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Frenkel Rutenberg T, Daglan E, Shadmi N, Iordache SD, Kosashvili Y, Eylon S. Fertility and pregnancy complications in female orthopaedic surgeons. Occup Med (Lond) 2024:kqae044. [PMID: 38776463 DOI: 10.1093/occmed/kqae044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2024] Open
Abstract
BACKGROUND While the number of female medical graduates continues to increase, only a few pursue an orthopaedic career. This is related to challenges regarding pregnancy and the peripartum period during orthopaedic training. AIMS To evaluate fertility, pregnancy-related complications and attitudes towards female orthopaedic surgeons in Israel. METHODS An electronic anonymous 34-question electronic web-based survey was sent to all Israeli female orthopaedic surgeons. Participation was voluntary. Questions were formulated to determine demographics, obstetrics medical history, teratogenic exposure, medical leave and breastfeeding parameters along with attitude towards pregnancy. RESULTS Twenty-six orthopaedic surgeons complied with the survey, 68% of all registered female orthopaedic surgeons. Participants age was 39.5 (±8.8). The average number of children for a female orthopaedic surgeon was 2.2 (±1.4), with an average of 1.3 (±1.1) deliveries during residency. The average age for a first child was 31.1 (±3.7) years. Four surgeons required fertility treatments and six had abortions. Thirty-eight per cent experienced pregnancy complications. Most surgeons were exposed to radiation and bone cement during pregnancy. The average duration of maternity leave was 19.4 (±9.9) weeks and return to work was associated with cessation of breastfeeding. Seventy-six per cent of surgeons felt that pregnancy had negatively influenced their training, and 12% reported negative attitudes from colleagues and supervisors. CONCLUSIONS Orthopaedic surgeons in Israel experience a delay in childbirth and higher rates of pregnancy complications. Most feel that their training is harmed by pregnancy. Programme directors should design a personalized support programme for female surgeons during pregnancy and the peripartum period.
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Affiliation(s)
- T Frenkel Rutenberg
- Sackler Faculty of Medicine, Rabin Medical Center, Beilinson Hospital, Tel Aviv University, Tel Aviv, Israel
| | - E Daglan
- Sackler Faculty of Medicine, Rabin Medical Center, Beilinson Hospital, Tel Aviv University, Tel Aviv, Israel
| | - N Shadmi
- Rappaport Faculty of Medicine, Hillel Yaffe Medical Center, Technion University, Haifa, Israel
| | - S D Iordache
- Sackler Faculty of Medicine, Rabin Medical Center, Beilinson Hospital, Tel Aviv University, Tel Aviv, Israel
| | - Y Kosashvili
- Sackler Faculty of Medicine, Rabin Medical Center, Beilinson Hospital, Tel Aviv University, Tel Aviv, Israel
| | - S Eylon
- ALYN Hospital, Pediatric & Adolescent Rehabilitation Center, Hebrew University, Jerusalem, Israel
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Marchand G, Arroyo A, Moir C, Blanco M, Gonzalez Herrera D, Hamilton B, Ruffley K, Petersen M, Fernandez S, Ulibarri H. Meta-analysis of residency program application and acceptance according to sex, race and ethnicity. J Int Med Res 2024; 52:3000605241244993. [PMID: 38759223 PMCID: PMC11107330 DOI: 10.1177/03000605241244993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 03/15/2024] [Indexed: 05/19/2024] Open
Abstract
OBJECTIVE We aimed to investigate trends in residency program application and acceptance rates according to sex and race and ethnicity. METHODS We collected data from the Journal of the American Medical Association Graduation Medical Education Reports. We extracted the data for 25 residency programs in the United States from 2005 to 2021 and conducted statistical analyses. RESULTS Men were most matched for orthopedics (84.7%, 95% confidence interval [CI] 84.2%-85.1%), and women for oncology (78.7%, 95% CI 78.2%-79.2%). The most matched program was orthopedics for the White subgroup (43.5%, 95% CI 43.2%-43.9%), radiology for the Black subgroup (20%, 95% CI 18.9%-20.9%), general surgery for the Hispanic subgroup (11%, 95% CI 10.7%-11.2%), and internal medicine for the Asian subgroup (35.3%, 95% CI 34.9%-35.6%). CONCLUSION Match rates for women were lower than those for men in all programs except psychiatry, pediatrics, obstetrics and gynecology, and dermatology. Match rates were significantly lower for Black, Hispanic, and Asian subgroups than the White subgroup in all programs except for internal medicine, with the Asian subgroup being higher. We observed a significant increase in both application and acceptance rates for women and racial and ethnic minorities over the past 40 years.
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Affiliation(s)
- Greg Marchand
- Marchand Institute for Minimally Invasive Surgery, Mesa, Arizona, USA
| | - Amanda Arroyo
- Marchand Institute for Minimally Invasive Surgery, Mesa, Arizona, USA
| | - Carmen Moir
- Marchand Institute for Minimally Invasive Surgery, Mesa, Arizona, USA
| | - Madison Blanco
- Marchand Institute for Minimally Invasive Surgery, Mesa, Arizona, USA
| | | | - Brooke Hamilton
- Marchand Institute for Minimally Invasive Surgery, Mesa, Arizona, USA
| | - Kate Ruffley
- Marchand Institute for Minimally Invasive Surgery, Mesa, Arizona, USA
| | - Mary Petersen
- Midwestern University College of Osteopathic Medicine, Glendale, Arizona, USA
| | - Sarena Fernandez
- Midwestern University College of Osteopathic Medicine, Glendale, Arizona, USA
| | - Hollie Ulibarri
- Marchand Institute for Minimally Invasive Surgery, Mesa, Arizona, USA
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Williams AJ, Malewicz JI, Pum JM, Zurakowski D, Day CS. How Did Black and Hispanic Orthopaedic Applicants and Residents Compare to General Surgery Between 2015 and 2022? Clin Orthop Relat Res 2024:00003086-990000000-01560. [PMID: 38578021 DOI: 10.1097/corr.0000000000003069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 03/07/2024] [Indexed: 04/06/2024]
Abstract
BACKGROUND Despite the heavy demand for and knowledge of the benefits of diversity, there is a persistent lack of racial, ethnic, and gender diversity in orthopaedic surgery. Since the implementation of diversity initiatives, data have shown that general surgery has been one of the top competitive surgical fields and has demonstrated growth in racial, ethnic, and gender diversity, making general surgery a good point of reference and comparison when analyzing racial and ethnic growth in orthopaedic surgery. QUESTIONS/PURPOSES (1) What were the growth rates for Black and Hispanic orthopaedic residency applicants and residents between 2015 and 2022? (2) How did the growth rates of Black and Hispanic individuals in orthopaedic surgery compare with those of general surgery? (3) How did applicant recruitment and resident acceptance differ between Black and Hispanic people in orthopaedic surgery? METHODS Applicant data were obtained from historical specialty-specific data from the Association of American Medical Colleges Electronic Residency Application Service Statistics database between 2018 and 2022, and resident data were obtained from the Accreditation Council of Graduate Medical Education Data Resource Book between 2015 and 2021. Between 2018 and 2022, the number of residency applicants totaled 216,677, with 17,912 Black residency applicants and 20,413 Hispanic residency applicants. Between 2015 and 2021, the number of active residents totaled 977,877, with 48,600 Black residents and 62,605 Hispanic residents. Because the applicant and resident data do not overlap throughout all years of observation, a sensitivity analysis of overlapping years (between 2018 and 2021) was conducted to ensure observed trends were consistent and valid throughout the study. All datasets obtained were used to establish the different racial and ethnic proportions of Black and Hispanic residency applicants and residents in four nonsurgical primary care specialties and four surgical subspecialties. A reference slope was created using data from the Association of American Medical Colleges and Accreditation Council of Graduate Medical Education to represent the growth rate for total residency applicants and residents, independently, across all residency specialties reported in each database. This slope was used for comparison among the resident and applicant growth rates for all eight selected specialties. Datapoints were placed into a scatterplot with regression lines, using slope equations to depict rate of growth and R2 values to depict linear fit. Applicant growth corresponded to applicant recruitment and resident growth corresponded to resident acceptance. Chi-square tests were used to compare residents and residency applicants for the Black and Hispanic populations, separately. Two-way analysis of variance with a time-by-specialty interaction term (F-test) was conducted to determine differences between growth slopes. RESULTS There was no difference in the growth rate of Black orthopaedic surgery applicants between 2018 and 2022, and there was no difference in the growth rate of Hispanic orthopaedic surgery applicants (R2 = 0.43; p = 0.23 and R2 = 0.63; p = 0.11, respectively). However, there was a very slight increase in the growth rate of Black orthopaedic surgery residents between 2015 and 2021, and a very slight increase in the growth rate of Hispanic orthopaedic surgery residents (R2 = 0.73; p = 0.02 and R2 = 0.79; p = 0.01, respectively). There were no differences in orthopaedic and general surgery rates of growth for Black applicants between 2018 and 2022 (0.004 applicants/year versus -0.001 applicants/year; p = 0.22), and no differences were found in orthopaedic and general surgery rates of growth for Black residents between 2015 and 2021 (0.003 residents/year versus 0.002 residents/year; p = 0.59). Likewise, Hispanic orthopaedic applicant growth rates did not differ between 2018 and 2022 from the rates of general surgery (0.004 applicants/year versus 0.005 applicants/year; p = 0.68), and there were no differences in orthopaedic and general surgery rates of growth for Hispanic residents (0.007 residents/year versus 0.01 residents/year; p = 0.35). Furthermore, growth rate comparisons between Black orthopaedic applicants and residents between 2018 and 2021 showed applicant growth was larger than resident growth, illustrating that the recruitment of Black applicants increased slightly more rapidly than resident acceptance. Growth rate comparisons between Hispanic applicants and residents showed a larger rate of resident growth, illustrating Hispanic resident acceptance increased slightly faster than applicant recruitment during that time. CONCLUSION We found low acceptance of Black residents compared with the higher recruitment of Black applicants, as well as overall low proportions of Black and Hispanic applicants and residents. Future studies might explore the factors contributing to the higher acceptances of Hispanic orthopaedic residents than Black orthopaedic residents. CLINICAL RELEVANCE We recommend that more emphasis should be placed on increasing Black and Hispanic representation at the department level to ensure cultural considerations remain at the forefront of applicant recruitment. Internal or external reviews of residency selection processes should be considered, and more immersive, longitudinal orthopaedic surgery clerkships and research mentorship experiences should be targeted toward Black and Hispanic students. Holistic reviews of applications and selection processes should be implemented to produce an increased racially and ethnically diverse applicant pool and a diverse residency work force, and implicit bias training should be implemented to address potential biases and diversity barriers that are present in residency programs and leadership.
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Affiliation(s)
- Alisha J Williams
- Wayne State University School of Medicine, Detroit, MI, USA
- Department of Orthopaedic Surgery, Henry Ford Health, Detroit, MI, USA
| | - Julia I Malewicz
- Wayne State University School of Medicine, Detroit, MI, USA
- Department of Orthopaedic Surgery, Henry Ford Health, Detroit, MI, USA
| | - John M Pum
- Wayne State University School of Medicine, Detroit, MI, USA
- Department of Orthopaedic Surgery, Henry Ford Health, Detroit, MI, USA
| | - David Zurakowski
- Director of Biostatistics for Departments of Anesthesiology and Surgery, Boston Children's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Charles S Day
- Wayne State University School of Medicine, Detroit, MI, USA
- Department of Orthopaedic Surgery, Henry Ford Health, Detroit, MI, USA
- Michigan State University College of Human Medicine, Detroit, MI, USA
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DiGioia Guthrie N, Abdeen A, Jain R, Tsao AK, Jones LC, Cohen-Rosenblum A. The Pregnant Arthroplasty Surgeon: A Women in Arthroplasty Committee Editorial. J Arthroplasty 2024; 39:569-572. [PMID: 37926221 DOI: 10.1016/j.arth.2023.10.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 10/27/2023] [Accepted: 10/30/2023] [Indexed: 11/07/2023] Open
Abstract
BACKGROUND Women orthopaedic surgeons face unique challenges during their careers. There are extremely low numbers of women in the field, particularly in the specialty of adult reconstruction. Factors contributing to low numbers of women entering this subspecialty include increased perceived physical demand relative to other fields, occupational hazards during pregnancy such as exposure to radiation and polymethylmethacrylate bone cement, concerns for work-life balance, and limited number of women within the subspecialty. The following editorial provides a framework to understand and manage the potential occupational hazards to pregnant and lactating surgeons, parental leave, and postpartum return to work. We aim to dispel any unfounded myths and provide evidence-based education that may help overcome these barriers. In doing so, we hope to encourage more women to consider adult reconstruction as a potential career. METHODS Our primary method consisted of completing an extensive literature review on the past and current articles about the aforementioned barriers which may contribute to the low number of women entering adult reconstruction. After this literature search was completed, we composed a comprehensive editorial that provided evidence-based education and recommendations for medical professionals. CONCLUSIONS Issues pertaining to parenthood, pregnancy, and lactation pose barriers to success for women in orthopedic surgery. These concerns may dissuade talented women from pursuing a rewarding career in adult reconstruction. Education on these issues is needed to help our early-career colleagues plan and care for their families. Clearly stated and published policies should be made available in all training programs, fellowships, and clinical practices to allow understanding and unbiased implementation. By being more inclusive, adult reconstruction will have access to the best possible surgeons, which will benefit not only patients but the field as a whole.
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Affiliation(s)
- Noelle DiGioia Guthrie
- Renaissance Orthopaedics and University of Pittsburgh Medical Center, Magee-Womens Hospital of UPMC, Pittsburgh, Pennsylvania
| | - Ayesha Abdeen
- Department of Orthopedic Surgery, Boston Medical Center/Boston University, Boston, Massachusetts
| | - Rina Jain
- Synergy Orthopedic Specialists, University of California San Diego Health Sciences Clinical Instructor, San Diego, California
| | - Audrey K Tsao
- Mid-Atlantic Permanente Medical Group, Kensington, Maryland
| | - Lynne C Jones
- Department of Orthopaedic Surgery, Johns Hopkins University School of Medicine, Johns Hopkins Bayview Medical Center, Baltimore, Maryland
| | - Anna Cohen-Rosenblum
- Department of Orthopaedic Surgery, Louisiana State University, New Orleans, Louisiana
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Han Y, Fones L, Shakked R, Hammoud S. Orthopedic Surgery Residency Program Rankings and Gender Diversity. Cureus 2024; 16:e56365. [PMID: 38633926 PMCID: PMC11022666 DOI: 10.7759/cureus.56365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/17/2024] [Indexed: 04/19/2024] Open
Abstract
Background Orthopedic surgery residency programs are some of the least gender-diverse specialty programs in medicine. Despite strong representation at the undergraduate and medical school levels and increased applications to orthopedic surgery residency programs by women, there is still a substantial gender gap at the resident level. This study explores the relationship between the gender diversity of orthopedic surgery residency programs and program rankings. Methodology Program rank, program director gender identity, and gender diversity data were collected for the top 100 programs by reputation in Doximity. Gender diversity was measured as the proportion of female residents in the program and alumni. Results The greatest percentage of women in a program was 33% and the smallest was 3%. After linear regression analysis, we found that there was a statistically significant positive correlation between program rank and the proportion of women. The higher ranked a program was, the greater the proportion of women. There was no significant correlation between program director gender, appointment year, and program rank. Conclusions These results suggest that, although there is still a long way to go before closing the gender gap in orthopedic surgery residency programs, higher-ranked programs are associated with greater gender diversity than their lower-ranked counterparts.
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Affiliation(s)
- Yuri Han
- Orthopedic Surgery, Robert Wood Johnson Medical School, Piscataway, USA
| | - Lilah Fones
- Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, USA
| | - Rachel Shakked
- Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, USA
| | - Sommer Hammoud
- Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, USA
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Xu AL, Humbyrd CJ, De Mattos CBR, LaPorte D. The Importance of Perceived Barriers to Women Entering and Advancing in Orthopaedic Surgery in the US and Beyond. World J Surg 2023; 47:3051-3059. [PMID: 37735223 DOI: 10.1007/s00268-023-07165-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/18/2023] [Indexed: 09/23/2023]
Abstract
BACKGROUND Global perceptions of barriers to women in orthopaedics have not been assessed. The purpose of this study was to determine the importance of international barriers to women entering and advancing within orthopaedic surgery. METHODS An anonymous, online survey was distributed to women medical students, trainees, and practicing surgeons via Women in Orthopaedics Worldwide, the "Women in Ortho" Facebook page, and individual programmes. Participants were asked to rate perceived barriers to (1) pursuing training and (2) career advancement on a scale of 1-5, with 5 being the most important and relative to other barriers. Descriptive statistics and univariate analyses were employed. RESULTS The survey yielded 237 US (84.0%) and 45 international (16.0%) respondents. Per entering orthopaedic surgery, the most important barriers were male-dominated culture, lack of a strong women mentor, and lack of female representation at home institution. Compared with the US surgeons/trainees, international respondents cited greater societal disapproval (2.8 ± 1.2 vs. 3.4 ± 1.3, P = 0.01). Medical students assigned less importance to lack of exposure, more to lack of resources for creating competitive applications (P < 0.05). Regarding career advancement, lack of women leadership, family responsibilities, and gender-biased selection for promotion were the most important. International surgeons/trainees noted greater concern for societal disapproval (3.5 ± 1.5 vs. 2.6 ± 1.3, P = 0.003) and were more likely to rank sexual harassment in their top three (17.6 vs. 4.2%, P = 0.02). CONCLUSION While notable differences exist, there is striking similarity across countries and position levels in perceived barriers to women entering and advancing in orthopaedic surgery. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Amy L Xu
- Department of Orthopaedic Surgery, The Johns Hopkins Hospital, 1800 Orleans Street, Baltimore, MD, 21287, USA.
| | - Casey J Humbyrd
- Department of Orthopaedic Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | | | - Dawn LaPorte
- Department of Orthopaedic Surgery, The Johns Hopkins Hospital, 1800 Orleans Street, Baltimore, MD, 21287, USA
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Meadows AM, Skinner MM, Hazime AA, Day RG, Fore JA, Day CS. Racial, Ethnic, and Sex Diversity in Academic Medical Leadership. JAMA Netw Open 2023; 6:e2335529. [PMID: 37747731 PMCID: PMC10520740 DOI: 10.1001/jamanetworkopen.2023.35529] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 08/18/2023] [Indexed: 09/26/2023] Open
Abstract
Importance For the past 50 years, significant gaps have existed in gender and racial diversity across various medical specialties, despite the many benefits of a diverse physician workforce. One proposed approach to increasing diversity is top-down diversification, in which diverse leadership results in increased minority and female workforce representation. Objective To investigate the changes in academic medical leadership diversity from 2007 to 2019 and to assess the recent leadership diversity of various specialties compared with the averages across all specialties. Design, Setting, and Participants This was a cross-sectional analysis of physicians in varying academic roles in 2007, 2019, and 2020. Demographic data were collected via specialized reports from the Association of American Medical Colleges. Included were 4 primary care specialties (internal medicine, family medicine, pediatrics, obstetrics/gynecology [OB/GYN] and 4 surgical specialties (orthopedic surgery, neurologic surgery, otolaryngology [ENT], general surgery). Study participants were faculty, program directors, and chairpersons. Data were analyzed for the years 2007, 2019, and 2020. Intervention Self-reporting of demographic information to residency programs collected via the Graduate Medical Education Track Survey. Main Outcomes and Measures Proportions of each race/ethnicity and sex among cohorts of participants and comparisons between them. Results The total number of individuals investigated included 186 210 faculty from 2019 (79 441 female [42.7%]), 6417 program directors from 2020 (2392 female [37.3%]), 1016 chairpersons from 2007 (89 female [8.8%]), and 2424 chairpersons from 2019 (435 female [17.9%]). When comparing chairperson diversity from 2007 to 2019, only internal medicine and general surgery experienced significant increases in minority (aggregate category used throughout the investigation to refer to anyone who self-identified as anything other than non-Hispanic White) representation (90% increase [11.7 percentage points, from 13.0% in 2007 to 24.7% in 2019]; P = .01 and 96% increase [13.0 percentage points, from 13.5% in 2007 to 26.5% in 2019]; P < .001), respectively; meanwhile, several specialties saw significant increases in female representation during this period (family medicine by 107.4%, P =.002; pediatrics by 83.1%, P =.006; OB/GYN by 53.2%, P =.045; orthopedic surgery by +4.1 percentage points, P =.04; general surgery by 226.9%, P =.005). In general, surgical specialties had lower leadership diversity than the average diversity of all residency programs, whereas primary care specialties had similar or increased diversity. Conclusions and Relevance Study results suggest that some specialties have made significant contributions toward bridging diversity gaps whereas others continue to lag behind. Our recommendations to improve academic medical leadership diversity include programs and institutions (1) publishing efforts and outcomes of diversity representation, (2) incorporating a representative demographic for leadership selection committees, and (3) actively promoting the importance of diversity throughout the selection process.
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Affiliation(s)
- Austin M. Meadows
- Henry Ford Health, Detroit, Michigan
- Wayne State University School of Medicine, Detroit, Michigan
| | | | | | | | | | - Charles S. Day
- Henry Ford Health, Detroit, Michigan
- Wayne State University School of Medicine, Detroit, Michigan
- Michigan State University College of Human Medicine, Grand Rapids
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Malik-Tabassum K, Lamb JN, Seewoonarain S, Ahmed M, Normahani P, Pandit H, Aderinto J, Rogers B. Women in trauma and orthopaedics: are we losing them at the first hurdle? Ann R Coll Surg Engl 2023; 105:653-663. [PMID: 36239962 PMCID: PMC10471437 DOI: 10.1308/rcsann.2022.0112] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/24/2022] [Indexed: 09/02/2023] Open
Abstract
INTRODUCTION Diversity in the healthcare workforce is associated with improved performance and patient-reported outcomes. Gender disparity in Trauma and Orthopaedics (T&O) is well recognised. The aim of this study was to compare factors that influence career choice in T&O between male and female final-year students. Furthermore, the trend of representation of women in T&O over the last decade was also compared with other surgical specialities. METHODS An online survey of final-year students who attended nationally advertised T&O courses over a 2-year period was conducted. Data from NHS digital was obtained to assess gender diversity in T&O compared with other surgical specialities. RESULTS A total of 414 students from 13 UK medical schools completed the questionnaire. Compared with male students (34.2%), a significantly higher proportion of women (65.8%) decided against a career in T&O, p<0.001. Factors that dissuaded a significantly higher percentage of women included gender bias, technical aspects of surgery, unsociable hours, on-call commitments, inadequate undergraduate training and interest in another specialty (p<0.05). Motivating factors for choosing a career in T&O were similar between both sexes. T&O was the surgical specialty with the lowest proportion of women at both consultant and trainee level over the last decade. CONCLUSION T&O remains an unpopular career choice among women. To enhance recruitment of women in T&O, future strategies should be directed toward medical students. Universities, orthopaedic departments and societies must work collaboratively to embed culture change, improve the delivery of the undergraduate curriculum, and facilitate students' exposure to operating theatres and female role models.
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Affiliation(s)
| | - JN Lamb
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, UK
| | | | - M Ahmed
- Brighton and Sussex University Hospitals NHS Trust, UK
| | | | - H Pandit
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, UK
| | | | - B Rogers
- Brighton and Sussex University Hospitals NHS Trust, UK
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Fresán A, Robles-García R, Yoldi-Negrete M, Guízar-Sánchez D, Tovilla-Zárate CA. To the bone: Prevalence and correlates of depression and anxiety among orthopedic residents in Mexico. Int J Psychiatry Med 2023:912174231199216. [PMID: 37653426 DOI: 10.1177/00912174231199216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
Abstract
OBJECTIVE The present study examined among orthopedic residents the relationship between the presence of depressive or anxious symptoms and the degree of perfectionism, perceived work-related distress, and involvement in the care of patient(s) who died. METHOD A cross-sectional online survey based on self-reported measures was used to collect the data from October 2019 to April 2021. RESULTS The sample consisted of 642 orthopedic residents (50.6% response rate; 70.9% male; average age 29.8 years old). A total of 12.5 and 18.4% reported depressive or anxious symptoms, respectively. On a scale of 0-100, the mean score of perceived work-related distress was 51.9. A third (33.6%) reported being involved in the care of patient(s) who had died. Higher levels of perceived work-related distress and higher scores on the indecision of action/perfectionism dimension were associated with depressive and anxious symptoms. Being involved in the care of patient(s) who had died was associated with having anxious symptoms (OR = 1.79; 95%CI = 1.18-2.72). CONCLUSIONS These results highlight the need for the systematic monitoring of the mental health status of orthopedic residents in Mexico, particularly those who report a high level of work-related distress or perfectionism or who have recently experienced the death of a patient.
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Affiliation(s)
- Ana Fresán
- Subdirección de Investigaciones Clínicas, Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Mexico
| | - Rebeca Robles-García
- Centro de Investigación en Salud Mental Global, Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Mexico
| | - María Yoldi-Negrete
- Subdirección de Investigaciones Clínicas, Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Mexico
| | - Diana Guízar-Sánchez
- Departamento de Fisiología de la Facultad de Medicina, Universidad Nacional Autónoma de México, Mexico
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Mody KS, Henstenburg J, Hammoud S. Team Physicians in Men's and Women's Professional Sports Leagues: Gender Representation and Career Path Analysis. Orthop J Sports Med 2023; 11:23259671231182991. [PMID: 37435423 PMCID: PMC10331195 DOI: 10.1177/23259671231182991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 02/13/2023] [Indexed: 07/13/2023] Open
Abstract
Background The most common orthopaedic fellowship is for sports medicine, but few fellowship-trained orthopaedic surgeons fill roles as team physicians. Gender disparities within the field of orthopaedics, coupled with male-dominated professional sports leagues in the United States, may lead to lower representation of women as professional team physicians. Purpose To (1) determine the career path trajectories of current head team physicians in professional sports, (2) quantify gender disparities across team physician representation, and (3) further characterize professional profiles of team physicians appointed to women's and men's professional sports leagues in the United States. Study Design Cross-sectional study. Methods This is a cross-sectional study of professional sports head team physicians in 8 major American sports leagues: American football (National Football League), baseball (Major League Baseball), basketball (National Basketball Association and Women's National Basketball Association), hockey (National Hockey League and National Women's Hockey League), and soccer (Major League Soccer and National Women's Soccer League). Online searches were used to compile information on gender, specialty, medical school, residency, fellowship, years in practice, clinical practice type, practice setting, and research productivity. Differences according to league type (men's vs women's leagues) were analyzed with the chi-square test for categorical variables, t test for continuous variables, and Mann-Whitney U test for nonparametric means. Bonferroni correction was applied for multiple comparisons. Results Within the 172 professional sports teams, 183 head team physicians were identified, including 170 men (92.9%) and 13 women (7.1%). Team physicians in both men's and women's sports leagues were predominantly men. Overall, 96.7% of team physicians in men's leagues were men, and 73.3% of team physicians in women's leagues were men (P < .001). The most common physician specialties were orthopaedic surgery (70.0%) and family medicine (19.1%). Compared with team physicians in women's leagues, those in men's leagues were more likely to be orthopaedic surgeons (40.0% vs 71.9%, respectively; P = .001) and to have more experience (15.9 vs 22.4 years, respectively; P < .001). Conclusion Study findings indicated disparities in gender, practice experience, and physician specialty representation among team physicians in men's versus women's professional sports leagues.
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Affiliation(s)
- Kush S. Mody
- Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | | | - Sommer Hammoud
- Rothman Orthopaedic Institute, Philadelphia, Pennsylvania, USA
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Haruno LS, Chen X, Metzger M, Lin CA, Little MT, Kanim LE, Poon SC. Racial and Sex Disparities in Resident Attrition in Orthopaedic Surgery. JB JS Open Access 2023; 8:e22.00148. [PMID: 37351087 PMCID: PMC10284323 DOI: 10.2106/jbjs.oa.22.00148] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/24/2023] Open
Abstract
Studies have suggested that female individuals and individuals from backgrounds under-represented in medicine (URiM) are at increased risk of attrition during residency. This likely exacerbates the lack of diversity in our field. The aims of this study were to (1) characterize demographic composition in orthopaedic residency from 2001 to 2018 and (2) determine the race/ethnicity and identify any disparities. Methods Demographic and attrition data from 2001 to 2018 were obtained from the Association of American Medical Colleges. Attrition data comprised the following categories: withdrawals, dismissals, and transfers to another specialty. Analysis compared demographic composition and determined attrition rates with subgroup analysis by race/ethnicity and sex. Results From 2001 to 2018, female orthopaedic residents increased from 8.77% to 15.54% and URiM residents from 9.49% to 11.32%. The overall and unintended attrition rates in orthopaedic surgery were 3.20% and 1.15%, respectively. Among female residents, the overall and unintended attrition rates were 5.96% and 2.09% compared with 2.79% and 1.01%, respectively, in male residents. URiM residents had overall and unintended attrition rates of 6.16% and 3.11% compared with 2.71% and 0.83%, respectively, for their White counterparts. Black/African American residents had an attrition rate of nearly 10%. Female residents averaged 12.9% of all residents but 24% of those leaving orthopaedics. URiM residents were 10.14% of all residents but 19.51% of those experiencing attrition. In logistic regression models, female residents had a relative risk (RR) of 2.20 (p < 0.001) for experiencing all-cause attrition and 2.09 (p < 0.001) for unintended attrition compared with male residents. Compared with their White male counterparts, URiM residents had a RR for overall and unintended attrition of 2.36 and 3.84 (p < 0.001), respectively; Black/African American residents had a RR for the same of 3.80 and 7.20 (p < 0.001), respectively. Conclusion Although female resident percentage has increased, orthopaedics continues to train fewer female surgeons than all other fields. Female and URiM residents in orthopaedic surgery are disproportionately affected by attrition. While recruitment has been the primary focus of diversity, equity, and inclusion efforts, this study suggests that resident retention through appropriately supporting residents during training is equally critical.
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Affiliation(s)
- Lee S. Haruno
- Department of Orthopaedic Surgery, Cedars Sinai Medical Center, Los Angeles, California
| | - Xi Chen
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Melodie Metzger
- Department of Orthopaedic Surgery, Cedars Sinai Medical Center, Los Angeles, California
| | - Carol A. Lin
- Department of Orthopaedic Surgery, Cedars Sinai Medical Center, Los Angeles, California
| | - Milton T.M. Little
- Department of Orthopaedic Surgery, Cedars Sinai Medical Center, Los Angeles, California
| | - Linda E.A. Kanim
- Department of Orthopaedic Surgery, Cedars Sinai Medical Center, Los Angeles, California
- Cedars Sinai Medical Center Spine Center, Los Angeles, California
| | - Selina C. Poon
- Shriners Children's Southern California, Pasadena, California
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Sobel AD, Lavorgna TR, Ames SE, Templeton KJ, Mulcahey MK. Interpersonal Interactions and Biases in Orthopaedic Surgery Residency: Do Experiences Differ Based on Gender? Clin Orthop Relat Res 2023; 481:369-378. [PMID: 36668700 PMCID: PMC9831198 DOI: 10.1097/corr.0000000000002457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 09/22/2022] [Indexed: 01/21/2023]
Abstract
BACKGROUND Women residents are underrepresented in orthopaedic surgery. The causes of the deficit of women in orthopaedic surgery are multifactorial, but by identifying the perceptions of women in orthopaedic residency training and comparing them with the perceptions of men, we can improve our understanding of ways to enhance the recruitment of qualified and diverse candidates. QUESTIONS/PURPOSES (1) What differences exist in the perceived experiences of residents identifying as women and men regarding professional, social, and personal interactions during residency training? (2) Are there differences in the percentage of women and men residents who have experienced harassment or discrimination in preresidency interviews, and are there differences in the type of harassment or discrimination experienced? METHODS A survey was generated using Academy of Critical Care: Development, Evaluation, and Methodology guidelines. Two focus groups with seven attending orthopaedic surgeons who participate in the Collaborative Orthopaedic Education Research Group and who are experts on gender diversity in orthopaedics were held to improve survey validity. The survey included binary-response, Likert, and free-text questions on the perception of professional, social, and personal interactions held by the resident being surveyed. The questions focused on a respondent's perception of interactions with staff members, patients, resident colleagues, and attending surgeons, as well as sexual harassment. Program directors at 10 selected Accreditation Council for Graduate Medical Education (ACGME)-accredited orthopaedic residency programs that participate in the Collaborative Orthopaedic Education Research Group shared the survey with residents at their institutions. There were 95 programs in the Collaborative Orthopaedic Education Research Group at the time this survey was distributed. In this program, directors or other interested teaching faculty in orthopaedic residency programs voluntarily participate to discuss and develop quality research on resident and fellow education. These 95 programs account for 46% of the ACGME-accredited programs in the United States at the time the survey was created and distributed. The 10 residency programs had a total of 232 enrolled residents; 15% (34) identified as women. This gender distribution models the national sample of orthopaedic residents. Survey reliability was assessed by calculating the Cronbach alpha after determining the variance in each relevant (nondemographic) survey item. The final survey was found to have excellent internal reliability (alpha = 0.95). Responses from residents identifying as women and those identifying as men were compared using Fisher exact tests for all categorical data, and two-tailed independent t-tests were used for all continuous data. Differences in each survey category (professional interactions, social interactions, personal interactions, and sexual harassment in preresidency interview experiences) were calculated. RESULTS Women reported experiencing microaggressions (left undefined to the survey respondent, but generally considered to be subtle, stunning, often automatic, and nonverbal exchanges that are "put downs") at work more frequently than men did (40% [six of 15] versus 5% [four of 74]; p < 0.001). Specifically, women perceived being interrupted (53% [eight of 15] versus 5% [four of 75]); p < 0.001) by men colleagues, called by their first name (67% [10 of 15] versus 4% [3 of 72]; p < 0.001), and given administrative tasks (27% [four of 15] versus 1% [one of 75]; p = 0.004) more often than men. More women than men perceived that patients (33% [five of 15] versus 0 of 74 [0%]; p < 0.001) and hospital staff (27% [four of 15] versus 7% [five of 74]; p = 0.01) respected their opinion less than that of men. More women than men perceived that group humor negatively targeted their gender (47% [seven of 15] versus 1% [one of 75]; p < 0.001) and that criticism of their surgical skill was based on their gender rather than their ability (33% [five of 15] versus 5% [four of 78]; p = 0.005). In residency or subinternship interviews, 20% of women reported experiencing sexual harassment as defined by a listing of known types of harassment in the question stem, compared with 0% of men (p = 0.004). Women reported harassment in the form of verbal remarks of a sexual nature and obscene images in the workplace, whereas men did not report any form of harassment during interviews. CONCLUSION These findings suggest that the greatest discrepancies in the perceived experiences of women and men residents lie in professional interactions, and women residents are more likely to experience sexual harassment and disparaging humor than men residents. CLINICAL RELEVANCE Addressing these discrepancies, particularly in the professional setting, will help to create a more inclusive work environment and attract more women to orthopaedic surgery. Annual distribution of the survey used in this study by program directors to residents in their programs can help to identify discrepant perceptions that, coupled with the collection of objective data, can be targeted for improvement.
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Affiliation(s)
- Andrew D. Sobel
- Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Tessa R. Lavorgna
- Department of Orthopaedic Surgery, Tulane Medical Center, New Orleans, LA, USA
| | - S. Elizabeth Ames
- Department of Orthopaedics and Rehabilitation, the University of Vermont College of Medicine, Burlington, VT, USA
| | - Kimberly J. Templeton
- Department of Orthopaedic Surgery, the University of Kansas Medical Center, Kansas City, KS, USA
| | - Mary K. Mulcahey
- Department of Orthopaedic Surgery, Tulane Medical Center, New Orleans, LA, USA
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Alomar AZ, Almonaie S, Nagshabandi KN, AlGhufaili D, Alomar M. Representation of women in orthopaedic surgery: perception of barriers among undergraduate medical students in Saudi Arabia. J Orthop Surg Res 2023; 18:19. [PMID: 36611180 PMCID: PMC9825039 DOI: 10.1186/s13018-022-03487-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 12/30/2022] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND While female participation has improved in several surgical specialties over time globally, no such increase has been observed in orthopaedic surgery over the past decades. The potential barriers to female participation are likely present from the beginning of medical education. Therefore, this study assessed the apparent lag in equal representation among men and women in orthopaedic surgery in the Kingdom of Saudi Arabia. METHODS This cross-sectional study used a questionnaire survey to investigate medical students' and interns' perceptions of women participating in orthopaedic surgery, their subspeciality preferences, and barriers preventing them from pursuing an orthopaedic career. The responses were analysed to understand general perceptions, gender-based differences, impact of clinical experiential learning, and exposure to orthopaedic surgery. RESULTS Approximately 565 medical students (49% females, 51% males) participated in the survey. Only 17% of students (11% females, 23% males) considered orthopaedic surgery as their future career option. While 31% of female and 17% of male students disagreed with the concept of female-appropriate orthopaedic subspecialties, most of the remaining male and female students perceived paediatric orthopaedics as a female-appropriate subspecialty. Concerning equal representation of women, gender bias and lack of a strong physique were the most frequently selected barriers by female and male students, respectively. Patient preference for male orthopaedicians, gender discrimination, social and family commitments, and need for physical strength were all perceived as barriers for women in orthopaedics. Overall, clinical experience and orthopaedic exposure did not significantly improve the likelihood of female students in choosing orthopaedic surgery as a career. CONCLUSIONS The bias against women in orthopaedic careers is prevalent among medical students early in their academic years. Clinical experience and exposure to orthopaedic surgery should be improved to make a significant impact on female participation in orthopaedic careers. Career building efforts in terms of improved career opportunities, career counselling, flexible working hours, social and family related adjustments and implementation of mentorship/research/fellowship programmes for females are needed to reduce gender discrimination and improve female orthopaedic participation. Furthermore, process improvements may yield greater flexibility for women pursuing the challenging field while accommodating other barriers faced by women in orthopaedic surgery.
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Affiliation(s)
- Abdulaziz Z. Alomar
- grid.56302.320000 0004 1773 5396Head of Arthroscopy and Sports Medicine Division, Orthopaedic Department, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Shahd Almonaie
- grid.411335.10000 0004 1758 7207College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | | | - Deema AlGhufaili
- grid.412149.b0000 0004 0608 0662College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Manar Alomar
- grid.412149.b0000 0004 0608 0662College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
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Filliquist B, Kapatkin AS, Vernau KM, Nakatani JY, Chou PY, Ilkiw JE. Training Surgical Residents Utilizing an Animal Shelter Fracture Program. JOURNAL OF VETERINARY MEDICAL EDUCATION 2022; 49:778-784. [PMID: 34779752 DOI: 10.3138/jvme-2021-0110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Working relationships between veterinary medical teaching hospitals, animal shelters, and rescue groups are one way to increase veterinary students' and residents' hands-on training. The goal of this study is to describe the use of a shelter fracture program to improve the surgical skills of surgical residents. In this program, the participating shelter and rescue organizations electronically submit cases. Following evaluation of radiographs and case approval by the orthopedic faculty, the case is scheduled for a physical evaluation. A resident takes primary surgical care together with a fourth-year student rotating through the orthopedic surgery service to ensure the proper pre-, peri-, and post-operative standard of care. All care is overseen by the orthopedic faculty. A veterinary student-run fracture foster program allows students to gain additional experience in the pre-, peri-, and post-operative care of shelter animals. The total number of shelter animals treated during a 9-year period was 373, with a mean annual case load of 41.1 cases (± 10.3). During the same time period, a total of 435 client-owned cases underwent surgical fracture treatment, with a mean annual case load of 48 cases (± 11.7). Surgical resident and student surveys show that this program contributes to their knowledge, skills, and confidence in treating fracture patients. A successful cooperative program provides advanced surgical fracture treatment of shelter animals, improving animals' quality of life as well as surgical residents' and veterinary students' skills training.
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15
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Muacevic A, Adler JR, Warnick EP, Baylor J, Grandizio LC. Analysis of the Most Frequently Cited Articles in Hand and Wrist Surgery: A Modern Reading List. Cureus 2022; 14:e32690. [PMID: 36686070 PMCID: PMC9847433 DOI: 10.7759/cureus.32690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/16/2022] [Indexed: 12/23/2022] Open
Abstract
The aim of this investigation was to analyze the 50 most frequently cited articles on hand and wrist surgery of all time and those published during the 21st century. We aimed to evaluate the article, author, and journal characteristics for these publications in order to create a modern reading list of impactful upper-extremity articles. A search of the Journal Citation Reports 2022 edition to identify journals containing possible hand or wrist-related articles was performed. Related journals were identified and then searched on the Web of Science database to identify hand and wrist articles. The top 50 most cited articles overall and the top 50 most cited articles from 2000-2021 were identified and indexed. Several bibliometric parameters, such as study type, study topic, study design, level of evidence, citation count, citation density, the institution of the lead author, the gender of lead and senior authors, and country were analyzed. For the most cited articles of all time, the number of citations ranged from 224 to 1109 with a mean of 368 citations and 15.0 citation density. Citations for the top 50 articles from 2000-2021 ranged from 153 to 950 with a mean of 233 citations and 14.5 citation density. For both groups, the most common level of evidence was level IV (33% and 27%). No correlation between journal impact factor and citation count or citation density was found. In both groups, "fracture" was the most common topic and papers were predominantly written by male authors. Frequently cited publications on hand and wrist surgery are often clinical papers that contain low levels of evidence and tend to focus on topics related to fracture care. Female authors remain underrepresented.
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Winfrey SR, Parameswaran P, Gerull KM, LaPorte D, Cipriano CA. Effective Mentorship of Women and Underrepresented Minorities in Orthopaedic Surgery: A Mixed-Methods Investigation. JB JS Open Access 2022; 7:JBJSOA-D-22-00053. [PMID: 36447495 PMCID: PMC9699573 DOI: 10.2106/jbjs.oa.22.00053] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
UNLABELLED Orthopaedic surgery is currently the least diverse medical specialty, and there is little research on the mentorship needs for women and underrepresented minorities (URMs) in orthopaedics. The purpose of this study was to examine the roles and functions of mentorship for women and URMs in orthopaedic surgery, to understand mentorship preferences, and to elucidate barriers to mentorship in orthopaedic surgery. METHODS Members of J. Robert Gladden Orthopaedic Society and Ruth Jackson Orthopaedic Society were invited to participate. An email with an anonymous link to the survey was distributed; the survey was open for responses from September 2020 through February 2021. The survey contained free-response and quantitative items about mentorship and its impact on current activities, career path, and ways to improve mentorship. Descriptive statistics, 1-way analysis of variance, frequencies, and Fisher exact test were used to analyze survey data. Qualitative data were deidentified and analyzed using thematic analysis techniques. RESULTS A total of 155 participants responded to the survey, of those, 151 (98%) met criteria for analysis. Sixty-four percent of participants were women, 15% identified as Black, 4% identified as Hispanic, and 9% identified as multiracial. Eighty-five percent of respondents had a mentor in orthopaedic surgery. Mentorship was often cited as useful for exposure to role models and skills development. Medical students were most likely to consider gender concordance with their mentor important. URM respondents reported greater importance of sharing race/ethnicity with their mentor (p = 0.005). In qualitative responses, participants commented on identity-specific challenges to mentorship, lack of time and institutional support for mentorship, and the disproportionate burden of mentorship on women and URMs. CONCLUSIONS Mentorship was highly valued among women and URMs in orthopaedic surgery across all career stages. Mentorship attracted students to orthopaedic surgery and allowed residents and surgeons to progress in the field. Sharing racial/ethnic identity in mentor-mentee relationships was important to both trainees and practicing surgeons.
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Affiliation(s)
- Sara R. Winfrey
- Department of Orthopaedic Surgery and Rehabilitation, Loyola University Medical Center, Maywood, Illinois
| | - Priyanka Parameswaran
- Department of Orthopaedic Surgery, School of Medicine, Washington University in St. Louis, St. Louis, Missouri
| | - Katherine M. Gerull
- Department of Orthopaedic Surgery, School of Medicine, Washington University in St. Louis, St. Louis, Missouri
| | - Dawn LaPorte
- Department of Orthopaedic Surgery, School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Cara A. Cipriano
- Department of Orthopaedic Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania,E-mail address for C.A. Cipriano:
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17
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Elkadi SH, Donaldson S, Krisanda E, Kessler MW. Trends in Medical Training and Leadership at Academic Orthopedic Programs. Cureus 2022; 14:e29100. [PMID: 36249616 PMCID: PMC9557866 DOI: 10.7759/cureus.29100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/12/2022] [Indexed: 12/04/2022] Open
Abstract
Introduction: When deciding on which programs to rank or fellowships to enter, medical students and residents may assess the program's prestige and specialty training opportunities. This report aimed to analyze the demographics of orthopedic department chairs and program directors (PDs), focusing on the prestige of their orthopedic training and medical school. Secondary data included fellowship, higher-level education, sex, professorship, years of practice, and total published research. Methods: We used U.S. News and Doximity to rank 192 medical schools and 200 orthopedic residency programs based on prestige rankings, respectively. We searched for the department chair, vice-chair, and PD via program websites, Council of Orthopaedic Residency Directors (CORD), Orthopedic Residency Information Network (ORIN), personal websites, LinkedIn, and Doximity. Subsequently, we searched for each individual’s demographic information, education and research history, employment history, and medical school attended. Results: We gathered data on 268 orthopedic surgeons with leadership positions at academic hospitals. Of the 268, 115 were department chairs, 15 were vice-chairs, 126 were PDs, 11 were both the chair and PD, and one was vice-chair and PD. Of the 268 physicians, 244 physicians were male (91.0%), while 22 were female (9.0%). The average residency reputation ranking overall was 59.7 ± 5.7. More specifically, for chairs, the average was 57.0 ± 8.3 (p < 0.005), and for PDs, the average was 63.6 ± 8.0 (p <0.005). There was no significant difference between chairs and PDs (p = 0.26). Conclusion: Orthopedic leaders were found to have trained at more prestigious programs. This trend could be explained by increased research opportunities at more prestigious programs or programs attempting to increase their own reputation. 9.0% of the leaders identify as female, which is comparable to the 6.5% of practicing female orthopedic surgeons. However, this further demonstrates a need for gender equity in orthopedic surgery. Assessing trends in the training of orthopedic surgeons with leadership positions will allow a better understanding of what programs look for in the hiring process.
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18
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Mencia MM, Bidaisee S, Quan Soon C, Cawich SO. Greater Gender Diversity Observed at Orthopaedic Conferences in the Caribbean Than in the United States or England. Cureus 2022; 14:e28224. [PMID: 36158370 PMCID: PMC9487172 DOI: 10.7759/cureus.28224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/19/2022] [Indexed: 11/05/2022] Open
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Meadows AM, Skinner MM, Faraj MT, Hazime AA, Day RG, Fore JA, Day CS. Racial, Ethnic, and Gender Diversity in Academic Orthopaedic Surgery Leadership. J Bone Joint Surg Am 2022; 104:1157-1165. [PMID: 35793794 DOI: 10.2106/jbjs.21.01236] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Multiple investigations in the past 50 years have documented a lack of racial/ethnic and gender diversity in the orthopaedic surgery workforce when compared with other specialties. Studies in other industries suggest that diversification of leadership can help diversify the underlying workforce. This study investigates changes in racial/ethnic and gender diversity of orthopaedic surgery leadership from 2007 to 2019 and compares leadership diversity to that of other surgical and nonsurgical specialties, specifically in terms of chairpersons and program directors. METHODS Demographic data were collected from The Journal of the American Medical Association and the Association of American Medical Colleges. Aggregate data were utilized to determine the racial, ethnic, and gender composition of academic leadership for 8 surgical and nonsurgical specialties in 2007 and 2019. Comparative analysis was conducted to identify changes in diversity among chairpersons between the 2 years. Furthermore, current levels of diversity in orthopaedic leadership were compared with those of other specialties. RESULTS A comparative analysis of diversity among program directors revealed that orthopaedic surgery had significantly lower minority representation (20.5%) when compared with the nonsurgical specialties (adjusted p < 0.01 for all) and, with the exception of neurological surgery, had the lowest proportion of female program directors overall, at 9.0% (adjusted p < 0.001 for all). From 2007 to 2019, orthopaedic surgery experienced no change in minority representation among chairpersons (adjusted p = 0.73) but a significant increase in female representation among chairpersons, from 0.0% (0 of 102) to 4.1% (5 of 122) (adjusted p = 0.04). Lastly, a significant decrease in minority and female representation was observed when comparing the diversity of 2019 orthopaedic faculty to orthopaedic leadership in 2019/2020 (p < 0.05 for all). CONCLUSIONS Diversity in orthopaedic surgery leadership has improved on some key fronts, specifically in gender diversity among chairpersons. However, a significant decrease in minority and gender representation was observed between 2019 orthopaedic faculty and 2019/2020 orthopaedic leadership (p < 0.05), which was a trend shared by other specialties. These findings may suggest a more pervasive problem in diversity of medical leadership that is not only limited to orthopaedic surgery.
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Affiliation(s)
- Austin M Meadows
- Department of Orthopedic Surgery, Henry Ford Health System, Detroit, Michigan.,Wayne State University School of Medicine, Detroit, Michigan
| | - Madelyn M Skinner
- Department of Orthopedic Surgery, Henry Ford Health System, Detroit, Michigan.,University of Michigan, Ann Arbor, Michigan
| | - Majd T Faraj
- Department of Orthopedic Surgery, Henry Ford Health System, Detroit, Michigan.,Oakland University William Beaumont School of Medicine, Auburn Hills, Michigan
| | - Alaa A Hazime
- Department of Orthopedic Surgery, Henry Ford Health System, Detroit, Michigan.,University of Michigan, Ann Arbor, Michigan
| | - Russell G Day
- Department of Orthopedic Surgery, Henry Ford Health System, Detroit, Michigan
| | - Jessi A Fore
- Department of Orthopedic Surgery, Henry Ford Health System, Detroit, Michigan.,Oakland University William Beaumont School of Medicine, Auburn Hills, Michigan
| | - Charles S Day
- Department of Orthopedic Surgery, Henry Ford Health System, Detroit, Michigan.,Wayne State University School of Medicine, Detroit, Michigan
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Academic Orthopaedics As a Driver of Gender Diversity in the Orthopaedic Workforce: A Review of 4,519 Orthopaedic Faculty Members. J Am Acad Orthop Surg Glob Res Rev 2022; 6:01979360-202202000-00005. [PMID: 35134006 PMCID: PMC8816373 DOI: 10.5435/jaaosglobal-d-21-00028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 02/05/2021] [Indexed: 11/25/2022]
Abstract
The purpose of this study was to perform a cross-sectional analysis on the gender composition of practicing academic orthopaedic surgeons using three databases composed of clinical orthopaedic surgeons.
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21
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Wessel LE, Paulson AE, Graesser EA, Moore AM, Dy CJ. Moving the Needle: Directed Intervention by the American Society for Surgery of the Hand Is Effective in Encouraging Diversity in Expert Panel Composition. JOURNAL OF HAND SURGERY GLOBAL ONLINE 2022; 4:65-70. [PMID: 35434572 PMCID: PMC9005378 DOI: 10.1016/j.jhsg.2021.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 11/30/2021] [Indexed: 11/29/2022] Open
Abstract
Purpose Recent efforts have been made by the American Society for Surgery of the Hand to encourage female inclusion in expert panels. We hypothesized that female representation on expert panels has increased over the past decade and that a directed intervention by the American Society for Surgery of the Hand would be associated with an increased percentage of submissions with female panelists. Methods We performed a retrospective analysis of Instructional Course Lecture and Symposium submissions for the 2011 through 2021 American Society for Surgery of the Hand Annual Meetings. Authorship was reviewed, and the gender of the proposed authors was recorded. Additionally, the status of “all-male panel” was attributed to panels with no proposed female authors. Submissions were reviewed and compared with meeting programs to determine the status of accepted or rejected. Longitudinal analysis was performed to determine trends in the gender composition of expert panels. Results In total, 1,687 submissions were reviewed, including 1,323 Instructional Course Lectures and 364 Symposia. Female authorship constituted 18% of authorship (1,170/6,663), and lead authorship was similarly distributed, with 18% being female (296/1,687). Overall, female representation has increased steadily over the past decade, with females constituting 13% (43/332) and 20% (163/818) of the submitted authors in 2011 and 2020, respectively. Similarly, all-male panels declined from 74% (76/103) to 46% (85/185) of panels over the same timeframe. Most strikingly, a sharp increase in gender representation was observed with the directed intervention noted in the 2021 Call for Abstracts, resulting in an increase in female authorship to 26% (295/1,124) and a decline in all-male panels to 29% (70/241). Conclusions Gender representation among hand surgery expert panels moved toward increased equity over the past decade, which has been aided by directed interventions. Clinical relevance Career development and trainee decision making are impacted by gender representation; directed and intentional interventions by professional organizations are effective in encouraging greater equity and diversity within the field.
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Bi AS, Fisher ND, Bletnitsky N, Rao N, Egol KA, Karamitopoulos M. Representation of Women in Academic Orthopaedic Leadership: Where Are We Now? Clin Orthop Relat Res 2022; 480:45-56. [PMID: 34398847 PMCID: PMC8673966 DOI: 10.1097/corr.0000000000001897] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 06/23/2021] [Indexed: 01/31/2023]
Abstract
BACKGROUND Women have long been underrepresented in orthopaedic surgery; however, there is a lack of quantitative data on the representation of women in orthopaedic academic program leadership. QUESTIONS/PURPOSES (1) What is the proportion of women in leadership roles in orthopaedic surgery departments and residency programs in the United States (specifically, chairs, vice chairs, program directors, assistant program directors, and subspecialty division chiefs)? (2) How do women and men leaders compare in terms of years in position in those roles, years in practice, academic rank, research productivity as represented by publications, and subspecialty breakdown? (3) Is there a difference between men and women in the chair or program director role in terms of whether they are working in that role at institutions where they attended medical school or completed their residency or fellowship? METHODS We identified 161 academic orthopaedic residency programs from the Accreditation Council for Graduate Medical Education (ACGME) website. Data (gender, length of time in position, length of time in practice, professorship appointment, research productivity as indirectly measured via PubMed publications, and subspecialty) were collected for chairs, vice chairs, program directors, assistant program directors, and subspecialty division chiefs in July 2020 to control for changes in leadership. Information not provided by the ACGME and PubMed was found using orthopaedic program websites and the specific leader's curriculum vitae. Complete data were obtained for chairs and program directors, but there were missing data points for vice chairs, assistant program directors, and division chiefs. All statistical analysis was performed using SPSS using independent t-tests for continuous variables and the Pearson chi-square test for categorical variables, with p < 0.05 considered significant. RESULTS Three percent (4 of 153) of chairs, 8% (5 of 61) of vice chairs, 11% (18 of 161) of program directors, 27% (20 of 75) of assistant program directors, and 9% (45 of 514) of division chiefs were women. There were varying degrees of missing data points for vice chairs, assistant program directors, and division chiefs as not all programs reported or have those positions. Women chairs had fewer years in their position than men (2 ± 1 versus 9 ± 7 [95% confidence interval -9.3 to -5.9]; p < 0.001). Women vice chairs more commonly specialized in hand or tumor compared with men (40% [2 of 5] and 40% [2 of 5] versus 11% [6 of 56] and 4% [2 of 56], respectively; X2(9) = 16; p = 0.04). Women program directors more commonly specialized in tumor or hand compared with men (33% [6 of 18] and 17% [3 of 18] versus 6% [9 of 143] and 11% [16 of 143], respectively; X2(9) = 20; p = 0.02). Women assistant program directors had fewer years in practice (9 ± 4 years versus 14 ± 11 years [95% CI -10.5 to 1.6]; p = 0.045) and fewer publications (11 ± 7 versus 30 ± 48 [95% CI -32.9 to -5.8]; p = 0.01) than men. Women division chiefs had fewer years in practice and publications than men and were most prevalent in tumor and pediatrics (21% [10 of 48] and 16% [9 of 55], respectively) and least prevalent in spine and adult reconstruction (2% [1 of 60] and 1% [1 of 70], respectively) (X2(9) = 26; p = 0.001). Women program directors were more likely than men to stay at the same institution they studied at for medical school (39% [7 of 18] versus 14% [20 of 143]; odds ratio 3.9 [95% CI 1.4 to 11.3]; p = 0.02) and trained at for residency (61% [11 of 18] versus 42% [60 of 143]; OR 2.2 [95% CI 0.8 to 5.9]; p = 0.01). CONCLUSION The higher percentage of women in junior leadership positions in orthopaedic surgery, with the data available, is a promising finding. Hand, tumor, and pediatrics appear to be orthopaedic subspecialties with a higher percentage of women. However, more improvement is needed to achieve gender parity in orthopaedics overall, and more information is needed in terms of publicly available information on gender representation in orthopaedic leadership. CLINICAL RELEVANCE Proportional representation of women in orthopaedics is essential for quality musculoskeletal care, and proportional representation in leadership may help encourage women to apply to the specialty. Our findings suggest movement in an improving direction in this regard, though more progress is needed.
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Affiliation(s)
- Andrew S. Bi
- New York University Langone Orthopedic Hospital, New York University Langone Medical Center, New York, NY, USA
| | - Nina D. Fisher
- New York University Langone Orthopedic Hospital, New York University Langone Medical Center, New York, NY, USA
| | | | - Naina Rao
- New York University Grossman School of Medicine, New York University Langone Medical Center, New York, NY, USA
| | - Kenneth A. Egol
- New York University Langone Orthopedic Hospital, New York University Langone Medical Center, New York, NY, USA
| | - Mara Karamitopoulos
- New York University Langone Orthopedic Hospital, New York University Langone Medical Center, New York, NY, USA
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Wang CX, Kale N, Miskimin C, Mulcahey MK. Social media as a tool for engaging medical students interested in orthopaedic surgery. Orthop Rev (Pavia) 2021; 13:24443. [PMID: 34745467 DOI: 10.52965/001c.24443] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Accepted: 05/22/2021] [Indexed: 12/11/2022] Open
Abstract
Objective Instagram and Twitter are two of the most popular social media platforms today. Beyond social communication, these platforms also have the potential to enhance medical education by providing early exposure and mentorship to students and residents in training. The purpose of this study was 1) to investigate orthopaedic surgery related content posted on Instagram and Twitter 2) to analyze who posts orthopaedic surgery related content and 3) to better understand how social media may be used to supplement medical education and exposure for students interested in orthopaedics. Design Three hashtags, #Orthopedics, #OrthopedicSurgery, and #OrthopedicSurgeon were searched on Instagram and Twitter from March 8 to March 18, 2020. Posts on both platforms were analyzed for the hashtag used, number of likes, source type (e.g. physician, company promoting a product), and type of post (e.g. advertisement, educational). Descriptive statistics were used to analyze the results. Setting This study was performed at the Tulane University School of Medicine, New Orleans, LA, by medical students, with guidance and supervision from faculty in the Tulane University Department of Orthopaedics. Results Data was collected from 212 (47.2%) Instagram and 237 (52.8%) Twitter posts over a 10-day period. Significantly more Instagram posts used the hashtags #Orthopedicsurgeon and #Orthopedicsurgery (P<.001), while more Twitter posts used the hashtag #Orthopedics (72.0% P<.001). Companies using these hashtags posted more frequently on Twitter than Instagram (P<.001), while a higher number of physicians, orthopaedic practices, and personal accounts utilized Instagram (P<.001). There was significantly more advertising content on Twitter (P<.001), while Instagram included more personal anecdotes, medical imaging and procedures (P<.001). Conclusion This study demonstrated that content related to orthopaedic surgery is regularly posted on both Instagram and Twitter. Instagram is a visually driven platform that more frequently posted educational and personal content from medical professionals and individuals, while Twitter predominantly published advertisements from companies and orthopaedic practices. The current use of Instagram may make it better suited for providing information and early exposure to medical students interested in the field. Levels of Evidence III.
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Future of women orthopaedists: signs of optimism in a 3-year follow-up survey. CURRENT ORTHOPAEDIC PRACTICE 2021. [DOI: 10.1097/bco.0000000000001032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Foster N, Price M, Bettger JP, Goodwin CR, Erickson M. Objective Test Scores Throughout Orthopedic Surgery Residency Suggest Disparities in Training Experience. JOURNAL OF SURGICAL EDUCATION 2021; 78:1400-1405. [PMID: 33454284 DOI: 10.1016/j.jsurg.2021.01.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 01/04/2021] [Indexed: 06/12/2023]
Abstract
Diversifying clinical residencies, particularly in fields that are historically dominated by majority male (M/M) cohorts, is critical to improve both the training experiences of residents and the overall physician workforce. Orthopedic surgery in particular has low numbers of females and under-represented minorities (F/URM) at all levels of training and practice. Despite efforts to increase its diversity, this field has become more homogeneous in recent years. To highlight potential barriers and disparate training environments that may contribute to this dynamic, we present 25 years' worth of institutional data on standardized exam performance throughout residency. We report that despite starting residency with standardized exam scores that were comparable to their M/M peers, F/URM orthopedic surgery residents performed progressively worse on Orthopaedic In-service Training Exams throughout residency and had lower first pass rates on the American Board of Orthopedic Surgery Part 1. Given these findings, we propose that disparate performance on standardized test scores throughout residency could identify trainees that may have different experiences that negatively impact their exam performance. Shedding light on these underlying disparities provides opportunities to find meaningful and sustained ways to develop a culture of diversity and inclusion. It may also allow for other programs to identify similar patterns within their training programs. Overall, we propose monitoring test performance on standardized exams throughout orthopedic surgery residency to identify potential disparities in training experience; further, we acknowledge that interventions to mitigate these disparities require a broad, systems wide approach and a firm institutional commitment to reducing bias and working toward sustainable change.
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Affiliation(s)
| | - Meghan Price
- Department of Neurosurgery, Division of Spine, Duke University Medical Center, Durham, North Carolina
| | - Janet Prvu Bettger
- Department of Orthopedic Surgery, Division of Spine, Duke University Medical Center, Durham, North Carolina
| | - C Rory Goodwin
- Department of Neurosurgery, Division of Spine, Duke University Medical Center, Durham, North Carolina
| | - Melissa Erickson
- Department of Orthopedic Surgery, Division of Spine, Duke University Medical Center, Durham, North Carolina.
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Lipa SA, Greene NE, Le HV, White AA, Gebhardt MC, Dyer GSM. Current Orthopaedic Residency Letters of Recommendation Are Not Biased by Gender of Applicant. JB JS Open Access 2021; 6:JBJSOA-D-20-00134. [PMID: 34278184 PMCID: PMC8280066 DOI: 10.2106/jbjs.oa.20.00134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Letters of recommendation (LORs) are highly influential in the residency selection process. Differences in language and length of LORs by gender have been demonstrated for applicants applying to surgical residencies and fellowships. This had yet to be studied in orthopaedic surgery. Given the gender disparity in the field, we sought to investigate the impact of gender on orthopaedic residency applicant LORs. We hypothesized that differences in length and language would be present for women applicants as compared to men.
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Affiliation(s)
- Shaina A Lipa
- Harvard Combined Orthopaedic Residency Program, Boston, Massachusetts
| | - Nattaly E Greene
- Harvard Combined Orthopaedic Residency Program, Boston, Massachusetts
| | - Hai V Le
- Department of Orthopaedic Surgery, University of California, Davis, Sacramento, California
| | | | - Mark C Gebhardt
- Department of Orthopedic Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - George S M Dyer
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, Massachusetts
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Acuña AJ, Sato EH, Jella TK, Samuel LT, Jeong SH, Chen AF, Kamath AF. How Long Will It Take to Reach Gender Parity in Orthopaedic Surgery in the United States? An Analysis of the National Provider Identifier Registry. Clin Orthop Relat Res 2021; 479:1179-1189. [PMID: 33871403 PMCID: PMC8133193 DOI: 10.1097/corr.0000000000001724] [Citation(s) in RCA: 55] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 02/11/2021] [Indexed: 01/31/2023]
Abstract
BACKGROUND Although previous studies have evaluated how the proportion of women in orthopaedic surgery has changed over time, these analyses have been limited by small sample sizes, have primarily used data on residents, and have not included information on growth across subspecialties and geographic regions. QUESTION/PURPOSE We used the National Provider Identifier registry to ask: How have the (1) overall, (2) regional, and (3) subspecialty percentages of women among all currently practicing orthopaedic providers changed over time in the United States? METHODS The National Provider Identifier Registry of the Centers for Medicare and Medicaid Services (CMS) was queried for all active providers with taxonomy codes pertaining to orthopaedic subspecialties as of April 2020. Women orthopaedic surgeons were identified among all physicians with subspecialty taxonomy codes. As all providers are required to provide a gender when applying for an NPI, all providers with queried taxonomy codes additionally had gender classification. Our final cohort consisted of 31,296 practicing orthopaedic surgeons, of whom 8% (2363 of 31,296) were women. A total of 11,714 (37%) surgeons possessed taxonomy codes corresponding with a specific orthopaedic subspecialty. A univariate linear regression analysis was used to analyze trends in the annual proportions of women who are active orthopaedic surgeons based on NPI enumeration dates. Specifically, annual proportions were defined using cross-sections of the NPI registry on December 31 of each year. Linear regression was similarly used to evaluate changes in the annual proportion of women orthopaedic surgeons across United States Census regions and divisions, as well as orthopaedic subspecialties. The national growth rate was then projected forward to determine the year at which the representation of women orthopaedic surgeons would achieve parity with the proportion of all women physicians (36.3% or 340,018 of 936,254, as determined by the 2019 American Medical Association Physician Masterfile) and the proportion of all women in the United States (50.8% or 166,650,550 of 328,239,523 as determined by 2019 American Community Survey from the United States Census Bureau). Gender parity projections along with corresponding 95% confidence intervals were calculated using the Holt-Winters forecasting algorithm. The proportions of women physicians and women in the United States were assumed to remain fixed at 2019 values of 36.3% and 50.8%, respectively. RESULTS There was a national increase in the proportion of women orthopaedic surgeons between 2010 and 2019 (r2 = 0.98; p < 0.001) at a compound annual growth rate of 2%. Specifically, the national proportion of orthopaedic surgeons who were women increased from 6% (1670 of 26,186) to 8% (2350 of 30,647). Assuming constant growth at this rate following 2019, the time to achieve gender parity with the overall medical profession (that is, to achieve 36.3% women in orthopaedic surgery) is projected to be 217 years, or by the year 2236. Likewise, the time to achieve gender parity with the overall US population (which is 50.8% women) is projected to be 326 years, or by the year 2354. During our study period, there were increases in the proportion of women orthopaedic surgeons across US Census regions. The lowest growth was in the West (17%) and the South (19%). Similar growth was demonstrated across census divisions. In each orthopaedic subspecialty, we found increases in the proportion of women surgeons throughout the study period. Adult reconstruction (0%) and spine surgery (1%) had the lowest growth. CONCLUSION We calculate that at the current rate of change, it will take more than 200 years for orthopaedic surgery to achieve gender parity with the overall medical profession. Although some regions and subspecialties have grown at comparably higher rates, collectively, there has been minimal growth across all domains. CLINICAL RELEVANCE Given this meager growth, we believe that substantive changes must be made across all levels of orthopaedic education and leadership to steepen the current curve. These include mandating that all medical school curricula include dedicated exposure to orthopaedic surgery to increase the number of women coming through the orthopaedic pipeline. Additionally, we believe the Accreditation Council for Graduate Medical Education and individual programs should require specific benchmarks for the proportion of orthopaedic faculty and fellowship program directors, as well as for the proportion of incoming trainees, who are women. Furthermore, we believe there should be a national effort led by American Academy of Orthopaedic Surgeons and orthopaedic subspecialty societies to foster the academic development of women in orthopaedic surgery while recruiting more women into leadership positions. Future analyses should evaluate the efficacy of diversity efforts among other surgical specialties that have achieved or made greater strides toward gender parity, as well as how these programs can be implemented into orthopaedic surgery.
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Affiliation(s)
- Alexander J. Acuña
- A. J. Acuña, T. K. Jella, L. T. Samuel, S. H. Jeong, A. F. Kamath, Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, OH, USA
- E. H. Sato, Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT, USA
- A. F. Chen, Orthopaedic and Arthritis Center, Brigham and Women’s Hospital, Boston, MA, USA
| | - Eleanor H. Sato
- A. J. Acuña, T. K. Jella, L. T. Samuel, S. H. Jeong, A. F. Kamath, Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, OH, USA
- E. H. Sato, Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT, USA
- A. F. Chen, Orthopaedic and Arthritis Center, Brigham and Women’s Hospital, Boston, MA, USA
| | - Tarun K. Jella
- A. J. Acuña, T. K. Jella, L. T. Samuel, S. H. Jeong, A. F. Kamath, Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, OH, USA
- E. H. Sato, Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT, USA
- A. F. Chen, Orthopaedic and Arthritis Center, Brigham and Women’s Hospital, Boston, MA, USA
| | - Linsen T. Samuel
- A. J. Acuña, T. K. Jella, L. T. Samuel, S. H. Jeong, A. F. Kamath, Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, OH, USA
- E. H. Sato, Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT, USA
- A. F. Chen, Orthopaedic and Arthritis Center, Brigham and Women’s Hospital, Boston, MA, USA
| | - Stacy H. Jeong
- A. J. Acuña, T. K. Jella, L. T. Samuel, S. H. Jeong, A. F. Kamath, Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, OH, USA
- E. H. Sato, Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT, USA
- A. F. Chen, Orthopaedic and Arthritis Center, Brigham and Women’s Hospital, Boston, MA, USA
| | - Antonia F. Chen
- A. J. Acuña, T. K. Jella, L. T. Samuel, S. H. Jeong, A. F. Kamath, Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, OH, USA
- E. H. Sato, Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT, USA
- A. F. Chen, Orthopaedic and Arthritis Center, Brigham and Women’s Hospital, Boston, MA, USA
| | - Atul F. Kamath
- A. J. Acuña, T. K. Jella, L. T. Samuel, S. H. Jeong, A. F. Kamath, Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, OH, USA
- E. H. Sato, Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT, USA
- A. F. Chen, Orthopaedic and Arthritis Center, Brigham and Women’s Hospital, Boston, MA, USA
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Van Heest AE, Agel J, Samora JB. A 15-Year Report on the Uneven Distribution of Women in Orthopaedic Surgery Residency Training Programs in the United States. JB JS Open Access 2021; 6:JBJSOA-D-20-00157. [PMID: 34095695 PMCID: PMC8169074 DOI: 10.2106/jbjs.oa.20.00157] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
This study was undertaken to update reports from 2004 to 2005 through 2008 to 2009, and 2009 to 2010 through 2013 to 2014, including 5 additional years of GME Track data. Our hypothesis is there have been no significant changes during the past 5 years in the distribution of Accreditation Council for Graduate Medical Education (ACGME)-accredited orthopaedics residency programs that train female residents, compared with the previous 10 years. Methods Data for ACGME-accredited orthopaedics residency training programs in the United States were analyzed for 5 consecutive academic years (2014-2015 through 2018-2019). Programs were classified as having no women, 1 woman, 2 women, or greater than 2 women in training. Programs were analyzed for percentage of female residents and classified as having above the national average (>20%), similar to the national average (between 10 and 20%), or below the national average (<10%). Results Analysis of the original 5 years (2004-2009) compared with the most recent data (2014-2019) demonstrated a statistically significant improvement in the number of programs training women (p < 0.001). From 2004 to 2009 to 2014 to 2019, the absolute number and percent of female trainees have increased (p < 0.001). Similar analysis of the middle 5 years (2009-2014) compared with the most recent 5 years (2014-2019) did not demonstrate a statistically significant change (p = 0.12). From 2014 to 2019, residency programs in the United States continue to train women at unequal rates: 37 programs had no female trainees, while 53 programs had >20% female trainees during at least one of these 5 years. Conclusions Female medical students continue to pursue orthopaedics at rates lagging behind all other surgical specialties. Not all residency programs train women at equal rates. If the rate of training of female residents over the past 15 years were projected over time, we would not achieve 30% women within orthopaedics residency training programs until approximately 2060. Level of Evidence III.
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Affiliation(s)
- Ann E Van Heest
- University of Minnesota, Department of Orthopaedic Surgery, Minneapolis, Minnesota
| | - Julie Agel
- University of Minnesota, Department of Orthopaedic Surgery, Minneapolis, Minnesota
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Abstract
Dual-fellowship-trained surgeons specializing in both pediatric and sport medicine are treating an increasing number of pediatric orthopedic injuries, making pediatric orthopedic sports medicine a potential new emerging subspecialty. With fellowship training now being the norm rather than the exception across orthopedics, it is possible that dual-fellowship training may become a prerequisite for treatment of pediatric sports medicine patients. This may impact the practices of surgeons trained in either pediatric or sports medicine alone. As the trend toward dual-fellowship training is likely to continue, future studies are needed to characterize the impact it has on patient care and training patterns.
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Affiliation(s)
- Maksim A Shlykov
- Department of Orthopaedic Surgery, Washington University School of Medicine/Barnes-Jewish Hospital, 660 South Euclid Avenue Campus Box 8233, St Louis, MO 63110, USA
| | - Pooya Hosseinzadeh
- Pediatric Adolescent Orthopaedic Surgery, Department of Orthopaedic Surgery, Washington University School of Medicine, 4S60, Suite 1B, One Children's Place, St Louis, MO 63110, USA.
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The Current State of Orthopaedic Educational Leadership. J Am Acad Orthop Surg 2021; 29:167-175. [PMID: 32694324 DOI: 10.5435/jaaos-d-20-00279] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 06/13/2020] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION It is important to understand the current characteristics of orthopaedic surgery program leadership, especially in the current climate of modern medicine. The purpose of this report was to describe the demographic, academic, and geographic characteristics of current orthopaedic chairs and program directors (PDs). METHODS Orthopaedic surgery residency programs were obtained from the Accreditation Council for Graduate Medical Education website and cross-referenced with the Electronic Residency Application Service, identifying 161 residency programs for the 2018 to 2019 cycle. All data were collected in January 2020 to best control for changes in leadership. Demographic and academic information were collected from public websites. For geographic analysis, the United States was divided into five regions, and training locations were categorized as appropriate. RESULTS A total of 153 chairs and 161 PDs were identified. 98.0% of chairs were men versus 88.8% of PDs (P = 0.001). Chairs had been in practice and in their current position for longer than PDs (26.4 vs 16.8 years [P < 0.005] and 9.1 vs 7.1 years [P = 0.014], respectively). Chairs had more publications and were more likely to be professors than PDs. PDs were more likely to remain at both the same region and institution that they trained in residency. The most common subspecialty was sports among chairs and trauma among PDs, although when compared with national averages orthopaedic trauma and orthopaedic oncology were the most overrepresented subspecialties. CONCLUSION Orthopaedic chairs are more likely to be men, have had longer careers, and have more academic accomplishments than their PD counterparts. Geography appears to have an association with where our leaders end up, especially for PDs. Subspecialization does not notably influence leadership positions, although orthopaedic trauma and orthopaedic oncology surgeons are more commonly represented than expected. This report serves to identify the current state of orthopaedic leadership and may provide guidance for those who seek these leadership positions.
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Yaghmour A, Alesa A, Anbarserry E, Abdullah Binmerdah M, Alharbi A, Housawi A, Almehdar M, Lytra H, Alsaywid B, Lytras DM. Challenges and Obstacles Faced by Trainee Female Physicians: An Integrative Research on Gender Discrimination, Stress, Depression and Harassment. Healthcare (Basel) 2021; 9:160. [PMID: 33546188 PMCID: PMC7913154 DOI: 10.3390/healthcare9020160] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Revised: 01/19/2021] [Accepted: 01/25/2021] [Indexed: 12/25/2022] Open
Abstract
This study's purpose is to assess the challenges and obstacles faced by female trainee physicians and suggest solutions that could resolve these issues and improve their performance. The study utilized an observational, analytical, cross-sectional design based on a self-administered open-ended and validated questionnaire which was distributed to 133 recruited female resident trainees of medical units in Jeddah, Saudi Arabia. The findings of the study revealed that 52% female trainees experienced gender discrimination, mostly (65%) by their superiors, while 40% were regularly harassed. About half (53%) of the interviewees were severely depressed, resulting in their reconsidering their career in medicine. A total of 14% thought of suicide, while four planned to end and five had attempted to end their life. However, only eight (6%) participants officially reported the cases of harassment to the accountable superiors. Half of them felt neglected by the healthcare administration, and one-fourth (24%) were underachieving in their studies and work. The study concluded that work dissatisfaction, limited clinical correspondence, high depression, burnout, stress and drop-out rates-all deriving from common gender discrimination-compose the alarming and complex challenges that female trainee residents in Jeddah of various levels and specialties have to face.
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Affiliation(s)
- Aisha Yaghmour
- College of Medicine, King Saud Bin-Abdul-Aziz University for Health Sciences, Ministry of National Guard, Jeddah 14611, Saudi Arabia; (A.Y.); (A.A.); (E.A.); (M.A.B.)
| | - Alaa Alesa
- College of Medicine, King Saud Bin-Abdul-Aziz University for Health Sciences, Ministry of National Guard, Jeddah 14611, Saudi Arabia; (A.Y.); (A.A.); (E.A.); (M.A.B.)
| | - Esraa Anbarserry
- College of Medicine, King Saud Bin-Abdul-Aziz University for Health Sciences, Ministry of National Guard, Jeddah 14611, Saudi Arabia; (A.Y.); (A.A.); (E.A.); (M.A.B.)
| | - Merihan Abdullah Binmerdah
- College of Medicine, King Saud Bin-Abdul-Aziz University for Health Sciences, Ministry of National Guard, Jeddah 14611, Saudi Arabia; (A.Y.); (A.A.); (E.A.); (M.A.B.)
| | - Ahlam Alharbi
- Department of Surgery, College of Medicine, King Abdulaziz University, Jeddah 21589, Saudi Arabia;
| | - Abdulrahman Housawi
- Planning and Organizational Excellence Administration, Saudi Commission for Health Specialties, Riyadh 11614, Saudi Arabia; (A.H.); (M.A.)
| | - Manal Almehdar
- Planning and Organizational Excellence Administration, Saudi Commission for Health Specialties, Riyadh 11614, Saudi Arabia; (A.H.); (M.A.)
| | - Hara Lytra
- School of Medicine, University of Patras, 26504 Patras, Greece;
| | - Basim Alsaywid
- College of Medicine, King Saud Bin-Abdul-Aziz University for Health Sciences, Ministry of National Guard, Jeddah 14611, Saudi Arabia; (A.Y.); (A.A.); (E.A.); (M.A.B.)
- Planning and Organizational Excellence Administration, Saudi Commission for Health Specialties, Riyadh 11614, Saudi Arabia; (A.H.); (M.A.)
- Urology Section, Department of Surgery, King Abdulaziz Medical City, Ministry of National Guard, Jeddah 11173, Saudi Arabia
| | - Dimitrios M. Lytras
- School of Medicine, National and Kapodistrian University of Athens, 11527 Athens, Greece
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Abstract
Europe represents true diversity, with cultural, linguistic and geopolitical variation spanning a large geographical area. Politics for many of its 750 million inhabitants revolves around the European Union (EU) and its 27 member states. The overarching goal of the EU is to promote peace and the values of the union (inclusion, tolerance, justice, solidarity and non-discrimination).1,2EFORT was created to connect orthopaedic associations across Europe, fostering relationships between member countries that celebrated diversity and facilitated the exchange of knowledge. Whilst the global landscape changes and politics attempts to interfere in how we live our lives, it is important to remember that a strong organization is a diverse one that evolves over time.Various initiatives exist across the global landscape to support diversity in terms of culture; gender; black, Asian and minority ethnic (BAME) groups; disability groups; lesbian, gay, bisexual, transgender and queer (or questioning) and others (LGBTQ+); and the 'ageing' surgeon. This article explores the creation of some of these initiatives and how they have been supported by different orthopaedic organizations. Cite this article: EFORT Open Rev 2020;5:743-752. DOI: 10.1302/2058-5241.5.200022.
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Mocanu V, Kuper TM, Marini W, Assane C, DeGirolamo KM, Fathimani K, Baxter NN. Intersectionality of Gender and Visible Minority Status Among General Surgery Residents in Canada. JAMA Surg 2020; 155:e202828. [PMID: 32804994 DOI: 10.1001/jamasurg.2020.2828] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Importance Within medical specialties, surgical disciplines disproportionately and routinely demonstrate the greatest underrepresentation of women and individuals from racial/ethnic minority groups. Understanding the role that diversity plays in surgical resident training may identify strategies that foster resident resiliency, optimize surgical training, and improve patient outcomes. Objective To examine the implication of gender and visible minority (VM [ie, nonaboriginal people who are not White individuals]) status for resiliency and training experiences of general surgery residents in Canada. Design, Setting, and Participants In this survey study, a 129-item questionnaire was emailed from May 2018 to July 2018 to all residents enrolled in all Canadian general surgery training programs during the 2017-2018 training year. Survey responses were extracted and categorized into 5 major themes. The survey was designed by the Resident Committee and reviewed by the Governing Board of the Canadian Association of General Surgeons. French and English versions of the survey were created, distributed, and administered using Google Forms. Main Outcomes and Measures Survey questions were formulated to characterize resident diversity and training experience. Self-perceptions of diversity, mentorship, and training experience were evaluated using a 5-point Likert scale (1 for strongly disagree, 2 for disagree, 3 for neither agree or disagree, 4 for agree, and 5 for strongly agree) and open-ended responses. The frequency of perceived unprofessional workplace encounters was evaluated using a 5-point scale (1 for daily, 2 for weekly, 3 for monthly, 4 for annually, and 5 for never). Results Of the 510 general surgery residents invited, a total of 210 residents (40.5%) completed the survey. Most respondents were younger than 30 years (119 [56.7%]), were women (112 [53.3%]), reported English as their first language (133 [63.3%]), did not identify as a VM (147 [70.0%]), had no dependents (184 [87.6%]), and were Canadian medical graduates (178 [84.8%]). Women residents who identified as VM compared with male residents who did not identify as a VM were less likely to agree or strongly agree that they had a collegial relationship with staff, (21 [63.6%] vs 61 [89.7%]; P = .01), to feel like they fit in with their training programs (21 [63.6%] vs 56 [82.3%]; P = .003), and to feel valued at work (15 [45.4%] vs 47 [69.1%]; P = .03). Both female residents and female residents who identified as VM described significant concerns about receiving fewer training opportunities because of their gender vs their male peers (54 [48.2%] vs 3 [3.0%]; P < .001). Ninety-one of 112 female residents (81.2%) reported feeling that their medical expertise was dismissed because of their gender at least once annually, with 37 women (33.0%) experiencing dismissal of their expertise at least once every week (P < .001). In contrast, 98% of male residents reported never experiencing dismissal of their medical expertise because of their gender. Similarly, residents with VM status vs those without VM status reported at least monthly dismissal of their expertise because of their race/ethnicity (9 of 63 [14.3%] vs 1 of 147 [0.7%]; P < .001). Conclusions and Relevance In this study, female sex and VM status appeared to be associated with adverse implications for the training experience of general surgery residents. These findings suggest that new strategies focused on the intersectionality of gender and race/ethnicity are needed to improve the training experience of at-risk residents.
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Affiliation(s)
- Valentin Mocanu
- Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta Hospital, Edmonton, Alberta, Canada
| | - Tanya M Kuper
- London Health Sciences Centre, Schulich School of Medicine and Dentistry, Division of General Surgery, Department of Surgery, Western University, East London, Ontario, Canada
| | - Wanda Marini
- Division of General Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Chadey Assane
- Division of General Surgery, Department of Surgery, University of Sherbrooke, Sherbrooke, Quebec, Canada
| | - Kristin M DeGirolamo
- General Surgery, Department of Surgery, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Kamran Fathimani
- Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta Hospital, Edmonton, Alberta, Canada
| | - Nancy N Baxter
- Division of General Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada.,Melbourne School of Population and Global Health, University of Melbourne, Victoria, Australia
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Shah RF, Mertz K, Gil JA, Eppler SL, Amanatullah D, Yao J, Chou L, Steffner R, Safran M, Hu SS, Kamal RN. The Importance of Concordance Between Patients and Their Subspecialists. Orthopedics 2020; 43:315-319. [PMID: 32931591 DOI: 10.3928/01477447-20200818-01] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Accepted: 07/12/2019] [Indexed: 02/03/2023]
Abstract
Concordance, the concept of patients having shared demographic/socioeconomic characteristics with their physicians, has been associated with improved patient satisfaction and outcomes in primary care but has not been studied in subspecialty care. The objective of this study was to investigate whether patients value concordance with their specialty physicians. The authors assessed the importance of concordance in subspecialist care in 2 cohorts of participants. The first cohort consisted of patients seeking care at a multispecialty orthopedic clinic. The second cohort consisted of volunteer participants recruited from an online platform. Each participant completed a survey scored on an ordinal scale which characteristics of their physicians they find important for their primary care physician (PCP) and a specialist. The characteristics included age, sex, ethnicity, sexual orientation, primary language spoken, and religion. The difference in concordance scores for PCPs and specialists were compared with paired t tests with a Bonferroni correction. A total of 118 patients were recruited in clinic, and a total of 982 volunteers were recruited online. In the clinic cohort, the level of importance for patient-physician concordance of age, ethnicity, language, and religion was not significantly different between PCPs and specialists. In the volunteer cohort, the level of importance for concordance of age, sex, national origin, language, and religion was not significantly different between PCPs and specialists. The volunteers recruited online had significantly higher concordance scores than the patients recruited in clinic for most variables. Patients find patient-physician concordance as important in specialty care as they do in primary care. This may have similar effects on patient outcomes in specialty care. [Orthopedics. 2020;43(5):315-319.].
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Alliston T, Foucher KC, Frederick B, Hernandez CJ, Iatridis JC, Kozloff KM, Lewis KJ, Liu XS, Mercer DM, Ochia R, Queen RM, Rimnac CM, van der Meulen MCH, Westendorf JJ. The importance of diversity, equity, and inclusion in orthopedic research. J Orthop Res 2020; 38:1661-1665. [PMID: 32267012 DOI: 10.1002/jor.24685] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 03/25/2020] [Accepted: 04/01/2020] [Indexed: 02/04/2023]
Affiliation(s)
- Tamara Alliston
- Department of Orthopaedic Surgery, University of California San Francisco, San Francisco, California
| | - Kharma C Foucher
- Department of Kinesiology and Nutrition, University of Illinois, Chicago, Illinois
| | | | - Christopher J Hernandez
- Nancy E. and Peter C. Meinig School of Biomedical Engineering and Sibley School of Mechanical and Aerospace Engineering, Cornell University, Ithaca, New York
| | - James C Iatridis
- Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, New York City, New York
| | - Kenneth M Kozloff
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, Michigan
| | - Karl J Lewis
- Department of Anatomy and Cell Biology, Indiana University School of Medicine, Indianapolis, Indiana
| | - X Sherry Liu
- Department of Orthopaedic Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Deana M Mercer
- Department of Orthopaedics and Rehabilitation, The University of New Mexico Health Sciences Center, Albuquerque, New Mexico
| | - Ruth Ochia
- Department of Bioengineering, Temple University, Philadelphia, Pennsylvania
| | - Robin M Queen
- Department of Biomedical Engineering and Mechanics, Virginia Tech, Blacksburg, Virginia
| | - Clare M Rimnac
- Department of Mechanical and Aerospace Engineering, Case Western Reserve University, Cleveland, Ohio
| | - Marjolein C H van der Meulen
- Nancy E. and Peter C. Meinig School of Biomedical Engineering and Sibley School of Mechanical and Aerospace Engineering, Cornell University, Ithaca, New York
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Judy RP, Talentino S, Bedi A, Lesniak BP. Ten Years of Sports Health: Authorship Characteristics and Levels of Evidence. Sports Health 2020; 12:573-578. [PMID: 32628560 DOI: 10.1177/1941738120922163] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
CONTEXT Sports Health: A Multidisciplinary Approach, now 10 years into production, has been ranked a top-25 journal in sport sciences and has tripled its impact throughout its existence. OBJECTIVE To evaluate authorship trends and levels of evidence (LOE) of articles published in Sports Health from 2009 to 2018. The secondary aim was to analyze funding sources and internationalization throughout the journal's tenure. DATA SOURCES All clinical studies published in Sports Health between the years 2009 and 2018 were examined. STUDY SELECTION All publications from the provided years were electronically reviewed by 2 reviewers and evaluated for inclusion criteria. Editorials, society news, memorials, letters to the editor, and corrigenda were excluded. STUDY DESIGN Systematic review. LEVEL OF EVIDENCE Level 5. DATA EXTRACTION Articles were examined for number of authors, presence of female authorship, funding, country of origin, international collaboration, academic degree or certification of first and senior authors, and LOE. Clinical articles were assigned LOE based on guidelines from the University of Oxford's Centre for Evidence-Based Medicine. RESULTS A total of 654 articles were examined. The percentage of high-LOE studies increased throughout the study period. The percentage of publications with female authors also increased throughout the study period. The mean number of authors per article increased from 3.2 to 4.6 over the 10-year period (P < 0.05). The percentage of publications with international collaboration stayed consistent, while the number of countries per year increased during the study period. Overall, institutions from 23 countries have published in Sports Health since its inception to the time of this study. CONCLUSION Female authorship in Sports Health surpasses industry standards, and the percentage of high-LOE studies remains remarkably high. Sports Health has stayed true to its multidisciplinary scope, as evidenced by the authors' varying degrees and numerous countries that publish in the journal.
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Affiliation(s)
- Ryan P Judy
- Department of Orthopaedic Surgery and Sports Medicine, Temple University, Philadelphia, Pennsylvania
| | - Spencer Talentino
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Asheesh Bedi
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, Michigan
| | - Bryson P Lesniak
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
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Abstract
BACKGROUND Despite near-equal enrollment of males and females in medical schools, orthopaedic surgery continues to have one of the lowest percentage of female orthopaedic residents. This suggests there may be factors that specifically influence females to select other specialties. Some of these possible reasons have been explored in other studies; however, in this study, we sought to identify latent or unobserved variables that may be influencing this difference by conducting an explanatory factor analysis of male and female residency preferences. PURPOSES/QUESTIONS In this study, by surveying a cohort of medical students at a single institution, we asked, is there a difference between males and females (1) in their perception of orthopaedic surgery and (2) in their preferences for residency and practice? We further asked, if there are differences, (3) is there a correlation between perception and preferences for residency and practice? METHODS A 46-question survey was sent to all current medical students (n = 628) at a major urban university with near-equal enrollment of males (55%, 345 of 628) and females (45%, 283 of 628) from September 2017 to November 2017. The survey consisted of two main parts: (1) desired attributes of a residency program and (2) perceptions of orthopaedic residency and practice. The design of the survey instruments closely followed The Checklist for Reporting Results of Internet E-Surveys (CHERRIES) checklist and went through several variations and pilot studies before release. In all, 33% (205 of 628) total medical students responded to the email survey, 55% (112 of 205) were male and 45% (93 of 205) were female. The proportion of male and female respondents matched the gender distribution of the total population surveyed, which at the time of the survey was 55% male and 45% female.The data analysis was performed using a Mann-Whitney U test and an explanatory factor analysis. The explanatory factor analysis was used to identify the correlation between survey variables among male and female students. An alpha less than 0.05 was considered significant for the Mann-Whitney U test and a factor greater than 0.5 was considered significant for the factor analysis. RESULTS Both male and female students ranked "work-life balance" and "variety in specialty" among the top three most important preferences. Females ranked "range of practice options," higher than males (72% females versus 60% males, r = 0.18; p = 0.009), and males ranked "previous exposure to the specialty" higher than females (65% females versus 71% males, r = 0.03; p = 0.70). Both male and female students had similar overall perceptions of orthopaedic surgery. Both males and females indicated that orthopedics is "male dominated," has "competitive entrance requirements," and requires "long residency work hours." They differed in their perception of "requires physical strength" (60% females versus 38% males, r = 0.28; p < 0.0005), and by how much orthopaedics is "male dominated" (95% females versus 77% males, r = 0.26; p < 0.0005). The factor analysis recognized that, although male and female students do have some similar residency preferences, the influence or weighing of those preferences is different for male and female students. In a manner similar to a personality assessment, the factor analysis produced four latent factors that can help explain variation seen in responses and helped identify influential factors that were not directly tested by the survey. The first such latent factor for females consisted of "work-life balance," "residency length," 'residency work hours," and "family-friendly specialty." Although the first latent factor for males consisted of "prestige," "income potential," "grade or step scores," and "competitiveness of residency program." The three subsequent latent factors also displayed variation in the make-up of the latent factors between males and female students. CONCLUSIONS This study of medical students at an urban medical school found that male and female students shared many preferences for residency specialties and held many of the same perceptions regarding orthopaedic surgery. The explanatory factor analysis indicated that male and female students weight preferences differently when selecting a specialty; this difference may account for the large differences in proportion between males and females in orthopaedic residency. CLINICAL RELEVANCE Attracting talented residents and attending physicians is important for the success of any medical department. Although orthopaedics attracts some of the most talented students, these students are predominantly male. By identifying the multifactorial areas that may be inadvertently discouraging females from applying, orthopaedic residency programs may be able to better address those issues and attract the best talent of both genders.
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What Are the Rates and Trends of Women Authors in Three High-impact Orthopaedic Journals from 2006-2017? Clin Orthop Relat Res 2020; 478:1553-1560. [PMID: 31688211 PMCID: PMC7310505 DOI: 10.1097/corr.0000000000001043] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The gender gap among authors publishing research in journals is narrowing in general medicine and various medical and surgical subspecialties. However, little is known regarding the gender gap among authors publishing research in orthopaedic journals. QUESTIONS/PURPOSES (1) What is the proportion of women first and last authors of original research articles in three high-impact orthopaedic journals from 2006 to 2017? (2) What is the proportion women first authors of original research by orthopaedic subspecialty from 2006 to 2017? METHODS A sample of original research publications from the even numbered months of issues of Clinical Orthopaedics and Related Research® (CORR®), the Journal of Bone and Joint Surgery, American volume (JBJS), and the American Journal of Sports Medicine (AJSM) were examined from 2006 to 2017. These journals were selected because of their clinical relevance, target audience, and relatively high impact factors. Over the studied period, a single author extracted and reviewed pertinent data, including the gender of the first and last authors and the primary subspecialty of the research article. The senior author refereed disputes regarding the primary subspecialty of each included article. The proportion of women first and last authors in each journal was compared between 2006 to 2017 using chi-square analysis. The proportion of women first authors according to orthopaedic subspecialty in which an article primarily focused its study was also compared between 2006 to 2017 using chi-square analysis. RESULTS Data were collected from 6292 articles, 13% (800) of which were first-authored by women and 10% (604) of which were last-authored by women. From 2006 to 2017, the overall percentage of women first authors in the examined journals increased (from 11% in 2006 to 17% in 2017; odds ratio 1.6563 [95 % CI 1.4945 to 1.8356]; p < 0.001). Overall across the period studied, the percentage of women first authors in JBJS was 14% while 12% of first authors in CORR and AJSM were women. Regarding subspecialty, the percentage of women first authorship ranged from 9% in the shoulder subspecialty to 21% in pediatric orthopaedics across all three journals. CONCLUSIONS There has been an increase in the percentage of women first authors in articles published in three high-impact orthopaedic journals from 2006 to 2017. This observed increase is encouraging in terms of promoting gender diversity in orthopaedics and may be reflective of a modest increase in the number of women entering the orthopaedic workforce. CLINICAL RELEVANCE Between 2006 and 2017, the overall number of women first authors in CORR, JBJS, and AJSM modestly increased. This may suggest a nascent narrowing of the gender gap in orthopaedics. Although this is a welcome finding in terms of promoting and encouraging gender diversity in this man-dominated field, the overall percentage of women authorship remains modest, at best. Future investigations should examine whether the modest increase in women first authorship over time found in this study translates into an increased percentage of senior/last authorship in the future, as this may have implications for women orthopaedic workforce retention.
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Does the Proportion of Women in Orthopaedic Leadership Roles Reflect the Gender Composition of Specialty Societies? Clin Orthop Relat Res 2020; 478:1572-1579. [PMID: 31180910 PMCID: PMC7310307 DOI: 10.1097/corr.0000000000000823] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Increasing the number of women in surgical subspecialties has been challenging, especially in orthopaedics, in which the percentage of women has remained relatively the same for the past several decades. Certain subspecialties, such as pediatric orthopaedics, have a greater proportion of women than other orthopaedic subspecialties do. Women in leadership roles in a specialty society (for example, on the board of directors) may serve as role models and help attract women to our specialty, leading to increased diversity. As the proportion of women in a specialty society increases, the leadership (board of directors) of the society might reflect the gender composition of that society's membership. It is not known whether gender diversity in orthopaedic societies is reflected in their leadership. QUESTION/PURPOSES: (1) Does the percentage of women members in a specialty society correlate with the percentage of women on its board of directors? (2) Does having a junior position on an orthopaedics subspecialty society's board of directors correlate with an increased percentage of women on its board of directors? METHODS We queried the executive directors of each of the 23 societies of the Board of Specialty Societies of the American Academy of Orthopaedic Surgeons to obtain the number and percentage of women members in each society, the number of women on each society's board of directors, the criteria for becoming a board member, and the presence or absence of junior board members. All 23 societies responded. We supplemented the data by reviewing these societies' bylaws. Society bylaws were studied to determine if the presence of a junior board member affected the percentage of women on its board of directors. We correlated the percentage of women in each society with the percentage of women on that society's board of directors and compared this across the studied societies. RESULTS We found a strong correlation between the percentage of women in a society and the percentage of women on the society's board of directors (r = .2333; p = .0495). The subspecialty society with the highest percentage of women (26%), the Pediatric Orthopaedic Society of North America, did not have the highest percentage of women on its board of directors (three of 20 members were women, 15%). The subspecialty society with the highest percentage of women on its board of directors, the Orthopaedic Research Society (seven of 16 members, 44%), did not have the highest percentage of women (25%). There was no correlation between presence of a junior board member and increased percentage of women in an orthopaedic society, nor was there a correlation between the presence of a junior board member and percentage of women on the board of directors in a society. CONCLUSIONS There is a correlation between the number of women members in an orthopaedic specialty society and the number of women on its board of directors. The correlation is not explained by the presence of a junior member position, which may be inspiring to younger women. Although a correlation exists, we could not predictably match societies with the highest percentage of women members to those with the highest percentage of women on their boards of directors, and vice versa. This study reveals the current percentage of women in orthopaedic specialty societies and the percentage of women in leadership positions. This is the first step towards diversity of gender in orthopaedics. LEVEL OF EVIDENCE Level III, prognostic study.
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Shah KN, Ruddell JH, Scott B, Reid DBC, Sobel AD, Katarincic JA, Akelman E. Orthopaedic Surgery Faculty: An Evaluation of Gender and Racial Diversity Compared with Other Specialties. JB JS Open Access 2020; 5:JBJSOA-D-20-00009. [PMID: 32803101 PMCID: PMC7386543 DOI: 10.2106/jbjs.oa.20.00009] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The American Academy of Orthopaedic Surgeons has adopted the strategic goal of evolving its culture and governance to become more strategic, innovative, and diverse. Given the charge to increase diversity, a focus on assessing and increasing diversity at the faculty level may help this cause. However, an analysis of gender and racial diversity among orthopaedic faculty has not been performed. The purpose of this study was to evaluate faculty appointments for underrepresented minority (URM) and female orthopaedic surgeons. We also aim to draw comparisons between orthopaedic surgery and other specialties.
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Affiliation(s)
- Kalpit N Shah
- Department of Orthopaedic Surgery, Warren Alpert School of Medicine, Brown University, Providence, Rhode Island
| | - Jack H Ruddell
- Department of Orthopaedic Surgery, Warren Alpert School of Medicine, Brown University, Providence, Rhode Island
| | - Brandon Scott
- Department of Orthopaedic Surgery, Warren Alpert School of Medicine, Brown University, Providence, Rhode Island
| | - Daniel B C Reid
- Department of Orthopaedic Surgery, Warren Alpert School of Medicine, Brown University, Providence, Rhode Island
| | - Andrew D Sobel
- Department of Orthopaedic Surgery, Warren Alpert School of Medicine, Brown University, Providence, Rhode Island
| | - Julia A Katarincic
- Department of Orthopaedic Surgery, Warren Alpert School of Medicine, Brown University, Providence, Rhode Island
| | - Edward Akelman
- Department of Orthopaedic Surgery, Warren Alpert School of Medicine, Brown University, Providence, Rhode Island
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Earp BE, Rozental TD. Expanding the Orthopaedic Pipeline: The B.O.N.E.S. Initiative. JOURNAL OF SURGICAL EDUCATION 2020; 77:704-709. [PMID: 31810902 DOI: 10.1016/j.jsurg.2019.11.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Revised: 09/16/2019] [Accepted: 11/10/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE Although the number of female medical school graduates has dramatically increased over the last decades, Orthopaedic surgery continues to struggle in attracting women and under-represented minorities to the field. Potential barriers include limited exposure during medical school and the scarcity of female mentors. We hypothesized that a structured, low-cost, workshop for medical students allowing exposure to orthopaedic surgery would increase students' interest in the field. Our primary outcome was the perceived satisfaction with the program and the number of students who subsequently expressed an interest in pursuing a career in orthopaedic surgery. Our secondary outcome was the number of student participants who subsequently matched in orthopaedic surgery. DESIGN Combining female faculty from surrounding hospitals, we developed a free half-day program including skills workshops and panel discussions for women medical students in the region. Participants were asked to complete an anonymous survey grading their satisfaction with the utility of the information presented, the comfort level in interacting with faculty and how the experience may have impacted their potential interest in orthopaedic surgery. Eligible participants were contacted by email to determine their ultimate career choices and match results. Furthermore, participants were followed over time to determine how many chose and matched into an orthopaedic surgery residency. SETTING The workshop took place in Boston at the Harvard Medical School affiliated hospitals. PARTICIPANTS Student participants were invited from all New England allopathic and osteopathic medical schools. Faculty participants included staff, residents and fellows from the Harvard Combined Orthopaedic Residency Program. RESULTS Over 3 years, 155 female medical students participated in the program and 97% found it useful. Among 59 students who have since become eligible for the match, 22 matched into an orthopaedic surgery residency. Eight of 36 (22%) match eligible first and second year participants matched in orthopaedic surgery while 14 of 23 (61%) match eligible third and fourth year student attendees successfully matched in orthopaedic surgery programs. CONCLUSIONS Taking advantage of local resources, we demonstrated that outreach is effective in enhancing students' interest in the field. We encourage as many programs as possible to consider similar initiatives.
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Affiliation(s)
- Brandon E Earp
- Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts.
| | - Tamara D Rozental
- Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, Massachusetts.
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Lin JS, Lattanza LL, Weber KL, Balch Samora J. Improving Sexual, Racial, and Ethnic Diversity in Orthopedics: An Imperative. Orthopedics 2020; 43:e134-e140. [PMID: 32003842 DOI: 10.3928/01477447-20200129-04] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Accepted: 02/07/2019] [Indexed: 02/03/2023]
Abstract
Orthopedics is the least diverse medical specialty. From residents to faculty, the representation of women and underrepresented minorities lags behind that of all other specialties. The crux of the disparity stems from the pipeline, as medical students who are female and are underrepresented minorities are simply not applying to orthopedic surgery. Grassroots efforts providing early exposure to orthopedics have led to a considerable proportion of alumnae pursuing science majors and eventually medical school. Institutions with a stated commitment to diversity have successfully produced residency classes with greater diversity. The culture should be one that combats biases, dispels misconceptions about orthopedics, and prioritizes recruiting/retaining diverse providers. [Orthopedics. 2020;43(3):e134-e140.].
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Summers MA, Matar RN, Denning JR, Dixon TL, Ramalingam WG, Asghar FA, Grawe BM. Closing the Gender Gap. JBJS Rev 2020; 8:e0211. [DOI: 10.2106/jbjs.rvw.19.00211] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Chen RE, Kuhns BD, Kaupp S, Voloshin I, Mannava S. Diversity among academic orthopedic shoulder and elbow surgery faculty in the United States. J Shoulder Elbow Surg 2020; 29:655-659. [PMID: 32197760 DOI: 10.1016/j.jse.2019.11.035] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Revised: 11/15/2019] [Accepted: 11/23/2019] [Indexed: 02/01/2023]
Abstract
BACKGROUND The purpose of this study was to perform a cross-sectional analysis of diversity among academic shoulder and elbow surgeons in the United States. METHODS US shoulder and elbow surgeons who participated in shoulder and elbow fellowship and/or orthopedic surgery resident education as of November 2018 were included. Demographic data (age, gender, race), practice setting, years in practice, academic rank, and leadership roles were collected through publicly available databases and professional profiles. Descriptive statistics were performed and findings were compared between different racial and gender groups. Statistical significance was set at P <.05. RESULTS A total of 186 orthopedic shoulder and elbow surgeons were identified as participating in shoulder and elbow fellowship and/or orthopedic surgery residency education. Overall, 83.9% were white, 14.5% were Asian, 1.1% were Hispanic, 0.5% were an other race, and 0% were African American. In addition, 94.6% of surgeons were male, whereas 5.4% were female. Further, 64.5% of all surgeons had been in practice for >10 years, and 39.2% worked in an urban setting. Less than half (40.3%) of the surgeons practicing primarily at academic institutions held a professor rank. White surgeons had a significantly greater time in practice vs. nonwhite surgeons (mean 18.8 vs. 12.6 years, P < .01) and were more likely to hold a professor rank (44.0% vs. 21.7%, P = .04). CONCLUSION Racial and gender diversity among US shoulder and elbow surgeons who participate in fellowship and residency education is lacking. Hispanic, African American, and female surgeons are underrepresented. Efforts should be made to identify the reasons for these deficiencies and address them to further advance the field of orthopedic shoulder and elbow surgery.
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Affiliation(s)
- Raymond E Chen
- University of Rochester Medical Center, Department of Orthopedics and Rehabilitation, Rochester, NY, USA
| | - Benjamin D Kuhns
- University of Rochester Medical Center, Department of Orthopedics and Rehabilitation, Rochester, NY, USA
| | - Shannon Kaupp
- University of Rochester Medical Center, Department of Orthopedics and Rehabilitation, Rochester, NY, USA
| | - Ilya Voloshin
- University of Rochester Medical Center, Department of Orthopedics and Rehabilitation, Rochester, NY, USA
| | - Sandeep Mannava
- University of Rochester Medical Center, Department of Orthopedics and Rehabilitation, Rochester, NY, USA.
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O'Reilly OC, Day MA, Cates WT, Baron JE, Glass NA, Westermann RW. Female Team Physician Representation in Professional and Collegiate Athletics. Am J Sports Med 2020; 48:739-743. [PMID: 31922898 DOI: 10.1177/0363546519897039] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Although a sex-based balance in US graduate medical education has been well-documented, a discrepancy remains in orthopaedic surgery. In orthopaedic sports medicine, the representation of women as team physicians has not previously been characterized. PURPOSE To quantify the sex-related composition of team physicians of select National Collegiate Athletic Association (NCAA) Division I collegiate and professional teams. Additionally, the authors assess the sex-related composition of orthopaedic surgeon team physicians specifically and compare these proportions to the sex-related composition of orthopaedic surgeon membership of the American Orthopaedic Society for Sports Medicine (AOSSM). STUDY DESIGN Cross-sectional study. METHODS Publicly available sex-related data were collected for team physicians in select NCAA Division I collegiate conferences and professional sports organizations. Subspecialty characteristics and sex distribution were described by use of percentages. Chi-square tests were used to assess whether sex distributions of team physicians in collegiate and professional sports were (1) representative between the populations of female and male physicians compared with the general public and (2) representative of the sex-based composition of orthopaedic surgeons nationally. RESULTS Women represented 12.7% (112/879) of all team physicians and 6.8% (30/443) of all orthopaedic surgeons (P < .0001). More than half (53.9%; 413/767) of male and 26.8% (30/112) of female team physicians were orthopaedic surgeons. In collegiate athletics, women comprised 18.1% of all team physicians and 7.7% of orthopaedic surgeon team physicians. In professional sports, women comprised 6.7% of all team physicians and 6.3% of orthopaedic surgeon team physicians, with the greatest proportion in the Women's National Basketball Association (31.3%). CONCLUSION Women comprise a minority of team physicians in select NCAA Division I collegiate and professional sports organizations. When compared with the composition of AOSSM orthopaedic surgeon membership, expected female orthopaedic surgeon representation varies between conferences and leagues with little statistical significance. Although efforts have been made to increase sex-based diversity in orthopaedic surgery, results of this study suggest that barriers affecting female orthopaedic surgeons as team physicians should be identified and addressed.
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Affiliation(s)
- Olivia C O'Reilly
- Department of Orthopaedics and Rehabilitation, The University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Molly A Day
- Department of Orthopaedics and Rehabilitation, The University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - William T Cates
- Department of Orthopaedics and Rehabilitation, The University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Jaqueline E Baron
- Department of Orthopaedics and Rehabilitation, The University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Natalie A Glass
- Department of Orthopaedics and Rehabilitation, The University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Robert W Westermann
- Department of Orthopaedics and Rehabilitation, The University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
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Is There Gender Inequality in Plastic Surgery? Evaluation of Society Leadership and Composition of Editorial Boards. Plast Reconstr Surg 2020; 145:433e-437e. [DOI: 10.1097/prs.0000000000006503] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Tougas C, Valtanen R, Bajwa A, Beck JJ. Gender of presenters at orthopaedic meetings reflects gender diversity of society membership. J Orthop 2019; 19:212-217. [PMID: 32071516 DOI: 10.1016/j.jor.2019.11.026] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Accepted: 11/23/2019] [Indexed: 10/25/2022] Open
Abstract
Objective To quantify the number of women presenters and their roles at national meetings across all orthopaedic sub-specialties. Methods A retrospective review of annual meeting programs for 2008 and 2017 from ten North American orthopaedic societies was conducted. Results A statistically significant increase was seen in the proportion of women presenting at society annual meetings between 2008 and 2017 (p < 0.0001). Women were more often authors presenting abstracts (p < 0.0001)) and less frequently faculty/instructors (p = 0.0051) and moderators/chairs (p = 0.0003) when compared to men. Conclusion Men continue to hold a higher proportion of more respected roles within orthopaedic academia.
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Affiliation(s)
- Caroline Tougas
- Department of Orthopaedic Surgery - Children's Mercy Kansas City, UMKC School of Medicine, 2401 Gillham Road, Kansas City, MO, 64108, USA
| | - Rosa Valtanen
- Stanford University, Department of Orthopedic Surgery, 450 Broadway Street, Pavilion C, 4th Floor, Redwood City, CA, 94063-6342, USA
| | - Arpun Bajwa
- University of Illinois, Chicago Medical College, University of Illinois Hospital & Health Sciences System, 820 South Wood St., Suite 100 CSN M/C 675, Chicago, IL, 60612, USA
| | - Jennifer J Beck
- Director of Outreach and Research, Center for Sports Medicine, Orthopaedic Institute for Children, Department of Orthopaedic Surgery, DGSOM, UCLA, 403 W Adams Blvd, Los Angeles, CA, 900007, USA
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Variability in Exposure to Subspecialty Rotations During Orthopaedic Residency: A Website-based Review of Orthopaedic Residency Programs. J Am Acad Orthop Surg Glob Res Rev 2019; 3:e010. [PMID: 31588419 PMCID: PMC6738553 DOI: 10.5435/jaaosglobal-d-19-00010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Introduction: The variability in exposure to various subspecialty rotations during orthopaedic residency across the United States has not been well studied. Methods: Data regarding program size, resident's sex, department leadership, university-based status of the program, outsourcing of subspecialty rotation, and geographic location were collected from websites of 151 US allopathic orthopaedic residency programs. The relationship of these factors with the time allotted for various clinical rotations was analyzed. Results: The number of residents in a program correlated positively with time allocated for elective rotations (r = 0.57, P = 0.0003). Residents in programs where the program director was a general orthopaedic surgeon spent more time on general orthopaedic rotations (22 versus 9.9 months, P = 0.001). Programs where the program director or chairman was an orthopaedic oncologist spent more time on oncology rotations ([3.8 versus 3 months, P = 0.01] and [3.5 versus 2.7 months, P = 0.01], respectively). Residents in community programs spent more time on adult reconstruction than university-based programs (6.6 versus 5.5 months, P = 0.014). Based on multiple linear regression analysis, time allotted for adult reconstruction (t = 2.29, P = 0.02) and elective rotations (t = 2.43, P = 0.017) was positively associated with the number of residents in the program. Conclusions: Substantial variability exists in the time allocated to various clinical rotations during orthopaedic residency. The effect of this variability on clinical competence, trainees' career choices, and quality of patient care needs further study.
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Kroin E, Garbarski D, Shimomura A, Romano J, Schiff A, Wu K. Gender Differences in Program Factors Important to Applicants When Evaluating Orthopaedic Surgery Residency Programs. J Grad Med Educ 2019; 11:565-569. [PMID: 31636827 PMCID: PMC6795318 DOI: 10.4300/jgme-d-18-01078.1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 06/25/2019] [Accepted: 08/01/2019] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Despite specialty-driven efforts to improve diversity in the field, few women apply to orthopaedic residency, and women are unevenly distributed among programs. There is little evidence-based information on factors that may attract female applicants. OBJECTIVE This study aims to identify factors important to applicants when evaluating orthopaedic residency programs and to identify gender-specific differences. METHODS All applicants to a single orthopaedic surgery residency program in the 2017 Match were asked to fill out an anonymous survey. Respondents rated the importance of 35 factors when evaluating orthopaedic residency programs. The percentage of highly rated factors was calculated. Statistical analysis was performed for each factor to assess differences by gender. RESULTS Of 1013 applicants who applied to orthopaedic surgery residency in 2017, 815 (80%) applied to our program, and 218 (27%) completed the survey. The most important factors when evaluating a residency program for both genders were (1) perceptions of current residents; (2) interactions with members of the program; (3) program reputation and fellowship placement; (4) geographic location; and (5) impressions after rotation at a program. Female applicants rated the presence of female and minority residents and faculty and program reputation for gender and racial/ethnic diversity higher than male applicants. CONCLUSIONS When choosing an orthopaedic surgery residency program, women more often reported the presence of female residents and faculty, program reputation for gender diversity, reputation for racial/ethnic diversity, presence of minority residents and faculty, and their personal interactions with members of the program as important factors.
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Adelani MA, Harrington MA, Montgomery CO. The Distribution of Underrepresented Minorities in U.S. Orthopaedic Surgery Residency Programs. J Bone Joint Surg Am 2019; 101:e96. [PMID: 31567811 DOI: 10.2106/jbjs.18.00879] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Orthopaedic surgery has generally lagged behind other surgical subspecialties with respect to racial and ethnic diversity in its U.S. residency programs. Efforts have been made to increase the number of underrepresented minorities (URMs) applying to orthopaedic surgery residencies; however, the impact on diversity at the residency program level is unknown. The purpose of this study was to determine whether orthopaedic surgery residency programs have become more racially diverse over time. METHODS The Graduate Medical Education Track database was queried for individual racial/ethnic identification of orthopaedic surgery residents in U.S. Accreditation Council for Graduate Medical Education (ACGME)-accredited programs for 15 consecutive years (2002-2003 through 2016-2017). The number of URMs in each residency program during each academic year was recorded. The number of programs per year with no URMs, 1 URM, 2 URMs, and >2 URMs was recorded, and the change over time was assessed. RESULTS The number of programs per year with >1 URM resident decreased over time, from 61 programs in 2002 to 53 programs in 2016, with the trough being 31 programs in 2010 (p < 0.0001). The number of programs per year without any URM residents increased over the period of study, from 40 programs in 2002 to 60 programs in 2016, with the peak being 76 programs in 2011 (p < 0.0001). CONCLUSIONS The number of residency programs with >1 URM resident has decreased significantly over time, suggesting that diversity at the program level is limited. Program-level diversity should be further examined as a potential barrier to the recruitment of URMs to orthopaedics. Difficulty attracting URM residents to certain programs may have the unintended consequence of effectively limiting potential positions for these candidates, which can decrease the odds of minority students matching into orthopaedics and, therefore, perpetuate the cycle of lack of diversity in our field.
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Affiliation(s)
- Muyibat A Adelani
- Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Melvyn A Harrington
- Department of Orthopedic Surgery, Baylor College of Medicine, Houston, Texas
| | - Corey O Montgomery
- Department of Orthopaedic Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas
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