Shawna L. Watson

The Burden of the Fellowship Interview Process on General Surgery Residents and Programs.

OBJECTIVES This study evaluated the effect of the fellowship interview process in a cohort of general surgery residents. We hypothesized that the interview process would be associated with significant clinical time lost, monetary expenses, and increased need for shift coverage. DESIGN An online anonymous survey link was sent via e-mail to general surgery program directors in June 2014. Program directors distributed an additional survey link to current residents in their program who had completed the fellowship interview process. SETTING United States allopathic general surgery programs. PARTICIPANTS Overall, 50 general surgery program directors; 72 general surgery residents. RESULTS Program directors reported a fellowship application rate of 74.4%. Residents most frequently attended 8 to 12 interviews (35.2%). Most (57.7%) of residents reported missing 7 or more days of clinical training to attend interviews; these shifts were largely covered by other residents. Most residents (62.3%) spent over

Telemedicine with mobile devices and augmented reality for early postoperative care

4000 on the interview process. Program directors rated fellowship burden as an average of 6.7 on a 1 to 10 scale of disruption, with 10 being a significant disruption. Most of the residents (57.3%) were in favor of change in the interview process. We identified potential areas for improvement including options for coordinated interviews and improved content on program websites. CONCLUSIONS The surgical fellowship match is relatively burdensome to residents and programs alike, and merits critical assessment for potential improvement.

Psychomotor Testing for Orthopedic Residency Applicants: A Pilot Study

Advanced features are being added to telemedicine paradigms to enhance usability and usefulness. Virtual Interactive Presence (VIP) is a technology that allows a surgeon and patient to interact in a “merged reality” space, to facilitate both verbal, visual, and manual interaction. In this clinical study, a mobile VIP iOS application was introduced into routine post-operative orthopedic and neurosurgical care. Survey responses endorse the usefulness of this tool, as it relates to The virtual interaction provides needed virtual follow-up in instances where in-person follow-up may be limited, and enhances the subjective patient experience.

Readability of Orthopaedic Patient-reported Outcome Measures: Is There a Fundamental Failure to Communicate?

OBJECTIVE The purpose of this study was to develop an objective motor skills testing system to aid in the evaluation of potential orthopedic residents. DESIGN Participants attempted a battery of 5 motor skills tests (4 novel tests and the Grooved Pegboard [GPT] Test) in one 10-minute session. A percentile-based scoring system was created for each test based on raw scores. One-way analysis of variance was used to compare testing scores among 3 cohorts. Each novel test and overall scores were compared with GPT scores as a relative measure of validity. SETTING The 2015 orthopedic surgery residency interview season at an academic institution. PARTICIPANTS Thirty orthopedic residents and 72 nonresidents (15 community volunteers and 57 orthopedic surgery residency applicants). RESULTS Overall, residents performed better than nonresidents (p < 0.0001) and applicants performed worse than residents or volunteers (p < 0.0001). There were positive correlations between the GPT score and overall battery score (r = 0.63), screw and nut test (r = 0.40), and mimic a structure test (r = 0.26). The fracture reduction test and drilling test scores did not correlate to performance on the GPT. CONCLUSIONS Psychomotor testing for surgical applicants is an area in need of study. This investigation successfully piloted a novel battery of tests, which is easily reproducible and thus may be feasible for use in the orthopedic surgery residency interview setting. Longitudinal evaluation is required to explore correlation with future operative skill.

Competitive bass anglers: a new concern in sports medicine

BackgroundPatient-reported outcome measures (PROMs) are increasingly used to quantify patients’ perceptions of functional ability. The American Medical Association and NIH suggest patient materials be written at or below 6th to 8th grade reading levels, respectively, yet one recent study asserts that few PROMs comply with these recommendations, and suggests that the majority of PROMs are written at too high of a reading level for self-administered patient use. Notably, this study was limited in its use of only one readability algorithm, although there is no commonly accepted, standard readability algorithm for healthcare-related materials. Our study, using multiple readability equations and heeding equal weight to each, hopes to yield a broader, all-encompassing estimate of readability, thereby offering a more accurate assessment of the readability of orthopaedic PROMS.Questions/Purposes(1) What proportion of orthopaedic-related PROMs and orthopaedic-related portions of the NIH Patient Reported Outcomes Measurement Information System (PROMIS®) are written at or below the 6th and 8th grade levels? (2) Is there a correlation between the number of questions in the PROM and reading level? (3) Using systematic edits based on guidelines from the Centers for Medicare and Medicaid Services, what proportion of PROMs achieved American Medical Association and NIH-recommended reading levels?MethodsEighty-six (86) independent, orthopaedic and general wellness PROMs, drawn from commonly referenced orthopaedic websites and prior studies, were chosen for analysis. Additionally, owing to their increasing use in orthopaedics, four relevant short forms, and 11 adult, physical health question banks from the PROMIS®, were included for analysis. All documents were analyzed for reading grade levels using 19 unique readability algorithms. Descriptive statistics were performed using SPSS Version 22.0.ResultsThe majority of the independent PROMs (64 of 86; 74%) were written at or below the 6th grade level, with 81 of 86 (94%) written at or below the 8th grade level. All item banks (11 of 11) and short forms (four of four) of the PROMIS® were written below the 6th grade reading level. The median reading grade level of the 86 independent PROMs was 5.0 (interquartile range [IQR], 4.6–6.1). The PROMIS® question banks had a median reading grade level of 4.1 (IQR, 3.5–4.8); the Adult Short Forms had a median reading grade level of 4.2 (IQR, 4.2–4.3) There was no correlation appreciated between the median reading grade level and the number of questions contained in a PROM (r = −0.081; p = 0.460). For PROMs above NIH-recommended levels, following edits, all (five of five) achieved NIH reading level goals and three (three of five) achieved American Medical Association goals. Editing of these PROMs improved readability by 4.3 median grade level (before, 8.9 [IQR, 8.4–9.1], after 4.6 [IQR, 4.6–6.4], difference of medians, 4.3; p = 0.008).ConclusionsPatient literacy has great influence on healthcare outcomes, and readability is an important consideration in all patient-directed written materials. Our study found that more than 70% of PROMs commonly used in orthopaedics, and all orthopaedic-related portions of the PROMIS® are written at or below the most stringent recommendations (≤ 6th grade reading level), and more than 90% of independent PROMs and all PROMIS® materials are written at or below an 8th grade level. Additionally, the use of the Centers for Medicare and Medicaid Services guidelines for editing high reading level PROMs yields satisfactory results.Clinical RelevanceFears of widely incomprehensible PROMs may be unfounded. Future research to identify the most appropriate readability algorithm for use in the healthcare sector, and revalidation of PROMs after readability-improving edits is warranted.

Fixation of calcaneal fractures through a mini-incision technique

ABSTRACT Objective: Competitive bass angling involves sport fishing against other anglers while targeting a species of fish known as the black basses. Due to the rapidly growing popularity of high school competitive bass angling in Alabama and the nature of the casting motion similar to that of overhead athletes, we sought to examine the prevalence of sports type injuries in this population. Methods: In spring 2016, an anonymous survey was distributed across two large scale competitive high school fishing tournaments, allowing for a broad sampling of anglers throughout the state of Alabama. Survey items included demographic information, relevant past medical history, and various pains associated with the shoulder, elbow and wrist. Results were recorded and analyzed electronically using Microsoft Excel and IBM SPSS statistical software. Results: A total of 257 surveys were recorded. The response rate was 61%. The mean age of participating anglers was 15 ± 1.61 years. The majority (42%) of anglers fished year round. On average, anglers casted nearly 1,000 more times while competing versus fishing recreationally. Approximately 15% of anglers experienced shoulder, elbow, and wrist pain. The most common factors associated with pain included higher tournament cast counts, number of competitive years, number of tournaments/year, number of tournaments, and use of light weight lures. Conclusion: A large portion of high school competitive anglers experience upper extremity pain. Knowledge of angling factors associated with pain allow for the creation of a modifiable routine to help reduce pain in affected anglers and prevent pain in healthy anglers.

Arthroscopic Versus Open Rotator Cuff Repair: Which Has a Better Complication and 30-Day Readmission Profile?

Category: Hindfoot, Trauma Introduction/Purpose: The management of calcaneal fractures is a source of debate among orthopaedic surgeons due to a high risk of complications. The goals of surgical fixation are to restore the alignment and articular surface of the calcaneus. A popular fixation technique is open fixation as it provides the best visualization of fracture fragments. However, the extensive soft tissue disruption often associated with a larger incision places patients at risk for wound healing complications and infection. Due to the high risk of complications, non-operative treatment is often recommended. However, malunion of calcaneus fracture with non- operative treatment leads to predictable complications as well. Due to wound concerns, fixation using a mini-incision technique has emerged as an option for restoring calcaneal anatomy while minimizing wound complications. Methods: From July 1, 2013 to December 31, 2015, 22 patients underwent surgical fixation of 25 displaced calcaneal fractures through a mini-incision technique. All patients were 18 years of age or older and had no history of prior fracture of the operative calcaneus. A chart review was performed to assess for complications defined as non-union, infection, or reoperation for any reason. To assess for restoration of calcaneal anatomy, preoperative and postoperative lateral radiographs were reviewed to assess the Angle of Gissane (normal: 130-145 degrees) and Bohler’s angle (normal: 20-40 degrees). Results: Of the 22 patients (25 fractures), 68.2% (15/22) were male and average age was 41.86 years old. History of tobacco use was present in 81.8% (18/22), alcohol use in 40.9% (9/22), and illicit drug use in 31.8% (7/22). Sixty-eight percent (17/25) of fractures were tongue type and 32% (8/25) were depression type. Average Bohler’s angle (BA) was 13.2 preoperatively and 26.4 degrees postoperatively. Of the 17 calcanei with an abnormal BA preoperatively, 14 (82.4%) had a normal BA restored by surgery. The average postoperative time at final radiograph was 3.9 months. Twelve percent (3/25) of fractures had complications. One reoperation for removal of painful hardware, one reoperation due to non-union and infection, and one reoperation due to infection only. Conclusion: Our results indicate the mini-incision technique is an effective option in restoring calcaneal anatomy while minimizing complications. The poor follow-up and multiple comorbidities present in patients in this study are likely common in the general calcaneal fracture population as well. These factors make techniques that reduce the risk for wound complications, such as the mini-incision, intriguing and potentially extremely useful. Further study comparing a mini-incision technique to more extensile approaches is needed.