Influence of Trainee Experience on Choice of Orthopaedic Subspecialty Fellowship

Orthopaedic Shoulder and Elbow Fellowship Directors in the United States Have Substantial Research Output but Lack Diversity

Purpose

To investigate the characteristics of shoulder and elbow fellowship directors (FDs).

Methods

FDs for shoulder and elbow fellowship programs in the United States were identified. Demographic, educational, and professional background data were collected from available curricula vitarum, institutional biographies, and the Scopus database. Data collected included age, sex, race/ethnicity, training locations, graduation years, advanced degrees, current institutional information, and personal research H-index.

Results

Thirty current orthopaedic shoulder and elbow FDs were identified. The mean Scopus H-index was 25.5. The mean age of FDs was 52.1 years. In total, 29 FDs (96.7%) were male and 1 (3.3%) was female. In addition, 25 of the 30 (83.3%) were White (83.3%), 4 were Asian, and 1 (3.3%) was Hispanic. Two (6.7%) had a military affiliation. Mean time from fellowship training graduation to FD appointment was 13.5 years. Mean number of years as FD was 6.1 years, whereas the number of years tenure with an FD-affiliated institution was 13.0 years. Mean calendar years for completion of orthopaedic residency training and fellowship training were 1998 and 2000, respectively. The residencies that produced the most future FDs were Hospital of the University of Pennsylvania (n = 2) and University of Nebraska Medical Center/Creighton University Health Foundation (n = 2). The fellowship that produced the most future FDs was Columbia University (n = 6). Moderate correlation was found between age and Scopus H-index (r = 0.48; P = .04) and years as FD and Scopus H-index (r = 0.42; P = .03).

Conclusions

Women and minorities are under-represented in leadership positions in shoulder and elbow surgery. Shoulder and elbow FDs have the highest H-index of any subspecialty reported in the orthopaedic literature. Research productivity is an important qualification when considering the characteristics of shoulder and elbow FDs.

Clinical Relevance

Fellowship directors can have a profound influence on current and future orthopaedic surgeons. It is important to identify the traits that characterize current fellowship directors to have a better understanding of who we choose as leaders in our field.

Factors Influencing Sports Medicine as a Career Choice Among Orthopaedic Trainees in Saudi Arabia

Background:

Sports medicine is one of the most popular orthopaedic specialties, with more fellowship applicants than in any other subspecialty of orthopaedics.

Purpose:

To investigate the factors influencing orthopaedic trainees to complete their fellowships and subsequently subspecialize in sports medicine in Saudi Arabia, as well as to compare the motivational factors of trainees planning to pursue sports medicine versus other orthopaedic specialties.

Study Design:

Cross-sectional study.

Methods:

An online anonymous questionnaire was distributed to 400 orthopaedic surgical trainees from 44 training centers (residency and fellowship training programs) across Saudi Arabia. The questionnaire identified trainees planning to select sports medicine as their career and the most influential factors affecting their choice; items exploring the influential factors were answered on a 5-point Likert-type scale. A comparison of responses was performed with candidates aiming to pursue other orthopaedic specialties. The chi-square or Fisher exact test was used to compare demographic parameters and the percentage of “agree” and “strongly agree” responses between trainees opting for sports medicine fellowships and those choosing other fellowships.

Results:

Of the 400 potential participants, 250 orthopaedic trainees (response rate, 63%) completed the survey (201 [80%] male and 49 [20%] female). Sports medicine was the most coveted specialty among trainees, with 70 (28%) participants opting for it as their career choice. The most prominent factors for the decision included disease prognosis and surgical outcomes (90%), personal interest (87%), experience during residency training (83%), type of surgical skills (81%), disease pathology and patient population (77%), expected workload and lifestyle (73%), role model or mentor (70%), and patient volume and variety of cases (67%). Significant differences compared with trainees who preferred other orthopaedic specialties included role model/mentor impact (70% vs 54%), expected rate of income (60% vs 47%), and private sector job opportunities (64% vs 45%) (P = .025, .034, and .020, respectively).

Conclusion:

Study findings indicated that a significant percentage of orthopaedic trainees in Saudi Arabia choose to specialize in sports medicine. Role model/mentorship, private sector job opportunities, and expected rate of income were the most influential when compared with the motivations of trainees not choosing sports medicine.

Characterizing Leadership Trends in Hand Surgery Fellowship Programs

Purpose

Methods

Results

Conclusions

Clinical relevance

Investigation of Fellowship Leadership in Orthopaedic Musculoskeletal Oncology

Introduction:

Methods:

Results:

Conclusion:

Factors Influencing Career Decisions and Satisfaction Among Newly Practicing Ophthalmologists

PURPOSE

To describe the career choices of newly practicing ophthalmologists and explore factors influencing career decisions and satisfaction.

METHODS

A cross-sectional study was conducted using data from an electronic survey of ophthalmologists who completed training within the prior 5 years. The survey included questions about demographic information, medical education, current practice, factors affecting career choices, and career satisfaction. Statistical comparisons were made based on gender, type of practice, subspecialty training, and practice area.

RESULTS

Surveys were completed by 696 (32%) newly practicing ophthalmologists, including 276 (40%) women, 179 (29%) academicians, and 465 (67%) subspecialists. A higher proportion of female respondents entered academics than male respondents (36% vs 26%, P = .009). Female and male respondents pursued fellowship training with similar frequency (64% vs 68%, P = .32), but men were more likely to seek vitreoretinal fellowships (30% vs 11%, P < .001) and women were more likely to undertake fellowships in pediatric ophthalmology (21% vs 8%, P < .001), uveitis (10% vs 2%, P = .002), and neuro-ophthalmology (6% vs 2%, P = .042). A total of 514 (83%) respondents reported being happy with work life.

CONCLUSIONS

The career choices of newly practicing ophthalmologists differ based on gender, type of practice, subspecialty training, and practice area. Many factors affect career decisions, and they have varying influence on subgroups within ophthalmology. Ophthalmologists have high levels of career satisfaction. This information may prove useful when developing workforce strategies to meet future eye care needs. NOTE: Publication of this article is sponsored by the American Ophthalmological Society.

Trends in the pursuit of multiple orthopedic surgery fellowships among orthopedic trainees in Saudi Arabia

Background

The increase in the enrollment of orthopedic surgery residents in multiple fellowship programs has gained considerable interest. Different factors may determine the specialty and number of fellowships trainees enroll in. This study aimed to elucidate these factors and determinants among orthopedic trainees.

Methods

This is a descriptive cross-sectional study, which was conducted among orthopedic surgical trainees (residency and fellowship training programs) in Saudi Arabia, between March 2021 and May 2021. The data were obtained through an online anonymous questionnaire aiming to clarify the most influential factors that determine the number of fellowships trainees choose, as well as to compare the choice of single fellowships with those of multiple ones.

Results

Two hundred and fifty orthopedic trainees (201 (80%) males and 49 (20%) females) completed the survey. Among them, 216 (86%) and 34 (14%) were residents and fellows, respectively, and 81% (n = 203) of the trainees preferred multiple fellowship training, and 22% (n = 47) preferred a single fellowship specialty. Notably, the male trainees preferred multiple fellowships to a single one (85% vs. 62%, p-value = 0.001), while the female trainees preferred single fellowships to multiple ones (38% vs. 15%, p-value = 0.001). The expected rate of income (17% vs. 9%), job opportunities in the private sector (17% vs. 9%), and availability and guarantee of jobs (33% vs. 23%) were the most significant factors that influenced the choices of the participants toward enrolling in multiple fellowships (p-values = 0.001, 0.001, and 0.004, respectively).

Conclusions

The study demonstrated that most of the orthopedic trainees in Saudi Arabia prefer the pursuits of multiple fellowship programs. Further, the female trainees preferred single fellowships, whereas the male ones preferred multiple fellowships. The main influencing factors for pursuing multiple fellowships were determined to be private job opportunities, financial gains, and job guarantees.

Orthopaedic Foot and Ankle Surgery Fellowship Directors Are Typically White Men in Their Early 50s With Strong Achievements in Research

Purpose

To determine the objective characteristics of orthopaedic foot and ankle fellowship directors (FDs) by concentrating on the demographic characteristics, academic background, institutional history, research experience, and professional affiliations of these leaders.

Methods

Data for each FD were collected by searching institutional biographies, personal websites, or publicly available curricula vitae. Data collection included the following variables: age, sex, race/ethnicity, previous training institutions, residency and fellowship graduation years, advanced degrees, military affiliation, institutional loyalty, year hired, FD career timeline, total number of publications, total number of citations, and h-index.

Results

Of the 47 FDs, 44 (93.6%) were men and 3 (6.4%) were women. The mean age was 50.8 ± 9.4 years. Most orthopaedic foot and ankle FDs were white (n = 42, 89.4%), followed by Asian (n = 4, 8.5%) and black or African American (n = 1, 2.1%). The mean Scopus h-index, total number of publications, and total number of citations for all foot and ankle FDs were 13.3 ± 9.5, 47.5 ± 45.8, and 898.1 ± 1,040.3, respectively. Among all foot and ankle FDs, the mean tenure in the FD position was 5.8 ± 4.6 years.

Conclusions

Orthopaedic foot and ankle FDs are primarily white men in their 50s, with minimal female and minority representations. These FDs are distinguished by their high level of research productivity. Additionally, orthopaedic foot and ankle training backgrounds seem to play an important role, given that most of the appointed FDs trained in only a few select programs.

Clinical Relevance

This study outlines some of the most important characteristics among foot and ankle FDs and identifies important disparities within this population of leaders that may have detrimental effects on the field.

Orthopaedic Sports Medicine Fellowship Directors Are Predominantly White Men With a High Degree of Research Productivity

PURPOSE

To determine the objective characteristics of fellowship directors (FDs) in orthopaedic sports medicine by focusing on the demographics, academic background, institutional history, research experience, and professional affiliations of FDs in this field.

METHODS

Data was collected for each FD via institutional biographies or publicly available curriculum vitae (CV). The data collected for each FD included age, gender, race/ethnicity, previous training institutions, residency and fellowship graduation years, additional advanced degrees, military affiliation, institutional loyalty, year hired by current institution, career timeline, Scopus H-index, number of publications, and total number of citations.

RESULTS

Of the 88 FDs, 87 (98.9%) were male and 1 (1.1%) was female. The mean age for all FDs was 54.7 years (± 9.1 standard deviation). The majority of FDs were White (n = 80; 90.9%). The mean Scopus H-index, total number of publications, and total number of citations were 22.5 ± 16.6, 90.0 ± 91.6, and 2773.9 ± 3962.9, respectively. On average, it took 9.5 ± 7.3 years from fellowship graduation until FD appointment. Additionally, the mean number of years of employment or affiliation with the current institution was 17.2 ± 9.4, and the mean number of years in an FD role was 10.9 ± 9.3.

CONCLUSION

Orthopaedic sports medicine fellowship directors are largely distinguished by their high level of research productivity and accomplishment. Additionally, orthopaedic training pedigree seems to play a role in FD role attainment, with a handful of orthopaedic residency and sports medicine fellowship programs producing a large percentage of current FDs. Finally, FDs are overwhelmingly white males with little female or minority representation.

CLINICAL RELEVANCE

This study outlines some of the most important characteristics among orthopaedic sports medicine fellowship directors and identifies racial and gender disparities within this population of leaders that may have detrimental effects on the field as a whole.

Trends in leadership at orthopaedic surgery sports medicine fellowships

BACKGROUND

Fellowship directors (FDs) in sports medicine influence the future of trainees in the field of orthopaedics. Understanding the characteristics these leaders share must be brought into focus. For all current sports medicine FDs, our group analyzed their demographic background, institutional training, and academic experience.

AIM

To serve as a framework for those aspiring to achieve this position in orthopaedics and also identify opportunities to improve the position.

METHODS

Fellowship programs were identified using both the American Orthopaedic Society for Sports Medicine and the Arthroscopy Association of North America Sports Medicine Fellowship Directories. The demographic and educational background data for each FD was gathered via author review of current curriculum vitae (CVs). Any information that was unavailable on CV review was gathered from institutional biographies, Scopus Web of Science, and emailed questionnaires. To ensure the collection of as many data points as possible, fellowship program coordinators, orthopaedic department offices and FDs were directly contacted via phone if there was no response via email. Demographic information of interest included: Age, gender, ethnicity, residency/fellowship training, residency/fellowship graduation year, year hired by current institution, time since training completion until FD appointment, length in FD role, status as a team physician and H-index.

RESULTS

Information was gathered for 82 FDs. Of these, 97.5% (n = 80) of the leadership were male; 84.15% (n = 69) were Caucasian, 7.32% (n = 6) were Asian-American, 2.44% (n = 2) were Hispanic and 2.44% (n = 2) were African American, and 3.66% (n = 3) were of another race or ethnicity. The mean age of current FDs was 56 years old (± 9.00 years), and the mean Scopus H-index was 23.49 (± 16.57). The mean calendar years for completion of residency and fellowship training were 1996 (± 15 years) and 1997 (± 9.51 years), respectively. The time since fellowship training completion until FD appointment was 9.77 years. 17.07% (n = 14) of FDs currently work at the same institution where they completed residency training; 21.95% (n = 18) of FDs work at the same institution where they completed fellowship training; and 6.10% (n = 5) work at the same institution where they completed both residency and fellowship training. Additionally, 69.5% (n = 57) are also team physicians at the professional and/or collegiate level. Of those that were found to currently serve as team physicians, 56.14% (n = 32) of them worked with professional sports teams, 29.82% (n = 17) with collegiate sports teams, and 14.04% (n = 8) with both professional and collegiate sports teams. Seven residency programs produced the greatest number of future FDs, included programs produced at least three future FDs. Seven fellowship programs produced the greatest number of future FDs, included programs produced at least four future FDs. Eight FDs (9.75%) completed two fellowships and three FDs (3.66%) finished three fellowships. Three FDs (3.66%) did not graduate from any fellowship training program. The Scopus H-indices for FDs are displayed as ranges that include 1 to 15 (31.71%, n = 26), 15 to 30 (34.15%, n = 28), 30 to 45 (20.73%, n = 17), 45 to 60 (6.10%, n = 5) and 60 to 80 (3.66%, n = 3). Specifically, the most impactful FD in research currently has a Scopus H-index value of 79. By comparison, the tenth most impactful FD in research had a Scopus H-index value of 43 (accessed December 1, 2019).

CONCLUSION

This study provides an overview of current sports medicine FDs within the United States and functions as a guide to direct initiatives to achieve diversity equality.

Orthopedic Oncology Experience During Residency

The objective of this study was to determine the characteristics and logistics of orthopedic oncology rotations at various residency programs across the USA and determine the effect of orthopedic oncology rotations on Orthopedic In-Training Examination (OITE) scores. An eight-question survey was sent to 162 orthopedic surgery residency programs obtained from the Accreditation Council for Graduate Medical Education public database. Pre-oncology rotation and post-oncology rotation OITE scores for 24 residents at a major academic medical center were collected and analyzed. The response rate was 43.8%. Survey results were as follows: 90.1% responded positively to having a dedicated orthopedic oncology rotation in their curriculum; 49.3% carried out their oncology rotation at a hospital outside of their home institution; 70.4% of programs had only one dedicated orthopedic oncology rotation throughout residency; 42.3% indicated that residents experience 6-10 weeks of dedicated orthopedic oncology training during the 5-year residency program; 42.2% indicated that residents experience oncology rotations during post-graduate year 4; and 80.3% of programs had orthopedic oncology trained surgeons on their faculty. The mean increase in OITE oncology scores after the rotation was 12.1% (p = 0.005). There are variations in orthopedic oncology curricula across residency programs, most notably in the number of weeks residents participate in a dedicated oncology rotation, the post-graduate year that residents rotate on an oncology service, and the location where residents obtain their orthopedic oncology training. Participating in a dedicated orthopedic oncology rotation resulted in significant improvement in scores on the oncology domain of the OITE.

Characteristics of Orthopaedic Sports Medicine Fellowship Directors

Background:

No study in the orthopaedic literature has analyzed the demographic characteristics or surgical training of sports medicine fellowship directors (FDs). Objective determinations as to what makes a physician qualified for this leadership position remain unclear; thus, it is important to identify these qualities as future physicians look to fill these roles.

Purpose:

To illustrate characteristics common among sports medicine FDs.

Study Design:

Cross-sectional study.

Methods:

The 2020 Accreditation Council for Graduate Medical Education Fellowship Directory was used to identify the FDs for all orthopaedic sports medicine fellowship programs in the United States. The characteristics and educational background data for FDs were gathered by 2 independent reviewers from up-to-date curricula vitarum, Web of Science, and institutional biographies and consolidated into 1 database. Data points gathered included age, sex, residency/fellowship training location and graduation year, name of current institution, length of time at current institution, time since training completion until being appointed FD, length of time in current FD role, and personal research H-index.

Results:

We identified 90 current orthopaedic sports medicine FDs. The mean Scopus H-index was 24.1 (median, 17). The mean age of FDs was 55.4 years; 87 of 90 (96.7%) were male and 3 (3.3%) were female; and 79/90 (87.8%) were White and 3/90 (3.3%) were African-American. The mean time to complete residency was 5.1 years (range, 5.0-6.0 years), and the most attended residency programs were the Hospital for Special Surgery (n = 9), the Harvard Combined Orthopaedic Residency Program (n = 5), and Duke University Medical Center (n = 4). The mean time required to complete a fellowship was 1.1 years (range, 1.0-2.0 years), and the fellowship programs that produced the most future FDs were the American Sports Medicine Institute (n = 11), the Steadman Hawkins Clinic (Vail) (n = 8), the Kerlan-Jobe Orthopaedic Clinic (n = 7), and the Hospital for Special Surgery (n = 7). The mean time from completion of fellowship to appointment as a FD was 12.8 years (range, 1-39 years).

Conclusion:

Women and minority groups are largely underrepresented among leadership positions in the field of orthopaedic sports medicine.

Analysis of Orthopaedic Job Availability in the United States Based on Subspecialty

BACKGROUND

The number of orthopaedic residency graduates pursuing additional subspecialty training has increased along with the percentage of advertised jobs requiring fellowship. As such, the implications of fellowship training on job availability and marketability may impact their choice of subspecialty. The purpose of this study was to evaluate job availability in the United States for general orthopaedics and orthopaedic subspecialties.

METHODS

Job advertisements in 2019 were reviewed from the career center databases of the Journal of Bone and Joint Surgery, American Academy of Orthopaedic Surgeons, as well as of individual subspecialty societies. Job listings were cross referenced to identify unique jobs within the United States, which were categorized by the orthopaedic training required, practice type, and location. To assess job availability, a ratio of fellows to job listings was calculated based on the number of matched candidates for nine subspecialty fellowships and the number of residency graduates entering general practice in 2019.

RESULTS

A total of 466 unique job listings were identified with 114 generalist and 352 subspecialist positions. The subspecialties with the lowest number of fellows per advertised job were foot and ankle (1.1), adult reconstruction (2.0), and trauma (2.1). The subspecialties with the highest number of fellows per advertised job were sports medicine (6.3), shoulder and elbow (5.8), and oncology (5.7). Job availability for general orthopaedics was higher than for any subspecialty. The highest percentage of positions advertised were hospital employed jobs compared with private practice and academic positions.

CONCLUSIONS

Job availability for fellowship graduates varies notably based on orthopaedic subspecialty. At this time, generalists and subspecialists trained in foot and ankle, adult reconstruction, and trauma seem to be in greatest demand. The reason for the differences in demand is likely multifactorial. Our findings should be considered by orthopaedic residents pursuing fellowship training in addition to weighing both personal interest and financial considerations in their subspecialty choice.

Trends in Leadership at Orthopedic Surgery Adult Reconstruction Fellowships

BACKGROUND

Fellowship directors (FDs) in adult reconstruction have a profound impact on current and future trainees within orthopedics. Our group sought to evaluate the shared characteristics among current adult reconstruction FDs to provide a framework for those aspiring to achieve this position and identify possible areas of improvement.

METHODS

Fellowship programs were identified using the American Association of Hip and Knee Surgeons Directory. Data for each FD were gathered via electronic mail, telephone, curriculum vitae, and online searches. Demographic information collected included age, gender, ethnicity, residency/fellowship training, residency/fellowship graduation year, year hired by current institution, time since training completion until FD appointment, length in FD role, and Scopus H-index.

RESULTS

Information was gathered for 94 FDs. Of these, 100% were males; 80.6% were Caucasian, 12.90% were Asian American, 5.38% were Hispanic, and 1.08% were African American. The average age (52.6 years old), H-index (16.54), year of residency (2000) and fellowship (2001) graduation, and time since training until FD appointment (9.55 years) were analyzed. The top training programs to produce future FDs were Mayo Clinic (residency) and Harvard University (fellowship).

CONCLUSION

Adult reconstruction FDs are frequently distinguished by their level of research productivity and experience, but certainly more demographic diversity is needed within this cohort. Specific training programs may inherently have a vital role in the development of individuals for future leadership positions. These developments could be a result of unique features inherent to the training programs or because of a subset of applicants who pursue specific programs with aspirations of subsequent leadership opportunities.

Factors Influencing Postgraduate Career Decisions of Ophthalmology Residents

Objective This study aims to identify factors that influence ophthalmology residents' decision to pursue fellowship training or to practice comprehensive ophthalmology after residency.

Design This is a cross-sectional study.

Methods An anonymous survey was sent to ophthalmology residents in the United States from the graduating class of 2018. The main outcome measure was the decision to seek fellowship training or to practice comprehensive ophthalmology. Information on demographics, residency program characteristics, and factors influencing career choices were collected.

Results The overall response rate was 24.0% (112/467). Among the 112 respondents, 88 (78.6%) matched into subspecialty training. Compared with residents entering comprehensive ophthalmology, there was a greater proportion of Asians (37.5 vs. 8.3%) and a smaller proportion of non-Hispanic whites (47.7 vs. 70.8%, p = 0.029) among residents pursuing fellowship training. Residents pursuing fellowships had fewer children (0.4 vs. 0.8, p = 0.049), had less debt (median debt ≤ $100,000 vs. > $200,000, p = 0.008), had more first-author publications (4.3 vs. 1.2, p< 0.001), decided on their postgraduate career path earlier (median time postgraduate second year [PGY2] versus postgraduate third year [PGY3], p = 0.016), and were more likely to plan to practice in an academic setting (51.1 vs. 29.2%, p< 0.001) and in an urban location (44.3 vs. 12.5%, p = 0.004). In a multiple logistic regression model, factors predictive of fellowship training included a desire to acquire special skills (odds ratio [OR] =4.39; 95% confidence intervals [CI]: 1.70–16.37) and work with new technology (OR = 2.92; 95% CI: 1.16–10.02). Factors that predicted a career in comprehensive ophthalmology were higher levels of educational debt (OR = 0.35; 95% CI: 0.12–0.77), a later timing of postgraduate decision (OR = 0.17; 95% CI: 0.02–0.65), and lifestyle considerations (OR = 0.13; 95% CI: 0.03–0.36). Gender, prestige, or perceived favorable job market was not significant factors.

Conclusion The majority of U.S. ophthalmology residents matched into fellowships. A desire to gain special skills and a desire to work with new technology were major factors influencing residents to seek fellowship training. Lifestyle considerations and educational debt were more important in the decision to choose a comprehensive ophthalmology career. Future research that includes more trainees and programs may minimize the selection bias issues present in this study.

Trends in Leadership at Spine Surgery Fellowships

STUDY DESIGN

Cross-sectional study.

OBJECTIVE

To illustrate demographic trends among spine fellowship leaders (FLs).

SUMMARY OF BACKGROUND DATA

No previous study in the orthopedic literature has analyzed the demographic characteristics or past surgical training of FL in an orthopedic sub-specialty. We attempt to illustrate demographic trends among spine fellowship leadership including fellowship directors (FDs) and co-fellowship directors (co-FDs). We also highlight the institutions that have trained these leaders at various levels.

METHODS

Our search for FDs was constructed from the 2018 to 2019 North American Spine Surgery (NASS) Fellowship Directory. Datapoints gathered included: age, sex, residency/fellowship training location, time since training completion until FD appointment, length in FD role, and personal research H-index.

RESULTS

We identified 103 FLs consisting of 67 FDs, 19 co-FDs, and another 16 individuals with a synonymous leadership title. 96.1% (99) of the leadership consisted of males while 3.9% (4) were female. The mean age was 52.9 years old and the mean h-index of the FLs was 23.8. FLs were trained in orthopedic surgery (n = 89), neurosurgery (n = 13), or combined orthopedic surgery and neurosurgery training (n = 1). The top fellowships programs producing future FLs were: Case Western Reserve University, Cleveland (n = 10), Washington University, St. Louis (n = 9), and Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia (n = 7).

CONCLUSION

Spine surgery fellowship directors are more likely to have graduated from certain residency and fellowship programs. This finding could be a result of the training provided by these centers or the institution's predilection to select applicants that are more likely to later seek academic leadership roles post-training.

LEVEL OF EVIDENCE

4.

How the Reputation of Orthopaedic Residency Programs Is Associated with Orthopaedic Fellowship Match Results

BACKGROUND

The primary goal of the present study was to determine if applicants from higher-ranking U.S. orthopaedic surgery residency programs match at a more desired position on their fellowship match-rank list compared with those applicants from lower-ranked residency programs.

METHODS

San Francisco Match provided results regarding applicant data and match results from 2014 to 2018 for all orthopaedic subspecialties except the hand and the shoulder and elbow. Unmatched applicants and international medical graduates were excluded. Residency programs were divided into 5 tiers (with tier 1 being the highest-ranked residency programs and tier 5 being the lowest-ranked programs) on the basis of 2018 Doximity rankings of orthopaedic residency programs. Statistical analysis consisted of descriptive statistics, chi-square tests, and analysis of variance.

RESULTS

Two thousand eight hundred and eleven applicants met inclusion criteria. Applicants from residency programs in tiers 1 and 2 applied to significantly fewer programs than those from tiers 3, 4, or 5 (p < 0.0001). Applicants from each tier were significantly more likely to attain interviews than applicants from all tiers below them (p < 0.01). Applicants from tier-1 residency programs matched at a significantly higher position on their rank list (p < 0.001) and were more desirably ranked by fellowship programs (p = 0.003) compared with all other tiers.

CONCLUSIONS

Applicants from the highest-ranking residency programs apply to fewer programs, interview at a greater percentage of these programs, and are more likely to match to 1 of their top-ranking programs than applicants from lower-ranking programs. However, the association of the applicant match position with the program ranking appears to be most pronounced when it comes to fellowships selecting which applicants to interview. These findings may help future applicants when determining which programs to apply to during the match.

Factors Influencing Subspecialty Choice of Orthopedic Residents: Effect of Gender, Year in Residency, and Presumptive Subspecialty

BACKGROUND

Subspecialty training is a common part of orthopedic surgical training. The factors which influence resident subspecialty choice have important residency design and workforce implications. Our objective was to present survey data gathered from orthopedic residents regarding their fellowship plans and relative importance of factors which influence those plans.

METHODS

An anonymous online survey tool was developed and distributed to orthopedic residents through their program directors at academic institutions across the country with orthopedic surgery residency programs.

RESULTS

227 residents completed the survey. 97% planned to pursue fellowship training after residency. The most common presumptive subspecialties were sports (29.7%), joints (17.3%) and shoulder/ elbow (12.8%). The majority of senior residents (57%) reported that their subspecialty choice had changed during residency. When making their choice of subspecialty, residents were most influenced by their experiences working on the subspecialty service in question, their experiences working with a mentor, and intellectual interest. The factors influencing their choice were affected by gender, residency year and presumptive subspecialty.

CONCLUSIONS

The most critical factors influencing subspecialty choice of orthopedic residents included experiences in rotations as a resident, intellectual interest and mentors in certain subspecialties. Factors influencing subspecialty choice changes over the course of residency and differ between male and female residents. This information may be useful for residency design, mentorship structuring, career counseling and for addressing subspecialty surpluses or shortages which arise in the future.Level of Evidence: IV.