Academic Characteristics of Orthopaedic Surgery Residency Applicants from 2007 to 2014

Update on the Selection Criteria of Plastic Surgery Residents: A Survey of Program Directors and Associate Program Directors

BACKGROUND

Plastic and reconstructive surgery (PRS) is recognized as a highly competitive specialty. Since the first assessment of resident selection criteria in 2007, PRS residency programs have adopted holistic review processes and adapted to changes such as a decline in medical schools participating in the Alpha Omega Alpha Honor Medical Society as well as the recent transition to pass/fail grading for the United States Medical Licensing Examination (USMLE) step 1 examination (Schultz et al. Plast Reconstr Surg Glob Open . 2020;8:e2892; Tadisina et al. Plast Reconstr Surg . 2017;139:330e-331e). This study was devised to evaluate current PRS residency criteria in light of these changes.

METHODS

An anonymous, 12-item, electronic survey was generated and distributed using Alchemer. An email was sent to 171 program directors (PDs) and associate program directors (APDs) of PRS residency programs. Survey questions were developed to collect data regarding respondent demographics and their desired criteria when assessing residency applicants. Complete responses were collected and analyzed with summary statistics and multivariate logistic regression using RStudio (version 1.3.109).

RESULTS

In total, 44 (25.7% response rate) of the 171 PDs and APDs completed the survey. Of the 16 programs (36.4%) with a USMLE cutoff score, 7 (43.8%) reported a range of 230 to 239 and 6 (37.5%) reported a range of 240 to 249. Without a score for step 1, the majority (48.8%) of respondents believe that step 2 scores will replace step 1 scores in terms of assessment criteria, and the content of recommendation letters was selected as the criterion with the greatest increase in weight (66.7%). In addition, 27.3% of programs require a step 2 score at the time of interview. The top 3 academic criteria in order of decreasing importance were the content of recommendation letters, clinical grades, and letter writers, whereas the top 3 nonacademic criteria were subinternship performance, maturity, and interview performance.

CONCLUSIONS

Plastic and reconstructive surgery remains a highly competitive specialty for residency applicants. Our findings suggest that Alpha Omega Alpha membership remains diminished in importance, whereas USMLE cutoff scores have increased. With recent changes in the step 1 grading system, PDs and APDs will rely more heavily on step 2 scores and the content of recommendation letters.

Factors that influence medical students' decision to pursue a career in orthopaedics: a comprehensive analysis

PURPOSE

Selecting a postgraduate medical or surgical specialty is a significant decision for medical students, influenced by factors such as demographics, academic performance, satisfaction, work environments, personal aspirations, passion for a specific specialty, exposure to different fields during medical education, lifestyle considerations, financial factors, job market conditions, and prospects. Our research focused on orthopaedic surgery, a highly competitive specialty with many applicants and a low acceptance rate. We aimed to investigate the factors that contribute to the sustained interest in this specialty despite the challenges of securing a residency position. Hence, this study aims to examine the potential factors that influence students' decision to pursue a career as an orthopaedic surgeon.

METHODS

This cross-sectional study explores the perspectives and attitudes of 211 fifth-year medical students towards orthopaedic surgery after completing their clinical rotation at Mutah University's School of Medicine in 2022. The inclusion criteria for the study were limited to fifth-year medical students who successfully finished the orthopaedic rotation. A questionnaire was employed to evaluate students' firm commitment to orthopaedics as a prospective career and the degree of their current interest in the specialty.

RESULTS

The study involved 210 participants, with 99 selecting orthopaedics as their specialty and 111 pursuing alternatives. Furthermore, 41.4% expressed the intention to apply for orthopaedic residencies. Factors impacting orthopaedics selection included family/peer input (p = 0.002), prestige (p = 0.002), research prospects (p = 0.005), leadership potential (p = 0.011). Chi-square analysis showed associations between choosing orthopaedics and male gender (p = 0.028), parental occupation in musculoskeletal fields (p = 0.038), and elective rotations (p = 0.016).

CONCLUSION

This study examines the factors that influence medical students' career preferences in orthopaedic surgery, highlighting the significance of familial and peer influences, job prestige perceptions, gender considerations, parental involvement, elective rotations, research and teaching potential assessments, and aspirations for leadership roles. These findings reveal the complex array of factors that guide medical students toward orthopaedic surgery.

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.

High Research Productivity During Orthopaedic Surgery Residency May Be Predicted by Number of Publications as a Medical Student

Introduction

Orthopaedic applicants have increased the average number of publications on their residency application to compete with the growing competitiveness of the field. The purpose of this study was to assess whether research productivity before orthopaedic residency and caliber of one's institution is correlated with academic productivity during residency.

Methods

Scopus was used to extract publication metrics. Quantity and quality (how often the publications were cited) were analyzed at 2 different time periods: before and during residency. All subjects in the study had graduated an ACGME-accredited orthopaedic surgery residency in 2021. Military residents, international medical graduates, and residents not listed on their department's website were excluded. Residents were categorized as both high (≥2 publications) or low (<2 publications) publishers according to their pre-residency publications. They were also categorized based on their program's Jones et al. research productivity ranking.

Results

For the 758 residents, the median number of publications was 0 (Interquartile Range [IQR]: 0-2) and 3 (IQR: 1-6) before and during residency, respectively. High publishing medical students had more publications during training than low publishers (6 [IQR: 3-14] and 2 [IQR: 1-4], p < 0.001). Residents at higher ranked programs also had more publications (4 [IQR: 2-9] and 2 [IQR: 0-4], p < 0.001). High publishing students now training at lower ranked institutions had more publications during residency than low publishers who trained at more productive institutions (4 [IQR: 1-9] and 3 [IQR: 1-6], p < 0.001).

Conclusion

Having 2 or more publications before residency is correlated with an increased number of publications during residency. While attending a higher academically productive program is associated with increased resident publications, a high publishing medical student would be expected to have more publications during residency than a low publishing student, regardless of program rank. Notably, most matched applicants continue to have zero publications before matriculation.

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.].

Analysis of Research Productivity of Orthopedic Surgery Residency Applicants

Background Orthopedic surgery has become an increasingly competitive specialty. With a pass-fail Step 1, an even greater emphasis on research has been placed to allow candidates to better distinguish themselves. This study analyzes the scholarly activity of accepted orthopedic residency applicants during medical school, assessing what factors, including the novel altmetric attention score, may be associated with greater research productivity. Methods A list of orthopedic residency programs was obtained from the Electronic Residency Application Service (ERAS). A total of 688 orthopedic residents from 180 programs who matriculated in 2020 from allopathic medical schools were identified. Resident demographic information and bibliometric data (total publications, orthopedic-related publications, h-index, and altmetric score) of publications published from July 1, 2016, to September 1, 2020, were collected. Descriptive statistics were calculated. Kruskal-Wallis tests analyzed the association between medical school characteristics and research productivity using Stata® 17.0 (StataCorp LLC, College Station, Texas). Results Postgraduate-Year-3 orthopedic residents (N=688) published 2,600 articles during medical school, averaging 3.8 articles per resident. The residents from a top 25 medical school for research had publication counts, altmetric scores, and h-indices, on average, that were higher than those from non-top 25 medical schools for research. Over 150 residents had no publications, and ~10 residents had more than 30 publications. Conclusions The results illustrate that medical school research status influences the research productivity of applicants. Also, given the average number of publications, most research listed on applications are abstracts and presentations. Utilization of the altmetric score may not yet be the best way of examining research experience because orthopedic applicants do not appear to use social networks for academic research.

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.

Effectiveness of an Orthopaedic Trauma Research Fellowship to Produce Successfully Matching Residents

OBJECTIVE

Orthopaedics is becoming increasingly competitive. Approximately 25% of applicants to orthopaedic surgery go unmatched each year. The mean US Medical Licensing Examination step scores and average publication numbers have increased markedly in recent years. Reapplicants have a match rate of <60%. This study describes the results of an orthopaedic trauma research fellowship and its effectiveness in obtaining a successful orthopaedic match.

METHODS

A 1 to 2-year research fellowship was established at a level 1 academic trauma center. Prefellowship and fellowship metrics of 11 fellows were recorded, including undergraduate and medical schools; step-1 + step-2 scores; Alpha Omega Alpha appointment; and publication, podium, poster, and chapter accomplishments.

RESULTS

The average step-1 score of the fellows was 218 (range, 192 to 252) and 232 (range, 212 to 254) for step-2. Seven of 11 fellows were reapplicants. Prefellowship, the average number of journal publications was 1, one podium, two posters, and zero textbook chapters. During fellowship, the average publications was 5, five podiums, six posters, and 1.5 textbook chapters. Ten of 11 fellows successfully matched into an orthopaedic residency, with six of seven being reapplicants.

CONCLUSIONS

Six of 7 reapplying fellows (86%) successfully matched highlighting the effectiveness of this fellowship. Research fellowships should be considered as an excellent choice for applicants who may be less than ideal candidates or reapplicants.

The Value of Signaling an Orthopaedic Surgery Program: A Survey to Orthopaedic Surgery Programs

INTRODUCTION

A new system was implemented by the Association of American Medical Colleges called the preference signaling program for the 2022 to 2023 orthopaedic surgery residency match. Applicants were able to signal 30 orthopaedic surgery programs to indicate high interest in a specific program. The purpose of this study was to address how important signaling was to an orthopaedic surgery program this 2022 to 2023 application cycle.

METHODS

A five-question survey was sent to orthopaedic surgery residency programs participating in the Electronic Residency Application Service this application cycle. Contact information was gathered through the Accreditation Council for Graduate Medical Education residency website and program websites.

RESULTS

Responses were obtained from 69 of the 151 programs (46%) contacted. The average number of applicants per program was 727 (range, 372 to 1031, SD 155). Thirty-four of 61 respondents (56%) stated that 100% of their interviewees signaled their program. Fifty-five of 61 respondents (90%) indicated that their interviewee pool consisted of 75% or more applicants who signaled. Applicants who signaled had a 24.4% (range, 12.77 to 47.41, SD 8.04) chance of receiving an interview. Applicants who did not signal had just a 0.92% (range, 0 to 13.10, SD 2.08) chance of receiving an interview. Fifty-four of the 63 applicants (86%) answered that signaling played an important role in considering an applicant for an interview.

CONCLUSION

Over half of the responding programs only interviewed applicants who signaled their program, and over 90% of programs' interview lists consisted of at least 75% of signaling applicants. Eighty-six percent of programs indicated that signaling played an important role in considering an applicant for an interview. Applicants who signaled were 26.5 times more likely to receive an interview than those who did not (P < 0.0001). With this information, applicants can narrow down their list of programs to apply to, knowing that their signal to a program will give them a better chance at receiving an interview.

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.

Predictors of Academic Productivity Among Spine Surgeons

INTRODUCTION

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

METHODS

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

RESULTS

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

DISCUSSION

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

An Evaluation of Research Publications for General Surgery Residents And its Influence on the Future Pursuit of Fellowship or Academic Career

INTRODUCTION

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, the rate of research outcomes among general surgery residents remains unknown. Our study aims to determine associated factors that influence publication rates before, during, and after general surgery residency.

METHODS

This observational study employed a cross-sectional design. We examined whether research outcomes during general surgery residency was associated with academic advancement or continued research involvement after residency. We identified 321 general surgery 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 405 residency 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

Among the 405 physicians analyzed, 3815 total publications were identified with a mean of 9.4 (SD 11.8) per person. The most reported study design was observational studies (46.5%; 1775/3815) and the least reported was systematic reviews/meta-analyses (1.4%; 52/3815). The number of publications before residency positively correlated with having a higher h-index (r = 0.4). We also found that physicians who completed a fellowship had more publications during residency (mean = 4.7, SD = 6.5) than those not pursuing a fellowship (mean = 1.5, SD = 2.7; t= -4.3. p ≤ 0.001). We observed a statistically significant increase in the likelihood a physician pursued a career in academic medicine if they pursued a fellowship (OR: 3.77, 95% CI: 2.0-7.2) and if they had published research as a primary author (OR 1.25, 95% CI: 1.0-1.5).

CONCLUSION

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

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

OBJECTIVE

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

SETTING

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

DESIGN AND PARTICIPANTS

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

RESULTS

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

CONCLUSIONS

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

The relative citation ratio (RCR) as a novel bibliometric among 2511 academic orthopedic surgeons

Objectively measuring research output is important for grant awards, promotion, and tenure, or self-evaluation of productivity. However, certain shortcomings limit common bibliometric indicators. The time- and field-independent relative citation ratio (RCR) was proposed to overcome these limitations. The objective of this study was to determine whether the RCR correlates with academic rank, gender, and PhD degree status among US academic orthopedic surgeons. Full-time faculty surgeons at Accreditation Council for Graduate Medical Education-accredited orthopedic surgery residency programs were included in this study. Mean (mRCR) and weighted (wRCR) RCR scores were collected from the National Institutes of Health iCite database to quantify scholarly "impact" and "production," respectively, and were compared by academic rank, gender, and PhD status. All information was collected from publicly available faculty listings on departmental websites. A total of 2511 orthopedic surgeons from 132 residency programs were assessed. Overall, the median (interquartile range) mRCR score was 1.56 (1.05-2.12) and the median wRCR score was 27.6 (6.97-88.44). Both metrics increased with each successive academic rank, except for department chairs. There was no difference in mRCR between male and female surgeons. Among assistant professors, males had higher wRCR scores. Both metrics were higher among surgeons with a PhD degree. The RCR offers key advantages over other indices, which are reflected in differences in score distributions compared with the widely used h-index. Nevertheless, implementation of the RCR should be preceded with careful consideration of its own limitations.

Does Research Training lead to Academic Success in Orthopedic Surgery? An Analysis of U.S Academic Orthopedic Surgeons

BACKGROUND

Academic surgeons are invaluable for scientific advancement and training the next generation of orthopedic surgeons.

OBJECTIVE

This study aimed to describe a cohort of academic orthopedic surgeons currently in practice with common academic metrics.

METHODS

ACGME-accredited orthopedic surgery programs with a university affiliation were identified. The primary independent variable in this study was formal research training as defined by a research fellowship or attainment of a PhD. Outcomes included academic rank, h-index attained, number of publications, and funding by the National Institutes of Health (NIH).

RESULTS

1641 orthopedic surgeons were identified across 73 programs. 116 surgeons (7.07%) received formal academic research training. The academic training group and non-academic training group had a similar completion rate of clinical fellowship programs (93.97% vs 93.77%, p=0.933), attainment of other advanced degrees (10.34% vs 8.46%, p=0.485), and years since completion of training (17.49-years vs 16.28-years, p=0.284). Surgeons completing academic research training had a significantly higher h-index (18.46 vs 10.88, p<0.001), higher publication number (67.98 vs 37.80, p<0.001), and more likely to be NIH funded (16.38% vs 3.15%, p<0.001). Surgeons completing academic training were more likely to be associate professors (34.48% vs 25.77%), professors (25.00% vs 22.82%), and endowed professors (10.34% vs 2.43%) (p<0.001). On regression analysis, formalized research training was independently associated with h-index and NIH funding (p<0.001 for both).

CONCLUSION

Formalized research training, either as a research fellowship or PhD, is associated with an increased h-index and likelihood of NIH funding, although this association was not found for academic rank after adjusted regression analysis.

Assessing the Impact of COVID-19 on the 2021 Orthopaedic Surgery Match Outcomes

The purpose of this study was to assess the influence of the COVID-19 pandemic on the 2021 orthopaedic surgery residency match outcomes. Because in-person away rotations and interviews were canceled during the 2020 to 2021 application cycle, we hypothesized that applicants would match at their home program at a higher rate in 2021 than in previous years.

Methods

We queried allopathic orthopaedic surgery residency websites and social media accounts for names of residents and medical school information for cohorts matching from 2017 through 2021. To assess availability of and participation in virtual away rotations, we administered a survey to Accreditation Council for Graduate Medical Education-accredited allopathic orthopaedic surgery residency programs. The primary outcome was the annual proportion of applicants matching at the program affiliated with their medical school ("home program"). Subgroup analyses were stratified by Doximity reputation ranking and availability of a virtual away rotation.

Results

We identified 2,632 residents who matched between 2017 and 2020 and 698 residents who matched in 2021. Overall home program match rate and likelihood of home matching were higher in 2021 compared with 2017 to 2020 (28% vs. 20%; odds ratio [OR] = 1.51, 95% confidence interval [CI] 1.24-1.82, p < 0.001). The increase in the home match rate at programs ranked in the top 30 (27% vs. 20%, p = 0.034) was similar to the increase at programs ranked outside the top 30 (28% vs. 20%, p < 0.001). Of the 66 (48%) programs that responded to the survey, 16 (24%) offered a virtual away rotation. Programs with a higher Doximity ranking were more likely than lower-ranked programs to offer a virtual away rotation (OR = 6.75, 95% CI 1.95-23.4, p = 0.003). Home match rates did not differ significantly between programs that offered a virtual away rotation and those that did not (26% vs. 32%, p = 0.271).

Conclusions

A higher proportion of orthopaedic surgery residency applicants matched at their home program in 2021 compared with previous years. Limitations on in-person activities due to the COVID-19 pandemic may have contributed to this rise.

Level of Evidence

N/A.

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.

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

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

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

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

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

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

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

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

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

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

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

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.

Orthopaedic Surgery Residency Program Websites: A Five-Year Update and the Rise of Social Media

Objective 

The importance of online information in the form of residency program websites has been well documented. With the rise of popularity of social media, another potential vital source of online information distribution exists. We aimed to examine the changes in orthopaedic surgery residency program websites and determine the use of social media by these programs.

Methods

A list of orthopaedic residency programs was obtained. Websites were then assessed for presence of numerous criteria. The presence of a social media account on Instagram, Twitter, and Facebook platforms was then determined.

Results

One hundred ninety-five websites out of 197 programs were identified. The most commonly present criterion was resident rotation schedule with 187 (96%) listings. Meanwhile, information on virtual sessions for prospective applicants was the least present at 26 (13%). Out of the 33 criteria assessed, websites contained an average of 20.4 criteria. Approximately half of the programs were noted to have a social media presence.

Conclusion

Website utilization and accessibility have improved over time as the importance of online information has continued to grow in the orthopaedic surgery residency application process. In order to increase their online presence, numerous programs have recently created or enhanced the profiles on social media platforms which may reach more users than websites alone.

Research During Orthopaedic Training

By the end of their training, all orthopaedic residents should be competent in understanding musculoskeletal research enough to navigate the literature and base clinical decisions on it. To accomplish this, the Accreditation Council for Graduate Medical Education requires involvement in scholarly activity. For those interested in academics and having additional involvement in research, there can be many benefits including professional achievement and intellectual /personal satisfaction. A number of potential career models exist for those interested in being engaged in musculoskeletal research, so trainees should seek the training and level of involvement in research that will help them achieve their individual academic goals. To that end, trainees should become involved with research early and identify research mentors in their field of interest (at home or from afar). Training programs and faculty members should create a milieu conducive to research productivity and support and equip trainees who have such aspirations.

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.

Characteristics of First-Year Residents in Top-Ranked United States Ophthalmology Residency Programs

Objective The aim of the study is to investigate the characteristics of first-year residents associated with attending a top-ranked United States (U.S.) ophthalmology residency program over the past decade.

Methods First-year ophthalmology residents in 2009, 2013, 2016, and 2019 were identified from institutional websites, Doximity, LinkedIn and the Wayback Machine. Publications were obtained from Scopus and Google Scholar; research productivity was measured using the h-index, and medical school region based on U.S. Census Bureau designations. Medical school and ophthalmology training program rankings were based on U.S. News & World Report (U.S. News) rankings and National Institutes of Health (NIH) funding. One-way ANOVA, Wilcoxon rank sum, χ 2, and t-tests were used to analyze trends, and odds ratios (ORs) were calculated using logistic regression.

Results Data were obtained on 81% (1,496/1,850) of the residents; 43% were female; 5% were international medical graduates (IMGs); and 10% had other graduate degrees. Over the decade, the mean h-index increased (0.87–1.26; p <0.05) and the proportion of residents who attended a top 20 medical school decreased (28–18%; p <0.05). In a multivariate logistic regression model, characteristics associated with being a first-year resident in a top 20 program ranked by U.S. News were female gender [OR: 1.32, 95% CI: 1.02–1.72], having a Master's degree [OR: 2.28, 95% CI: 1.29–4.01] or PhD [OR: 2.23, 95% CI: 1.32–3.79], attending a top 20 [OR: 5.26, 95% CI: 3.66–7.55] or a top 40 medical school by NIH funding [OR: 2.45, 95% CI: 1.70–3.54], attending a medical school with a mean USMLE Step 2 score above 243 [OR: 1.64, 95% CI: 1.01–2.67] or located in the Northeast [OR: 2.00, 95% CI: 1.38–2.89] and having an h-index of one or more [OR: 1.92, 95% CI: 1.47–2.51]. Except for gender, these characteristics were also significantly associated with matching to a top 20 ophthalmology program by NIH funding.

Conclusion Female gender, graduate degrees, research productivity, and attending a medical school with high research productivity, high mean USMLE Step 2 score or in the Northeast were key characteristics of first-year residents in top-ranked U.S. ophthalmology residency programs.

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.

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.

Gap Year Research Fellowship Opportunities for Medical Students Interested in Orthopaedic Surgery

Orthopaedic surgery is becoming an increasingly competitive specialty. The purpose of this study was to identify existing orthopaedic research fellowships in the United States and to determine important characteristics including the number of positions offered by each program and the average number of publications from completing the program.

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.

The Orthopaedic Match: Defining the Academic Profile of Successful Candidates

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSION

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

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

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

Orthopaedic Surgery Residency Match After an Early-Exposure Research Program for Medical Students

Introduction:

The purpose of this study was to determine the proportion of students matching in orthopaedic surgery after a structured, early-exposure mentored research program and what factors were associated with those students compared with participants who matched in other specialties.

Methods:

Program data were reviewed from 2007 to 2015. Multivariable binary logistic regression analysis was used to evaluate student and research factors associated with orthopaedic surgery match.

Results:

Of 174 students, 117 (67%) matched into surgical residency programs, with 49% (n = 85) matching into orthopaedic surgery. The percentage of women matching into orthopaedic surgery (37%) was less than that of men (53%), which, however, increased over the study period. Students who matched in orthopaedic surgery had greater numbers of publications (3.55 [range 0 to 17] average publications) compared with students who matched in other specialties (1.98 (range 0 to 11) average publications). The average number of publications per student increased from 0.79 (±1.44, range 0 to 10, 40%) preprogram to 1.95 (±2.28, range 0 to 11, 71%) postprogram. Measured factors associated with orthopaedic surgery match were publications with program mentor, postprogram first authorship, and total publications.

Discussion:

Approximately half of the participants matched into orthopaedic surgery. Analysis showed that research productivity increased after program participation and was statistically associated with increased likelihood of orthopaedic surgery match.

The Geographic Movement Patterns and Career and Personal Interests of Orthopaedic Surgery Residents in the United States

Orthopaedic surgery continues to be a highly desired residency specialty for graduating medical students in the United States. The geographic preferences and trajectories of orthopaedic surgery applicants are not well understood.

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.

Cost Analysis of Medical Students Applying to Orthopaedic Surgery Residency: Implications for the 2020 to 2021 Application Cycle During COVID-19

Although studies have evaluated the economic burden to medical students desiring an orthopaedic residency broadly, no study has evaluated in detail the application costs, away rotation costs, interview costs, and total costs. Given that the Association of American Medical Colleges and the American Orthopaedic Association's Council of Orthopaedic Residency Directors have recommended orthopaedic surgery residency programs for the 2021 residency application cycle cancel away rotations and in-person interviews, our objective was to evaluate the cost savings to medical students applying during this time and the potential implications.

Gender, Race, Age, Allopathic Degree, Board Score, and Research Experience Among Applicants Matching to General and Orthopedic Surgery Residencies, 2015-2019

BACKGROUND

Surgical fields are historically dominated by male physicians. Increasing the diversity of the physician workforce improves training and patient experiences. We aim to investigate any differences in qualifications and match rates between male and female applicants to general surgery (GS) and orthopedic surgery (OS) residencies in the United States.

METHODS

A retrospective cohort analysis was performed utilizing the Association of American Medical Colleges data regarding Electronic Residency Application Service (ERAS) applicants and matched Accreditation Council for Graduate Medical Education (ACGME) residents into GS and OS residencies from 2015 to 2019. Descriptive statistics and independent sample T-tests were performed with significance defined as P < .05.

RESULTS

26 568 GS and 7076 OS ERAS applicants matched at a rate of 25.2% and 55.3%, respectively. Men and women matched into GS at rates of 23.0% and 29.2%, respectively. Men and women matched into OS at rates of 55.2% and 56.2%, respectively. Men aged ≥36 years matched into OS at a significantly higher rate than women aged years ≥36 (11.9% vs. 1.4%, P = .009). Female GS ERAS applicants and entering ACGME residents had a higher mean number of research experiences than male GS ERAS applicants (2.66 vs. 2.26, P < .001) and entering male GS ACGME residents (2.96 vs. 2.56, P = .008).

CONCLUSIONS

Male and female GS and OS applicants have similar qualifications. Women match into GS and OS at higher rates than men but comprise disproportionately lower numbers of applicants. Greater mentorship opportunities and recruitment of female applicants are needed to expand, diversify, and increase representation of women in surgery.

Medical Student Publications in Neurosurgery: At Which U.S. Academic Institutions Do Medical Students Publish Most?

BACKGROUND

The neurosurgery residency match is a competitive process. While medical research offers esteemed learning opportunities, productivity is closely evaluated by residency programs. Accordingly, students work diligently to make contributions on projects within their neurosurgery departments. The present study evaluated medical student research productivity for each of the 118 U.S. neurosurgery residency programs.

METHODS

A retrospective review of publications for 118 neurosurgery programs from January 1, 2015, to April 1, 2020, was performed. The primary outcome was any publication with a medical student as the first author. Secondary outcomes included number of faculty in each department, department region, and medical school ranking. The number of student first author publications was compared among programs, regions, and medical schools.

RESULTS

Mean numbers of medical student first author publications and faculty members per institution were 16.27 and 14.46, respectively. The top 3 neurosurgery departments with the greatest number of student first author publications were Johns Hopkins University, Brigham and Women's Hospital, and University of California, San Francisco. Salient findings included a positive correlation between the number of medical student first author publications from a neurosurgery department and the number of departmental faculty (P < 0.001, R = 0.69). Additionally, the mean number of first author medical student publications at the top 30 programs was higher than the mean for the remaining programs (P < 0.0001).

CONCLUSIONS

This study is the first to evaluate neurosurgery medical student productivity in North America. By systematizing first authorships, incoming students who desire to pursue neurosurgery can be informed of institutions with student involvement, and departments that use medical student expertise can be recognized.

An Analysis of Trends in National Residency Matching Program Match Data for Orthopedic Surgery

Due to electronic residency applications, US Medical Licensing Examination Step 1 scores are frequently used by orthopedic surgery program directors to screen applicants. Prospective applicants therefore often use Step 1 scores as a proxy for specialty competitiveness. The goal of this investigation was two-fold: (1) to determine whether trends in Step 1 scores are indicative of trends in competitiveness of orthopedic surgery and (2) to report the characteristics that optimize a US medical student's match success. A retrospective review of published National Resident Matching Program data from 2009 to 2018 was performed for orthopedic surgery residency applicants. Additional data from the Charting Outcomes reports were used for specific analyses of applicant characteristics. From 2009 to 2018, the number of orthopedic surgery residency positions grew at an annual rate of 1.51% (95% confidence interval [CI], 1.37% to 1.64%; P<.001), accommodating the 1.26% (95% CI, 0.63% to 1.90%; P=.006) annual increase in the number of applicants who ranked orthopedic surgery as their preferred specialty choice (only choice or first choice). There were no significant changes in the applicant-to-position ratio (95% CI, -0.85% to 0.37%; P=.483) or the match rate for US seniors who ranked orthopedic surgery as their preferred choice (95% CI, -0.23% to 0.87%; P=.313). Increases in mean Step 1 scores of matched orthopedic surgery applicants parallel national Step 1 growth trends (0.49% vs 0.44%, respectively). Although orthopedic surgery is currently a competitive specialty to match into, this has been the case since 2009. Increasing Step 1 scores of matched applicants is not unique to orthopedic surgery and should not be misinterpreted as a proxy for increasing competitiveness of the specialty. [Orthopedics. 2020;43(6):e616-e622.].

Do Year-Out Programs Make Medical Students More Competitive Candidates for Orthopedic Surgery Residencies?

OBJECTIVE

As orthopedic surgery residency programs are becoming more competitive, medical students interested in orthopedics are increasingly completing "year-out" programs. This study sought to evaluate student and faculty perceptions of these programs.

DESIGN

A survey evaluating baseline characteristics was disseminated to directors of year-out programs identified through postings on the orthopedics forum, Orthogate.org. A second survey was sent to all program directors (PDs) of accredited US orthopedic residencies, while a final survey was distributed to participants identified by year-out PDs.

SETTING

Ninety-six orthopedic year-out programs at 56 institutions were contacted.

PARTICIPANTS

Twenty-six year-out programs, 72 PDs of ACGME-accredited orthopedic residencies, and 34 year-out participants from 6 programs completed our questionnaires.

RESULTS

73.1% (19) year-out program provided funding to participants, averaging $30,368. 84.6% (22) reported >75% match rates into orthopedics for participants. 65.4% (17) of programs selected students between their MS3/MS4 school years. 4.2% (3) of residency PDs agreed or strongly agreed that year-out programs were important factors for consideration in residency programs, compared with 82.4% (28) of year-out participants and 69.2% (18) of year-out PDs (p < 0.001). 58.8% (2) of year-out participants cited completion of a year-out for improving the chance of matching into any orthopedic residency, while 85.3% (29) wanted to be more competitive for top programs. The average Step 1 score was 248, which was insignificantly different from the national average for matched orthopedic applicants.

CONCLUSIONS

Orthopedic year-out programs have dramatically increased in number over the last 20 years. Most of these programs are funded, 1-year clinical research fellowships with relative match success for participants pursuing orthopedic residencies. While year-out PDs and students consider participation in such programs to be an important factor for residency applications, and often participate in them in order to improve their competitiveness for matching at desired programs, residency PDs overall hold different views.

Analysis of academic publishing output among 1634 successful applicants in the 2011-2018 neurosurgery residency match

BACKGROUND

Research productivity is a key criterion for applicant selection reported by residency program directors. Research volume reported on neurosurgery residency applications has risen steadily over the past decade.

OBJECTIVE

Perform retrospective bibliographic searches of successful applicants who matched into U.S. neurosurgery residency programs from 2011 to 2018, and assess the relationship between academic publishing and residency placement.

METHODS

Gender, MD/PhD status, U.S. News research ranking of medical school, and international medical graduate status (IMG) were determined for 1634 successful applicants from 2011 to 2018. Indexed publications before and after the start of residency were tabulated by Scopus®. Publication counts were stratified by first author, basic/clinical science, case reports, reviews, or other research. We then compared publishing trends across demographic variables and match cohorts.

RESULTS

Average pre-residency publications increased from 2.6 [1.7, 3.4] in 2011 to 6.5 [5.1, 7.9] in 2018. Men, PhD-holders, Top 20 and Top 40 U.S. medical school graduates, and IMGs had higher pre-residency publication counts overall. After stratifying by match cohort, however, there was no significant effect of gender on pre-residency publications. Applicants matching into residency programs with highly ranked affiliated hospitals had significantly higher pre-residency publications.

CONCLUSION

Publishing volume of successful neurosurgery applicants in the U.S. has risen recently and is associated with the stature of matched residency programs. Given the gap between verifiable and claimed research on residency applications, attention is needed to objectively evaluate research credentials in the selection process. The impending phase out of USMLE step 1 scores may increase emphasis on academic productivity.

Evaluating the Standardized Letter of Recommendation Form in Applicants to Orthopaedic Surgery Residency

INTRODUCTION

A standardized letter of recommendation (SLOR) form for orthopaedic surgery residency programs has recently been adopted for use, but it has not been scientifically evaluated. The purpose of this study is to investigate the usefulness of the SLOR form in the selection process.

METHODS

All SLOR forms submitted to our institution over a single application cycle were extracted and analyzed. The United States Medical Licensing Examination Step 1 scores, grades in clinical rotations, Alpha Omega Alpha status, and the number of publications were recorded for each applicant. Correlations were calculated with Spearman rho, and inter-rater reliability was evaluated by calculating intraclass correlation coefficients.

RESULTS

One thousand one hundred thirty-seven SLOR forms were analyzed for 513 applicants. There was substantial rank inflation with the SLOR form; the majority (92%) of applicants were rated as either ranked to match or in the top one-third of their rank list. Objective applicant factors such as grades and Step 1 scores demonstrated a very weak to nonexistent correlation with the summative rank (rho 0.07 to 0.13, P ≤ 0.012). Poor inter-rater reliability was observed with the intraclass correlation coefficient ranging from 0.22 to 0.33 (P < 0.001).

CONCLUSIONS

The usefulness of the SLOR form is limited by the very high ratings observed for all questions, and in particular, the final summative rank. Measures to reduce rank inflation must be implemented to improve the discriminant ability of the SLOR form, and if this cannot be accomplished, perhaps the form should be abandoned.

LEVEL OF EVIDENCE

Level III Retrospective.

Restructuring of an Orthopaedic Surgery Residency Research Rotation Correlates with Increased Academic Productivity in Teaching Faculty

INTRODUCTION

Contribution toward clinical research is paramount to the education of physician trainees and is required by the Accreditation Council for Graduate Medical Education. From 1987 through 2015, our single institution orthopaedic surgery residency research experience included 2 dedicated research rotations. Because few resident projects were pursued to completion, feedback was used to restructure the curriculum, including the appointment of 2 clinical orthopaedic faculty to serve as codirectors, development of a revised curriculum, use of research teams, and a centralized research database. Our group previously displayed increased resident productivity within 2 years after the 2015 implementation. The aim of this study was to investigate the impact of orthopaedic residency curricular changes on scholarly activity of orthopaedic teaching faculty.

METHODS

The curriculum vitae (CVs) of a single institution's orthopaedic teaching faculty were collected and retrospectively reviewed from 2014 through 2018 to determine academic productivity of clinical faculty. Indicators of academic productivity included peer-reviewed publications (including journal impact factors) and podium or poster presentations.

RESULTS

Twenty-three of 27 faculty members responded to our request for CVs. One hundred three CVs were reviewed on 23 faculty. All academic indicators increased over 5 years. Multivariate analysis of variance (MANOVA) using a multivariate repeated measures analysis was completed. A sphericity χ2 test was violated for all measures, precluding us from using unadjusted univariate analysis. Univariate MANOVA with repeated measures displays significance regarding impact factor (f < 0.02, p < 0.05) and journal publications (f < 0.004, p < 0.05). Subsequent multivariate analysis shows similar results regarding impact factor (f < 0.0008), journal publications (0.0005), and poster presentations (f < 0.016).

CONCLUSIONS

Improved structure of an established resident research rotation combined with enhanced faculty mentorship resulted in a significant increase in academic productivity for clinical teaching faculty of the department of orthopaedic surgery. This increase parallels that seen in orthopaedic resident research productivity; indicating a positive impact on teaching faculty scholarly activity.

LEVEL OF EVIDENCE

III.

The Evolving Impact of COVID-19 on Medical Student Orthopedic Education: Perspectives From Medical Students in Different Phases of the Curriculum

Introduction:

The world-wide lockdown caused by Coronavirus Disease 2019 (COVID-19) has upended the trajectories of lives everywhere. The medical profession has been on the front lines of this rapidly developing situation, which in turn has called for unprecedented changes in the medical school curriculum. These changes have severe implications for medical students interested in applying to competitive surgical specialties like orthopedics.

Methods:

As medical students in 3 different class years pursuing orthopedic surgery, we provide our perspectives on the impact that COVID-19 has had on medical student orthopedic education.

Results:

With the removal of away rotations and a shift to virtual interviews, rising fourth year medical students are arguably the most impacted as they prepare for the orthopedic residency application process. Third year students, who are in the exploratory phase of choosing a specialty, also face uncertainties in the shift to a “new” clerkship experience that may (1) be of shorter duration, (2) implement shifts to limit overcrowding of clinical space, and (3) increase the use of telehealth over direct patient contact.

Discussion:

The COVID-19 pandemic has altered the course of medical students’ orthopedic education in unprecedented ways. We believe the following suggestions may be helpful for students seeking alternative, supplemental ways of learning: (1) read up on major orthopedic journals, (2) reach out to orthopedic surgeons in areas of interest, (3) reach out to program directors/medical clerkship directors/program coordinators for opportunities to attend their educational curriculum virtually, (4) attend online lectures and hospital grand rounds, and (5) practice suturing technique with a practice kit.

Conclusions:

While the medical education landscape remains uncertain amid the evolving conditions of COVID-19, as medical students we strive to learn from this pandemic and respond to future unforeseen challenges with resilience, dedication, and compassion: all qualities we admire in orthopedic surgeons.

Factors Considered When Ranking Military Orthopedic Surgery Residency Candidates

INTRODUCTION

The intangible personal characteristic grit has become a popular topic of concentration within contemporary psychology studies. Grit is defined as persistent work on a focused topic for an extended period of time until a desired goal is achieved. Its application to physician selection and development is not well known. We sought to determine which factors were considered most important among leadership within the U.S. Army's orthopedic surgical training programs when selecting applications and ascertain if grit was one of the primary factors.

MATERIALS AND METHODS

A standardized, 18-question survey was sent to all program chairs, program directors, and assistant program directors at the six U.S. Army orthopedic surgery residency programs. Questions included demographic factors pertaining to both the individual and their respective training program. Participants were asked to rank, in order, the 10 most important variables when considering applicants. Each variable was ranked using a point system (1-10 with 10 as the best score), referred to as the factor score (FS). Further statistical analyses using descriptive statistics, paired t-test, and ANOVA were performed and reported.

RESULTS

The response rate was 83% (15/18). The most important variable considered was the applicant's performance on their audition rotation (FS = 9.8), which was significantly more important than any other variable (P = 0.001). The second most important variable was the applicant's USMLE scores (FS = 7.13), followed by involvement in research (FS = 5.60) and conscientiousness (FS = 4.73), respectively. Grit was considered the fifth most important variable (FS = 4.27). There was no significant difference in the ranking of grit among the different programs (P = 0.282). In applicants with low United States Medical Licensing Examination scores according to leadership idiosyncrasy, their audition rotation was considered a redeeming portion of their application (P = 0.02) followed by their level of grit.

CONCLUSIONS

The most important factor when considering an orthopedic surgery applicant was how well the applicant performed on an audition rotation, followed by their United States Medical Licensing Examination scores. Grit has become an important consideration in resident selection.