Lisa K. Cannada, MD, FAAOS

AAOS Now

Published 11/1/2019
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Lisa K. Cannada, MD, FAAOS

Data Presented in Fellowship Choice Article Are Concerning

Editor’s note: The following letter is in response to the article titled, “New Survey Data Illustrate Developing Trends in Fellowship Choice,” which was written by Sanar Yokhana, MD; Ryan J. Kozlowski, MD; Ali Omari, BS; Muhammad T. Padela, MD, MSc; Zain Sayeed, MD, MHA; and Sam Nasser, MD, and published in the November 2018 issue of AAOS Now.

This letter concerns the accuracy of the article titled, “New Survey Data Illustrate Developing Trends in Fellowship Choice.” Fellowship education is a frontline topic of interest for residents and training programs alike. I have concerns about the data reported and the lack of references provided for this article.

First, the authors indicated they sent the survey to all post-graduate year (PGY)-1 through -5 residents in the 168 U.S. programs participating in the Electronic Residency Application System. The match results are reported annually by the National Resident Matching Program (NRMP). The date and other details regarding the survey request were not clear. A review of the NRMP match data for the past seven years fails to identify a year with exactly 168 residency programs. In 2017, the numbers indicate 165 programs with 727 residency positions (2016: n = 163 programs/717 positions; 2015: n = 161 programs/703 positions; 2014: n = 162 programs/695 positions; and 2013: n = 163 programs/692 positions).

I assume that 2013–2017 would be the PGY-1 through -5 years surveyed. That leaves a total of 3,534 residents from PGY-1 through -5, according to the official date of the NRMP. If the survey was sent to all residents, the survey response of 277 people represents a 2 percent response rate (not 48 percent as reported). This discrepancy is concerning.

In addition, the authors’ choice to survey PGY-1 through -3 residents may skew the results, as those trainees have not made choices regarding fellowship. The purpose of delaying fellowship choice into the fourth year is to allow residents maximum exposure to multiple subspecialties in order to make an informed decision. The match process was developed, in part, to delay the fellowship match until the fourth year. The authors did not indicate the time in the academic calendar the survey was sent. If it was early in the year, PGY-1 residents may not have experienced an orthopaedic surgery rotation. There is a lack of references with some of the statements made, especially regarding variation and subspecialty choice between genders. Accurate match data regarding gender selection in fellowships and match rates are available.

Fellowship selection is a hot topic. With the emergence of a single match day and the knowledge that more residents are applying for fellowships than positions available, accurate data must be disseminated.

Lisa K. Cannada, MD, FAAOS, is an orthopaedic trauma surgeon and member of the AAOS Now Editorial Board. She has been in practice for 16 years and is active in multiple organizations.

References

  1. https://www.mk0nrmpcikgb8jxyd19h.kinstacdn.com/wp-content/uploads/2017/06/Main-Match-Results-and-Data-2017.pdf
  2. Cannada LK: Women in orthopaedic fellowships: what is their match rate, and what specialties do they choose? Clin Orthop Relat Res 2016; 474:1567-61.
  3. Cannada LK, Luhmann SJ, Hu SS, et al: The fellowship match process: the history and a report of the current experience. J Bone Joint Surg Am 2015;97:e3.

Clarification

Editor’s note: The authors of the article “New Survey Data Illustrate Developing Trends in Fellowship Choice,” which was written by Sanar Yokhana, MD; Ryan J. Kozlowski, MD; Ali Omari, BS; Muhammad T. Padela, MD, MSc; Zain Sayeed, MD, MHA; and Sam Nasser, MD, and published in the November 2018 issue of AAOS Now, were asked to clarify several statements made in the article. The following lists the issues and the authors’ responses.

  1. The authors state that they surveyed every residency and every year resident. That would put the total number surveyed at close to 3,500 individuals. If they received 277 responses, that is far from a 48 percent response rate.
    Response: “Program directors were contacted through his or her email that were obtained from FREIDA, a free online service provided by the American Medical Association and asked to forward the survey to all of their current residents. Upon forwarding the survey, the directors were asked to return a confirmation email that allowed the authors to determine exactly how many residents received this survey. In total, we received a confirmation from 21 programs, totaling 572 residents. Of the 572 residents who we confirmed received the survey, we received a response from 277 residents.”
  2. There are 640 residents per post-graduate year (PGY) (3,200 total), and the authors only had 300 residents respond. How does that reach 48 percent? And how do PGY-1 and -2 know about fellowships? PGY-4 apply and only 48 percent responded—so, 48 out of 640 is only 7.5 percent.
    Response: “From previous data, 90 percent of orthopaedic residents end up pursuing a fellowship post-graduation. Therefore, PGY-1 and -2 will be exposed to this idea early in their careers from seniors and staff and by rotating through different fields if they didn’t already have an idea entering residency. It is true (from our data) that 59 percent of PGY-1 and 30 percent of PGY-2 did not know which fellowship they planned to pursue; however, they still declared an intent to pursue a fellowship. The idea in including PGY-1 and -2 in the survey was to gauge interest and see differences between the groups and how they evolved over time.”