22 results on '"Selina Poon"'
Search Results
2. Does a Career in Orthopaedic Surgery Affect a Woman's Fertility?
- Author
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Damayea I Hargett, Shannon Lorimer, Selina Poon, Samara Friedman, Cynthia Nguyen, Marilan Luong, and Monica Payares
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medicine.medical_specialty ,medicine.medical_treatment ,media_common.quotation_subject ,Specialty ,Fertility ,Miscarriage ,03 medical and health sciences ,0302 clinical medicine ,Pregnancy ,medicine ,Humans ,Orthopedic Procedures ,Orthopedics and Sports Medicine ,Child ,media_common ,Voluntary childlessness ,030222 orthopedics ,Assisted reproductive technology ,Career Choice ,business.industry ,Infant, Newborn ,Orthopedic Surgeons ,030229 sport sciences ,medicine.disease ,Orthopedics ,Family planning ,Family medicine ,Cohort ,Female ,Surgery ,business - Abstract
Background Orthopaedic surgery lags behind other specialties in the recruitment of women. Concerns about fertility, pregnancy, and childbearing may be a deterrent to women when considering orthopaedic surgery as a specialty. Methods An anonymous 168-item survey was distributed to the members of Ruth Jackson Orthopedic Society and the Women in Orthopaedics, an online group exclusive to female orthopaedic surgeons. Respondents were queried regarding family planning, contraceptive length of use, fertility, perinatal work habits, age and stage at each pregnancy, pregnancy complications, and miscarriages. Results Eight hundred one surveys were collected. Seven hundred fifty (94%) expressed interest in having children of their own, with 60% having at least one child at the time of the survey. The average maternal age at birth of the first child was 33.6 ± 3.6 years. Voluntary childlessness was reported by 6% (49/801) of survey respondents. Eighteen percent of this group stated that their choice as an orthopaedic surgeon served as a barrier to having children. Among those with children, childbearing was intentionally delayed by 53% because of their career choice (425/801). Fifty-two percent did not conceive their first child until the end of their training. Complications during pregnancy were reported among 24%. A total of 853 children were conceived by this cohort with assisted reproductive technology being used 106 times. Miscarriages were reported by 38% (304/801). Of those who miscarried, only 28% informed their employer and 8% took time off during or immediately after their miscarriage. Conclusion Most respondents desire to have children but two-thirds delay doing so because of their career choice and its demands. Having a family is an important part of life for many orthopaedic surgeons, and our study provides an updated description of the fertility and pregnancy characteristics of female orthopaedic surgeons to help guide present and future surgeons in their family planning.
- Published
- 2021
3. Do women experience microaggressions in orthopaedic surgery? Current state and future directions from a survey of women orthopaedists
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Julie Balch Samora, Selina Poon, Susan Haralabatos, Marilan Luong, and Jaime Denning
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medicine.medical_specialty ,business.industry ,Family medicine ,Orthopedic surgery ,medicine ,Orthopedics and Sports Medicine ,Current (fluid) ,business - Published
- 2020
4. The Cost of Maternity Leave for the Orthopaedic Surgeon
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Marilan Luong, Mara Karamitopoulos, Christina Hardesty, Jennifer M. Weiss, Cynthia Nguyen, and Selina Poon
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Adult ,030222 orthopedics ,medicine.medical_specialty ,Time Factors ,Demographics ,business.industry ,Internship and Residency ,Orthopedic Surgeons ,030229 sport sciences ,Parental Leave ,Physicians, Women ,03 medical and health sciences ,0302 clinical medicine ,Maternity leave ,Surveys and Questionnaires ,Family medicine ,Orthopedic surgery ,Costs and Cost Analysis ,medicine ,Humans ,Female ,Orthopedics and Sports Medicine ,Surgery ,business ,Average cost - Abstract
INTRODUCTION Maternity leave among orthopaedic surgeons is not well understood. This study seeks to quantify past and current maternal leave characteristics of female orthopaedic surgeons. METHODS A survey was distributed to the members of the Ruth Jackson Orthopaedic Society and Women in Orthopaedics, an online group exclusive to female orthopaedic surgeons in practice or in training. The survey was open from April 2018 to October 2018 with access gained by way of a web-based link. Respondents were queried regarding demographics and maternity leave characteristics including age at conception, length of leave given/taken, and cost. RESULTS A total of 801 surveys were completed with 452 surveys returning with information regarding past pregnancies. Of the 452 surgeons with children, the average leave offered was 4.6 ± 4.2 weeks for the first child, with 8.2 ± 7.4 weeks taken. A difference was observed (P < 0.001) between the amount of leave taken between residents (6.3 ± 5.0 weeks), fellows (8.3 ± 7.2 weeks), and practicing surgeons (9.6 ± 8.5 weeks). The average cost of the first leave was $40,932 ± 61,258. The average cost during training was different than during practice ($154 versus $45,350, P < 0.001). The length of leave offered (P = 0.05) and taken (P < 0.001) affects the cost, whereas delivery type, timing of stopping clinic, taking calls, and operating did not. Each additional week of leave offered saved a surgeon $2,583, and each additional week taken cost $3,252. DISCUSSION Residents take shorter leaves than fellows and attendings. The cost of taking leave is substantial, and the cost during practice is higher than during training. The amount of leave taken is greater than the amount of paid leave offered.
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- 2020
5. Underrepresented Minority Applicants Are Competitive for Orthopaedic Surgery Residency Programs, but Enter Residency at Lower Rates
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Prakash Gorroochurn, Nadeen O. Chahine, Daniel Kiridly, Rocio A.L. Crabb, Rachel Gecelter, Kate Nellans, Selina Poon, Alyssa Rothman, and Stephen Wendolowski
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030222 orthopedics ,medicine.medical_specialty ,business.industry ,Ethnic group ,Internship and Residency ,030229 sport sciences ,United States ,Representation (politics) ,03 medical and health sciences ,Race (biology) ,Orthopedics ,0302 clinical medicine ,Underrepresented Minority ,Family medicine ,Orthopedic surgery ,Ethnicity ,Humans ,Medicine ,Orthopedics and Sports Medicine ,Surgery ,Personnel Selection ,business ,Minority Groups - Abstract
Orthopaedic surgery residency programs have the lowest representation of ethnic/racial minorities compared with other specialties. This study compared orthopaedic residency enrollment rates and academic metrics of applicants and matriculated residents by race/ethnicity.Data on applicants from US medical schools for orthopaedic residency and residents were analyzed from 2005 to 2014 and compared between race/ethnic groups (White, Asian, Black, Hispanic, and Other).Minority applicants comprised 29% of applicants and 25% of enrolled candidates. Sixty-one percent of minority applicants were accepted into an orthopaedic residency versus 73% of White applicants (P0.0001). White and Asian applicants and residents had higher USMLE Step 1. White applicants and matriculated candidates had higher Step 2 Clinical Knowledge scores and higher odds of Alpha Omega Alpha membership compared with Black, Hispanic, and Other groups. Publication counts were similar in all applicant groups, although Hispanic residents had significantly more publications. Black applicants had more volunteer experiences.In orthopaedic surgery residency, minority applicants enrolled at a lower rate than White and Asian applicants. The emphasis on USMLE test scores and Alpha Omega Alpha membership may contribute to the lower enrollment rate of minority applicants. Other factors such as conscious or unconscious bias, which may contribute, were not evaluated in this study.
- Published
- 2019
6. Ethnic and Sex Diversity in Academic Orthopaedic Surgery: A Cross-sectional Study
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Neeraj Vij, Ian Singleton, Roy Bisht, Francisco Lucio, Selina Poon, and Mohan V. Belthur
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Male ,Cross-Sectional Studies ,Orthopedics ,Ethnicity ,Humans ,Orthopedics and Sports Medicine ,Surgery ,Female ,Orthopedic Procedures ,United States ,White People - Abstract
Although the diversity in orthopaedic residency programs has been studied, the diversity within academic orthopaedics has not.The board of specialty societies, five leading journals and the National Institutes of Health RePORTER tool, and three accreditation organizations were explored.The board of directors comprised 220 (72%) Caucasians, 36 (12%) Asians, 4 (1%) Hispanic/Latinos, 29 (9%) African Americans, and 18 (6%) Other individuals; 250 (81%) were men, and 57 (19%) were women. The editorial boards comprised 288 (77%) Caucasians, 62 (16%) Asians, 14 (4%) Hispanic/Latinos, 8 (2%) African Americans, and 4 (1%) Other individuals; 341 (91%) were men, and 35 (9%) were women. The National Institutes of Health grant recipients comprised 117 (64%) Caucasians, 58 (32%) Asians, 4 (2%) Hispanic/Latinos, and 3 (2%) African Americans; 128 (70%) were men, and 54 (30%) were women. On average, Caucasians, Asians, Hispanic/Latinos, and African Americans received $776,543, $439,600, $420,182, and $494,049, respectively. On average, men and women received $759,426 and $419,518, respectively. The accreditation boards comprised 45 (82%) Caucasians, 6 (11%) Asians, and 4 (7%) African Americans; 45 (82%) were men, and 10 (18%) were women.Academic orthopaedic surgery does not resemble the United States. Residency, fellowship committees, and professional organization boards need to become aware of these disparities.
- Published
- 2021
7. A 10 Year Review of Designated Leadership Positions of the American Orthopaedic Foot & Ankle Society (AOFAS)
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Bopha Chrea, A. Holly Johnson, Judith F. Baumhauer, James E. Meeker, Lara C. Atwater, and Selina Poon
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Orthopedics and Sports Medicine - Abstract
Category: Other Introduction/Purpose: In 2019 the majority of U.S medical students were women (50.5%). Despite this, in 2019 Orthopaedic surgery had the lowest representation of female surgeons (5.8%). Previously, the American Society for Surgery of the hand (ASSH) and Pediatric Orthopaedic Society of North America (POSNA) published their gender diversity data. However, no such study has been conducted in the largest membership organization for foot and ankle trained orthopaedic surgeons. This study sought to investigate whether increased female representation in the American Orthoapedic Foot & Ankle Society (AOFAS) membership roster is reflected in different levels within the organization. Methods: The 2012-2022 membership rosters were obtained from the American Orthopaedic Foot & Ankle Society (AOFAS) and compared by gender. Volunteer, elected and appointed leadership positions and rates of engagement were compared for each of the activities. Leadership positions were defined as appointment as committee chair, vice chair of board of directors. When available, time for advancement through leadership positions was analyzed by gender. Comparative data was available for comparison to two other respective subspecialty groups (ASSH and POSNA) from previously published studies. Results: Between 2012-2022, the percentage of female membership in the AOFAS has continued to increase from 7.5 (n=76) to 13% (n=163) (Table 1). Engagement in committee membership positions in this time has more than doubled from 11/26 (14.4%) to 57/163 (34.9%) (Table 1-3). When participation trends were evaluated by gender, women showed higher rates of committee involvement than their male counterparts (Table 4). In 2021 the percentage of female committee involvement more than doubled their male counterparts (female 57% vs male 23.2 %) (Figure 1). This committee gender composition trend has been seen in the ASSHA and POSNA however is more pronounced in the AOFAS. Representation of women in committee chair positions and elected positions has not seen this same parallel increase (Figure 2). Conclusion: The AOFAS is on trend with the respective Orthopaedic subspecialities. Female membership within the society has increased over the past ten years. The rates of female involvement within committee membership positions have seen a parallel increase. It will take time to mature into leadership roles as we continue to increase diversity within our respective subspecialty organizations. Inception of the Diversity Equity and Inclusion and Women's Subcommittee demonstrate a continued emphasis on this core value within the society.
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- 2022
8. A 10-Year Review of Designated Leadership Positions of the American Orthopaedic Foot & Ankle Society (AOFAS)
- Author
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Bopha Chrea, Holly Johnson, Judith Baumhauer, Amanda Holleran, Lara C. Atwater, and Selina Poon
- Subjects
Orthopedics and Sports Medicine - Abstract
Background: In 2019 the majority of US medical students were women (50.5%). However, despite this representation, female representation within orthopaedic surgery remains low when compared to male counterparts. Previously, the American Society for Surgery of the Hand (ASSH) and Pediatric Orthopaedic Society of North America (POSNA) published their gender diversity data. No such study has been conducted in the American Orthopaedic Foot & Ankle Society (AOFAS), which is the largest membership organization for foot and ankle–trained orthopaedic surgeons. This study sought to investigate whether increased female representation in the AOFAS membership roster is reflected in different levels within the organization. Methods: The 2012-2022 membership rosters were obtained from the AOFAS and compared by gender. Volunteer, elected, and appointed leadership positions as well as rates of engagement were compared for each of the activities. Leadership positions were defined as committee chair, vice chair, or board of directors (BOD). When available, time for advancement through leadership positions to the presidential role was analyzed by gender. Comparative data were available for 2 other respective subspecialty groups, ASSH and POSNA, from previously published studies. Results: Between 2012 and 2022, the percentage of female membership in the AOFAS has continued to increase from 7.5% (n=76) to 13% (n=163). Engagement in committee membership positions during this time has more than doubled from 11 of 26 (14.4%) to 57 of 163 (34.9%). When participation trends were evaluated by gender, women showed higher rates of committee involvement than their male counterparts. In 2021 compared to 2012, the percentage of female committee members more than doubled compared with their male counterparts (female 34.9% to male 23.2% vs female 14.4% to male 16.8%). This increase in female gender committee composition trend has been seen in the ASSH and POSNA, but it is more pronounced in the AOFAS. Representation of women in committee chair positions and elected positions has not seen this same parallel increase. Conclusion: The female membership of the AOFAS has a similar gender composition to other orthopaedic subspecialities. Female membership within the society has increased over the past 10 years. The rates of female involvement within committee membership positions have seen a parallel increase. It will take time to mature into leadership roles as we continue to increase diversity within our respective subspecialty organizations. Inception of the AOFAS Diversity Equity and Inclusion and Women’s Subcommittee demonstrate a continued emphasis on this core value within the society. Level of Evidence: Level IV, cohort study.
- Published
- 2022
9. Editorial Comment: Diversity and Disparities in Orthopaedic Surgery
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Alice Chu and Selina Poon
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Male ,medicine.medical_specialty ,Social Determinants of Health ,media_common.quotation_subject ,Sexism ,Racism ,Sex Factors ,Risk Factors ,Humans ,Medicine ,Orthopedic Procedures ,Orthopedics and Sports Medicine ,Healthcare Disparities ,Personnel Selection ,media_common ,business.industry ,Health Status Disparities ,General Medicine ,Diversity and Disparities in Orthopaedic Surgery (Guest Editors Alice Chu Md, Selina Poon Md, Mph) ,Culturally Competent Care ,Race Factors ,Family medicine ,Orthopedic surgery ,Female ,Surgery ,business ,Diversity (politics) - Published
- 2020
10. A Five-year Review of the Designated Leadership Positions of Pediatric Orthopaedic Society of North America
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Joshua M. Abzug, Robert Cho, Selina Poon, Michelle S. Caird, Jennifer M. Weiss, and Marilan Luong
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030222 orthopedics ,medicine.medical_specialty ,Gender diversity ,business.industry ,education ,Medical school ,030229 sport sciences ,Representation (politics) ,Pediatric orthopedics ,03 medical and health sciences ,0302 clinical medicine ,Family medicine ,Orthopedic surgery ,medicine ,Orthopedics and Sports Medicine ,business - Abstract
Despite the growing number of women entering medical school, female representation among orthopedic surgery is the lowest compared with all areas of medicine. In 2014, 47.7% of students entering medical school were women, but only 13.7% of orthopedic residents were women. Pediatric orthopedics have been successful in enrolling women compared with other orthopedic subspecialties. This is an investigation of female representation among the Pediatric Orthopaedic Society of North America membership roster, providing insight into the effect on the increased gender diversity in the membership of an organization and its correlation with leadership positions at different levels within the organization.
- Published
- 2019
11. Cadaveric Study of the Safety and Device Functionality of Magnetically Controlled Growing Rods After Exposure to Magnetic Resonance Imaging
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Yen Hsun Chen, Selina Poon, Daniel M. Walz, Ryan Nixon, Stephen Wendolowski, Rachel Gecelter, Terry D. Amaral, Daniel A. Grande, Adam Graver, and Jon-Paul DiMauro
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030222 orthopedics ,Thermal injury ,medicine.diagnostic_test ,business.industry ,Magnetic resonance imaging ,Scoliosis ,medicine.disease ,Magnetic Resonance Imaging ,Mr imaging ,Spine ,Rod ,03 medical and health sciences ,0302 clinical medicine ,Magnets ,medicine ,Humans ,Orthopedic Procedures ,Orthopedics and Sports Medicine ,business ,Cadaveric spasm ,Pedicle screw ,030217 neurology & neurosurgery ,Closed circuit ,Biomedical engineering - Abstract
Cadaveric study. To establish the safety and efficacy of magnetically controlled growing rods (MCGRs) after magnetic resonance imaging (MRI) exposure. MCGRs are new and promising devices for the treatment of early-onset scoliosis (EOS). A significant percentage of EOS patients have concurrent spinal abnormalities that need to be monitored with MRI. There are major concerns of the MRI compatibility of MCGRs because of the reliance of the lengthening mechanism on strongly ferromagnetic actuators. Six fresh-frozen adult cadaveric torsos were used. After thawing, MRI was performed four times each: baseline, after implantation of T2–T3 thoracic rib hooks and L5–S1 pedicle screws, and twice after MCGR implantation. Dual MCGRs were implanted in varying configurations and connected at each end with cross connectors, creating a closed circuit to maximize MRI-induced heating. Temperature measurements and tissue biopsies were obtained to evaluate thermal injury. MCGRs were tested for changes to structural integrity and functionality. MRI images obtained before and after MCGR implantation were evaluated. Average temperatures increased incrementally by 1.1°C, 1.3°C, and 0.5°C after each subsequent scan, consistent with control site temperature increases of 1.1°C, 0.8°C, and 0.4°C. Greatest cumulative temperature change of +3.6°C was observed adjacent to the right-sided actuator, which is below the 6°C threshold cited in literature for clinically detectable thermal injury. Histologic analysis revealed no signs of heat-induced injury. All MCGR actuators continued to function properly according to the manufacturer’s specifications and maintained structural integrity. Significant imaging artifacts were observed, with the greatest amount when dual MCGRs were implanted in standard/offset configuration. We demonstrate minimal MRI-induced temperature change, no observable thermal tissue injury, preservation of MCGR-lengthening functionality, and no structural damage to MCGRs after multiple MRI scans. Expectedly, the ferromagnetic actuators produced substantial MR imaging artifacts. Level V.
- Published
- 2018
12. 11. Prophylactic use of local vancomycin does not decrease acute surgical site infection in adolescent idiopathic scoliosis
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Robert Cho, Selina Poon, De-An Zhang, Stephen Stephan, and Marilan Luong
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medicine.medical_specialty ,education.field_of_study ,business.industry ,Incidence (epidemiology) ,medicine.medical_treatment ,Population ,Context (language use) ,Retrospective cohort study ,Perioperative ,Internal medicine ,Spinal fusion ,medicine ,Deformity ,Vancomycin ,Surgery ,Orthopedics and Sports Medicine ,Neurology (clinical) ,medicine.symptom ,business ,education ,medicine.drug - Abstract
BACKGROUND CONTEXT Perioperative surgical site infections for adolescent idiopathic scoliosis after posterior spinal fusion range from 0.3-1.6%. Morbidities associated with infections include hospital readmissions, reoperations, and long-term antibiotic use. Prophylactic and local administration of vancomycin powder into the wound has been shown to decrease rates of surgical site infections among the adult population, and many pediatric deformity surgeons have adopted its use in an effort to decrease infections in the adolescent idiopathic scoliosis population. However, efficacy has not been established in this population. PURPOSE The purpose of this study is to investigate the efficacy of prophylactic, local application of vancomycin powder in decreasing surgical site infections in the adolescent idiopathic scoliosis population following posterior spinal fusion. STUDY DESIGN/SETTING Retrospective cohort study PATIENT SAMPLE Patients OUTCOME MEASURES Our primary outcome was the incidence of surgical site infection following posterior spinal fusion. Secondary outcomes included: demographics, surgical data, and infectious data. METHODS A multicenter, retrospective database query of 9 sites belonging to an organization of nonprofit medical facilities was performed for data from January 2008 to February 2019. ICD-9, ICD-10 and CPT codes were used to identify adolescent idiopathic scoliosis patients who underwent posterior spinal fusion. Identified patients were then separated into 2 groups. The vancomycin group had application of prophylactic, local vancomycin into the wound prior to closure and the nonvancomycin group had no local vancomycin added. Demographic and surgical data was compiled and SSI rates were tabulated and compared between the 2 groups. RESULTS A total of 1,917 adolescent idiopathic scoliosis patients underwent posterior spinal fusion from January 2008 to February 2019. Differences in age, body mass index, female to male ratio, and fusion levels were not statistically significant (p>0.05). The vancomycin group had 1,252 (65.3%) patients with 6 (0.48%) diagnosed with a surgical site infection, compared to 665 (34.7%) patients with 5 (0.75%) diagnosed with a surgical site infection in the nonvancomycin group (p=0.45). Of the 6 infections in the vancomycin group, 4 cultures were positive for gram-negative bacteria. Among the 5 infections in the nonvancomycin group, only 1 culture returned positive for gram-negative bacteria. CONCLUSIONS The prophylactic use of local vancomycin did not demonstrate significantly decreased rates of surgical site infections in adolescent idiopathic scoliosis patients undergoing primary posterior spinal fusion (0.48% vs 0.75%). Further studies are required to elucidate the effectiveness of the use of vancomycin in this population. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.
- Published
- 2021
13. A 5-Year Review of the Designated Leadership Positions of the American Society for Surgery of the Hand (ASSH)
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Meghan McCullough, Rolanda Willacy, Marilan Luong, Joshua M. Abzug, and Selina Poon
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Male ,medicine.medical_specialty ,education ,030230 surgery ,Representation (politics) ,Specialties, Surgical ,03 medical and health sciences ,Physicians, Women ,0302 clinical medicine ,Cultural diversity ,medicine ,Humans ,Orthopedics and Sports Medicine ,Early career ,Societies, Medical ,Surgeons ,030222 orthopedics ,business.industry ,Hand surgery ,United States ,Surgery ,Leadership ,Female ,business ,Early analysis - Abstract
Purpose Despite near equal representation of women in medical schools since 2008, the percentage of women in surgical subspecialties has remained low. Hand surgery accounts for one of the highest percentages of women, at 19%. Ascension to leadership positions has not yet been fully studied among this group. Our study examined whether increased female representation translated to representation at different levels within the organization. Methods The 2014 to 2018 membership rosters were obtained from the American Society for Surgery of the Hand (ASSH) and compared by gender. Leadership and volunteer committee positions were evaluated as published in the annual ASSH Committee Reference Book. Leadership positions were defined as appointment to committee chair or Council or acceptance to the Young Leaders Program. Rates of engagement were compared for each of the leadership activities. When available, the time for advancement through various leadership positions was also analyzed by gender. Results Between 2014 and 2018, the percentage of female ASSH Active Members steadily increased from 11% to 14%. Engagement in early career activities such as committees and the Young Leaders Program also increased: committee positions from 16% to 17% and Young Leaders Program membership from 27% to 40% female representation across the same period. Relative to the overall number of eligible females in the society, women applied at a greater rate and achieved positions at an average of 2 years earlier than their male counterparts. Conclusions There is a steady increase in the percentage of women within the ASSH. Female ASSH members applied for early career leadership positions at a higher rate and achieved these positions earlier than their male counterparts. This may indicate that future women leaders are appropriately supported in the organization. Clinical relevance The ASSH has been committed to increasing gender and ethnic diversity. Early analysis demonstrates an increase in women surgeons’ participation in early career leadership activities within the society.
- Published
- 2019
14. Academic Metrics Do Not Explain the Underrepresentation of Women in Orthopaedic Training Programs
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Selina Poon, Rachel Gecelter, Stephen Wendolowski, Nadeen O. Chahine, Alyssa Rothman, Rocio A.L. Crabb, Kate Nellans, Meredith Akerman, and Daniel Kiridly
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Male ,030222 orthopedics ,medicine.medical_specialty ,Students, Medical ,business.industry ,MEDLINE ,Internship and Residency ,General Medicine ,United States ,03 medical and health sciences ,0302 clinical medicine ,Orthopedics ,Family medicine ,Orthopedic surgery ,Medicine ,Humans ,Orthopedics and Sports Medicine ,Surgery ,Female ,School Admission Criteria ,030212 general & internal medicine ,business ,Women, Working - Abstract
Among medical specialties, orthopaedic surgery persistently has one of the lowest representations of women in residency programs. This study examined whether differences exist in the academic metrics of the orthopaedic residency applicants and enrolled candidates by sex, which may be contributing to the persistent underrepresentation of women. Differences in enrollment rate in orthopaedic residency programs also were analyzed. We hypothesized that academic metrics were similar for female and male applicants and thus do not explain the underrepresentation of women in training programs.Academic data of first-time applicants (n = 9,133) and candidates who enrolled in an orthopaedic residency (n = 6,381) in the U.S. from 2005 to 2014 were reviewed. The United States Medical Licensing Examination (USMLE) Step-1 and Step-2 Clinical Knowledge (CK) scores, Alpha Omega Alpha (AΩA) Honor Medical Society status, number of publications, and volunteer experiences were compared by sex and were analyzed over time.From 2005 to 2014, representation of female applicants increased from 12.6% to 16.0%, corresponding with an increase in the percentage of enrolled female residents (from 12.9% to 16.1%); 70.3% of male and 67.1% of female applicants to orthopaedic residency enrolled as residents (p = 0.082). Mean academic metrics increased significantly over time for applicants and enrolled candidates, irrespective of sex. Comparing by sex, the mean USMLE Step-1 scores of male applicants and enrolled candidates were approximately 2% higher than those of female applicants (p0.0001). Volunteer experiences of female applicants and enrolled candidates were 12% higher compared with male applicants (p0.0001). There was no significant difference in USMLE Step-2 CK scores, number of publications, or AΩA status by sex.The enrollment rate of male and female applicants in orthopaedic residencies was similar and did not change during the 10-year study period. The academic metrics of applicants and enrolled candidates have increased significantly. The academic metrics were found to be comparable by sex; the differences in USMLE Step-1 scores and volunteer experiences were small relative to the magnitude of accomplishments that these values represent. The growth rate of the proportion of women in orthopaedic residencies lags other surgical subspecialties but appears to be independent of academic metrics.
- Published
- 2019
15. Current Trends in Sex, Race, and Ethnic Diversity in Orthopaedic Surgery Residency
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Lewis Lane, Daniel Kiridly, Selina Poon, Rachel Gecelter, Muhammad Mutawakkil, Myriam Kline, and Stephen Wendolowski
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Male ,medicine.medical_specialty ,Native Hawaiian or Other Pacific Islander ,media_common.quotation_subject ,Ethnic group ,White People ,Specialties, Surgical ,03 medical and health sciences ,Race (biology) ,0302 clinical medicine ,Cultural diversity ,medicine ,Ethnicity ,Humans ,Orthopedics and Sports Medicine ,Sex Distribution ,Minority Groups ,media_common ,030222 orthopedics ,Asian ,business.industry ,Internship and Residency ,030229 sport sciences ,Hispanic or Latino ,Hispanic origin ,Black or African American ,Orthopedics ,Orthopedic surgery ,Pacific islanders ,Surgery ,Female ,business ,Surgical Specialty ,Demography ,Diversity (politics) - Abstract
BACKGROUND The representation of minorities among medical students has increased over the past two decades, but diversity among orthopaedic residents lags behind. This phenomenon has occurred despite a recent focus by the American Academy of Orthopaedic Surgeons on the recruitment of minorities and women. OBJECTIVE To analyze the impact of recent efforts on diversity in orthopaedic residents in comparison with other surgical specialties from 2006 to 2015. METHODS Data from the American Association of Medical Colleges on residents in surgical specialty programs in the years 2006 to 2015 were analyzed. Linear regression models were used to estimate trends in diversity among orthopaedic residents and residents in other surgical specialties. A mixed model analysis of variance was used to compare rates of diversification among different specialties over time. RESULTS Female representation in orthopaedic programs increased from 10.9% to 14.4% between 2006 and 2015. However, the rate of increase was significantly lower compared with other specialties (all P < 0.05) studied, except for urology (P = 0.64). Minority representation in orthopaedics averaged 25.6% over the 10-year period. Residents of Hispanic origin in orthopaedic programs increased (P = 0.0003) but decreased for Native Hawaiian/Pacific Islander (P < 0.0001). During the same period, white representation increased (P = 0.004). No significant changes were found in African Americans or Asian American representation. Diversity decreased among orthopaedic residents over the period studied (P = 0.004). CONCLUSIONS Recruitment efforts have not reversed the sex, racial, and ethnic disparities in orthopaedic residents. Orthopaedics has the lowest representation of women and minorities among residencies studied. The rate of increase in women lags behind all surgical subspecialties, except for urology.
- Published
- 2019
16. Evaluation of Sex, Ethnic, and Racial Diversity Across US ACGME-Accredited Orthopedic Subspecialty Fellowship Programs
- Author
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Stephen Wendolowski, Daniel Kiridly, Myriam Kline, Selina Poon, Alexa Vetere, Levi Brown, Rachel Gecelter, and Lewis Lane
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Male ,medicine.medical_specialty ,media_common.quotation_subject ,Graduate medical education ,Ethnic group ,Subspecialty ,White People ,03 medical and health sciences ,0302 clinical medicine ,Asian People ,Cultural diversity ,medicine ,Ethnicity ,Humans ,Orthopedics and Sports Medicine ,Fellowships and Scholarships ,Sex Distribution ,Minority Groups ,media_common ,030222 orthopedics ,Career Choice ,business.industry ,Racial Groups ,Hand surgery ,030229 sport sciences ,Cultural Diversity ,United States ,Orthopedics ,Education, Medical, Graduate ,Family medicine ,Orthopedic surgery ,Pacific islanders ,Surgery ,Female ,business ,Diversity (politics) ,Specialization - Abstract
In recent years, there has been an increasing trend toward subspecialization in orthopedic surgery via fellowships. This study sought to characterize sex, ethnic, and racial representation within each fellowship program and to examine their changes over time to identify trends and/or gaps. Demographic data were obtained from the National Graduate Medical Education Census. Diversity was assessed using proportions of minority and female trainees. The trends in racial, ethnic, and sex diversity from 2006 to 2015 for orthopedics as a whole and within each subspecialty were analyzed. Of 3722 orthopedic fellows, 2551 identified as white (68.5%), 648 as Asian (17.4%), 175 as Hispanic (4.7%), 161 as black (4.3%), 8 as Native Hawaiian/Pacific Islander (0.21%), and 3 as American Indian/Alaskan Native (0.08%). Further, 479 identified as female (12.9%). Racial and ethnic minority representation among orthopedic fellows did not increase over time. Female representation did increase proportionally with female residents. Asian fellows preferred reconstructive adult and spine, whereas white fellows preferred sports medicine, hand surgery, and trauma. Female fellows preferred pediatrics, hand surgery, and musculoskeletal oncology. Although sex diversity among orthopedic fellows has increased in the past 10 years, racial and ethnic minority representation lacked similar growth. Asian and female fellows preferred specific subspecialties over others. These data are presented as an initial step in determining factors that attract minority groups to different orthopedic subspecialties. Further research should define specific factors and identify ways to increase minority distribution among fellowship programs. [ Orthopedics . 2018; 41(5):282–288.]
- Published
- 2018
17. Maximal Force Generated by Magnetically Controlled Growing Rods Decreases With Rod Lengthening
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Hillard T. Spencer, Selina Poon, Ronen Sever, Reginald Fayssoux, and Robert Cho
- Subjects
030222 orthopedics ,Bone Development ,Bone development ,business.industry ,Background data ,Repeated measures design ,Level iv ,Rod ,Standard deviation ,Orthopedic Fixation Devices ,03 medical and health sciences ,0302 clinical medicine ,Scoliosis ,Mixed effects ,Medicine ,Humans ,Orthopedics and Sports Medicine ,Growing rod ,business ,030217 neurology & neurosurgery ,Biomedical engineering - Abstract
Objectives To evaluate the maximal force generated by magnetically controlled growing rods (MCGRs) at three different lengthened positions. Summary of Background Data The introduction of MCGRs has been met with great enthusiasm by surgeons managing early-onset scoliosis. These devices offer the potential to decrease the cost and morbidity associated with repeated surgeries, compared to traditional growing rods. One potential negative consequences of growing rod treatments is the law of diminishing returns, where the spine length gained decrease with each subsequent lengthening. The cause of this phenomenon is unknown and probably multifactorial, yet it may be affected by the strength of the lengthening mechanism in the MCGRs. Methods Twelve MCGRs (90-mm actuator length) were obtained and tested to evaluate the maximal force generated at different lengths. The maximal lengthening force measured in pounds-of-force generated by each rod was recorded at expansion lengths of 0, 25, and 40 mm. Longitudinal analysis was performed using mixed effects linear regression to account for repeated measures and variability between individual implants. Results At 0 mm of actuator lengthening, the mean maximum force was 46.8 lb (standard deviation [SD] 2.06, range 43–50). At 25 mm of expansion, the mean maximum force was 44.9 lb (SD 2.48, range 39.4–49.5). At 40 mm of lengthening, the mean maximum force was 43.2 lb (SD 5.56, range 27.3–49.1). In the mixed effects linear model, there was a statistically significant decrease in the maximal force generated with progressive MCGR lengthening, at an average decrease of 0.089 lb of force (95% CI, 0.030–0.148; p = .003) per millimeter of lengthening. Conclusion There is a small but statistically significant decrease in the maximal force generated by MCGR as the rods are lengthened. The decrease in force generated may result in diminished spine length gained with each subsequent MCGR lengthening. Level of Evidence Level IV.
- Published
- 2017
18. 52. Pre-emptive opioid-sparing medication protocol decreases pain and length of hospital stay in children undergoing posterior spinal instrumented fusion for scoliosis
- Author
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Marilan Luong, De-An Zhang, Robert Cho, and Selina Poon
- Subjects
medicine.medical_specialty ,Gabapentin ,business.industry ,Patient-controlled analgesia ,medicine.medical_treatment ,Context (language use) ,Scoliosis ,medicine.disease ,Hydromorphone ,Acetaminophen ,Anesthesia ,Orthopedic surgery ,medicine ,Surgery ,Orthopedics and Sports Medicine ,Neurology (clinical) ,business ,Oxycodone ,medicine.drug - Abstract
BACKGROUND CONTEXT Poorly controlled postoperative pain following posterior spinal instrumented fusion (PSIF) for scoliosis may be associated with delayed ambulation and longer hospital stays. Multimodal analgesia use has been shown to provide superior analgesia with improved recovery in other orthopedic subspecialities, but has not been described with pediatric patients undergoing spinal surgery. We describe a novel, pre-emptive, opioid-sparing pain medication protocol that is started 2 days prior to surgery, in accordance with first-order pharmacokinetics, and continued postoperatively until discharge with the goal of decreasing postoperative pain, improving mobilization, and decreasing the patient's length of hospital stay. PURPOSE The purpose of this study was to determine if adequate blood concentrations of non-opioid analgesia prior to surgery can decrease the total amount and duration of opioids used postoperatively, while providing optimal pain control. STUDY DESIGN/SETTING Single institution retrospective chart review. PATIENT SAMPLE Patients who had undergone PSIF from March 2014 to November 2017. OUTCOME MEASURES Variables analyzed between both groups were length of hospital stay, total opioid consumption and maximum pain scores per day from surgical discharge date. METHODS We retrospectively reviewed 116 PSIF cases from March 2014 to November 2017. Fifty-two patients received standard analgesia, and 64 patients received the pre-emptive protocol consisting of a standardized combination of acetaminophen, celecoxib, and gabapentin 2 days prior to surgery and continued during their inpatient stay. Scheduled oxycodone and intravenous hydromorphone via patient controlled analgesia (PCA) were given to both groups equally during their hosptial stays. We analyzed legth of stay, total opioid consumption, and maximum pain scores per day from surgical to discharge date. RESULTS Length of hospital stay significantly differed, with means of 3.9 days in the pre-emptive group and 4.5 days in the standard analgesia group (p CONCLUSIONS This is a preliminary report demonstrating a significant decrease in maximal pain score and length of stay following PSIF on a cohort of patients receiving a novel pre-emptive opioid-sparing pain medication protocol. Future studies should investigate degrees of mobilization and opioid consumption and pain levels after discharge from the hospital. FDA DEVICE/DRUG STATUS Univailable from authors at time of publication.
- Published
- 2019
19. A pilot cadaveric study of temperature and adjacent tissue changes after exposure of magnetic-controlled growing rods to MRI
- Author
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Stephen Wendolowski, Jon-Paul DiMauro, Selina Poon, Rachel Gecelter, Yen Hsun Chen, Daniel A. Grande, Adam Graver, Terry D. Amaral, and Ryan Nixon
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Hot Temperature ,Osteogenesis, Distraction ,Pilot Projects ,Scoliosis ,Rod ,03 medical and health sciences ,0302 clinical medicine ,Cadaver ,medicine ,Humans ,Orthopedics and Sports Medicine ,Tissue temperature ,030222 orthopedics ,medicine.diagnostic_test ,business.industry ,Magnetic resonance imaging ,Slight change ,Anatomy ,medicine.disease ,Magnetic Resonance Imaging ,Fresh frozen ,Magnets ,Surgery ,Nuclear medicine ,business ,Cadaveric spasm ,030217 neurology & neurosurgery - Abstract
To test for possible thermal injury and tissue damage caused by magnetic-controlled growing rods (MCGRs) during MRI scans. Three fresh frozen cadavers were utilized. Four MRI scans were performed: baseline, after spinal hardware implantation, and twice after MCGR implantation. Cross connectors were placed at the proximal end and at the distal end of the construct, making a complete circuit hinged at those two points. Three points were identified as potential sites for significant heating: adjacent to the proximal and distal cross connectors and adjacent to the actuators. Data collected included tissue temperatures at baseline (R1), after screw insertion (R2), and twice after rod insertions (R3 and R4). Tissue samples were taken and stained for signs of heat damage. There was a slight change in tissue temperature in the regions next to the implants between baseline and after each scan. Average temperatures (°C) increased by 0.94 (0.16–1.63) between R1 and R2, 1.6 (1.23–1.97) between R2 and R3, and 0.39 (0.03–0.83) between R3 and R4. Subsequent histological analysis revealed no signs of heat induced damage. Recurrent MRI scans of patients with MCGRs may be necessary over the course of treatment. When implanted into human cadaveric tissue, these rods appear to not be a risk to the patient with respect to heating or tissue damage. Further in vivo study is warranted. N/A.
- Published
- 2016
20. A Cadaveric Study on Safety and Device Functionality of Magnetic-Controlled Growing Rods (MCGRs) after Exposure to Magnetic Resonance Imaging (MRI)
- Author
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Jon-Paul DiMauro, Adam Graver, Selina Poon, Daniel A. Grande, Ryan Nixon, Yen Hsun Chen, Daniel M. Walz, Terry D. Amaral, Rachel Gecelter, and Stephen Wendolowski
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medicine.medical_specialty ,medicine.diagnostic_test ,business.industry ,Medicine ,Surgery ,Orthopedics and Sports Medicine ,Magnetic resonance imaging ,Neurology (clinical) ,Radiology ,business ,Cadaveric spasm ,Rod ,Biomedical engineering - Published
- 2017
21. Maximal Force Generated by Magnetically Controlled Growing Rods Decreases with Rod Lengthening
- Author
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Selina Poon, Hillard T. Spencer, Ronen Sever, and Robert Cho
- Subjects
Orthopedics and Sports Medicine - Published
- 2017
22. Maximal Force Generated by Magnetically Controlled Growing Rods at Different Magnetic Controlled Growing Rod Length Decreases with Rod Lengthening
- Author
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Vangie Luong, Jaclyn Krawiec, Robert Cho, Hillard T. Spencer, and Selina Poon
- Subjects
business.industry ,Medicine ,Surgery ,Orthopedics and Sports Medicine ,Neurology (clinical) ,Growing rod ,Composite material ,business ,Rod - Published
- 2017
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