An Analysis of Research from Faculty at U.S. Adult Reconstruction Fellowships

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.

Variations in Patient Satisfaction Scores Between HCAHPS and a Novel Orthopedic Practice-Specific Survey

Performance on the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey can affect up to 33% of a physician's reimbursement from the Centers for Medicare & Medicaid Services. At this pseudo-private orthopedic practice, the authors characterized how physicians often achieve drastically different scores between HCAHPS and an Internal Patient Satisfaction Questionnaire (IPSQ). Eighteen physicians were ranked separately according to percentage of top-box scores on HCAHPS and IPSQ. There was an inverse relationship between physician rank for the 2 surveys according to Spearman correlation coefficient (ρ = -0.36, P = .15). Qualitative subanalysis indicated that although "physician interaction" was the most common reason for negative comments on HCAHPS, "ancillary staff" and "workflow" concerns were common on IPSQ. The outpatient setting remains a critical component in achieving high-quality orthopedic care. Consequently, HCAHPS alone may not be a sufficient indicator of patient satisfaction for orthopedic and other subspecialty practices.

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.

Matching in Orthopaedic Surgery

In 2016, 1,137 fourth year medical students submitted applications for orthopedic surgery residency positions. Students applied to an average of 79 programs, resulting in in a total of 89,846 applications being submitted for 727 first year residency positions. This ratio of 124 applications per position is two SDs above the mean relative to other medical specialties. The average applicant for orthopaedic surgery residency attends 2.4 away rotations, as attending 2 away rotations increases an applicant's odds of matching, and submits 83 applications. This excessive number of applications overburdens programs, subjects applicants to considerable costs, and diminishes the quality of fit between interviewees and programs. Eighty-three percent of program directors use step 1 United States Medical Licensing Examination scores as a screening tool to decrease the number of applications necessary for review. The average matched applicant attended 11.5 interviews, and Step 1 scores, research productivity, and Alpha Omega Alpha (AOA) status can be used to predict the number of applications necessary to obtain 12 interviews. AOA membership has the strongest influence on interview yield. Applicants report spending an average of approximately $7,000 on the interview process, and 72% borrow money to cover these costs. Post-interview contact, although forbidden by the National Resident Matching Program , has been reported by 60% to 64% of applicants.

Worldwide arthroplasty research productivity and contribution of Turkey

Purpose

Bibliometrics is increasingly used to assess the quantity and quality of scientific research output in many research fields worldwide. However, to the best of our knowledge, no studies have documented the main characteristics of arthroplasty publications from different countries. This study aimed to evaluate the worldwide research productivity and status of Turkey in the field of arthroplasty using bibliometric methods and to provide an insight into the arthroplasty research for surgeons and researchers.

Methods

The Web of Science database was searched to identify arthroplasty articles published between 2006 and 2016. The contributions of countries were evaluated based on publication count, citation average, h-index and publication rate in the top 10 ranked journals. Each countries publication output was adjusted according to population size.

Results

A total of 26.167 articles were identified. World arthroplasty publications were increased significantly over time (p < .005). The United States was the most productive country with 9007 articles (34,4% of total) followed by England with 2939 articles (11,4 of total) and Germany with 1881 articles (7,1% of total). According to average citations per item, Scotland was in the first place followed by Denmark and Sweden, whereas in the first place according to publication output adjusted by population size was Switzerland followed by Denmark and Scotland. The United States was also in the first place according to h-index and publication rate in the top 10 ranked journals. Founding average was 28,8% (7539 of 26164) for the arthroplasty articles that were analyzed in the study.

Conclusion

There is a rapid increase in the number of articles in arthroplasty research from 2006 to 2016. The United States was the most productive country as measured by total publications in the arthroplasty field. However, some small European countries with high in-come have higher quality of articles and better productivity when adjusted for population. Gross domestic product (GDP) per capita and research foundation had positive affect on arthroplasty publications, both qualitatively and quantitatively.

Factors Associated With Publication Impact at Shoulder and Elbow Surgery Fellowships

OBJECTIVE

Quantitative metrics for comparing fellowship programs are lacking in orthopedic surgery. The purpose of this work was to determine the publication citation frequency at shoulder and elbow fellowships in the United States and to identify factors associated with increased productivity.

METHODS

American shoulder and elbow fellowship program faculty members in 2015 were identified. Research productivity metrics such as academic career duration, total publications, publications between 2010 and 2014 and total citations were recorded for each faculty member. Citations from total unique publications for each program were recorded. Factors associated with increased citation frequency of publications were identified.

RESULTS

A total of 28 shoulder and elbow training programs with a total of 43 fellowship positions were included for analysis, and a total of 84 surgeons were identified as fellowship faculty. The median [interquartile range] number of citations for total publications from 2010 to 2014 was 1594 [708-4048] per program and 743 [331-1321] per faculty member. Medical school affiliation, number of fellowship faculty, and the fellowship faculty members׳ cumulative years of academic career duration were significantly associated with higher numbers of total program citations on univariate analysis. However, only cumulative faculty years of academic career duration remained significant on multivariate analysis (F = 10.4, p < 0.001).

CONCLUSIONS

Total years of experience of a faculty in a fellowship program and medical school affiliation appear to be the most significant factors associated with increased publication citation frequency among many others. These data may be useful for prospective applicants evaluating fellowships and program leadership seeking to improve their academic productivity.

Choosing a Femoral Head: A Survey Study of Academic Adult Reconstructive Surgeons

BACKGROUND

Our aim was to examine how academic adult reconstructive surgeons have interpreted evidence on femoral head material in total hip arthroplasty (THA).

METHODS

A 16-question survey to evaluate attitudes toward ceramic and cobalt-chrome head use was emailed to 274 faculty at 42 US adult reconstruction fellowship programs.

RESULTS

With 116 respondents, the response rate was 42.2%. Faculty use ceramic heads 72.9% of the time. The most common reason why respondents do not use ceramic heads is cost (44.8%). Ninety-four percent of faculty have observed head-neck taper corrosion in cobalt-chrome on polyethylene THA, while 9.5% of faculty have observed head-neck taper corrosion in ceramic on polyethylene THA. Only 6.0% of surgeons have seen Biolox Delta ceramic fracture.

CONCLUSION

Adult reconstruction thought leaders are guided by evidence suggesting that with ceramic heads, taper corrosion and fracture are rare. Cost and personal experience also strongly influence their implant selection. Efforts to equalize cost of ceramic and cobalt-chrome heads may free surgeons to practice in a purely evidence-based fashion.