male counterparts (11.2 versus 8.94; P = 0.003). Applicant variables most predictive of match success in 2023 were interview offers (area under the receiver operating characteristic curve [AUC] = 0.802), step 2 CK score (AUC = 0.673), and step 1 score (AUC = 0.648).

DISCUSSION

The preference signaling program seems to be accomplishing its goals of reducing applications and more evenly distributing interviews. Away rotations, signals, and geographic connections represent the strongest predictors of applications resulting in a successful match. Applicants must use their signals carefully to maximize their chance of success.

LEVEL OF EVIDENCE

Level III.

Preference Signaling Survey of Program Directors-After the Match

INTRODUCTION

The 2022 to 2023 orthopaedic residency cycle implemented a preference signaling program (PSP), allowing applicants to send "signals" to up to 30 programs to demonstrate their genuine interest. With the conclusion of the 2022 to 2023 cycle, the primary purpose of this study was to analyze program director (PD) perceptions of the PSP after the match cycle and provide a retrospective evaluation of the effects of the PSP on the orthopaedic resident selection process.

METHODS

A 21-question survey was distributed to 98 PDs (32.7% response rate). Contact information was obtained from a national database.

RESULTS

Most respondents (96.9%) participated in the American Orthopaedic Association's PSP. The majority (93.7%) view preference signaling as a positive change. Most PDs (56.2%) reported a decreased number in applications received compared with previous years. Receiving a preference signal was ranked among the most important factors in resident selection, and most PDs agreed that preference signaling should be used to screen applicants (84.4%) and differentiate similar applicants (96.8%). Moreover, 65.6% of PDs indicated that they would not rank or invite applicants to interview without a signal or completion of a formal away rotation. PDs report that in the 2022 to 2023 cycle, 98.5% of applicants who matched at their program had sent a preference signal.

DISCUSSION

Preference signaling was one of the most important factors assessed during its inaugural application cycle and is anticipated to remain a key tool for screening and differentiating candidates. Applicants should strategically select signal recipients to enhance their success in the match.

Barriers to Entry: Socioeconomic Discrepancies Between Unmatched First-Time Applicants and Reapplicants in the Field of Orthopaedic Surgery

INTRODUCTION

Orthopaedic surgery remains a competitive surgical subspecialty with more applicants than spots each year. As a result, numerous students fail to match into these competitive positions each year with a growing number of reapplicants in consecutive application cycles. We sought to understand the socioeconomic factors at play between this growing reapplicant pool compared with first-time applicants to better understand potential discrepancies between these groups. Our hypothesis is that reapplicants would have higher socioeconomic status and have less underrepresented minority representation compared with successful first-time applicants.

METHODS

A retrospective review of deidentified individual orthopaedic surgery applicant data from the American Association of Medical Colleges was reviewed from 2011 to 2021. Individual demographic and application data as well as self-reported socioeconomic and parental data were analyzed using descriptive and advanced statistics.

RESULTS

Of the 12,112 applicants included in this data set, 77% were first-time applicants (61% versus 17% successfully entered into an orthopaedic surgery residency vs versus unmatched, respectively), whereas 22% were reapplicants. In successful first-time applicants, 12% identified as underrepresented minorities in medicine. The proportion of underrepresented minorities was significantly higher among unmatched first-time applicants (20%) and reapplicants (25%) ( P < 0.001). Reapplicants (mean = $83,364) and unmatched first-time applicants (mean = $80,174) had less medical school debt compared with first time applicants (mean = $101,663) ( P < 0.001). More than 21% of reapplicants were found to have parents in healthcare fields, whereas only 16% of successful first-time applicants and 15% of unsuccessful first-applicants had parents in health care ( P < 0.001).

CONCLUSIONS

Reapplicants to orthopaedic surgery residency have less educational debt and are more likely to have parental figures in a healthcare field compared with first-time applicants. This suggests the discrepancies in socioeconomic status between reapplicants and first-time applicants and the importance of providing resources for reapplicants.

Perceptions of Preference Signaling in Orthopaedic Surgery: A Survey of Applicants and Program Directors

INTRODUCTION

To improve transparency between candidates and training programs, a preference signaling program (PSP) was implemented before the 2022 to 2023 orthopaedic surgery match. The PSP allows applicants to 'signal' up to 30 programs, informing the program of the applicant's particular interest in interviewing for their available position(s). This study reports the perspectives of orthopaedic surgery residency applicants and program directors (PDs) on the effects of preference signaling on the orthopaedic match.

METHODS

Electronic surveys were distributed to PDs and applicants.

RESULTS

Almost all programs participated in the PSP (90%), and most of the applicants (97.6%) used 25 to 30 of their allotted preference signals. Most of the applicants (67.2%) thought that their likelihood of obtaining an interview was improved at 'signaled' programs but decreased at programs without a 'signal' designation (85.3%). Both applicants and PDs considered preference signaling to be one of the three most important factors for interview selection, along with Step 2 CK score and letters of recommendation. The applicants did not think that their likelihood of matching would improve with fewer allotted signaling tokens (35.2%), and 55.2% of PDs believed 21 to 30 tokens were optimal.

CONCLUSION

Preference signaling is highly regarded by applicants and PDs. Signaling a program will likely improve an applicant's chance to interview. The optimal number of signaling tokens remains unknown, although both groups favored a larger allotment of tokens than has been seen in other specialties. Universal guidelines and recommendations for applicants and PDs would improve the utility of preference signaling.

Contemporary Trends in the Orthopaedic Surgery Residency Match and the Effects of COVID-19

Objective

We aimed to elucidate associations between geographic location, size, and ranking of medical schools that orthopaedic surgery residents graduate from and the residencies that they match both pre-COVID-19 and post-COVID-19 pandemic by examining the 2017 to 2022 orthopaedic surgery residency cohorts.

Methods

Demographics were extracted using Doximity Residency Navigator platform, the 2021 US News and World Report, and program websites. Medical schools were classified as large if they had >613 medical students. Postgraduate year 1 (PGY-1) (2021 match) and PGY-2 (2022 match) residents were classified as the COVID-19 cohort. Location was categorized as Northeast, Midwest, South, and West. Chi-square tests, Cohen's H value, and descriptive statistics were used for analysis with statistical significance set at p <0.05.

Results

Four thousand two hundred forty-three residents from 160 accredited US orthopaedic residency programs (78.4%) were included. Northeastern applicants were most likely to match in the same region (p <0.01), and southern applicants were most likely to match at their home program (p <0.001). Applicants affected by the COVID-19 pandemic did not differ from their predecessors with regards to matching to the same region (p = 0.637) or home program (p = 0.489). Applicants from public medical schools were more likely to match in the same region and at their home program (p <0.001), whereas those from private medical schools were more likely to match at top-ranked residencies (p <0.001). Students from both top 25- and top 50-ranked medical schools were more likely to match at their home program (p <0.01) and attend top 20-ranked residency programs (p <0.0001).

Conclusion

These results demonstrate significant associations between matched residencies and attended medical schools' geographic location, school type, and ranking. During the pandemic, geographic trends were overall unchanged, whereas residents from large or lower-ranked schools were more likely to match at home programs, and those from private or top-ranked schools were less likely to attend top residencies.

The Utility of the Standardized Letter of Recommendation for Orthopedic Surgery Residency Applicants: A Systematic Review

Despite widespread adoption for evaluating residency candidates, few studies have evaluated the orthopedic standardized letter of recommendation (SLOR). A systematic review using PubMed, Embase, and Web of Science was performed in June 2022. Study design and results from SLOR investigations were compiled. Common outcomes studied were summative rank statement scores and SLOR individual domains. Applicants were rated ranked to match or in the top one-third of rank lists in non-normally distributed frequencies. The association of summative rank statement score with match outcome was rarely studied. Applicants' ratings skew positively, the utility is reportedly limited, and influence on match outcome has been inadequately studied. [Orthopedics. 2024;47(1):e1-e5.].

Rapidly Increasing Number and Cost of Residency Applications in Surgery

BACKGROUND

Surgical specialties represent the most competitive residency positions to obtain, and applicants for these spots may apply to increasingly more programs in an attempt to match. We describe trends in residency applications across all surgical specialties from 2017 to 2021 application cycles.

MATERIALS AND METHODS

This review of the 2017, 2018, 2019, 2020, and 2021 surgical residency application cycles used the American Association of Medical Colleges' Electronic Residency Application Service (ERAS) databases. Data from a total of 72,171 applicants to United States surgical residencies during the study's time period were included. The 2021 ERAS fee schedule was used to calculate the cost of applications.

RESULTS

The number of applicants across the study interval remains unchanged. Trends suggest more women and underrepresented minorities in medicine are applying to surgical residencies today compared to 5 years ago. The mean number of applications per applicant increased 32.0% from 39.3 in 2017 to 51.8 in 2021, resulting in an increased application fee cost of $329 per applicant. Mean total cost for application fees alone in 2021 were $1211 per applicant. In 2021, the cost of applying to surgical residency for all applicants was over $26 million, a nearly $8 million increase from 2017.

CONCLUSIONS

There has been an increase in the number of applications per applicant in the past 5 residency application cycles. Increased applications create barriers and burdens for applicants, and residency program personnel. These rapid increases are unsustainable and require intervention, although a viable solution has yet to be elucidated.

Academic Faculty Demonstrate Weak Agreement in Evaluating Orthopaedic Surgery Residents

Background

As objective metrics fade, subjective elements of orthopaedic surgery applicants carry increasing importance during recruitment. Academic orthopaedic surgeons believe they can select for high-performing orthopaedic residents. However, can they agree? The purpose of this study was (1) to analyze an academic orthopaedic surgery department to determine whether they agree on which residents performed best during residency and; (2) to correlate preresidency and intraresidency factors with postresidency evaluations of resident performance.

Methods

With Institutional Review Board [IRB] approval, an orthopaedic surgery department completed surveys to evaluate residency performance for 10 years of graduated residents (2012-2022). Faculty determined (1) Post-Residency Class Rank (PRCR)-ranked from the highest (1) to lowest performing resident (5) relative to their class based on faculty perspective of performance-and (2) Rank List Score (RLS)-ranked based off the 5-point AOA SLOR used during recruitment interviews. RLS assessed how likely the department would have graduates in the program again based on residency performance. Free marginal Cohen's kappa statistics assessed faculty inter-rater agreement. Preresidency metrics (United States Medical Licensing Exam [USMLE] 1 and 2 scores, research publications, etc) were correlated with Orthopaedic In-Training Exam (OITE) scores, research productivity, American Board of Orthopaedic Surgery (ABOS) scores, and faculty-derived rankings. Linear regressions with forward variable entry (p < 0.05) were used to determine factors associated with excellent resident performance.

Results

Eighteen of 25 faculty members (72%) provided survey responses evaluating 46 residents. Faculty agreed 37% and 38% of the time for PRCR (kappa 0.26) and RLS (kappa 0.23), respectively. Step 2 score was the only preresidency factor significantly associated with PRCR (p = 0.03, r2 = 0.15) and RLS (p = 0.02, r2 = 0.3). The only intraresidency factor significantly correlated with PRCR (p = 0.002, r2 = 0.50) and RLS (p = 0.01, r2 = 0.39) was PGY-4 OITE score.

Conclusions

An academic orthopaedic surgery department is able to come to a consensus on evaluations of residency performance relative to peers in the same year of training (PRCR) and an objective standard (RLS). Step 2 and Post-Graduate Year (PGY)-4 OITE scores were the only preresidency and intraresidency factors with significant association to higher postresidency, faculty-derived performance scores.

Level of Evidence

III.

Education Research in Orthopaedic Surgery

With the ever-changing dynamics of surgical training, it is essential for the content of educational research to evolve simultaneously. This study aimed to assess the current state of scholarly work in orthopaedic training education and to identify particular educational topics that are trending in the literature.

Differences in the Academic Attributes of Matched and Unmatched Orthopaedic Surgery Residency Applicants are Narrowing

Orthopaedic surgery remains one of the most competitive residency specialties, with the number of applicants outpacing the availability of residency positions each year. The purpose of this study was to analyze present-day orthopaedic surgery match data, identify differences between matched and unmatched applicants, and compare our findings to previous trends.

Methods

Applicant data from the National Resident Matching Program from 2016 to 2022 were analyzed. The number of matched and unmatched US allopathic senior orthopaedic applicants relative to the number of available positions was used to determine respective match rates. Performance metrics and applicant characteristics were compared by match status. Trends were compared with those of previous analysis from 2006 to 2014.

Results

The number of applicants increased from 863 in 2016 to 1,068 in 2022. The match rate decreased from 75% in 2016 to 66% in 2022 (p < 0.0001). Matched applicants had a higher number of contiguous ranks (12.3 vs. 6.5; p < 0.001), United States Medical Licensing Examination (USMLE) Step-1 score (248 vs. 240; p < 0.001), USMLE Step-2 score (255 vs. 247; p < 0.001), Alpha Omega Alpha (AOA) membership (38% vs. 13%; p < 0.001), and enrollment at a top 40 National Institutes of Health (NIH)-funded medical school (34% vs. 24%, p < 0.001). Compared with 2006 to 2014 data, a smaller percentage of matched applicants were enrolled in a top 40 NIH-funded medical school (34% vs. 37%, p = 0.013). The mean differences in USMLE Step-1 score (16 vs. 8.25 points, p < 0.001) and USMLE Step-2 score (16 vs. 8.25 points, p = 0.002) in favor of matched applicants nearly halved compared with that in 2006 to 2014. In addition, there was no longer a significant difference in the number of research products (abstracts, presentations, posters, and publications) between matched and unmatched applicants (p = 0.309).

Conclusions

Differences in the academic attributes of matched and unmatched orthopaedic surgery applicants have become less profound over time, making it increasingly difficult to predict a successful match based on USMLE Step scores, AOA membership, research productivity, and medical school research reputation. Future studies should evaluate differences in subjective metrics (e.g., away rotation and interview performance and letters of recommendation) by match status.

Residency Match Rates in Orthopaedic Surgery Based on Sex, Under-Represented in Medicine Status, and Degree Type

Orthopaedic surgery is well recognized as one of the most competitive and least diverse medical specialties. Despite efforts toward improving diversity, studies have shown that gender and racial/ethnic disparities continue to persist in orthopaedic graduate medical education. Therefore, we sought to identify the match rates of traditionally under-represented groups within orthopaedic surgery—female candidates, racial and ethnic minorities under-represented in medicine (URiM), and osteopathic physicians—compared with their application rates.

Predictors of Academic Productivity Among Spine Surgeons

INTRODUCTION

The relationship between research productivity in training and future productivity as an attending spine surgeon is not well-established in the literature nor has the effect of geographic location of training institutions on future academic success been investigated. The aim of our study was to (1) summarize characteristics of academically productive spine surgeons, (2) assess predictors of long-term academic productivity, and (3) establish the effect of geographic location on long-term academic productivity.

METHODS

A query was conducted of the 2021 to 2022 North American Spine Society Spine Fellowship Directory of all orthopaedic and neurosurgical spine fellowship selection committee members for each institution participating in the spine fellowship match. The attending publication rate and h-index were determined. A multivariate linear regression model was developed. P value was set to <0.05.

RESULTS

We identified 310 orthopaedic and neurosurgical spine surgeons, representing 76 fellowship programs. Multivariate linear regression analysis identified that the publications during residency (P < 0.001) and during fellowship (P < 0.001) were significant predictors of an increased publication rate as an attending surgeon. By contrast, the preresidency publication rate (P = 0.729) was not significantly predictive of the attending publication rate. Multivariate analysis of h-index found that residency publication rate had a positive correlation (P = 0.031) compared with preresidency (P = 0.579) or fellowship (P = 0.257) rates. Attendings who had attended residency in the Northeast and currently practicing in the Northeast had a higher publication rate (P < 0.001 and P = 0.004, respectively).

DISCUSSION

A higher number of publications in residency and fellowship were markedly predictive of an increased publication rate as an attending spine surgeon. By contrast, preresidency publications may not be indicative of future academic productivity as an attending. Location may also contribute to attending publication rate and favor those who undergo residency training and ultimately practice in the Northeast.

The Student You Know: Orthopedic Surgery Home Program Match Rates and Geographic Relationships Before and After COVID-19

OBJECTIVE

In March 2020, COVID-19 was declared a pandemic by the World Health Organization. This led to the outright cancellation of away rotations and in person residency interviews for the class of 2021. This study aims to identify the geographic relationships in the orthopedic match and further explore COVID-19's effect on these geographic relationships. Furthermore, we aim to compare the home program match rates before and after COVID-19.

SETTING

Southern Illinois University School of Medicine, Department of Orthopedic Surgery (tertiary, university-based).

DESIGN AND PARTICIPANTS

Residency websites and social media sites were used to record basic residency information as well as each resident's year, matriculated medical school, and matriculated medical school geographic data. This information was used to evaluate the proportion of orthopedic residents from "home program" medical schools and evaluate the geographic relationship of matched orthopedic residents. 202 Orthopedic residencies were initially identified and 134 allopathic and nonmilitary residency programs met the inclusion criteria. In all, 3253 of the 3931 (82.7%) current U.S orthopedic residents were included in the analysis.

RESULTS

In the 4 orthopedic surgery residency classes before the pandemic (2017-2020), 21.8% of residency slots were filled by home program students. During the pandemic match cycle (2021), this number jumped to 28.2% (p < 0.0006). The increase was observed consistently across residency subgroup analysis: class size, doximity rank, and doximity research rank. Correspondingly, there was a statistically significant increase from 34.7% (2017-2020) to 39.3% (2021) (p = 0.0318) in residencies matching with same state medical students. Regional trends stayed consistent. Our study showed that residency programs matched applicants who went to same region medical schools during the 2020 to 2021 cycle at nearly the exact same rate as they did pre-pandemic (63.6%, up from 63.3%).

CONCLUSIONS

Our study demonstrates that despite widespread virtual away rotations and virtual open houses, residency programs showed an increased preference for their home program students. This trend was significant and widespread, highlighting the generalized nationwide hesitation of both residency programs and students on the virtual interview process.

Which Application Factors Are Associated With Outstanding Performance in Orthopaedic Surgery Residency?

BACKGROUND

Identifying ideal candidates for orthopaedic surgery residency is difficult. Data available for applicant selection are evolving; preclinical grades and the Alpha Omega Alpha (AOA) honors society are being phased out at some medical schools. Similarly, three-digit United States Medical Licensing Examination (USMLE) Step 1 scores have been eliminated. There is renewed interest in improving resident selection to provide a diverse, comprehensive educational opportunity that produces orthopaedic surgeons who are prepared for practice.

QUESTIONS/PURPOSES

We sought to identify whether (1) academic achievements, (2) letters of recommendation, (3) research activity, and (4) miscellaneous factors available on Electronic Residency Application Service (ERAS) applications were associated with outstanding residency performance.

METHODS

Ten faculty members (22% of all full-time faculty) with extensive educational involvement for at least 7 years, whose expertise covered all subspecialty departments at an urban, academic orthopaedic surgery residency program, were given an anonymous survey on the performance of the four most recent classes of residency graduates (24 residents). This survey was developed due to the lack of a validated residency outcomes tool or objective metrics for residency performance. The evaluated criteria were decided upon after discussion by a relatively large group of academic orthopaedic surgeons considering the factors most important for graduating orthopaedic residents. The faculty were selected based on their long-term knowledge of the residency, along with their diversity of specialty and backgrounds; there were no nonresponders. Faculty graded each resident on a scale from 1 to 10 (higher is better) on six criteria: surgical technical skills, research productivity, clinical knowledge, professionalism, personality, and fellowship match. The mean of the faculty ratings made by all faculty for all six criteria was calculated, producing the overall residency performance score. Factors available on each resident's ERAS application were then correlated with their overall residency performance score. Categorical ERAS factors, including AOA status, five or more honors in core clerkships, at least three exceptional letters of recommendation, collegiate athletics participation, expertise with a musical instrument, and research (6-year) track residents, were correlated with overall residency performance score via point biserial analysis. Continuous ERAS factors including USMLE Step 1 and Step 2 scores, number of publications before residency, number of research years before residency, medical school ranking, and number of volunteer experiences were correlated with overall residency performance score via Pearson correlation. USMLE Step 1 three-digit scores were evaluated despite their recent elimination because of their historic importance as a screening tool for residency interviews and for comparison to USMLE Step 2, which retains a three-digit score. Application factors with a p < 0.2 on univariate analysis (five or more honors in core clerkships, at least three exceptional letters of recommendation, research track residents) were included in a stepwise linear regression model with "overall residency performance score" as the outcome variable. All p values < 0.05 were considered significant.

RESULTS

The mean overall residency performance score was 7.9 ± 1.2. Applicants with at least five honors grades in core clerkships had overall residency performance scores 1.2 points greater than those of their peers (95% confidence interval (CI) 0.3 to 2.0; p = 0.01, Cohen ƒ 2 = 0.2, representing a small effect size). ERAS applications including at least three exceptional letters of recommendation were associated with a 0.9-point increase in residency performance (95% CI 0.02 to 1.7; p = 0.046, Cohen ƒ 2 = 0.1, representing a small effect size). Participation in the residency research (6-year) track was associated with a 1-point improvement in residency performance (95% CI 0.1 to 1.9; p = 0.03, Cohen ƒ 2 = 0.2, again, representing a small effect size). Together, these three factors accounted for 53% of the variance in overall residency performance score observed in this study.

CONCLUSION

Past clinical excellence, measured by core clerkship grades and exceptional letters of recommendation, is associated with slightly improved overall orthopaedic residency performance scores. Applicants meeting both criteria who also complete a research track residency may perform substantially better in residency than their counterparts, as these three factors accounted for half of all the variance observed in the current study. Although minimum requirements are necessary, traditionally used screening factors (such as USMLE scores, AOA status, medical school rank, and number of publications) may be of less utility in identifying successful future residents than previously thought.

LEVEL OF EVIDENCE

Level III, therapeutic study.

Preference-Signaling During the Orthopaedic Surgery Residency Application Process

The orthopaedic surgery residency selection process has grown more competitive over recent years, with programs receiving an unprecedented number of applications. As an effort to target applications to programs of interest, the American Orthopaedic Association has announced the introduction of a formal preference-signaling program into the 2022 to 2023 orthopaedic surgery residency selection cycle. This system will allow applicants to assign "signals" to a total of 30 programs. The purpose of this article was to (1) discuss implications of the new preference-signaling program, (2) introduce the framework of the "strategic signaling spear" for applicants to conceptualize the power of all methods of preference-signaling to improve their odds of matching, and (3) describe the role of strong mentorship at all stages of the residency application process.

Correlations Between Department and Training Program Online Presence and Women in Orthopedic Surgery Training

Background

Orthopedic residency programs increasingly use websites and social media to reach students. This accelerated during the COVID-19 pandemic, especially as away rotations became limited. Women remain a minority of orthopedic residents, and there are no data that indicate the correlation between department/program website content or social media presence on the gender diversity of residency classes.

Methods

Orthopedic department websites were assessed between June 2021 and January 2022 to identify program director's gender, as well as the gender composition of the faculty and residents. Instagram presence for the department and/or program was also identified.

Results

There was no correlation found between the residency program director's gender and the gender diversity of residents in a given program. The percentage of women faculty identified on a department website was significantly correlated with the percentage of women residents in the program, regardless of the program director's gender. While there was an increase in the percentage of women residents among programs with Instagram accounts for the class that started in 2021, this was negated when the percentage of women faculty was taken into account.

Conclusion

Efforts on multiple fronts will be needed to increase the number and percentage of women applying for and training in orthopedic surgery. Given the increasing use of digital media, we need a better understanding of what information, including faculty gender diversity, can be conveyed through this format that is useful for women medical students interested in orthopedic surgery to address their concerns about the field.

Evaluating Databases With Orthopaedic Surgery Residency Program Information

INTRODUCTION

Orthopaedic surgery residency applicants submit more applications than ever before. While this issue is multifactorial, increased information and transparency regarding residency programs are important. This study aimed to evaluate the completeness and variability of the information that is currently available regarding orthopaedic residency programs on two publicly available databases, the Fellowship and Residency Electronic Interactive Database (FREIDA) and the newly created Orthopaedic Residency Information Network (ORIN).

METHODS

Orthopaedic surgery residency programs were identified and evaluated using FREIDA and ORIN on September 11, 2021. Information on the FRIEDA and ORIN databases were evaluated in the following categories: program overview, the residency application, and education information. Univariate statistical analysis was performed on the data.

RESULTS

Of the 194 programs that participated in the FREIDA database, over 48% failed to include basic program information including resident demographics and key application information including USMLE Step requirements. Of the 141 programs that participated in the ORIN database, most the programs did not report USMLE Step median and cutoff scores and clerkship grades. Depending on the database and type of information, factors including the program's National Institutes of Health funding, reputation, size, and type were associated with the availability of information.

CONCLUSION

This study showed that while most orthopaedic surgery residency programs participate in FREIDA and ORIN, the information included was highly variable and incomplete for nearly all programs. Improving the completeness of information in these databases has the potential to allow students to make more informed application decisions.

Perspectives of Orthopedic Surgery Program Directors on the USMLE Step 1 Scoring Change

The orthopedic surgery residency application process is highly competitive, and residency programs rely on objective measures, such as the United States Medical Licensing Examination (USMLE) Step 1 score, to assist in applicant selection. To deemphasize standardized test scores and improve student well-being, governing bodies have elected to change the Step 1 examination to a pass/fail grading system beginning in 2022. Given the utility of Step 1 in the orthopedic surgery residency application process, this change will significantly affect how applicants are assessed. To determine how this change will affect the process, we developed and validated a 19-item anonymous electronic survey and invited program directors (PDs) from orthopedic surgery residency programs accredited by the Accreditation Council for Graduate Medical Education to respond. The 86 surveys that were completed represented a 43.2% response rate (86 of 199). Only 4.7% of orthopedic surgery PDs believe that this change is a good idea, and 91.7% of PDs believe that the change will make it more difficult to compare applicants objectively. In addition, 90.7% of PDs report that they will increase emphasis on the Step 2 CK (clinical knowledge) examination in comparing residency applicants for their program, with 90.4% of PDs reporting that they will require students to submit their Step 2 scores via the Electronic Residency Application Service. These results indicate that changing the Step 1 scoring to pass/fail is unpopular among orthopedic surgery PDs. Further, losing the numeric Step 1 score will increase reliance on Step 2 scores and emphasis on less objective measures, such as where an applicant attended medical school. [Orthopedics. 2022;45(5):e257-e262.].

Exploring Match Space: How Medical School and Specialty Characteristics Affect Residency Match Geography in the United States

PURPOSE

To explore how school and specialty characteristics impact the geographic match location of U.S. senior medical students.

METHOD

The authors collected student match data between 2018 and 2020 from U.S. MD-granting medical schools and calculated the distance between students' medical schools and residency training programs. They use the term "match space" to describe this distance. Match space was codified on a 5-point ordinal scale by where the student matched: 1 = home institution, 2 = home state, 3 = an adjacent state, 4 = the same or adjacent U.S. Census division (and not adjacent state), and 5 = skipped at least one U.S. Census division. Ordinal logistic regression correlated school and specialty characteristics with match space.

RESULTS

During the study period, 26,102 medical students, representing 66 medical schools from 28 states, matched in 23 specialties. Fifty-nine percent of students were from public institutions, and 27% of schools ranked in the top 40 of National Institutes of Health (NIH) research funding. The match space was higher for students graduating from private institutions (odds ratio [OR] 1.14; 95% confidence interval [CI], 1.06 to 1.22) and matching into more competitive specialties (OR 1.07; 95% CI, 1 to 1.14). The match space was lower for students graduating from top NIH-funded institutions (OR 0.89; 95% CI, 0.85 to 0.94) and from schools with a higher percentage of in-state matriculants (OR 0.75; 95% CI, 0.72 to 0.77).

CONCLUSIONS

School characteristics such as region, public/private designation, NIH funding, and percentage of in-state students were associated with residency match geography. Matching into more competitive specialties also showed a marginal increase in match distance. These findings suggest that a student's choice of specialty and medical school may impact subsequent geographic placement for residency training, which should be considered by students and residency programs alike.

Racial, Ethnic, and Gender Diversity in Academic Orthopaedic Surgery Leadership

BACKGROUND

Multiple investigations in the past 50 years have documented a lack of racial/ethnic and gender diversity in the orthopaedic surgery workforce when compared with other specialties. Studies in other industries suggest that diversification of leadership can help diversify the underlying workforce. This study investigates changes in racial/ethnic and gender diversity of orthopaedic surgery leadership from 2007 to 2019 and compares leadership diversity to that of other surgical and nonsurgical specialties, specifically in terms of chairpersons and program directors.

METHODS

Demographic data were collected from The Journal of the American Medical Association and the Association of American Medical Colleges. Aggregate data were utilized to determine the racial, ethnic, and gender composition of academic leadership for 8 surgical and nonsurgical specialties in 2007 and 2019. Comparative analysis was conducted to identify changes in diversity among chairpersons between the 2 years. Furthermore, current levels of diversity in orthopaedic leadership were compared with those of other specialties.

RESULTS

A comparative analysis of diversity among program directors revealed that orthopaedic surgery had significantly lower minority representation (20.5%) when compared with the nonsurgical specialties (adjusted p < 0.01 for all) and, with the exception of neurological surgery, had the lowest proportion of female program directors overall, at 9.0% (adjusted p < 0.001 for all). From 2007 to 2019, orthopaedic surgery experienced no change in minority representation among chairpersons (adjusted p = 0.73) but a significant increase in female representation among chairpersons, from 0.0% (0 of 102) to 4.1% (5 of 122) (adjusted p = 0.04). Lastly, a significant decrease in minority and female representation was observed when comparing the diversity of 2019 orthopaedic faculty to orthopaedic leadership in 2019/2020 (p < 0.05 for all).

CONCLUSIONS

Diversity in orthopaedic surgery leadership has improved on some key fronts, specifically in gender diversity among chairpersons. However, a significant decrease in minority and gender representation was observed between 2019 orthopaedic faculty and 2019/2020 orthopaedic leadership (p < 0.05), which was a trend shared by other specialties. These findings may suggest a more pervasive problem in diversity of medical leadership that is not only limited to orthopaedic surgery.

Analysis of Current Orthopedic Surgery Residents and Their Prior Medical Education: Does Medical School Ranking Matter in Orthopedic Surgery Match?

OBJECTIVE

The purpose of this study was to determine the strength of the association between medical school ranking and orthopedic surgery residency ranking using the current cohort of orthopedic surgery residents.

DESIGN

We obtained a list of accredited programs from Doximity for orthopedic surgery residency programs and U.S. News & World Report for medical schools. Each orthopedic surgery residency program webpage was evaluated for the presence of an orthopedic surgery residency roster. For each resident, the medical school attended, allopathic or osteopathic degree, and year of post-graduate training was recorded. Orthopedic surgery residency programs and medical schools were assigned to one of four tiers for each based on their respective ranking. Descriptive statistics, Chi squared tests and Pearson residuals were used to analyze the association of orthopedic surgery residency tier and medical school tier. Post-hoc pairwise comparisons were performed utilizing the Bonferroni correction to account for 16 tests, correcting the significance level to p = 0.003.

SETTING

187 orthopedic surgery residency program webpages.

PARTICIPANTS

4123 orthopedic surgery residents.

RESULTS

There was a significant association between medical school tier and orthopedic surgery residency tier (X² [9] = 1214.78, p < 0.001). The post-hoc residual values were statistically significant for 75% (12/16) of tests performed. The majority of Tier 1 orthopedic surgery residents 50.5% (800/1585) attended a Tier 1 medical school. The strongest positive association exists between Tier 1 medical students attending Tier 1 residencies (residual = 23.978, p < 0.001). The strongest negative association with Tier 4 residencies was with Tier 1 medical schools (residual= -15.656, p< 0.001).

CONCLUSIONS

Medical school ranking is an important consideration for prospective orthopedic surgery applicants and may become more important with less objective measures of academic performance such as United States Medical Licensing Examination Step 1.

LEVEL OF EVIDENCE

Observational.

Utility of Virtual Spine Neurosurgery Education for Medical Students

OBJECTIVE

Distance learning has become increasingly important to expand access to neurosurgical spine education. However, emerging online spine education initiatives have largely focused on residents, fellows, and surgeons in practice. We aimed to assess the utility of online neurosurgical spine education for medical students regarding career interests, knowledge, and technical skills.

METHODS

A survey assessing the demographics and effects of virtual spine education programming on the interests, knowledge, and technical skills was sent to attendees of several virtual spine lectures. The ratings were quantified using 7-point Likert scales.

RESULTS

A total of 36 responses were obtained, of which 15 (41.7%) were from first- or second-year medical students and 18 (50.0%) were from international students. Most respondents were interested in neurosurgery (n = 30; 80.3%), with smaller numbers interested in radiology (n = 3; 8.3%) and orthopedic surgery (n = 2; 5.6%). The rating of utility ranged from 5.69 ± 1.14 to 6.50 ± 0.81 for career, 5.83 ± 0.94 to 6.14 ± 0.80 for knowledge, and 5.22 ± 1.31 to 5.83 ± 1.06 for clinical skills. Of the 36 respondents, 26 (72.2%) preferred virtual neurosurgical spine education via intermixed lectures and interactive sessions. The most common themes regarding the utility of virtual spine education were radiology by 18 (50.0%), anatomy by 12 (33.3%), and case-based teaching by 8 (22.2%) respondents.

CONCLUSIONS

Virtual distance learning for neurosurgical spine education is beneficial for students by enabling career exploration and learning content and clinical skills. Although the overall benefit was lowest for clinical skills, virtual programming could serve as an adjunct to traditional in-person exposure. Distance learning could also provide an avenue to reduce disparities in medical student neurosurgical spine education locally and globally.

The Impact of COVID-19 on the Orthopaedic Surgery Residency Match

Introduction Matching into an orthopaedic surgery residency program presents a challenging accomplishment for applicants to achieve in any given year. Due to the profound changes to the application process caused by the coronavirus disease 2019 (COVID-19) pandemic it was theorized that there would be a change in the number of graduates matching close to their home medical school region, state, and program.

Methods Orthopaedic surgery residency program Web sites and social media accounts were accessed to elucidate current resident data, including graduates' medical school, and geographical location of their school. Chi-square analysis was performed to identify trends in current residents matching within their home program, state, and region associated with the 2021 orthopaedic match. These numbers were compared with previous year's successful applicants.

Results In 2021, a significant 4.4% (p=0.02) increase in successful matches within applicants' home states occurred (33.4% vs. 37.8%) and home programs (p<0.001) when compared with previous years (21.2% vs. 27.4%). However, in 2021, there was no significant change in home region matching (p=0.56) with 60% of successful matches occurring in home regions. This was statistically consistent with what was observed in previous years (61.4%).

Conclusion The COVID-19 pandemic was associated with restrictions in travel and interview options resulting in a significant increase in the number of orthopaedic applicants who matched into their home program, or at programs in their home state compared with previous years. Although no statistically significant regional change occurred during the 2021 match, it remains the leading predictor of where successful applicants will match. With many unknowns related to the upcoming match cycles it is important for applicants and programs to have a general idea of recent trends and outcomes to best focus their efforts, especially if diversity and minority inclusion are considered in highly competitive specialties like orthopaedic surgery.

Orthopaedic Surgery Residency Program Adherence to Universal Interview Offer Day Guidelines: A Retrospective Analysis

INTRODUCTION

The 2020 to 2021 application cycle was marked by structural changes due to the COVID-19 pandemic. Adaptations included the American Orthopaedic Association Council of Residency Program Directors recommendations for a universal interview offer day (UIOD), synchronizing applicant interview offer release. As a novel process within orthopaedics, there are limited data on the execution and effect of a UIOD. Study goals include determining (1) residency program adherence to the Council of Residency Program Directors UIOD guidelines during the 2020 to 2021 cycle, (2) how quickly programs filled available interviews, and (3) any difference in time from release to booking between applicants using edu and com e-mail domains.

METHODS

Orthopaedic residency programs and applicants using the Thalamus interview management software platform during the 2020 to 2021 residency application cycle were analyzed, representing 46 residency programs and 993 interviewees (22% and 77% of the national total, respectively).

RESULTS

Of the programs included in this study, 19 (41%) were strictly adherent to the UIOD and time, 14 (30%) were weakly adherent and sent out offers outside of the assigned time, and 13 (28%) were nonadherent and sent out offers on dates other than the UIOD. The average time to fill to 80% capacity was 26 ± 14 minutes (range 3 to 77 minutes) for the 33 programs that released on the UIOD. Applicants with edu e-mail domains scheduled their first interview an average of 1.8 minutes after those with com e-mail domains (14.8 versus 13.0 minutes, P < 0.05).

CONCLUSION

Despite more than 60% of the residency programs committing to participate, less than half of the programs that initially agreed to participate were strictly adherent to guidelines during the first UIOD in orthopaedic surgery. Although additional research is needed to analyze the unique, fully virtual 2020 to 2021 recruitment season, a phased or waved approach to the UIOD may improve the process for all stakeholders in future cycles.

LEVEL OF EVIDENCE

Level V.

COVID-19 Increased Residency Applications and How Virtual Interviews Impacted Applicants

Background

The number of residency applications submitted by medical students has risen at an alarming rate, causing increased cost of applications and subsequent interview travel. These both contribute to increased cost for medical students. In light of these concerns, specialty governing bodies have proposed ideas to fight these trends including, application limits, interview limits, using a preference signaling system, and continuing virtual interviews. During the Covid-19 pandemic, all residency interviews were performed virtually, essentially making travel expenses negligible. However, this created a new concern with regards to assessing program and applicant compatibility, as compared to in-person interactions and did nothing to combat the increases in application numbers. Therefore, we want to critically assess the effects of virtual interviews on number of applications submitted, number of interview invites received, and number of interviews attended. We also aim to analyze how applicants viewed the virtual process.

Methods

600 medical students were eligible to participate. 456 students from years 2018-2020 were eligible to be surveyed following the NRMP match. 144 students were eligible to be surveyed following 2021 NRMP match. The survey was distributed to medical school graduates just prior to graduation and asked how many programs each student applied to, how many interview invites they received, and how many interviews they attended. The 2021 survey also asked, “How did virtual interviews affect your interview experience?” The quantitative results were compared with student's t-test and qualitative results are presented below. 

Results

The average number of programs each applicant applied to increased from 35.4 to 47.7 (p-value=0.002) when residency interviews switched from in-person to virtual. However, interview invites received and interviews attended did not change (16.8 vs 16.3, p-value=0.91, 11.8 vs 12.7, p-value=0.18). There were 188 participants in the in-person interview group (response rate=41.2%) and 128 participants in the virtual interview group (response rate=83.3%). The standard deviation and range also increased for number of applications, number of interview invites received, and number of interviews attended. 

There were 123 responses to the free response question. 36 had a positive experience, 44 were neutral, 47 were negative. The positive themes included 15 noted less expenses, 18 noted more convenient/less time, and 18 were able to attend more interviews. Negative themes included, 38 noted difficulty assessing program fit, 19 wanted to see the program or city in person, eight had increased interest in home/local programs, six found it difficult to make connections or stand out. 

Conclusion

Sixty-three percent of students reported a positive or neutral experience with virtual interviews. Students applied to more programs when interviews were virtual, but did not receive more interview invites or attend more interviews. These results suggest that virtual interviews are sufficient to conduct residency interviews, however the number of applications continues to rise with no increase in the number interview invites received or number of interviews attended. The increase in the standard deviation and range for all three variables may point to some applicants being able to get more invites and attend more interviews leaving less available spots for other applicants. 

Current Trends of Research Productivity among Students Matching at Top Ophthalmology Programs

Importance San Francisco Match publishes no data on the research output of matched applicants to an ophthalmology residency.

Objective The aim of this study was to examine the temporal trends in publication volume by medical students who successfully matched into a top ophthalmology residency.

Methods This retrospective case series compared all residents in the top 30 ophthalmology residency programs from the class of 2022 and 2017. Publication volume from before September 15th of the residents' fourth year of medical school was recorded using PubMed and Google Scholar. We recorded total number of publications (any authorship), first/second author publications, and ophthalmology-specific publications. Using Welch's t-test, publication volumes were statistically compared against all others.

Results One-hundred sixty-one residents from the class of 2022 and 145 residents from the class of 2017 were included. Total publications per matched applicant (mean ± standard deviation) were 3.04 ± 0.35 for the class of 2022 and 1.67 ± 0.23 for the class of 2017. Mean publications in ophthalmology journals were 1.07 ± 0.20 (2022) and 0.58 ± 0.13 (2017); mean first author publications were 1.00 ± 0.13 (2022) and 0.64 ± 0.11 (2017) and mean second author publications were 0.70 ± 0.10 (2022) and 0.37 ± 0.06 (2017). Research productivity in all four metrics (total, ophthalmology journals, first author, and second author publications) was significantly higher for the class of 2022 than the class of 2017 (p = 0.001; p = 0.03; p = 0.03; p = 0.02, respectively) supporting the trend of increasing research output among students. Applicants with PhD degrees had statistically more total and first author publications in 2017 (p = 0.01; p = 0.045), but only more first author publications in 2022 (p = 0.01). International applicants produced significantly more total publications in 2022 (p < 0.001).

Conclusions Overall, after a 5-year period, the authors found matched applicants had significantly increased publications compared with those at the beginning of the period. We also identified several applicant factors that may have variable effects on research publication. This analysis emphasizes the growing importance of research in the match process and can help future applicants navigate the ophthalmology match.

Machine Learning for The Prediction of Ranked Applicants and Matriculants to an Internal Medicine Residency Program

Phenomenon: Residency programs throughout the country each receive hundreds to thousands of applications every year. Holistic review of this many applications is challenging, and to-date, few tools exist to streamline or assist in the process for selecting candidates to interview and rank. Machine learning could assist programs in predicting which applicants are likely to be ranked, and among ranked applicants, which are likely to matriculate.Approach: In the present study, we used the machine learning algorithm Random Forest (RF) to differentiate between ranked and unranked applicants as well as matriculants and ranked non-matriculants to an internal medicine residency program in northern New England over a three-year period. In total, 5,067 ERAS applications were received during the 2016-17, 2017-18, and 2018-19 application cycles. Of these, 4,256 (84.0%) were unranked applicants, 754 (14.9%) were ranked non-matriculants, and 57 (1.12%) were ranked matriculants.Findings: For differentiating between ranked and unranked applicants, the RF algorithm achieved an area under the receiver operating characteristic (AUROC) curve of 0.925 (95% CI: 0.918-0.932) and area under the precision-recall curve (AUPRC) of 0.652 (0.611-0.685), while for differentiating between matriculants and ranked non-matriculants, the AUROC was 0.597 (95% CI: 0.516-0.680) and AUPRC was 0.114 (0.075-0.167). The ranks of matriculated applicants were significantly higher using the algorithmic rank list as compared with the actual rank list for the 2017-18 (median rank: 98 versus 204, p < .001) and 2018-19 cycles (74 versus 192, p = .006), but not the 2016-17 cycle (97 versus 144, p = .37).Insights: The RF algorithm predicted which applicants among the overall applicant pool were ranked with impressive accuracy and identified matriculants among ranked candidates with modest but better-than-random accuracy. This approach could assist residency programs with triaging applicants based on the likelihood of a candidate being ranked and/or matriculating.

The US Medical Licensing Examination Step 1 Scoring Change: A Survey of Orthopaedic Surgery Residency Applicants From the 2019 to 2020 Match Cycle

INTRODUCTION

The USMLE Step 1 examination has been used as an objective measure for comparing residency applicants. Recently, the National Board of Medical Examiners and the Federation of State Medical Boards decided that the USMLE Step 1 examination will transition to a pass/fail result starting no earlier than 2022. The purpose of this study was to investigate the perspective of medical students who applied for orthopaedic surgery residency positions during the 2019 to 2020 interview cycle on the USMLE scoring change, and the potential effect this change may result in for future applicants and the residency selection process.

METHODS

A 15-item anonymous web-based survey was sent to 1,090 orthopaedic surgery residency applicants from four regionally diverse residency programs. The survey elicited attitudes toward the transition of the Step 1 examination to pass/fail and perspectives this change may or may not have on the residency selection process.

RESULTS

Responses were received from 356 applicants (32.7%). The majority (61.6%) disagreed with the change to pass/fail scoring, and 68.5% do not believe that the change will decrease stress levels in medical students. For interview invitations, respondents chose Step 2 clinical knowledge, letters of recommendation, and performance on away rotations as the most influential factors in the absence of a Step 1 score.

CONCLUSION

Most of the students surveyed who applied for an orthopaedic surgery residency position during the most recent application cycle disagreed with the National Board of Medical Examiner/Federation of State Medical Board decision to change Step 1 to pass/fail and feel that this change may have disadvantage in certain student groups while either increasing or having no effect on medical student stress.

LEVEL OF EVIDENCE

IV.

Formal Orthopaedic Surgery "Boot Camp" Curriculum to Optimize Performance on Acting Internships

Orthopaedic surgery is one of the most competitive residency specialties in the National Residency Matching Program. To improve the odds of matching, senior medical students applying in the field participate in orthopaedic surgery away rotations with programs across the country. Students who do well on these rotations have a higher likelihood of matching because clinical performance is a principal criterion used by admissions committees to rank applicants. On the other hand, these rotations can be physically and emotionally taxing on medical students because poor performance can negatively affect their application and, thus, chances of matching at that institution. Unfortunately, the resources provided by medical schools to prepare students for these high-stakes rotations are usually sparse and unstructured. To address this gap in training at our institution, we developed a formal "boot camp" offered through the university to prepare interested senior medical students for their orthopaedic surgery acting internships. This course focuses on building a solid foundation of musculoskeletal knowledge and exposing students to surgical and procedural skills that are fundamental to the practice of orthopaedic surgery. Over the 2 years, this course has been offered at our institution, and it has proven successful in outcome measures, such as student satisfaction and preparedness, student orthopaedic knowledge, program director evaluations, and match rate. This article describes the novel 1-month curriculum, which includes lectures, laboratory, and clinical experience.

An Orthopaedic Virtual Clinical Clerkship for Visiting Medical Students: Early Successes and Future Implications

OBJECTIVE

The visiting orthopaedic clerkship is viewed by both students and program directors as an important part of the orthopaedic surgery residency application process, despite being criticized as costly and inefficient. Restrictions due to the COVID-19 pandemic prevented students from participating in in-person clerkships at institutions other than at their home programs, necessitating a virtual replacement for the in-person orthopaedics clerkship experience. It remains unclear how the virtual clerkships will affect the application process this year, and moving forward. We describe and review our institution's initial experience with a virtual orthopaedic clerkship. We hypothesize that students would view the virtual clerkship as valuable, and that students would see a role for such clerkships going forward.

DESIGN

A virtual orthopaedic surgery clerkship was created and students were invited to enroll. Thirty-one 4th-year medical students participated. Each clerkship included 8 two-hour sessions. Each session was moderated by a faculty member, and participants included only medical students. Students presented virtual cases, which provided the basis for the discussion and education. At the conclusion of each clerkship, students were given an anonymous survey assessing various aspects of the clerkship.

RESULTS

Twenty-seven students responded to the survey. Overall, 15 students rated the experience as outstanding, 11 excellent, and 1 good. Twenty-two students saw a role for virtual clerkships moving forward, and five students did not see a role moving forward. Student reported strengths of the clerkship included direct faculty interaction, structured curriculum, and student-centered discussions. Lack of hands-on experience was cited as the biggest weakness.

CONCLUSIONS

Students valued the opportunity for a virtual clerkship, and most could envision a role for such virtual clerkships moving forward. We suggest that virtual clerkships may be a cost-effective and useful tool in helping both students and programs navigate the residency selection process.

How Did Coronavirus-19 Impact the Expenses for Medical Students Applying to an Orthopaedic Surgery Residency in 2020 to 2021?

BACKGROUND

Orthopaedic surgery is one of the most competitive specialties for residency applicants. For the 2021 residency match, the coronavirus-19 pandemic introduced complexity for programs and applicants because away rotations were limited and in-person interviews were cancelled. This may have changed the landscape in terms of expenses for candidates in important ways, but this topic has been insufficiently studied.

QUESTIONS/PURPOSES

Given that in 2021, students did not attend away rotations and all interviews were held virtually, we asked (1) What were the financial savings associated with this change? (2) Was medical school geographic region associated with differences in expenses when applying to residency?

METHODS

A retrospective, cross-sectional analysis of the 2020 and 2021 Texas Seeking Transparency in Application to Residency Dashboard database was performed. The data were derived from an online survey of a nationwide pool of applicants from 87% (123 of 141) of US allopathic medical schools upon conclusion of the match. The response percentage was 29% (521 of 1794). We believe this nationwide dataset represents the largest and most current data for this applicant group. Responses from applicants applying to orthopaedic surgery residency in the year before the COVID-19 pandemic application changes (2020) and during COVID-19 (2021) were queried and compared. After the orthopaedic surgery match, the database was evaluated for individual (application costs, away rotation expenses, and interview expenses) and total expenses for medical school seniors applying to orthopaedic surgery residency. Applicant characteristics were compared between application cycles. The 2020 to 2021 Texas Seeking Transparency in Application to Residency Dashboard database had 521 responses (n = 263 in 2020 and n = 258 in 2021) from applicants applying to orthopaedic surgery residency. Demographic and applicant characteristics were comparable between application cycles. Median expenses are reported with percentile distributions and geographic comparisons. A Mann-Whitney U test or Kruskal-Wallis H test was used to determine whether there were statistically significant differences in expenses between years and between medical school regions at a p value threshold of < 0.05.

RESULTS

For all applicants, the median total expenses (USD 7250 versus USD 2250), application costs (USD 2250 versus USD 1750), away rotation expenses (USD 2750 versus USD 250), and interview expenses (USD 2250 versus USD 75) declined in 2021 compared with 2020 (all p < 0.001). The median total savings in expenses for all applicants in 2021 compared with 2020 was USD 5000. In 2021, median total expenses were lower in all geographic regions with the greatest savings from applicants in the West (USD 6000); in addition, the difference in median total expenses between the geographic region with the highest total expenses and the lowest total expenses was lower in the pandemic year than it was in the year prior (USD 1000 versus USD 1500; p < 0.001). In 2021, there were differences in total expenses between the Northeast (USD 1750), West (USD 1750), and Central (USD 2750) regions (p < 0.001). From 2020 to 2021, only application fees from Northeast applicants differed (USD 2250 versus USD 1250; p < 0.001). In 2020, interview expenses were not different between all regions (USD 2250 Northeast and West versus USD 2750 Central and South; p = 0.19); similarly in 2021, interview expenses were similar between all regions (USD 75 versus USD 75; p = 0.82). Finally, in 2020, Northeast (USD 3250) and Western (USD 3250) applicants spent more for away rotations than Southern (USD 2750) and Central (USD 2250) applicants (p = 0.01). In 2021, applicants from schools in the South (USD 250) and Central (USD 250) regions spent more than their counterparts (USD 0; p = 0.028).

CONCLUSION

In the COVID-19 application cycle, the median expenditures of orthopaedic residency candidates were USD 5000 lower than they were in the previous year; the difference can be attributed to the use of virtual interviews and the lack of away rotations. There are geographic implications, with applicants from Western United States medical schools potentially saving the most. Despite the financial savings during the 2021 match, further study related to the long-term success of the current application process (both for applicants and programs) is needed. The recommendation in May 2020 by the AOA Council of Orthopaedic Residency Directors (CORD) to limit the number of applications submitted by candidates with USMLE Step 1 scores greater than 235 did not result in any considerable decline in applications submitted or expenses. A better understanding of how differences in these expenses may influence our specialty's ability to attract socioeconomically diverse candidates would be important, and we need to explore perceived and actual financial obstacles to obtaining this diversity in the application process. Finally, avenues should be explored by program directors and chairpersons to reduce the expenses of the traditional application process while maintaining recruitment of top candidates.

LEVEL OF EVIDENCE

Level IV, economic analysis.

The Orthopaedic Resident Selection Process: Proposed Reforms and Lessons From Other Specialties

INTRODUCTION

Proposals for substantive reforms to the orthopaedic resident selection process are growing, given increasing applicant competitiveness, burgeoning inefficiencies and inequities of the current system, and impending transition of Step 1 to pass/fail. The COVID-19 pandemic has further catalyzed the need for reforms, offering unprecedented opportunities to pilot novel changes. However, a comprehensive collation of all proposed and implemented orthopaedic reforms is currently lacking. Thus, we aimed to characterize proposed orthopaedic-specific resident selection reforms in the context of reforms implemented by other specialties.

METHODS

EMBASE, MEDLINE, Scopus, and Web of Science databases were searched for references proposing reforms to the orthopaedic resident selection process published from 2005 to 2020. An inductive approach to qualitative content analysis was used to categorize reforms.

RESULTS

Twenty-six articles proposing 13 unique reforms to the orthopaedic resident selection process were identified. The most commonly proposed reforms included noncognitive assessments (n = 8), application caps (n = 7), standardized letters of recommendation (n = 5), program-specific supplemental applications (n = 5), creation of a centralized database of standardized program information (n = 4), use of a standardized applicant composite score (n = 4), and a moratorium on postinterview communication (n = 4). Importantly, nearly all of these reforms have also been proposed or implemented by other specialties.

DISCUSSION

Numerous reforms to the orthopaedic resident selection process have been suggested over the past 15 years, several of which have been implemented on a program-specific basis, including noncognitive assessments, supplemental applications, and standardized letters of recommendation. Careful examination of applicant and program experiences and Match outcomes after these reforms is imperative to inform future directions.

Differences in Fourth-Year Orthopaedic Away Rotation Opportunities and Fees Among Osteopathic and Allopathic Medical Students 1 Year After the Implementation of the Single Accreditation System

Fourth-year away rotations are well recognized as an important modifiable variable that has been shown to increase a student’s opportunity to match into orthopaedic surgery. The purpose of this article was to determine whether allopathic (MD) and osteopathic (DO) medical students have equal opportunities for away rotations in terms of (1) eligibility and (2) fees associated with rotations after the single accreditation merger.

How Does Geographic Region Affect the Total and Individual Costs for Medical Students Applying to the Competitive Surgical Residencies?

OBJECTIVE

Studies have individually assessed the expenses for medical students desiring a surgical residency in neurosurgery, orthopaedic surgery, otolaryngology, plastic surgery, and urology. A detailed comparison of expenses by geographic region have not been reported. The aim was to geographically compare the expenses of United States medical students applying to the 5 most competitive surgical residencies.

SETTING/PARTICIPANTS

Anonymous nationwide survey of plastic surgery, orthopaedic surgery, otolaryngology, urology, and neurological surgery residency applicants.

DESIGN

A cross sectional, retrospective analysis of the 2019-2020 Texas STAR Dashboard database, an online tool generated from a nationwide survey of students. Individual (application, away rotation, interview) and total costs for medical school seniors were recorded in addition to applicant characteristics. Mean and median costs were reported for each specialty with percentile distributions and geographic comparisons. A Kruskal-Wallis H test was performed to compare differences in costs between surgical specialties and medical school region.

RESULTS

In total, 1136 applicants to surgical residency were included. The number of applicants to orthopaedic surgery (OS) (n = 459), neurological surgery (NS) (n = 121), urology (UR) (n = 191), plastic surgery (PS) (n = 117), and otolaryngology (OTO) (n = 248) were reported. Mean total costs were (OS; $8,205), (NS; $11,882), (UR; $8,207), (PS; $10,845), and (OTO; $7,516) (p ≤ 0.029). Application fees were only significantly different in the northeast and southern applicants between the different specialties, notably orthopaedic surgery applicants spent the most. In all geographic regions excluding the west, neurosurgery and plastic surgery applicants spent significantly more than other specialties for interview costs and away rotation costs. In all geographic regions neurosurgery and plastic surgery applicants spent significantly more than other specialties in total costs.

CONCLUSIONS

Orthopaedic surgery applicants spend the most on application fees in select geographic regions. Neurosurgery and plastic surgery applicants spend more on interviews, away rotations, and total costs in nearly all geographic regions.

Variability in Hand Surgery Training Among Plastic and Orthopaedic Surgery Residents

Background:

A career in hand surgery in the United States requires a 1-year fellowship after residency training. Different residency specialty programs may vary in case volume. The purpose of this study was to characterize variation in hand surgery training within and between orthopaedic and plastic surgery residents.

Methods:

Publicly available hand surgery case logs for graduating orthopaedic and plastic surgery residents during the 2010 to 2011 to 2018 to 2019 academic years were obtained through the Accreditation Council of Graduate Medical Education. Student t-tests were used to compare mean case volumes among several categories between plastic surgery (PRS) and orthopaedic surgery (OS) residents. Intraspecialty variation was assessed by comparing the 90th and 10th percentiles in each category.

Results:

A total of 6,254 orthopaedic and 1,070 plastic surgery graduating residents were included. The mean hand surgery case volume for orthopaedic residents (OS 247.0) was significantly lower than that for plastic surgery residents (PRS 412.0) (P < 0.0001). Orthopaedic residents performed more trauma cases (OS 133.2, PRS 54.5; P < 0.0001) but fewer nerve repairs (OS 3.3, PRS 28.5 P < 0.0001) and amputations (OS 6.4, PRS 15.8; P < 0.0001). Nerve decompression case volumes were similar between the two specialties (OS 50.2, PRS 47.3; P = 0.34). Case volumes among orthopaedic residents varied considerably in amputations and among plastic surgery residents in replantation/revascularization procedures.

Conclusions:

Orthopaedic surgery residents performed significantly more trauma cases than plastic surgery residents did, but fewer overall cases, nerve repairs, and amputations, while nerve decompression volumes were similar between specialties. This information may help inform residency and fellowship directors regarding areas of potential training deficiency.

The Orthopaedic Interview Spreadsheet: Classification and Comparison to the National Resident Matching Program

INTRODUCTION

The Orthopaedic Interview Spreadsheet (OIS) is an annual, open-source Google sheet used by prospective orthopaedic surgery applicants to share applicant statistics, interview data, and program information. The purpose of the current study was to determine whether self-reported applicant statistics within the OIS were representative of the official orthopaedic applicant pool, as reported by the National Resident Matching Program (NRMP).

METHODS

A total of 243 self-reported applicants from the 2017-2018 (n=136) and 2019-20 (n=107) orthopaedic surgery residency application cycles who used the OIS were identified.

USMLE

Step1 scores, Step2 scores, total research items reported on the Electronic Residency Application Service® (ERAS), and Alpha Omega Alpha (AOA) status were compared to NRMP weighted means from the 2018 and 2020 Charting Outcomes in the Match reports using one-sampled t-tests and one-sample binomial tests.

RESULTS

According to the 2017-2018 OIS data, the self-reported Step 1 score (n=126) (M:251.3 ±10.5, p<0.001), Step 2 score (n=113) (M:259.4 ±8.5, p<0.001), and total research items (n=129) (M:8.9 ±8.6, p=0.019) were all statistically different from their respective NRMP weighted means. The NRMP cohort of applicants with AOA membership (36.4%) was significantly different than the OIS cohort (53.7%), (p<0.001). Similarly, for 2019-2020, the OIS Step 1 score (n=105) (M: 248.8 ±0.7, p=0.016) and Step 2 score (n=93) (M:257.4 ±9.4, p<0.001) were statistically different from their respective NRMP weighted means. OIS total research items (n=102) (M: 15.0 ±15.2, p=0.656) was not statistically different from its NRMP weighted mean. The NRMP cohort of applicants with AOA membership (36.4%) was significantly different than the OIS cohort (53.7%), (p=0.040).

CONCLUSION

Prospective applicants should be cautious about using this document to solely gauge their competitiveness during the application process. The real value of the OIS is its non-quantifiable message board functions that provide peer-to-peer mentorship and the collaborative, uncensored community it fosters.

Transparency in the Ophthalmology Residency Match: Background, Study, and Implications

Background Medical students are applying to dramatically more ophthalmology residency programs than in the past, causing an increased administrative burden for programs and financial harm to students. This study considers the background of this situation and looks at how a lack of transparency surrounding potential residency match filters contributes. Furthermore, this study raises several potential solutions to this lack of transparency that may increase the functionality of the ophthalmology residency match. Objective The purpose of this study was to determine the availability and consistency of potential ophthalmology residency match filters through training program websites and the American Medical Association's (AMA) Residency & Fellowship Database (FREIDA). Methods This study was a cross-sectional observational study of ophthalmology residency program websites and AMA's FREIDA database entries. For 119 ophthalmology residency programs, five potential filters were evaluated for both availability and consistency on individual residency websites and FREIDA. These filters were: (1) whether a program required a minimum United States Medical Licensing Examination (USMLE) Step 1 score; (2) minimum number of letters of recommendation required; 3) whether a minimum USMLE Step 2 score was required; (4) if the program accepts the Comprehensive Osteopathic Medical Licensing Examination (COMLEX) sequence in lieu of the USMLE; and (5) ability of the residency to sponsor a visa (J-1, H-1B, or F-1). Each program's website and FREIDA entry were independently evaluated by two authors to increase validity, with a third author brought in to break the tie in case of a disagreement. Results Only two ophthalmology residency programs had information about all five filters both available and consistent on their website and FREIDA. Inter-reviewer reliability was 92.5%. Conclusions Information about potential filters used in the ophthalmology residency match is neither publicly available nor consistent. This lack of transparency may contribute to the phenomenon of medical students applying to dramatically more ophthalmology residency programs. A standardized database of these filters is needed to increase transparency to applicants, which may reduce the expenses of medical students and the workload of program directors.

The Effect of the COVID-19 Pandemic on Orthopaedic Residency Program Social Media Utilization

The COVID-19 pandemic created an unprecedented challenge for orthopaedic surgery residency applicants when away rotations were canceled and interviews were held virtually. The authors hypothesized that (1) Instagram would have more total social media accounts compared with Twitter or Facebook, (2) most social media accounts on all platforms would be created during 2020, and (3) the average number of Instagram followers would be higher among highly ranked programs.

Methods

A list of Accreditation Council for Graduate Medical Education-accredited orthopaedic surgery residency programs (n = 202) that were ranked by reputation was acquired from Doximity. Public Instagram, Facebook, and Twitter profiles of orthopaedic surgery residency programs were identified through a manual search. Variables assessed on each social media platform were all available summary statistics provided by the social media platform. Instagram accounts were categorized into 5 tiers based on numeric reputation ranking, with 40 programs in each tier (except tier 5 with 42 programs). Descriptive statistics were calculated, and continuous data were presented as mean ± standard deviation. Goodness-of-fit regression values were calculated for observed trends.

Results

One-hundred seventy-four social media accounts were identified. There was a higher percentage of Instagram accounts (66.1%) compared with Facebook (13.2%) or Twitter (20.7%). From 2010 to 2020, an exponential increase (R² = 0.88) of social media accounts was observed during 2020. Instagram profiles (77.2%, 98/115 [95 in 2020, 3 in 2021]) were created after the cancelation of away rotations in May 2020. Instagram profiles had 1,029 ± 522.4 average followers, more than Facebook and Twitter. Tier 1 residency programs had the largest average follower count with 1,462.4 ± 584.3 followers.

Conclusion

Social media presence increased exponentially during 2020. Instagram was the social media platform with the most accounts. Many Instagram accounts were created during 2020, and most were created after away rotations were canceled during the COVID-19 pandemic. Instagram accounts averaged the most followers. Top tier orthopaedic residency programs had a greater number of accounts and average followers than lower tier programs.

Increasing lengths of rank order lists of applicants and programs of US medical residencies

BACKGROUND

To match medical students into residency training programs, both the program and student create rank order lists (ROLs). We aim to investigate temporal trends in ROL lengths across 7 match cycles between 2014 and 2021 for both matched and unmatched residency applicants and programs.

METHODS

retrospective study of ROLs of 7 match cycles, 2014-2021. Residency match and ROL data were extracted from the NRMP database to assess the number of programs filled and unfilled, length of ROLs, position matched, and average ranks per position for osteopathic (DO) and allopathic (MD) medical programs.

RESULTS

For filled residency programs, the average ROL length consistently increased from 70.72 in 2015 to 88.73 in 2021 (P = .003), with ROL lengths consistently longer for filled vs unfilled residency programs (P < .001). The average ROL length for matched applicants increased consistently from 10.41 in 2015 to 12.35 in 2021 (P = .002), with matched applicants having consistently longer ROLs than unmatched applicants (P < .001). From 2015 to 2021, in both MD and DO applicants, progressively lower proportions of applicants matched their first and second choices.

CONCLUSION

Trends across the past 7 residency match cycles suggest that ROL lengths for both programs and applicants have been increasing with matched programs and applicants submitting significantly longer ROLs than unmatched applicants. Additionally, fewer applicants are matching at their preferred programs over time. Our findings support the mounting evidence that the Match has become increasingly congested and we discuss the possible factors that may be contributing to the current state of the Match as well as potential solutions.

The Orthopaedic Match: Defining the Academic Profile of Successful Candidates

BACKGROUND

Research productivity forms a vital part of the resident selection process and can markedly affect the chance of a successful match. Current reports regarding the publication record among prospective orthopaedic surgery residents are likely inaccurate. Potential applicants have a poor understanding of the strength of their research credentials in comparison to other candidates.

METHODS

We identified matched applicants from the 2013 to 2017 orthopaedic surgery residency application cycles. We performed a bibliometric analysis of these residents using Scopus, PubMed, and Google Scholar to identify published articles and calculate the h-index of each applicant at the time of application. Details were collected on medical school, advanced degrees, publication type, first authorship, and article relatedness to orthopaedic surgery.

RESULTS

We included 3,199 matched orthopaedic surgery applicants. At the time of application, the median h-index was 0, the median number of publications was 1, and 40% of successful candidates did not hold any publications. The h-index (R 0.08, P < 0.0001) and median number of publications of matched orthopaedic surgery residency candidates significantly increased (R 0.09, P < 0.0001) across application cycles. Furthermore, the proportion of matched applicants without publications at the time of application significantly decreased (R -0.90, P = 0.0350). Conversely, the percentage of articles first-authored by applicants decreased (R -0.96, P = 0.0093), but article relatedness to orthopaedic surgery remained constant (R 0.82, P = 0.0905). Strikingly, notable changes were observed in the type of articles published by successful applicants: the proportion of preclinical studies decreased (R -0.07, P = 0.0041), whereas clinical research articles increased (R 0.07, P = 0.0024).

CONCLUSION

The publication count held by successful orthopaedic surgery applicants is substantially lower than the nationally reported average. Matched orthopaedic surgery candidates demonstrate increasingly impressive research achievements each application cycle. However, increased academic productivity comes at the cost of reduced project responsibility and a shift toward faster-to-publish articles.

Perspectives on the Orthopaedic Surgery Residency Application Process During the COVID-19 Pandemic

The COVID-19 pandemic has led to the cancellation of away rotations and other experiences fundamental to orthopaedic surgery residency application. Limited information is available on the experiences of applicants and program directors (PDs) during the COVID-19 pandemic residency application cycle. This study aimed to evaluate the current perspectives of applicants and PDs regarding the orthopaedic surgery residency application process.

Effect of the COVID-19 Pandemic on the Orthopaedic Surgery Residency Application Process: What Can We Learn?

INTRODUCTION

The goal of this study was to assess the influence of the coronavirus disease 2019 pandemic on the orthopaedic surgery residency application process in the 2020 to 2021 application cycle.

METHODS

A survey was administered to the program directors of 152 Accreditation Council for Graduate Medical Education-accredited orthopaedic surgery residency programs. The following questions were assessed: virtual rotations, open houses/meet and greet events, social media, the selection criteria of applicants, the number of applications received by programs, and the number of interviews offered by programs.

RESULTS

Seventy-eight (51%) orthopaedic residency programs responded to the survey. Of those, 25 (32%) offered a virtual away rotation, and 57 (75%) held virtual open houses or meet and greet events. Thirteen of these programs (52%) reported virtual rotations as either "extremely important" or "very important." A 355% increase was observed in social media utilization by residency programs between the 2019 to 2020 and 2020 to 2021 application cycles, with more programs finding social media to be "extremely helpful" or "very helpful" for recruiting applicants in 2020 to 2021 compared with the previous year (39% versus 10%, P < 0.001).

CONCLUSION

Although many of the changes seen in the 2020 to 2021 application cycle were implemented by necessity, some of these changes were beneficial and may continue to be used in future application cycles.