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Silvestre J, Ahn J, Dehghan N, Gitajn IL, Slobogean GP, Harris MB. Analysis of the diversity pipeline for the orthopedic trauma surgeon workforce in the United States. Injury 2024; 55:111695. [PMID: 38959676 DOI: 10.1016/j.injury.2024.111695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Revised: 05/23/2024] [Accepted: 06/19/2024] [Indexed: 07/05/2024]
Abstract
INTRODUCTION There is a lack of research on the state of racial, ethnic, and gender diversity in the emerging orthopedic trauma workforce. The purpose of this study was to analyze the training pathway for diverse candidates in orthopedic trauma as it relates to race, ethnicity, and sex. METHODS Self-reported demographic data were compared among allopathic medical students, orthopedic surgery residents, orthopedic trauma fellows, and the general population in the United States (2013-2022). Race categories consisted of White, Asian, Black, and Native American/Alaskan Native (NA/AN), and Native Hawaiian/Pacific Islander (NH/PI). Ethnicity categories were Hispanic/Latino or non-Hispanic/Latino. Sex categories were male and female. Representation was calculated at each stage of accredited training. Participation-to-prevalence ratios (PPRs) quantified the equitable representation of demographic groups in the emerging orthopedic trauma workforce relative to the US population. PPR thresholds were used to classify representation as overrepresented (PPR > 1.2), equitable (PPR = 0.8-1.2), and underrepresented (PPR < 0.8). RESULTS Relative to medical school and orthopedic surgery residency, fewer female (48.5 % vs 16.7 % vs 18.7 %, P < 0.001), Hispanic (6.1 % vs 4.5 % vs 2.6 %, P < 0.001), Black (6.9 % vs 5.0 % vs 3.1 %, P < 0.001), and Asian (24.0 % vs 14.3 % vs 12.2 %, P < 0.001) trainees existed in orthopedic trauma fellowship training. In contrast, more male (51.5 % vs 83.3 % vs 81.3 %, P < 0.001) and White (62.8 % vs 79.1 % vs 84.0 %, P < 0.001) trainees existed in orthopedic trauma fellowship relative to earlier training stages. There were zero NA/AN or NH/PI trainees in orthopedic trauma (PPR = 0). Relative to the US population, Hispanic (PPR = 0.14), Black (PPR = 0.25), and female (PPR = 0.37) trainees were underrepresented in orthopedic trauma. In contrast, Asian (PPR = 2.04), male (PPR = 1.64), and White (PPR = 1.36) trainees were overrepresented in orthopedic trauma. CONCLUSION Women, racial, and ethnic minorities are underrepresented in the emerging orthopedic trauma workforce relative to the US population, and earlier stages of training. Targeted recruitment and guided mentorship of these groups may lead to greater interest, engagement, and diversity in orthopedic trauma.
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Affiliation(s)
- Jason Silvestre
- Medical University of South Carolina, Charleston, SC, United States.
| | - Jaimo Ahn
- University of Michigan Medical School, Ann Arbor, MI, United States
| | - Niloofar Dehghan
- University of Arizona College of Medicine Phoenix, Phoenix, AZ, United States
| | - Ida L Gitajn
- Dartmouth-Hitchcock Medical Center, Lebanon, NH, United States
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Williams AJ, Malewicz JI, Pum JM, Zurakowski D, Day CS. How Did Black and Hispanic Orthopaedic Applicants and Residents Compare to General Surgery Between 2015 and 2022? Clin Orthop Relat Res 2024; 482:1361-1370. [PMID: 38578021 PMCID: PMC11272338 DOI: 10.1097/corr.0000000000003069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 03/07/2024] [Indexed: 04/06/2024]
Abstract
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 R 2 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 (R 2 = 0.43; p = 0.23 and R 2 = 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 (R 2 = 0.73; p = 0.02 and R 2 = 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.
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Affiliation(s)
- Alisha J. Williams
- Wayne State University School of Medicine, Detroit, MI, USA
- Department of Orthopaedic Surgery, Henry Ford Health, Detroit, MI, USA
| | - Julia I. Malewicz
- Wayne State University School of Medicine, Detroit, MI, USA
- Department of Orthopaedic Surgery, Henry Ford Health, Detroit, MI, USA
| | - John M. Pum
- Wayne State University School of Medicine, Detroit, MI, USA
- Department of Orthopaedic Surgery, Henry Ford Health, Detroit, MI, USA
| | - David Zurakowski
- Director of Biostatistics for Departments of Anesthesiology and Surgery, Boston Children’s Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Charles S. Day
- Wayne State University School of Medicine, Detroit, MI, USA
- Department of Orthopaedic Surgery, Henry Ford Health, Detroit, MI, USA
- Michigan State University College of Human Medicine, Detroit, MI, USA
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DeAngelis RD, Brown JB, Dehghani B, Karnuta JM, Minutillo GT, Kogan M, Donegan DJ, Mehta S. Let's Take a Look at the Tape: The Impact of ERAS Video Prompts on Interview Offerings for Orthopaedic Surgery Residency Applicants: A Prospective Observational Study. J Am Acad Orthop Surg 2024:00124635-990000000-01060. [PMID: 39083504 DOI: 10.5435/jaaos-d-24-00174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Accepted: 05/28/2024] [Indexed: 08/02/2024] Open
Abstract
INTRODUCTION Matching into an orthopaedic surgery residency consistently reinforces a competitive landscape, challenging the applicants and programs. A group of orthopaedic surgery residency programs implemented video prompts asking applicants to respond to a standardized question by video recording. Assessing the impact of this video on the decision to offer an interview can help guide programs and applicants through the interview process. METHODS Twenty residency applications to one institution requiring video prompts were randomly selected and deidentified. Thirteen experienced faculty from various orthopaedic surgery programs served as applicant reviewers. The reviewers evaluated the electronic residency application service (ERAS) application and determined whether they would grant the applicant an interview ("no," "maybe," or "yes") before and after watching the video prompt. The reviewer also scored the impact of the applicant's dress, facial presentation, and video background distractions on their evaluation of the video. Multivariable logistic regressions were conducted using a group of applicants where interview status was not impacted by the video compared with the group of applicants where the interview status changed after video review. An alpha value of 0.05 was used to define significance. RESULTS The video prompt impacted the decision to offer an interview 29.3% of the time; 15.8% were switched from "yes" or "maybe" to "no" and 13.5% were switched from "no" or "maybe" to "yes." For the positively impacted applicants, facial presentation score was significantly higher (P = 0.005). No recorded variables were associated with decreased chance of interview. DISCUSSION Video prompts impacted the decision to offer interviews to orthopaedic surgery applicants approximately one-third of the time, with a similar number of applicants being positively and negatively impacted. Facial presentation score was associated with increased chance of interview, and no variables were associated with decreased chance of interview. Thus, the answer to the videos presumably negatively impacted applicants.
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Affiliation(s)
- Ryan D DeAngelis
- From the Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA (DeAngelis, Brown, Dehghani, Karnuta, Minutillo, Donegan, and Mehta), and the Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL (Kogan)
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Silvestre J, Benn L, Chen AF, Lieberman JR, Peters CL, Nelson CL. Diversity of Backgrounds and Academic Accomplishments for Presidents Elected to Hip and Knee Arthroplasty Societies in the United States. J Arthroplasty 2024; 39:1856-1862. [PMID: 38309637 DOI: 10.1016/j.arth.2024.01.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Revised: 01/19/2024] [Accepted: 01/24/2024] [Indexed: 02/05/2024] Open
Abstract
BACKGROUND Academic accomplishments and demographics for presidents of hip and knee arthroplasty societies are poorly understood. This study compares the characteristics of presidents nominated to serve the Hip Society, Knee Society, and American Association of Hip and Knee Surgeons. METHODS This was a cross-sectional study of arthroplasty presidents in the United States (1990 to 2022). Curriculum vitae and academic websites were analyzed for demographic, training, bibliometric, and National Institutes of Health (NIH) funding data. Comparisons were made between organizations and time periods (1990 to 2005 versus 2006 to 2022). RESULTS There were 97 appointments of 78 unique arthroplasty presidents (80%). Most presidents were male (99%) and Caucasian (95%). There was 1 woman (1%) and 5 non-Caucasian presidents (2% Asian, 3% Hispanic). There were no differences in demographics between the 3 arthroplasty organizations and the 2 time periods (P > .05). Presidents were appointed at 55 ± 10 years old, which was on average 24 years after completion of residency training. Most presidents had arthroplasty fellowship training (68%), and the most common were the Hospital for Special Surgery (21%) and Massachusetts General Hospital (8%). The median h-index was 53 resulting from 191 peer-reviewed publications, which was similar between the 3 organizations (P > .05). There were 2 presidents who had NIH funding (2%), and there were no differences in NIH funding between the 3 organizations (P > .05). CONCLUSIONS Arthroplasty society presidents have diverse training pedigrees, high levels of scholarly output, and similar demographics. There may be future opportunities to promote diversity and inclusion among the highest levels of leadership in total joint arthroplasty.
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Affiliation(s)
- Jason Silvestre
- Medical University of South Carolina, Charleston, South Carolina
| | - Lancelot Benn
- Howard University College of Medicine, Washington, District of Columbia
| | | | - Jay R Lieberman
- Keck School of Medicine of University of Southern California, Los Angeles, California
| | | | - Charles L Nelson
- Perelman School of Medicine at University of Pennsylvania, Philadelphia, Pennsylvania
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Yao JJ, Aggarwal M, Lopez RD, Namdari S. Current Concepts Review: Large Language Models in Orthopaedics: Definitions, Uses, and Limitations. J Bone Joint Surg Am 2024:00004623-990000000-01136. [PMID: 38896652 DOI: 10.2106/jbjs.23.01417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/21/2024]
Abstract
➤ Large language models are a subset of artificial intelligence. Large language models are powerful tools that excel in natural language text processing and generation.➤ There are many potential clinical, research, and educational applications of large language models in orthopaedics, but the development of these applications needs to be focused on patient safety and the maintenance of high standards.➤ There are numerous methodological, ethical, and regulatory concerns with regard to the use of large language models. Orthopaedic surgeons need to be aware of the controversies and advocate for an alignment of these models with patient and caregiver priorities.
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Affiliation(s)
- Jie J Yao
- Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, Pennsylvania
| | | | - Ryan D Lopez
- Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Surena Namdari
- Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, Pennsylvania
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Sabesan VJ, Lavin A, Lama G, Daji AV, Fomunung CK, Fernandez CA, Jackson GR, Cannada LK. The Sex or Race of Program Directors May Not Play a Significant Role in Impacting Diversity Among Orthopaedic Surgery Residents. Arthroscopy 2024:S0749-8063(24)00259-7. [PMID: 38593927 DOI: 10.1016/j.arthro.2024.03.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 03/18/2024] [Accepted: 03/23/2024] [Indexed: 04/11/2024]
Abstract
PURPOSE To identify the influence of residency program characteristics, including the presence of under-represented minorities in medicine (URiM) and/or female program directors (PDs), on the race and sex distribution of orthopaedic surgery residency trainees. METHODS All active and Accreditation Council for Graduate Medical Education-accredited orthopaedic surgery residency programs from 2017-2021 that reported usable information in the Residency Explorer Tool were included. Data collected included program characteristics, as well as faculty and resident sex distribution, ethnicity, race, and demographic characteristics. The PDs' specific sex, ethnicity, race, and demographic characteristics were collected using residency program websites. The prevalence of factors in programs with the top quartile of female and URiM residents was compared with that in programs with the bottom 3 quartiles. RESULTS Data were obtained from 148 of 200 Accreditation Council for Graduate Medical Education-accredited programs (3,694 residents). The 52 excluded programs had no usable information in the Residency Explorer Tool or on an identifiable program website. Overall, 15.9% of residents in orthopaedic surgery residency programs were women and 14% were under-represented minorities. The rates of female PDs and chairs were 12.4% and 6.9%, respectively, whereas those of URiM PDs and chairs were 8.3% and 4.6%, respectively. Programs with more female residents were not associated with female PDs (P = .79) or URiM PDs (P = .48). Programs with a greater percentage of URiM residents were not associated with URiM PDs (P = .16). Larger programs (P = .021) and university-based programs (P = .048) had a greater percentage of female residents. Orthopaedic residency programs with visa sponsorship had a greater percentage of URiM residents (P = .017). CONCLUSIONS Programs with a higher percentage of female or URiM residents did not show a significant association with having female or URiM PDs. Larger programs and university-affiliated programs were more likely to have a larger percentage of female residents, whereas programs that offered visa sponsorship had a higher percentage of URiM residents. CLINICAL RELEVANCE This study highlights factors influencing diversity among orthopaedic surgery residents. Although the presence of female or URiM PDs does not influence the percentage of female or URiM residents, other program characteristics such as size, affiliation, and visa sponsorship offer potentially actionable insights for promoting greater diversity in orthopaedic training. Doing so may increase under-represented groups within the field and could ultimately impact patient care and improve health care equity.
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Affiliation(s)
- Vani J Sabesan
- John F. Kennedy, Hospital Corporation of America/University of Miami Orthopaedic Surgery Program, Palm Beach, Florida, U.S.A.; Palm Beach Shoulder Service at Atlantis Orthopaedics HCA Florida, Palm Beach, Florida, U.S.A
| | - Alessia Lavin
- John F. Kennedy, Hospital Corporation of America/University of Miami Orthopaedic Surgery Program, Palm Beach, Florida, U.S.A.; Palm Beach Shoulder Service at Atlantis Orthopaedics HCA Florida, Palm Beach, Florida, U.S.A
| | - Gabriel Lama
- Florida International University Herbert Wertheim College of Medicine, Miami, Florida, U.S.A
| | - Akshay V Daji
- John F. Kennedy, Hospital Corporation of America/University of Miami Orthopaedic Surgery Program, Palm Beach, Florida, U.S.A
| | - Clyde K Fomunung
- John F. Kennedy, Hospital Corporation of America/University of Miami Orthopaedic Surgery Program, Palm Beach, Florida, U.S.A.; Palm Beach Shoulder Service at Atlantis Orthopaedics HCA Florida, Palm Beach, Florida, U.S.A
| | - Carlos A Fernandez
- John F. Kennedy, Hospital Corporation of America/University of Miami Orthopaedic Surgery Program, Palm Beach, Florida, U.S.A.; Palm Beach Shoulder Service at Atlantis Orthopaedics HCA Florida, Palm Beach, Florida, U.S.A
| | - Garrett R Jackson
- John F. Kennedy, Hospital Corporation of America/University of Miami Orthopaedic Surgery Program, Palm Beach, Florida, U.S.A.; Palm Beach Shoulder Service at Atlantis Orthopaedics HCA Florida, Palm Beach, Florida, U.S.A.; Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri, U.S.A..
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Tabaie SA, Schermerhorn JT, Baird M, Lattanza L, Ode G, Mesfin A. AOA Critical Issues: Perceptions on the State of Diversity, Equity, and Inclusion in Orthopaedic Surgery: A Survey of the AOA Membership. J Bone Joint Surg Am 2023; 105:1920-1926. [PMID: 37651571 DOI: 10.2106/jbjs.23.00392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
Abstract
BACKGROUND Orthopaedic surgery continues to trail other specialties in increasing diversity among its physician workforce. Various efforts have been and are currently being made to not only increase diversity, but also promote equity and inclusion in the field. The purpose of this study was to survey members of the American Orthopaedic Association (AOA) to determine how leaders in orthopaedics view diversity, equity, and inclusion (DEI) at the present time and to understand their perspective while moving into the future. METHODS An anonymous 11-question survey was disseminated online to AOA members in May 2022. These individuals were identified by the AOA membership directory and the email ListServe. The survey included free-response and multiple-choice questions. Demographic information was self-identified, and both qualitative and quantitative data were collected. RESULTS Of the 1,657 AOA members who were provided the survey, 262 (15.8%) responded. Approximately 29.5% (77) and 45.6% (119) of the surveyed population ranked "retention of underrepresented populations in orthopaedic residency (women, URiM)" as "very important" or "absolutely essential," respectively. The answers to the free-response questions identified multiple core themes that responders were passionate about, namely resident and attending physician recruitment and retention, as well as resident selection. CONCLUSIONS Leaders in the field of orthopaedic surgery desire for action to be taken in the field of DEI. The findings of this survey denote positive attitudes even though many inequalities still pervade the field of orthopaedics. Through mentorship, objective evaluation, transparency, and continued intentional action, orthopaedic surgery is well-positioned to continue to move forward with DEI.
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Affiliation(s)
| | | | - Michael Baird
- Walter Reed National Military Medical Center, Bethesda, Maryland
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Fisher MW, Askew M, Baird M, Ozdemir S, Williams S, Ramirez V, Kilcoyne K, Dingle M. Pipeline to Military Orthopaedic Leadership: 20 Years of Race and Gender Diversity Trends Within Military Orthopaedic Surgery Fellowship Training. JB JS Open Access 2023; 8:e23.00019. [PMID: 37850210 PMCID: PMC10578742 DOI: 10.2106/jbjs.oa.23.00019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2023] Open
Abstract
Background The lack of trainees from underrepresented race and gender backgrounds in orthopaedic surgery fellowship training has been well reported in the literature. The purpose of this study was to investigate the demographic trends of federally sponsored military orthopaedic surgery fellows in the Army, Navy, and Air Force. We hypothesize that there has been an increase in women selected for fellowship but that there has been no change in the race demographics of military fellows over the past 2 decades. Methods A retrospective review of all available demographic data collected by the Army, Air Force, and Navy since the beginning of tracking federally funded fellowship training in orthopaedic surgery was completed (1998-2021). Data were grouped into 4-year periods for analysis to closely mirror the military assignment cycle. Results Three hundred sixty-two military orthopaedic surgery fellowship board selectees were included in our analysis. The proportion of women fellows increased from 3% (n = 2/69) over 2001 to 2004 to 21% (n = 17/82) during 2017 to 2020 (p < 0.05). Fellows who identified as White comprised 82% (n = 297) of the cohort during the study period. Individuals who identified as Asian were the next highest proportion of fellows at 4% (n = 16), followed by Black (n = 14, 4%) and Hispanic (n = 13, 3%). Individuals who identified as Native Hawaiian/Pacific Islander represented 1% (n = 3), and an additional 6% (n = 20) fellows identified as "other" or "undeclared." Over the 20-year study period, representation of Asian, Black, Native Hawaiian, and Hispanic fellows did not increase (p = 0.79, 0.81, 0.45, 0.34, respectively). Conclusions Within military orthopaedics, there has been increased representation of women in fellowship training over the past 20 years. However, the proportion of fellows from underrepresented racial and ethnic groups has remained stagnant. One barrier to improving gender and race representation is the currently imprecise and inconsistent collection of demographic information. Importantly, fellowship training has a direct effect on future leadership opportunities within the military orthopaedic surgery community. A more diverse leadership may help to inspire future generations of military orthopaedic surgeons. Level of Evidence IV.
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Affiliation(s)
- Miles W.A. Fisher
- Department of Orthopedic Surgery San Antonio Military Medical Center Fort Sam Houston, Texas
| | - Morgan Askew
- Alpert Medical School at Brown University, Providence, Rhode Island
| | - Michael Baird
- Department of Orthopaedics, Walter Reed National Military Medical Center, Bethesda, Maryland
| | - Sevil Ozdemir
- Michigan State University College of Human Medicine, East Lansing, Michigan
| | - Shaun Williams
- Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Valentina Ramirez
- Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Kelly Kilcoyne
- Department of Orthopaedics, Walter Reed National Military Medical Center, Bethesda, Maryland
| | - Marvin Dingle
- Department of Orthopaedics, Walter Reed National Military Medical Center, Bethesda, Maryland
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Gillikin TB, Lanzetta NJ, Swiatek PR, Gerlach EB, Terry MA, Tjong VK. Characteristics of Team Physicians in the National Football League: The Road to Success and a Call for Diversity. Orthop J Sports Med 2023; 11:23259671231177660. [PMID: 37457047 PMCID: PMC10345930 DOI: 10.1177/23259671231177660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 02/26/2023] [Indexed: 07/18/2023] Open
Abstract
Background The role of team physician (TP) in professional sports is a highly coveted position within sports medicine. There is currently limited research on the demographic characteristics of TPs within the National Football League (NFL). Purpose To identify demographic characteristics and educational backgrounds of NFL head TPs (HTPs) and assistant TPs (ATPs). Study Design Cross-sectional study. Methods A list of TPs was identified through the National Football League Physicians Society (NFLPS). Variables investigated include age, gender, race, medical specialty, location and year of residency and fellowship training, leadership among medical societies and editorial boards, academic rank, and personal Scopus Hirsch index (h-index). Linear regression was performed to determine correlation, and t tests were used to assess differences in the h-index. Results Of the 170 TPs, 21.2% were HTPs and 78.8% were ATPs. TPs were 97.6% male, 91.2% were non-Hispanic White, and 60% had attained an academic rank. The mean ages of the HTPs and ATPs were a 56.2 ± 9.6 and 52.6 ± 9.6 years, respectively (P = .047). Among orthopaedic surgeons, the most common subspecialties were sports medicine (70.5%), foot and ankle (7.6%), and spine (5.7%). Of the TPs, 48.2% and 32.9% worked for a team in the same state in which they graduated residency and fellowship, respectively. HTPs and ATPs had been in the NFLPS for a mean of 16.9 ± 10.8 and 8.8 ± 8.3 years, respectively (P < .001). Further, TPs holding an academic rank had a mean h-index of 14.0 ± 19.3, while those without an academic rank had a mean h-index of 6.2 ± 8.8 (P < .01). HTPs and ATPs had mean h-indices of 15.7 ± 15.9 and 9.6 ± 16.3 (P = .0503), respectively. Conclusion TPs in the NFL are typically White men in their mid-50s who have trained at specific high-ranking institutions and obtained a fellowship in sports medicine. HTPs were likely to be older with longer tenures within the NFLPS and with more impactful research than their ATP counterparts.
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Affiliation(s)
- Tyler B. Gillikin
- Department of Orthopaedic Surgery, Northwestern University, Chicago, Illinois, USA
| | - Nicholas J. Lanzetta
- Department of Orthopaedic Surgery, Northwestern University, Chicago, Illinois, USA
| | - Peter R. Swiatek
- Department of Orthopaedic Surgery, Northwestern University, Chicago, Illinois, USA
| | - Erik B. Gerlach
- Department of Orthopaedic Surgery, Northwestern University, Chicago, Illinois, USA
| | - Michael A. Terry
- Department of Orthopaedic Surgery, Northwestern University, Chicago, Illinois, USA
| | - Vehniah K. Tjong
- Department of Orthopaedic Surgery, Northwestern University, Chicago, Illinois, USA
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Koech H, Albanese J, Saeks D, Habashi K, Strawser P, Hall M, Kim K, Maitra S. Minority Resident Physicians' Perspectives on the Role of Race/Ethnicity, Culture, and Gender in Their Surgical Training Experiences. JOURNAL OF SURGICAL EDUCATION 2023; 80:833-845. [PMID: 37121866 DOI: 10.1016/j.jsurg.2023.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 03/22/2023] [Accepted: 03/31/2023] [Indexed: 05/23/2023]
Abstract
BACKGROUND Female and racial/ethnic minority representation in surgical programs continues to trail behind other medical specialties. Various structural and perceived obstacles which contribute to a difficult path for underrepresented minority (URM) trainees have been identified, and efforts to reduce these hurdles are underway. Gaining perspective and insight from current surgical minority trainees may add valuable insight to aid with improving and innovating strategies to recruit and retain URM surgeons. OBJECTIVE To characterize how race/ethnicity, cultural background, and gender affect the surgical training experience of URM surgical residents in all areas of surgery a focus on the field of Orthopedic Surgery, given its particularly poor rates of diversity. METHODS Authors conducted semi-structured video interviews on current surgical residents or fellows who were members of underrepresented populations including Female, African-American/Black, Latino, Asian, Native American, and First or Second-generation immigrant status. Recruitment was achieved through a combination of voluntary, convenience, and snowball sampling procedures. Interview transcripts were then coded using conventional thematic analysis. Themes were iteratively expanded into subthemes and subsequently categorized utilizing a pile-sorting methodology. RESULTS Among 23 surgical trainees 12 self-identified as Black (60.9%), 5 as Asian (17.4%), 1 as Hispanic (4.4%), and 5 as Caucasian (17.4%). Twelve residents identified as male (52%) and 11 as female (48%). Six surgical specialties were represented with the majority of participants (83%) being trainees in surgical subspecialties, among those orthopedic surgery was most strongly represented (57%). Analysis of their responses revealed 4 major themes: positive experiences, problems related to minority status, coping strategies, and participant suggested interventions. Themes were distilled further to sub-themes. Positive experiences' sub-themes included finding a supportive community, pride in minority status, and being able to better relate to patients. Negative experiences related to minority status' subthemes included perceived microaggressions and additional pressures, such as greater scrutiny and harsher punishments relative to their nonminority counterparts, which negatively impacted their surgical training. Most respondents did not feel there were dedicated resources to help alleviate these additional burdens, so some sought help outside of their training programs while others tried to assimilate, and others felt isolated. Recommended proposed interventions included validating the URM resident experience, providing education/training, and creating opportunities for mentorship. IMPLICATIONS/CONCLUSIONS URM surgical trainees face numerous challenges related to their minority status. Recruitment and retention of URM in medicine would benefit from individual early and longitudinal mentorship, mitigating imposter syndrome, acknowledging the challenges faced by residents, and seeking feedback from both past and current residents.
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Affiliation(s)
- Hilary Koech
- UNLV Department of Orthopedics, University Medical Center, Las Vegas, Nevada
| | - Jessica Albanese
- UNLV Department of Orthopedics, University Medical Center, Las Vegas, Nevada; Duke University Department of Orthopedics, Duke University Medical Center, Durham, North Carolina
| | - Douglas Saeks
- Kirk Kerkorian School of Medicine, University of Nevada, Las Vegas (UNLV), Las Vegas, Nevada.
| | - Kian Habashi
- Duke University Department of Orthopedics, Duke University Medical Center, Durham, North Carolina
| | - Payton Strawser
- UNLV Department of Orthopedics, University Medical Center, Las Vegas, Nevada
| | - Michael Hall
- UNLV Department of Orthopedics, University Medical Center, Las Vegas, Nevada
| | - Kelvin Kim
- UNLV Department of Orthopedics, University Medical Center, Las Vegas, Nevada
| | - Sukanta Maitra
- UNLV Department of Orthopedics, University Medical Center, Las Vegas, Nevada; Duke University Department of Orthopedics, Duke University Medical Center, Durham, North Carolina
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White PB, Giordano JR, Chen M, Bitterman AD, Oni JK, Zacchilli M, Poon SC, Cohn RM. Residency Match Rates in Orthopaedic Surgery Based on Sex, Under-Represented in Medicine Status, and Degree Type. JB JS Open Access 2023; 8:JBJSOA-D-22-00143. [PMID: 36969690 PMCID: PMC10032572 DOI: 10.2106/jbjs.oa.22.00143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/24/2023] Open
Abstract
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.
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Affiliation(s)
- Peter B. White
- Department of Orthopaedic Surgery, Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York
| | - Joshua R. Giordano
- Department of Orthopaedic Surgery, Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York
| | - Matthiew Chen
- Department of Orthopaedic Surgery, Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York
| | - Adam D. Bitterman
- Department of Orthopaedic Surgery, Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York
- Department of Orthopaedic Surgery, Northwell Health Huntington Hospital, Huntington, New York
| | - Julius K. Oni
- Department of Orthopaedic Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Michael Zacchilli
- Department of Orthopaedic Surgery, Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York
- Department of Orthopaedic Surgery, Northwell Health Lenox Hill Hospital, New York, New York
| | - Selina C. Poon
- Shriners for Children Medical Center, Pasadena, California
| | - Randy M. Cohn
- Department of Orthopaedic Surgery, Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York
- Department of Orthopaedic Surgery, Northwell Health Long Island Jewish Valley Stream, Valley Stream, New York
- E-mail address for R.M. Cohn:
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12
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Sinclair MK, Chhabra AB. Recruiting, Supporting and Retaining Diversity in Hand Surgery. Hand Clin 2023; 39:33-42. [PMID: 36402524 DOI: 10.1016/j.hcl.2022.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
All surgical fields that lead to a career in Hand Surgery have a stark lack of diversity of sex/gender and race, at every level of the workforce, from trainees to practicing physicians. Despite consistent statistics in publications on lack of diversity in surgical fields, a guide to effective recruitment and retention is lacking. Although we recognize that a strategy cannot be applied in all practices, this article provides actionable items to consider in the commitment and work toward a more just and equitable practice of Hand Surgery.
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Affiliation(s)
- Micah K Sinclair
- Department of Orthopaedic Surgery & Musculoskeletal Medicine, Children's Mercy Hospital, University of Missouri Kansas City, University of Kansas Medical Center, 2401 Gillham Road, Kansas City, MO 64108, USA.
| | - A Bobby Chhabra
- Department of Orthopaedic Surgery, Hand Surgery, University of Virginia Health, PO Box 800159, Charlottesville, VA 22908-0159, USA
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Rodarte P, Kammire MS, Israel H, Poon SC, Cannada LK. The other side of conflict: Examining the challenges of female orthopaedic surgeons in the workplace. Am J Surg 2023; 225:46-52. [PMID: 36243560 DOI: 10.1016/j.amjsurg.2022.09.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Revised: 08/21/2022] [Accepted: 09/18/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND As more women begin to enter the traditionally male-dominated field of orthopaedics, it is critical to examine their experiences in navigating gender-based conflicts in the workplace. METHODS An anonymous survey was distributed via a web link to approximately 1,100 members of Ruth Jackson Orthopaedic Society (RJOS) and 1,600 members of Women in Orthopaedics (WIO) Facebook group, with an estimated response rate of 50% and 50% respectively and protocols to mitigate duplicate response. Questions included demographics and presented several workplace scenarios. RESULTS Of the 373 respondents, 72% described experiencing some type of workplace conflict self-attributed to being female. Additionally, 8% reported either being forced out or leaving their previous job due to workplace conflict, leading to depression, anxiety, and burnout. 17% of respondents would not choose the same career again if given the opportunity. CONCLUSIONS Workplace conflict diminishes a surgeon's career satisfaction and may ultimately contribute to burnout. Understanding the relationship between gender bias and orthopaedic surgery is essential in moving towards change, and addressing these issues will create a more positive working environment for female surgeons.
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Affiliation(s)
- Patricia Rodarte
- Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Maria S Kammire
- University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | | | - Selina C Poon
- Shriner's for Children Medical Center, Pasadena, CA, USA
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Lamanna DL, Chen AF, Dyer GSM, Johnson AE, McCarthy CJ. Diversity and Inclusion in Orthopaedic Surgery from Medical School to Practice: AOA Critical Issues. J Bone Joint Surg Am 2022; 104:e80. [PMID: 36129676 DOI: 10.2106/jbjs.21.01271] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Orthopaedic surgery has historically been one of the least diverse fields in medicine in the U.S. Despite having been declared a critical issue by the American Orthopaedic Association, a lack of diversity and inclusion across all metrics remains a persistent problem. In order to balance representation within orthopaedic surgery, a multiyear and multilevel approach should be considered across the life cycle of a surgeon. Talented individuals from diverse backgrounds must be identified and given early exposure to orthopaedic surgery. They must be nurtured, mentored, and retained. Representation at the medical student, resident, and faculty level is vital to ensuring diversity across the next generation of surgeons.We cannot alter representation within orthopaedics unless we broaden the candidate selection pool. Medical school classes provide the selection pool for residency, residency provides the candidates for fellowship, fellowships provide the candidates for employment, and employment provides the pool for promotion to leadership positions. Through each progression, there is a loss of underrepresented applicants, which leads to a lack of balanced representation in orthopaedic surgery. With stronger efforts to identify and retain individuals at each phase of a surgeon's career, we hope to mitigate the loss of talented and diverse individuals from this field.We challenge the paradigm of increasing diversity that focuses only on the resident selection level. Instead, efforts must begin at the medical student level. Efforts for early and meaningful exposure to the field through a musculoskeletal curriculum and rotations as well as connection through mentorship and sponsorship are vital for retention. At each ascending level of education, reinvestment in each individual is critical. Exposure, mentorship, retention, and promotion should lead to a more diverse and rich future. To achieve this, deliberate and longitudinal action should be instituted to increase diversity within orthopaedics.
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Affiliation(s)
- Daniel L Lamanna
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Antonia F Chen
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - George S M Dyer
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Anthony E Johnson
- Department of Surgery and Perioperative Care, Dell Medical School, The University of Texas at Austin, Austin, Texas
| | - Colm J McCarthy
- Department of Orthopaedic Surgery, St. Anne's Hospital, Fall River, Massachusetts.,Boston University School of Medicine, Boston, Massachusetts
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15
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Gordon AM, Conway CA, Sheth BK, Magruder ML, Vakharia RM, Levine WN, Razi AE. How Did Coronavirus-19 Impact the Expenses for Medical Students Applying to an Orthopaedic Surgery Residency in 2020 to 2021? Clin Orthop Relat Res 2022; 480:443-451. [PMID: 34913886 PMCID: PMC8846343 DOI: 10.1097/corr.0000000000002042] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 10/13/2021] [Indexed: 01/31/2023]
Abstract
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.
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Affiliation(s)
- Adam M. Gordon
- Department of Orthopaedic Surgery, Maimonides Medical Center, New York, NY, USA
| | - Charles A. Conway
- Department of Orthopaedic Surgery, Maimonides Medical Center, New York, NY, USA
| | - Bhavya K. Sheth
- Department of Orthopaedic Surgery, Maimonides Medical Center, New York, NY, USA
| | - Matthew L. Magruder
- Department of Orthopaedic Surgery, Maimonides Medical Center, New York, NY, USA
| | - Rushabh M. Vakharia
- Department of Orthopaedic Surgery, Maimonides Medical Center, New York, NY, USA
| | - William N. Levine
- Department of Orthopaedic Surgery, Columbia University Medical Center, New York, NY, USA
| | - Afshin E. Razi
- Department of Orthopaedic Surgery, Maimonides Medical Center, New York, NY, USA
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Ramos TA, Silver J, Owusu-Ansah G, Mulcahey MK. Letter to the Editor: How Long Will It Take to Reach Gender Parity in Orthopaedic Surgery in the United States? An Analysis of the National Provider Identifier Registry. Clin Orthop Relat Res 2021; 479:2757-2758. [PMID: 34570744 PMCID: PMC8726553 DOI: 10.1097/corr.0000000000001998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Accepted: 09/08/2021] [Indexed: 01/31/2023]
Affiliation(s)
| | - Julia Silver
- Tulane University School of Medicine, New Orleans, LA, USA
| | | | - Mary K. Mulcahey
- Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, LA, USA
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