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ABSTRACTThe 13th Annual Augustus White Symposium was held at the Beth Israel Deaconess Medical Center (BIDMC) on October 11, 2017. The 2017 symposium was dedicated to an important yet often overlooked topic in medicine: “African American Males Entering the Medical Field: Disparity, Diminishing, Distressing.” There has been a troubling decline in the representation of African-American men in medicine over the past 36 years. Although this problem is complex and multifactorial, there is no better time for change than now. Increasing diversity and inclusion in the medical community is essential to the training of aspiring physicians and to the care of a growing diverse patient population. This article highlights the significance of this problem while offering potential solutions to alter its course.

BACKGROUND The Miller’s Review of Orthopaedics (MRO) and the AAOS Comprehensive Orthopaedic Review (COR) are two commonly used review books for the Orthopaedic In-Training Examination (OITE). However, both resources are quite extensive in terms of book length. The authors recently published a concise OITE review handbook titled High-Yield Orthopaedics (HYO). This study aimed to validate HYO by determining the prevalence of 2018 OITE answers found in the handbook.METHODS The 2018 OITE questions were categorized into one of three question types by the first author. Taxonomy 1 (T1) questions tested recall or recognition; taxonomy 2 (T2) questions tested interpretation; and taxonomy 3 (T3) questions tested problem-solving. Two authors (HVL and PKC) then independently reviewed HYO to determine if answers to the 2018 OITE questions were available in the handbook. Interobserver reliability was assessed via percent agreement and Cohen’s kappa (κ) coefficient. Discrepancies were resolved after joint review.RESULTS Of the 270 OITE questions available for review, 97 (35.9%) were classified as T1 questions, 85 (31.5%) as T2 questions, and 88 (32.6%) as T3 questions. The answers to 198 OITE questions (73.3%) were detected in HYO—58 answers to T1 questions (59.8%), 63 answers to T2 questions (74.1%), and 77 answers to T3 questions (87.5%). The concordance between the two reviewers was 258 out of 270 questions (95.6%) with κ coefficient of 0.88.CONCLUSION Compared to MRO and COR, High-Yield Orthopaedics is a more concise resource that still comprehensively reviews all 11 knowledge domains tested on the OITE. Answers to 198 of the 270 questions (73.3%) on the 2018 OITE were found in the handbook. HYO is a valid and high-yield review material for OITE preparation.LEVEL OF EVIDENCE Level V Expert Opinion

Degenerative cervical myelopathy (DCM) canlead to pain, disability, and permanentneurological impairment. Here, we comparedpatients who were admitted through clinic versus the emergency department (ED) for surgical management of DCM.

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.MethodsLORs for 2019 to 2020 applicants who applied to a single academic institution were selected for review. Female and male applicants were matched by medical school attended and United States Medical Licensing Examination Step 1 score. LORs were analyzed using both qualitative and quantitative analyses. Letters were evaluated for their word count, presence of language terms, and frequency of language terms. A similar subgroup language analysis was performed for standardized LORs (SLORs).ResultsSix hundred fifty-six applicants met the initial screening criteria-126 women and 530 men. After matching, 71 female applicants were paired with 111 male applicants. Word count was, on average, longer for female applicants. LORs for female applicants were more likely to contain language terms that characterized their ability, achievement, participation in athletics, awards received, fit, leadership, and personality traits. Of these terms, ability and participation in athletics were also found more frequently in LORs written for women. In addition, language characterizing technical skills was found more frequently in LORs of female applicants. Similar codes were found to be statistically significant in the SLOR subgroup analysis.ConclusionThis study highlights that current orthopaedic surgery residency LORs do not appear to be biased by applicant gender. LORs were longer for female applicants and described them more positively. Future female orthopaedic residency applicants should be assured that current female candidates are applying with at least similar if not greater subjective qualifications to their male counterparts based on the findings of this study.

BACKGROUND The Miller’s Review of Orthopaedics (MRO) and the AAOS Comprehensive Orthopaedic Review (COR) are two commonly used review books for the Orthopaedic In-Training Examination (OITE). However, both resources are quite extensive in terms of book length. The authors recently published a concise OITE review handbook titled High-Yield Orthopaedics (HYO). This study aimed to validate HYO by determining the prevalence of 2018 OITE answers found in the handbook.METHODS The 2018 OITE questions were categorized into one of three question types by the first author. Taxonomy 1 (T1) questions tested recall or recognition; taxonomy 2 (T2) questions tested interpretation; and taxonomy 3 (T3) questions tested problem-solving. Two authors (HVL and PKC) then independently reviewed HYO to determine if answers to the 2018 OITE questions were available in the handbook. Interobserver reliability was assessed via percent agreement and Cohen’s kappa (κ) coefficient. Discrepancies were resolved after joint review.RESULTS Of the 270 OITE questions available for review, 97 (35.9%) were classified as T1 questions, 85 (31.5%) as T2 questions, and 88 (32.6%) as T3 questions. The answers to 198 OITE questions (73.3%) were detected in HYO—58 answers to T1 questions (59.8%), 63 answers to T2 questions (74.1%), and 77 answers to T3 questions (87.5%). The concordance between the two reviewers was 258 out of 270 questions (95.6%) with κ coefficient of 0.88.CONCLUSION Compared to MRO and COR, High-Yield Orthopaedics is a more concise resource that still comprehensively reviews all 11 knowledge domains tested on the OITE. Answers to 198 of the 270 questions (73.3%) on the 2018 OITE were found in the handbook. HYO is a valid and high-yield review material for OITE preparation.LEVEL OF EVIDENCE Level V Expert Opinion

ABSTRACTThe 13th Annual Augustus White Symposium was held at the Beth Israel Deaconess Medical Center (BIDMC) on October 11, 2017. The 2017 symposium was dedicated to an important yet often overlooked topic in medicine: “African American Males Entering the Medical Field: Disparity, Diminishing, Distressing.” There has been a troubling decline in the representation of African-American men in medicine over the past 36 years. Although this problem is complex and multifactorial, there is no better time for change than now. Increasing diversity and inclusion in the medical community is essential to the training of aspiring physicians and to the care of a growing diverse patient population. This article highlights the significance of this problem while offering potential solutions to alter its course.

Background: Although diversity has improved across certain orthopaedic subspecialties, enhancing diversity within spine surgery has remained a challenge. We aimed to investigate the current state of sex, racial, and ethnic diversity among academic orthopaedic spine surgeons in the United States., Methods: In January 2024, a cross-sectional analysis of orthopaedic spine surgery faculty in the United States was conducted using the Doximity database to identify eligible surgeons. Fellowship-trained orthopaedic spine surgeons (professor, associate professor, and assistant professor) who graduated residency between 1990 and 2022 were included. Race, sex, academic rank, residency year of graduation, and H-Index scores were recorded using publicly available information from faculty profile pages and the Doximity database., Results: Four hundred fifty-two spine faculty were included in the analysis: 95.1% men and 4.84% women. Across race and ethnicity, 315 surgeons (69.7%) were White, 111 (24.6%) Asian, 15 (3.32%) Black or African American, and 11 (2.43%) Hispanic or Latino or of Spanish origin. Of the 101 professor-level surgeons, 3 (2.97%) were Black men. Among female professors, none were Black, Asian, or Hispanic/Latino. No Hispanic or Latino female professors, associate professors, or assistant professors were identified. The sex and race/ethnicity demographics that have increased in percentage over time include White women (0.92% to 6.08%), Asian men (11.0% to 26.5%), Asian women (0% to 1.66%), and Hispanic/Latino men (1.83% to 3.87%). The surgeon demographic groups that demonstrated minimal fluctuations over time included Black men, Black women, and Hispanic/Latino women., Conclusion: Our findings demonstrate that underrepresentation among academic spine surgeons remains an ongoing challenge that warrants increased attention. Enhancing the representation of Black and Hispanic men, as well as Black, Asian, and Hispanic women, in spine surgery requires a deliberate effort at every level of orthopaedic training., (Copyright © 2024 by the American Academy of Orthopaedic Surgeons.)

Introduction: Quantitative parameters for diagnosis of congenital lumbar stenosis (CLS) have yet to be universally accepted. This study establishes parameters for CLS using CT, assessing the influences of patient sex, race, ethnicity, and anthropometric characteristics., Methods: Interpedicular distance (IPD), pedicle length, canal diameter, and canal area were measured using 1,000 patients between 18 and 35 years of age who were without spinal pathology., Results: Irrespective of disk level, threshold values for CLS were 16.1 mm for IPD, 3.9 mm for pedicle length, 11.5 mm for canal diameter, and 142.5 mm2 for canal area. Notable differences based on patient sex were observed, with men demonstrating larger CLS threshold values with respect to IPD and canal area across all vertebral levels from L1 to L5. Based on patient anthropometric factors, no strong or moderate associations were observed between any spinal measurement and patient height, weight, or body mass index across all levels from L1 to L5. However, notable differences were observed based on patient race and ethnicity from L1 to L5. Asian patients demonstrated the largest pedicle lengths, followed by White, Hispanic, and Black patients in descending order. White patients demonstrated the largest IPD, canal AP diameter, and canal area, followed by Asian, Hispanic, and Black patients in descending order. Black patients demonstrated the smallest values across all anatomic measurements relative to Asian, White, and Hispanic patients., Conclusion: This study reports 25,000 measurements of lumbar central canal dimensions to establish quantitative thresholds for the diagnosis of CLS. Although not influenced by patient height, weight, or body mass index as one might intuit, canal dimensions were influenced by patient sex, race, and ethnicity. These findings may help explain differences in predisposition or prevalence of lumbar nerve root compression among patients of different races, which can be important when considering rates of surgery and access to care., (Copyright © 2024 by the American Academy of Orthopaedic Surgeons.)

Background: The increasing accessibility of artificial intelligence (AI) text-to-image generators offers a novel avenue for exploring societal perceptions. The present study assessed AI-generated images to examine the representation of gender and racial diversity among orthopaedic surgeons., Methods: Five prominent text-to-image generators (DALL·E 2, Runway, Midjourney, ImagineAI, and JasperArt) were utilized to create images for the search queries "Orthopedic Surgeon," "Orthopedic Surgeon's Face," and "Portrait of an Orthopedic Surgeon." Each query produced 80 images, resulting in a total of 240 images per generator. Two independent reviewers categorized race, sex, and age in each image, with a third reviewer resolving discrepancies. Images with incomplete or multiple faces were excluded. The demographic proportions (sex, race, and age) of the AI-generated images were then compared with those of the 2018 American Academy of Orthopaedic Surgeons (AAOS) census., Results: In our examination across all AI platforms, 82.8% of the images depicted surgeons as White, 12.3% as Asian, 4.1% as Black, and 0.75% as other; 94.5% of images were men; and a majority (64.4%) appeared ≥50 years old. DALL·E 2 exhibited significantly increased diversity in representation of both women and non-White surgeons compared with the AAOS census, whereas Midjourney, Runway, and ImagineAI exhibited significantly decreased representation., Conclusions: The present study highlighted distortions in AI portrayal of orthopaedic surgeon diversity, influencing public perceptions and potentially reinforcing disparities. DALL·E 2 and JasperArt show encouraging diversity, but limitations persist in other generators. Future research should explore strategies for improving AI to promote a more inclusive and accurate representation of the evolving demographics of orthopaedic surgery, mitigating biases related to race and gender., Clinical Relevance: This study is clinically relevant as it investigates the accuracy of AI-generated images in depicting diversity among orthopaedic surgeons. The findings reveal significant discrepancies in representation by race and gender, which could impact societal perceptions and exacerbate existing disparities in health care., Competing Interests: Disclosure: The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article (http://links.lww.com/JBJS/I106)., (Copyright © 2024 by The Journal of Bone and Joint Surgery, Incorporated.)