Matching in Orthopaedic Surgery

The impact of surgical elective exposure during medical school upon residency match rates

Objective

This study aims to investigate potential differences in surgical subspecialty match rates between medical schools with and without elective rotations in the respective surgical subspecialties.

Design

Data on duration of surgical rotations were retrieved from each school's public website. Fisher exact tests were performed to identify any statistically significant differences in surgical specialty match rates by allopathic versus osteopathic and elective clinical exposure. A linear regression was performed to determine the correlation between number of surgical electives offered and proportion of students matching in any surgical subspecialty.

Results

The number of surgical electives offered by allopathic medical schools positively correlated with the proportion of students matching in any surgical specialty (R2 = 0.038, p = 0.018). Elective rotations in surgical subspecialties were associated with higher match rates in ophthalmology (OR 1.864, 95 % CI 1.196, 3.059, p < 0.01) and plastic surgery (OR 2.543, CI 95 % 1.061, 7.972, p < 0.05).

Conclusion

There are significant differences in match distribution between allopathic and osteopathic medical schools for surgical subspecialties. This may be due to differences in clinical exposure to these specialties offered to students at their respective medical schools. Medical schools can support students' successful match into competitive surgical subspecialties by increasing students' exposure through elective rotations.

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.

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

BACKGROUND

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

METHODS

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

RESULTS

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

DISCUSSION

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

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.

Applicant Perceptions of Postinterview Communication During the 2022 to 2023 Neurosurgery Recruitment Cycle: A Cross-Sectional Survey Study

OBJECTIVES

To evaluate and describe neurosurgery applicant perceptions of the postinterview communication (PIC) process during the US residency match.

METHODS

A voluntary and anonymous postmatch web-based survey was developed and sent to 209 candidates who applied to 1 academic neurosurgery practice during the 2022-2023 recruitment cycle, approximately 1 week following match day. Survey questions focused on their perceptions of and participation behaviors with PIC and how this impacted their final rank list.

RESULTS

Seventy-eight (37.3%) of the 209 candidates responded to the survey. Sixty-four (84.2%) respondents reported submitting a letter of intent (LOI) to their number 1 ranked program. Sixty-one (82%) felt pressured to send a LOI to improve their rank status, fearing that it may harm them if they did not. Fifty-four (73.0%) respondents felt pressured to send an early LOI despite not seeing the program in person to communicate interest before programs certified their rank lists. Fourteen (18.9%) respondents agreed that a second look experience impacted their rank list enough to where they regretted an early LOI. Fifty-five (76.4%) respondents disagreed that second-look attendance had no impact on their rank status with a program. Fifty (71.4%) respondents agreed that PIC causes undue stress during the match process. Sixty-one (84.7%) respondents agreed that aspects of PIC require universal guidelines.

CONCLUSIONS

This is the first study to describe the perceptions of PIC and behaviors of neurosurgery applicants during the US residency match process. Standardized PIC practices may help to ensure transparency and relieve stress for applicants during the match process.

Recent Trends in the Effect of Race and Gender on the Orthopedics Match

Introduction Orthopedics has a reputation for being competitive but not diverse. Leaders of the orthopedics community have been making efforts to increase the participation of women and minorities in the field by raising awareness and strengthening pipeline programs. We aim to explore the trends in the risk of not matching by comparing the proportions of women and underrepresented populations in the applicant pools versus proportions in residency programs. Simultaneously, we aim to evaluate if women or underrepresented population applicants exhibit a lower likelihood of applying to orthopedics compared to male and White applicants. Methods The study received an IRB exemption. The authors collected Accreditation Council for Graduate Medical Education (ACGME) data books for the years 2015-2016 to 2022-2023 to obtain demographic information on orthopedic residents in training during each of those academic years. The pool of corresponding applicants (for example: residents in training during the 2021-2022 academic year would consist of five classes, made up of applicants from 2016-2017 to 2020-2021) was then tabulated from Electronic Residency Applications Service (ERAS) statistics, which are publicly available on the Association of American Medical Colleges (AAMC) website. The race and gender composition of the applicant pool was compared to that of corresponding enrolled residents to calculate the relative risk (RR) of women not matching compared to men and underrepresented population applicants (Blacks, Hispanics, Asians, and Native Americans) compared to White applicants. ERAS data was subsequently used to calculate the percentages of each demographic applying to all residency programs and orthopedic programs. Results For female applicants into orthopedic residency, they had a similar RR of going unmatched when compared to their male counterparts. In the academic year 2020-2021, there was an exception to this as women had a slightly higher RR of going unmatched. All underrepresented populations had a higher risk of not matching compared to White applicants for all cycles, peaking for residents in training in 2020-2021. The trendline improved for residents in the following year. Throughout the study, women accounted for 46.61% of applicants applying for any residency; however, they only accounted for 16.98% of applicants applying for orthopedic residency. A similar discrepancy is noted among Asian applicants but not Black or Hispanic applicants. Conclusions Underrepresented populations were increasingly less likely to match into orthopedics relative to White applicants until 2021. In the academic year of 2021-2022, there was an improvement in this trend for all studied underrepresented populations. Although the exact explanation for this is unclear, it is associated with the transition to virtual applicant interactions. The female gender did not appear to be a consistent advantage or disadvantage in the match. Women and Asian applicants were less likely to apply to orthopedics than other specialties.

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.].

The Mentee Perspective: Evaluating Mentorship of Medical Students in the Field of Orthopaedic Surgery

INTRODUCTION

Mentorship is an invaluable facet of medical education. The purpose of this study was to analyze medical student perspectives of mentorship they received and the influence this has on their participation in the field of orthopaedic surgery.

METHODS

We conducted a cross-sectional study of medical students interested in pursuing orthopaedic surgery through an 18-question survey distributed through social media and e-mail.

RESULTS

Two hundred fifteen students completed this survey, with over 50% of students reporting that they have a mentor in orthopaedic surgery while 34% were actively seeking one. Most students found mentors through research opportunities (25%) and cold e-mails (20%). Common hurdles to mentorship were access (38%) and finding common time (30%). Peer mentorship had a higher mean satisfaction score in all domains, except facilitating matching, and there was a significant difference between groups (e.g., peer mentor versus program director; P < 0.001). Sex, race, and degree type were not significantly related to students' access to or their evaluation of mentors (P > 0.05 for all).

CONCLUSION

Overall, this study demonstrates that medical students across the nation rely on mentorship to guide them on their path to becoming an orthopaedic surgeon.

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.

Reimagining the Path of an Unmatched Orthopaedic Residency Application: A Survey of Program Directors

Background

Few evidence-based suggestions are available to help applicants and mentors improve reapplication outcomes. We sought to provide program directors' (PDs) perspectives on actionable steps to improve reapplicants' chances for a match.

Methods

The PDs were asked to rank positions unmatched applicants can pursue, steps these applicants can take for the next application cycle, and reasons why reapplicants do not match.

Results

Responses from 66 of 123 PDs were received (53.6% response rate). Obtaining new recommendation letters and rotating with orthopaedics were the highest 20 ranked steps unmatched applicants can take. No curriculum vitae (CV) improvement, poor interview, and poor letters of recommendation were the most important reasons hindering applicants from matching when reapplying.

Conclusions

Steps reapplicants could prioritize include obtaining new recommendation letters, rotating in orthopaedics, and producing new research items. CV strengthening and improving interview skills address the 2 main reasons why unmatched applicants failed in subsequent attempts.

Level of Evidence

Level IV.

What Are the Trends in Research Publication Misrepresentation Among Orthopaedic Residency and Fellowship Applicants From 1996 to 2019? A Systematic Review

BACKGROUND

Because research experience is increasingly important in ranking orthopaedic residency and fellowship applicants, determining the accuracy of candidates reporting their scholarly activity is essential. However, disparate and inconsistent findings have made it difficult to draw meaningful conclusions from individual studies.

QUESTIONS/PURPOSES

In this systematic review, we asked: (1) What percentage of research publications are misrepresented among orthopaedic residency and fellowship applicants? (2) What percentage of applications contain one or more example of academic misrepresentation? (3) Is research misrepresentation associated with any individual applicant characteristics? (4) What is the publication status of articles listed by applicants as having been submitted to journals?

METHODS

A systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. PubMed, EBSCOhost, Medline, and Google Scholar electronic databases were searched on March 10, 2022, to identify all studies that evaluated research misrepresentation in orthopaedic residency and fellowship applications between January 1, 1995, and March 1, 2022. Articles were included if full-text articles in English were available and the study reported on research misrepresentation among orthopaedic residency or fellowship applicants. Studies investigating nonorthopaedic publications, systematic reviews, case studies, duplicate studies among databases, and gray literature were excluded. Two reviewers independently evaluated the quality of included studies using the Methodological Index for Nonrandomized Studies (MINORS) tool. This is a validated assessment tool that grades noncomparative studies from 0 to 16 and studies with control groups from 0 to 24, based on eight criteria related to study design, outcomes assessed, and follow-up. All included articles were noncomparative studies, so the maximum score here was 16, with higher scores indicating better study quality. The mean MINORS score was 13 ± 1 in the studies we included. The final analysis included 10 studies with 5119 applicants. Eight studies evaluated orthopaedic residency applicants and two evaluated fellowship applicants. The applicant classes ranged from 1996 to 2019. Research misrepresentation was defined among studies as nonauthorship of an existing article, claimed authorship of a nonexistent article, or incorrect listing of authorship order for an existing article. Each study's findings and definition of research misrepresentation were considered to allow for a discussion of overall trends. The percentage of misrepresentation was further broken down by the misrepresentation type. Applicant characteristics and destination of submitted articles were also evaluated. Given the potential overlap between applicants among the studies, no pooled analysis was conducted, and results are presented as a narrative summary.

RESULTS

The percentage of overall publication misrepresentation was estimated to range between 1% (13 of 1100) and 21% (27 of 131), with more-recent studies reporting a lower proportion of overall articles misrepresented. Most studies we found claimed that authorship of a nonexistent article was the most common type of misrepresentation. Nonauthorship of an existing article and incorrect authorship order were less common. The percentage of applications with at least one misrepresentation was approximately 20% between 1998 and 2017. Most studies found no applicant characteristics, such as match outcomes, demographic markers, or academic records, that were consistently associated with a higher odds of the candidate misrepresenting his or her research credentials. Finally, approximately half of the articles listed as submitted to journals went on to publication, with one-third going to a different journal with a lower Impact Factor.

CONCLUSIONS

Our systematic review found that the percentage of overall publication misrepresentations among orthopaedic residency and fellowship applicants has generally been low over the past 20 years. However, approximately one-fifth of applications had at least one research misrepresentation, with 2% having multiple misrepresentations on reported publications. There were no consistent applicant characteristics associated with higher odds of research misrepresentation. Additionally, most of the articles listed as submitted to journals for publication were ultimately published.

CLINICAL RELEVANCE

Although the decrease in overall publication misrepresentation is encouraging, our finding that one-fifth of applicants have research misrepresentation is a cause for concern. In light of a continually evolving application process, orthopaedic residency and fellowship programs must ensure there is integrity related to information that is self-reported by applicants. These findings also serve to encourage faculty members involved in the application screening and decision process to limit biases related to applicant demographics perceived to be associated with a high odds of misrepresentation. Furthermore, governing agencies and program leadership should evaluate methods of verifying unpublished work and provide opportunities for applicants to give publication updates throughout the application cycle.

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.

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.

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.

Virtual Pediatric Orthopaedic Fellowship Interviews During the Pandemic: What Did the Applicants and Programs Think?

BACKGROUND

The COVID-19 pandemic precluded in-person interviews for the 2020-2021 fellowship application cycle and may impact future interview cycles. No information is available detailing the implications of a virtual format on either the interviewee or the fellowship program.

METHODS

Two surveys regarding the 2020-2021 virtual interview season were developed and distributed by the Pediatric Orthopaedic Society of North America (POSNA) Fellowship Training and Practice Qualifications Committee: one survey for fellowship applicants and one survey for fellowship program directors.

RESULTS

Surveys were completed by 45 pediatric orthopaedic fellowship applicants and 34 fellowship program directors. Nineteen (42.2%) applicants applied to more programs because of the virtual format and 30 (66.7%) applicants accepted more interviews because of the virtual format. Thirty-one (67%) applicants did not feel the virtual interview format negatively affected their match process. Thirty-eight (84.4%) applicants indicated that they saved >$2000 with the virtual format. Approximately half (22/45, 48.5%) of the applicants would keep the fellowship-interview process virtual-even if in-person interviews were possible-whereas 8 (17.8%) applicants would transition back toward in-person interviews.Most program directors utilized online interviews for the first time (n=28, 82.3%) during the 2020-2021 application cycle. Programs interviewed more applicants for the 2020-2021 cycle than in the prior 5 years (19.3 vs. 15.7 applicants, P <0.01), with programs interviewing 10.1 applicants per fellowship position. The majority (n=22, 64.7%) of programs utilized Zoom for the interview platform. Program directors indicated that the applicants were either more accomplished (n=14, 41.2%) or similar in accomplishment (n=20, 58.8%) when compared with the applicants from prior years. Half of the program directors (n=17, 50%) surveyed would utilize virtual interviews next year, even if in-person interviews are possible.

CONCLUSIONS

During the 2020-2021 fellowship application process, interviewees applied to and were interviewed at more programs because of the virtual format, while saving >$2000. In a similar manner, fellowship programs were able to interview a greater number of applicants without adversely impacting the applicant quality. Approximately half of the interviewees and program directors would continue to perform virtual interviews, even if in-person interviews are possible.

LEVEL OF EVIDENCE

Level V.

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.

Perceptions of the Universal Interview Offer Day in the Orthopaedic Surgery Residency Interview Process

INTRODUCTION

The American Orthopaedic Association's Council of Orthopaedic Residency Directors recommended implementing a universal offer day (UOD) in the 2020 residency match. Although this decision was an attempt to benefit applicants, it is important to assess how this endeavor was perceived.

METHODS

Questionnaires for applicants and program directors asked about the perception of the UOD and the experience with it. Responses were included from 383 applicants (43% response rate) and 84 program directors (45% response rate).

RESULTS

Applicant Survey: Most of the students (81.5%) were worried or very worried about the interview offer process. Most of the applicants (64.0%) stated that the UOD decreased their stress. The majority (93.2%) indicated that they would like to see the UOD continue in future years. Program Director Survey: Most of the program directors (83.1%) mentioned that they would like to see the UOD continued, and 86.8% indicated that they would participate in a similar process if implemented in future cycles.

DISCUSSION

Benefits of a standardized interview offer date include decreased stress and fewer clinical interruptions. Advantages can also extend to scheduling conflicts and over-interviewing. These favorable results, along with positive experiences from other specialties implementing a UOD, encourage the continued use of this approach for offering interviews.

DATA AVAILABILITY

N/A.

TRIAL REGISTRATION NUMBERS

N/A.

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.

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.

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 Role of Advanced Academic Degrees in Orthopaedic Sports Medicine Faculty

Background:

Limited knowledge exists on the role of advanced academic degrees within faculty positions in orthopaedic sports medicine.

Purpose:

To 1) provide an assessment of the baseline demographics of advanced degrees among orthopaedic sports medicine faculty and 2) examine the impact of advanced degrees on research productivity and career attainment of orthopaedic sports medicine faculty.

Study Design:

Cross-sectional study; Level of evidence, 4.

Methods:

Orthopaedic sports medicine academics were identified using faculty listings on websites of the 200 orthopaedic surgery residency programs during the 2020-2021 academic year. Advanced degrees were defined as those additional to the primary medical degree (Doctor of Medicine [MD] or Doctor of Osteopathic Medicine [DO]). Outcome measures included timing of advanced degree obtainment, residency program rankings, research productivity, and current academic rank and leadership roles. Statistical analysis was performed using chi-square and Mann-Whitney U tests to determine the association of advanced degrees on outcome measures.

Results:

In total, 911 orthopaedic sports medicine faculty members were identified, of whom 100 had an advanced degree. The most common advanced degrees were Master of Science (MS/MSc; 38%), Doctor of Philosophy (PhD; 23%), and Master of Business Administration (MBA; 13%). The presence of an advanced degree was associated with greater research productivity, including higher h-index and number of publications, as well as more editorial board positions on orthopaedics journals ( P < .001). Advanced degrees were not significantly associated with attending a higher ranked orthopaedic surgery residency program, current academic rank, or leadership roles. At the institutional level, orthopaedic sports medicine programs that employed faculty with an advanced degree had a higher residency program ranking and the presence of a sports medicine fellowship was more likely ( P < .05).

Conclusion:

Advanced degrees in orthopaedic sports medicine were associated with greater faculty research engagement and employment at a higher ranked institution; they were not associated with matching to a highly ranked orthopaedic surgery residency program, higher faculty rank, or academic leadership roles.

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.

An analysis of publication trends of orthopedic surgery residency graduates in relation to academic achievement

CONTEXT

Traditionally, the Accreditation Council for Graduate Medical Education (ACGME) requires residency programs to implement research and other scholarly activities into their training curriculum. Encouraging residents to publish during residency is believed to promote research throughout their careers; however, no study has attempted to quantify research productivity among orthopedic surgery residents before, during, and after residency.

OBJECTIVES

To determine whether publishing in peer-reviewed journals during orthopedic residencies was an indicator of continued academic achievement after graduation.

METHODS

This study was observational in nature and employed a cross-sectional design. We examined whether research outcomes during orthopedic residency was associated with academic advancement or continued research involvement after residency. We identified 201 orthopedic residency programs on the Doximity website and randomly selected 50 to include in our sample. Of these programs, graduate rosters for 31 programs were located and subsequently included. Of the 341 graduates identified, we recorded the number of peer-reviewed publications, H-indices, fellowships, and whether the graduate pursued a career in private practice or academia.

RESULTS

Orthopedic residency graduates from 31 programs published a total of 1923 peer-reviewed manuscripts. On average, residents had a total of 5.6 publications and an h-index of 3.2. Residents entering academia and pursuing fellowships had a significantly higher total number of publications, higher number of first-author publications, and greater H-indices compared to those who did not enter academia or pursue a fellowship.

CONCLUSIONS

Increased research productivity was associated with continued academic pursuits and an increased likelihood of pursuing fellowship training after residency.

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.

Orthopaedic Surgery Away Rotations

Away rotations have become a critical factor for a successful orthopaedic surgery residency match. Away rotations significantly improve an applicant's chance of matching into an orthopaedic residency. Away rotations were limited during the 2020 to 2021 academic year because of the COVID-19 pandemic. During the 2021 to 2022 academic year, the American Association of Medical Colleges coalition recommended students only complete 1 rotation outside their home institution, whereas the American Orthopaedic Association Council of Residency Directors argued that multiple rotations should be allowed. We sought to quantify the impact of these restrictions on orthopaedic surgery applicants during the 2020 to 2021 residency application cycle.

Selecting the Next Class: The “Virtual Orthopaedic Rotation”

Introduction:

Methods:

Results:

Discussion:

Orthopaedic Surgery Residency Application, and Selection Criteria Adaptations, in Times of COVID-19

Amid the COVID-19 pandemic, medical education and residency application have faced unprecedented changes. This has forced residency directors to alter their selection criteria in the absence of away rotations and the implementation of nationwide virtual interviews.

Effects of COVID-19 on Geographical Trends in the Orthopaedic Surgery Residency Match

Historically, medical students often match within the same geographic location or to an orthopaedic surgery residency program affiliated with their medical school. The objective of this investigation was to determine differences in geographic trends between orthopaedic residents matching before and during the Coronavirus-19 (COVID-19) pandemic.

Incidence of Research Gap Years in Orthopaedic Residency Applicants: The New Standard?

Introduction:

The purpose of this study was to (1) determine the incidence of a research gap year (RGY) in orthopaedic residency applicants at a single institution over a seven-year span; (2) compare applicant characteristics between applicants who did a RGY with those who did not, and (3) report variables associated with match success for RGY applicants.

Methods:

Applicants who reported taking a year out from medical school to pursue research on their Electronic Residency Application Service to a single institution from 2014 to 2015 through 2020 to 2021 were reviewed.

Results:

A strong positive correlation was noted between the percentage of applicants who participated in a RGY and time (Pearson correlation: r = 0.945 [95% confidence interval (CI), 0.666­0.992], P = 0.001). Over the study period, 11% of applicants had done a RGY, most commonly after their third year of medical school (82.7%). Most RGY applicants matched orthopaedics (72.8%) and 19.4% matched at the same institution they did their RGY.

Conclusion:

The percentage of RGY applicants to the study institution nearly doubled between 2014 to 2015 and 2020 to 2021. RGY applicants had a higher match rate than nationally published match rates. Further study is needed on a national level.

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.

A virtual sub-internship for otolaryngology-head and neck surgery

OBJECTIVE

During the COVID-19 pandemic, away rotations were suspended for safety purposes. This led to the development of online interactive learning modules for students, now known as virtual sub-internships (VSIs). To date, VSIs within otolaryngology-head and neck surgery (OHNS) have been limited in their description and design.

STUDY DESIGN

Cross-sectional survey.

SETTING

ACGME-accredited OHNS residency program.

METHODS

Our curriculum for an OHNS VSI is presented. Based on the model used by our OHNS residency program, the VSI consisted of a 2-week block of activities and interactive small-group discussions. A post-VSI feedback survey was distributed to participants; results are reported.

RESULTS

Six 2-week VSI sessions were administered. Twenty-one individuals participated from all US regions, median 4 individuals per session. Fifteen participants (71.4%) completed the feedback survey. Of survey respondents, 20% lacked a home OHNS residency program, and no respondents' home-programs featured a VSI. All respondents were satisfied with the schedule and organization of the VSI, and 73.3% (11 of 15) felt it was of appropriate duration. All respondents reported a high degree of familiarity with the program, with a greater (86.7%) or equal (13.3%) level of interest in applying to the residency program as a result of participating in the VSI.

CONCLUSION

This VSI curriculum offers a well-received virtual learning experience for medical students applying to OHNS residency. It provides an opportunity for programs to expand their appeal to potential applicants who may otherwise be restricted in their ability to travel.

Impact of clinical research coordinators on research output in orthopedic surgery

Aim: To describe the efficacy of clinical research coordinators (CRCs) in terms of research output among faculty, residents and medical students. Materials & methods: We analyzed and reviewed departmental research output from the 3 years prior to the hire of 3 CRCs compared with the 3 years following. Results: From 2014 to 2016, the department output was a total of 27 peer-reviewed publications, 16 oral presentations and 33 poster presentations. From 2017-2019 there was a 52% increase in publications (n = 41), 131% increase in oral presentations (n = 37) and a 61% increase in poster presentations (n = 53). Conclusion: The implementation of CRCs has markedly increased tangible research output and trainee involvement. This role may serve as a valuable model for other academic departments.

Implementation and Evaluation of a Formal Virtual Medical Student Away Rotation in Orthopaedic Surgery During the COVID-19 Pandemic: A Single Institution Pilot Experience

Away rotations are a valuable experience for medical students when applying for residency. In light of the coronavirus disease 2019 pandemic, there has been significant interest in the development of virtually based substitutes. This study evaluates the utility of a formal virtual fourth-year medical student away rotation in orthopaedic surgery by surveying participants and provides recommendations for success.

Methods

A 2-week virtual orthopaedic elective was offered to fourth-year medical students in lieu of traditional in-person away rotations. The course consisted of multiple components such as subspecialty case-based didactics, "happy hours" with residents, assigned resident mentors, student case presentations, and observation of resident lectures. After course completion, anonymous surveys were administered to participants to evaluate the rotation.

Results

Twenty-three of 24 participating students (96%) completed the student survey, and 22 of 24 participating faculty and residents (82%) completed the resident/faculty survey. Most students were very (87%) or somewhat (9%) satisfied with their experience and found the rotation to be a very (35%) or somewhat useful (61%) substitute for an in-person rotation. Students indicated that the rotation very (91%) or somewhat positively (9%) influenced their perception of the program. All students indicated that the rotation was very educational. Most students (91%) reported that the rotation was very useful for learning about the program and culture, with subspecialty didactics and happy hours most useful. Faculty and residents indicated that the rotation was useful for getting to know the students (17% "very useful" and 83% "somewhat useful") and for assessing student characteristics, such as knowledge base and communication skills.

Conclusions

A formal virtual orthopaedic surgery away rotation can be a valuable experience for medical students which provides educational value, insight into program culture, and an opportunity to demonstrate interest in the program. The curriculum and recommendations presented in this study can be used as a preliminary template for others interested in creating successful virtual rotations.

The Impact of COVID-19 on the Orthopaedic Sports Medicine Fellowship Application Process

Over the last year, coronavirus disease 2019 (COVID-19) has spread across the world as a global pandemic, bringing unprecedented changes to the healthcare landscape for patients and physicians. Medical trainees have been similarly affected, as medical schools throughout the United States have implemented remote learning-based curriculums and withdrawn third- and fourth-year students from in-hospital clerkships. Of particular importance is the impact of COVID-19 on current orthopaedic surgery residents applying to subspecialty fellowship programs. Because of the highly transmissible nature of the virus and current social distancing restrictions, orthopaedic sports medicine fellowship interviews are being held virtually during the 2020–2021 application cycle. This transition to videoconference interviewing may de-emphasize an applicant's unique personality or interpersonal interactions that are traditionally captured in a variety of settings during the interview day. In turn, this may lead to increased prioritization of various aspects of the application, such as the applicant’s residency program, letters of recommendation, and research productivity. Matching to a sports medicine fellowship program is an inherently competitive process and the COVID-19 pandemic presents novel challenges to orthopaedic residents in their efforts to successfully match. The purpose of this review is to describe the changes made to the orthopaedic sports medicine fellowship interview process resulting from COVID-19 during the 2020-2021 application cycle and discuss how these changes may impact the future fellowship application process. This review discusses the changes made to the orthopaedic sports medicine fellowship interview process caused by COVID-19 during the 2020–2021 application cycle. This review also assesses how such changes may impact the future application process and proposes potential adaptations to the current virtual interview format if it should become the new standard moving forward.

Medical Student Mentorship in Orthopaedic Surgery

Mentorship is a key aspect of medical education, but the availability and quality of mentorship varies considerably between institutions. The lack of standardization results in information asymmetry and creates notable inequities. This disparity is particularly important for students interested in pursuing competitive specialties, such as orthopaedic surgery. The purpose of this study was to (1) demonstrate the importance of mentorship in orthopaedics, (2) provide a framework for orthopaedic surgeon mentors, and (3) guide medical students interested in activating and expanding their networks.

Online Information and Mentorship: Perspectives From Orthopaedic Surgery Residency Applicants

INTRODUCTION

Applying to orthopaedic surgery residency is competitive. Online information and mentorship are important tools applicants use to learn about programs and navigate the process. We aimed to identify which resources applicants use and their perspectives on those resources.

METHODS

We surveyed all applicants at a single residency program for the 2018 to 2019 application cycle (n = 610) regarding the importance of online resources and mentors during the application process. We defined mentorship as advice from faculty advisors or counselors, orthopaedic residents, medical school alumni, or other medical students. We also assessed their attitudes about the quality and availability of these resources. Applicants were asked to rank resources and complete Likert scales (1 to 5) to indicate the relative utility and quality of options. Descriptive statistics were used to summarize data for comparisons.

RESULTS

The response rate was 42% (259 of 610 applicants). Almost 50% of applicants reported that they would have likely applied to fewer programs if they had better information. Applicants used program websites with the highest cumulative frequency (96%), followed by advice from medical school faculty/counselors and advice from orthopaedic residents at home institution (both 82%). The next two most popular online resources were a circulating Google Document (78%) and the Doximity Residency Navigator (73%). On average, the quality of online resources was felt to be poorer than mentorship with advice from orthopaedic residents receiving the highest quality rating (4.16) and being ranked most frequently as a top three resource (122 votes). Mentorship comprised three of the top five highest mean quality ratings and three of the top five cumulative rankings by usefulness.

CONCLUSION

Applicants reference online resources frequently, despite valuing mentorship more. If the orthopaedic community fostered better mentorship for applicants, they may not feel compelled to rely on subpar online information. Both online information and mentorship can be improved to create a more effective application experience.

Effect of Change in USMLE Step 1 Grading on Orthopaedic Surgery Applicants: A Survey of Orthopaedic Surgery Residency Program Directors

Introduction:

Recently, the Federation of State Medical Boards and the National Board of Medical Examiners, cosponsors of the United States Medical Licensing Examination (USMLE), changed the USMLE Step 1 results from a three-digit score to a pass/fail format. The purpose of this study was to analyze the opinions of program directors (PDs) to predict how the evaluation of orthopaedic surgery residency applicants will change following the change.

Methods:

A 17-question online survey was distributed to PDs via e-mail. This survey covered program demographics, questions regarding the relative importance of various factors for selection of interviews, and perceived changes and effect of the scoring change. Responses were aggregated and analyzed.

Results:

PDs indicated that the three highest scored factors were (1) failure in prior attempts in USMLE/COMLEX examinations (4.7), (2) audition elective/rotation within your department (4.5), and (3) personal prior knowledge of the applicant (4.1). In addition, 38 PDs (81.1%) anticipate that they will require USMLE Step 2 clinical knowledge scores for interview consideration.

Conclusion:

Most orthopaedic surgery PDs think that the change in score reporting for the USMLE Step 1 will result in additional requirements and changes in how programs select applicants and do not support the decision.