Assessing Gender Differences in Technical Skills and Confidence in Orthopaedic Surgery Residency Applicants

INTRODUCTION

Variations in confidence for procedural skills have been demonstrated when comparing male and female medical students in surgical training. This study investigates whether differences in technical skill and self-reported confidence exist between male and female medical students applying to orthopaedic residency.

METHODS

All medical students (2017 to 2020) invited to interview at a single orthopaedic residency program were prospectively evaluated on their technical skills and self-reported confidence. Objective evaluation of technical skill included scores for a suturing task as evaluated by faculty graders. Self-reported confidence in technical skills was assessed before and after completing the assigned task. Scores for male and female students were compared by age, self-identified race/ethnicity, number of publications at the time of application, athletic background, and US Medical Licensing Examination Step 1 score.

RESULTS

Two hundred sixteen medical students were interviewed, of which 73% were male (n = 158). No gender differences were observed in suture task technical skill scores or mean difference in simultaneous visual task scores. The mean change from pre-task and post-task self-reported confidence scores was similar between sexes. Although female students trended toward lower post-task self-reported confidence scores compared with male students, this did not achieve statistical significance. Lower self-reported confidence was associated with a higher US Medical Licensing Examination score and with attending a private medical school.

DISCUSSION

No difference in technical skill or confidence was found between male and female applicants to a single orthopaedic surgery residency program. Female applicants trended toward self-reporting lower confidence than male applicants in post-task evaluations. Differences in confidence have been shown previously in surgical trainees, which may suggest that differences in skill and confidence may develop during residency training.

Surgical Games: A Simulation-Based Structured Assessment of Orthopedic Surgery Resident Technical Skill

BACKGROUND

Simulation-based education and objective evaluation of surgical skill have been incorporated into many surgical training programs. We describe the development and implementation of a timed, multitask, station-based Surgical Games to evaluate orthopedic resident surgical skills.

METHODS

Participants in the study were postgraduate-year 2 to 5 orthopedic surgery residents from a single institution. Residents completed 4-timed simulated tasks: cadaveric carpal tunnel release (CTR), Sawbones model of total knee arthroplasty (TKA), Sawbones model of ankle fracture open reduction internal fixation (ORIF), and knee arthroscopy simulator (KAS) of removal of loose body. Evaluations were performed using standardized score sheets by attending surgeons. Resident performance was analyzed by postgraduate-year and number of weeks of prior task-related residency training.

RESULTS

A total of 32 residents were assessed at the 4 stations. Total scores were significantly different for CTR (p = 0.006), TKA (p = 0.05), and the KAS (p = 0.004) by year of training, but not for the ankle ORIF task. Residents with more task-specific experience performed significantly better on the KAS (p < 0.001), TKA (p = 0.002), and CTR (p = 0.02) tasks but not on the ankle ORIF task (p = 0.1). Overall, residents rated the exercise valuable to their education with mean scores of 3.9 ± 0.54 on a 5-point Likert Scale.

CONCLUSIONS

This Surgical Games exercise provided an objective evaluation of surgical skill that correlated with year-in-training and prior experience in skill-specific rotations for the KAS, TKA, and CTR tasks. This surgical skills assessment provided an opportunity for effective structured feedback and identification of areas for improvement.

Comparative Assessment of Grit, Conscientiousness, and Self-Control in Applicants Interviewing for Residency Positions and Current Orthopaedic Surgery Residents

OBJECTIVE

The purpose of this study was to quantify grit, conscientiousness, and self-control in orthopaedic residency applicants and current orthopaedic surgery residents. As part of a continual reassessment of the selection process, this study will help to improve this process by assessing the introduction of these non-cognitive assessments. This is the first study to both evaluate and compare the applicants' scores to those of current residents. This introduction will allow selection of not only the current top performers but those who have the wherewithal (read grit) to sustain their efforts throughout their residency.

DESIGN

A cross-sectional study composed of a confidential electronic survey consisting of a 17-item Grit scale, 10-item Self-control scale, and 9-item Conscientiousness scale was completed by medical school applicants and orthopaedic residents.

SETTING

Department of Orthopaedic Surgery, Hospital for Special Surgery.

PARTICIPANTS

Fifty-six (100%) medical student applicants (mean age = 27) were invited to participate in our study following a full day of interviews. Forty-five residents (mean age = 31) were asked and 32 (72%) completed the same surveys 4 months later.

RESULTS

There was a significant difference in grit for medical students (M = 4.19, SD = 0.34) and residents (M =3.86, SD = 0.48); t(86) = 3.76, p = 0.000. All grit subscales were also significantly different for medical students versus residents. Medical students (conscientiousness M = 4.60, SD = 0.41; self-control M = 3.51, SD = 0.30) and residents (conscientiousness M = 4.42, SD = 0.53; self-control M = 3.31, SD = 0.73) scored similarly in the conscientiousness t(86) = 1.75, p = 0.084 and self-control scales t(86) = 1.74, p = 0.086. Academic performance indicators such as the USMLE scores and residency ranking were also compared among medical student applicants.

CONCLUSIONS

The similar and above average levels of conscientiousness and self-control demonstrate the persevering nature of the individual who elects to pursue an orthopaedic residency program. Although the grit levels were different between medical school student and residents, they were above average for both groups, again demonstrating the type of individual willing to pursue an orthopaedic residency program. This study was the first to demonstrate varying degrees of grit for high-performing students versus residents in a competitive program, which seems to suggest that grit can vary over time. Future studies will investigate the validity of these non-cognitive variables in predicting achievement prospectively in a residency program.

An Initiative to Standardize the Identification of and Acute Response to Postoperative Lower-Extremity Neurological Deficits: Effects on Provider Knowledge, Confidence, and Communication Skills

BACKGROUND

Although relatively uncommon, neurological deficits following hip and knee arthroplasty can have permanent and debilitating consequences. This study was conducted to quantify the effectiveness of an educational curriculum aimed at standardizing the identification of and acute response to postoperative neurological deficits in the inpatient setting, specifically with respect to improvements in clinician knowledge, confidence levels, and communication skills.

METHODS

A multidisciplinary committee at a single, high-volume academic institution created an algorithm delineating the appropriate clinical actions and escalation procedures in the setting of a postoperative neurological deficit for each clinical practitioner involved in care for patients who undergo arthroplasty. An educational curriculum composed of online learning modules and an in-person "boot camp" featuring simulations with standardized patients was developed, along with assessments of clinician knowledge, confidence levels, and communication skills. Nurses, physical therapists, physician assistants, residents, fellows, and attending surgeons were encouraged to participate. The intervention spanned a 5-month period in 2015 with a mean time of 18.4 weeks between baseline assessments and the time of the latest follow-up.

RESULTS

Online modules were completed by 322 individuals, boot camp was completed by 70 individuals, and latest assessments were completed by 38 individuals. The percentage correct on the knowledge assessment increased from 74.5% before the learning modules to 89.5% immediately after (p < 0.001) but degraded over time such that there was no significant difference between baseline and the latest follow-up scores (p = 0.11). Over the course of the boot camp, physician assistants and residents successfully performed approximately 91% of the indicated actions on the scoring rubric; physical therapists and nurses successfully performed 78%. Scores on the communication skills assessment showed a significant mean increase (p = 0.02) over the course of the intervention from 30.32 to 32.50, and the mean self-assessed confidence survey scores increased by 16.7%, from 7.2 to 8.4 (p < 0.001).

CONCLUSIONS

A multimodality educational curriculum aimed at quality improvement can produce significant knowledge improvements, but these gains may not be maintained over time without further instruction. Gains in confidence and communication skills appear to be more long-lasting.

Fatal Toxoplasmosis in a Bald Eagle (Haliaeetus leucocephalus)

Toxoplasma gondii tachyzoites were identified in the myocardium of a bald eagle (Haliaeetus leucocephalus) that died of necrotizing myocarditis. The diagnosis was confirmed by immunohistochemical staining with T. gondii-specific polyclonal antibodies. This is a new host record for T. gondii.