Orthopaedic surgery residency program ranking and the current state of leadership: what are the characteristics of the leaders in the “Top-tier” programs?

Abstract

Background: Orthopaedic surgery residency program ranking and leadership can influence applicant and program decision-making. The study objective was to evaluate the relationship between program rankings and characteristics of their leadership. Methods: The Accreditation Council for Graduate Medical Education, Doximity, and program-specific websites were queried, identifying 193 programs and 426 leaders for analysis. Leadership positions evaluated included: Chairs, Vice Chairs, Program Directors, and Assistant Program Directors. Residency programs were categorized into tiers based on 2022-2023 Doximity reputation ranking. Program ranking was stratified as follows: Tier 1 (rank 1-50, highest-ranking programs), Tier 2 (rank 51-100), Tier 3 (rank 101-150), and Tier 4 (rank 151-201, lowest-ranking programs). Leaders were described according to demographics, training, research productivity, and experience. Results: A total of 426 leaders at 193 programs were included. The average number of leadership positions per program was 2.2±1.0. Higher-tier programs had more leadership positions and were more likely to have chairpeople (P<0.001). They also had a larger proportion of women leaders (P=0.023), although only 11.2% of leaders overall were women. Residency training outside the US did not vary across tiers (P=0.881). Higher-tier leaders were more likely to complete fellowship (P<0.001) and specialize in pediatrics, oncology, and spine (P<0.032), although trauma was the most common specialty among leaders regardless of ranking. Program rank correlated strongly with program size (number of residents) (r2=−0.69) and weakly with leadership h-index (r2=−0.33) and research documents (r2=−0.40). Rank did not correlate with years in practice (r2=0.06), years until attaining a leadership position (r2=0.06), or years in present leadership position (r2=0.07). Conclusions: Program ranking correlated with the number of leaders and residents, as well as research productivity, but not with years of experience or training within the US. Top-tier programs have a higher proportion of women leaders, although the overall number is still low.

Orthopedic Surgery Residency Program Rankings and Gender Diversity

“…Therefore, while our study did not find a significant difference between the proportion of women in program directorship of the top and bottom 50 of the programs we included, it is likely that there will be a significantly higher proportion of female program directors in the top 100 programs we included vs. the bottom 100. Furthermore, given the results of our study, the Julian et al five-year update, and the Huyke-Hernandez et al "top-tier" program analysis, future studies can hypothesize that the faculty of higher-ranked programs are more gender diverse, which could correlate with the higher proportion of female leaders [18] and residents (our present study) at higher-ranked programs.…”

“…We examined program directors from the top 100 programs based on reputation, while Elkadi et al assessed those from 200 orthopedic residency programs, suggesting increased female representation in program directorship at higher-ranked programs [17]. Indeed, a paper investigating the characteristics of leadership in "top-tier" orthopedic surgery residency programs supports this, as they found that higher-tier programs had a larger proportion of women leaders with statistical significance after examining 193 programs [18]. Therefore, while our study did not find a significant difference between the proportion of women in program directorship of the top and bottom 50 of the programs we included, it is likely that there will be a significantly higher proportion of female program directors in the top 100 programs we included vs. the bottom 100.…”

Location, location, location: How does residency program leadership vary according to geographic region?

“…It was a cross-sectional extraction of data that cannot identify influence or causation among studied variables and outcomes. The present study employed the methodology of prior published works that incorporated Doximity in orthopaedics 24,25 . The current study relies upon the accuracy of various internet sources concerning leadership information, which may affect the results.…”