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Surgeons play a crucial role in the cost efficiency of the operating room through total operative time, use of supplies, and patient outcomes. This study aimed to examine the effect of surgeon education on disposable supply usage during laparoscopic cholecystectomy. Surgeons were educated about the cost of disposable equipments without incentives for achieved cost reductions. Surgical supply costs for laparoscopic cholecystectomy in fiscal year (FY) 2013 were compared with FY 2014. The average disposable supply cost per laparoscopic cholecystectomy was reduced from $589 (n = 586) in FY 2013 to $531 (n = 428) in FY 2014, representing a 10% reduction in supply costs (P < .001). Adjustments included reduction in the use of expensive fascial closure devices, clip appliers, suction irrigators, and specimen retrieval bags. Disposable equipment cost for laparoscopic cholecystectomy can be reduced by surgeon education. These techniques can likely be used to reduce costs in an array of specialties and procedures.

Surgical currency is a critical component of medical corps readiness. We report a review of surgeons embedded into a civilian institution and analyze whether this improves surgical currency and wartime readiness. Patient management and operative volume were acquired from four surgeons embedded at a civilian institution and compared to operative case loads of surgeons based at a military treatment facility (MTF). The surgeons embedded in the civilian institution had a mean of 49.3 cases compared to a mean of 8.3 cases for surgeons at the MTF over this 6-month period. In addition, the embedded surgeons obtained 44.4 to 94.7% of these cases during their civilian experience as opposed to cases done at the MTF. The cases performed by the embedded orthopedic surgeon (n = 247) was over 20 times the mean number of cases (mean = 12) performed at the MTF. Over a 6-month period, the trauma surgeon and general surgeon each evaluated 150 and 170 new trauma patients, respectively. In addition, the trauma/critical care surgeon cared for 250 critical care patients over this same 6-month period. This study demonstrates that embedding surgeons into a civilian institution allows them to maintain skill sets critical for currency and wartime readiness.

As the number of female medical students and surgical residents increases, the increasing number of female academic surgeons has been disproportionate. The purpose of this brief report is to evaluate the AAMC data from 1969 to 2018 to compare the level of female academic faculty representation for surgical specialties over the past four decades. The number of women as a percentage of the total surgeons per year were recorded for each year from 1969-2018, the most recent year available. Descriptive statistics were performed. Poisson regression examined the percentage of women in each field as the outcome of interest with the year and specialty (using general surgery as a reference) as two predictor variables. Data from the American Association of Medical Colleges (AAMC). All full-time academic faculty physicians in the specialties of obstetrics and gynecology (OB/GYN), general surgery, ophthalmology, otolaryngology (ENT), plastic surgery, plastic surgery, urology, neurosurgery, orthopaedic surgery and cardiothoracic surgery as per AAMC records. The percentage of women in surgery for all specialties evaluated increased from 1969 to 2018 (OR 1.04, p<0.001). Compared with general surgery, the rate of yearly percentage change increased more slowly in neurosurgery (OR 0.84; P = .004), orthopaedic surgery (OR 0.82; P = .002), urology (OR 0.59; P < .001), and cardiothoracic surgery (OR 0.38; P < .001). There was no significant difference in the rate of yearly percentage change for plastic surgery (OR 1.01; P = .840). The rate of yearly percentage change increased more rapidly in OB/GYN (OR 2.86; P < .001), ophthalmology (OR 1.79; P < .001) and ENT (OR 1.70; P < .001). Representation of women in academic surgery is increasing overall but is increasing more slowly in orthopaedic surgery, neurosurgery, cardiothoracic surgery and urology compared with that in general surgery. These data may be used to inform and further the discussion of how mentorship and sponsorship of female students and trainees interested in surgical careers may improve gender equity in the future.

Background Women and minorities remain underrepresented in orthopaedic surgery. In an attempt to increase the diversity of those entering the physician workforce, Nth Dimensions implemented a targeted pipeline curriculum that includes the Orthopaedic Summer Internship Program. The program exposes medical students to the specialty of orthopaedic surgery and equips students to be competitive applicants to orthopaedic surgery residency programs. The effect of this program on women and underrepresented minority applicants to orthopaedic residencies is highlighted in this article. Questions/purposes (1) For women we asked: is completing the Orthopaedic Summer Internship Program associated with higher odds of applying to orthopaedic surgery residency? (2) For underrepresented minorities, is completing the Orthopaedic Summer Internship Program associated with higher odds of applying to orthopaedic residency? Methods Between 2005 and 2012, 118 students completed the Nth Dimensions/American Academy of Orthopaedic Surgeons Orthopaedic Summer Internship Program. The summer internship consisted of an 8-week clinical and research program between the first and second years of medical school and included a series of musculoskeletal lectures, hands-on, practical workshops, presentation of a completed research project, ongoing mentoring, professional development, and counselling through each participant’s subsequent years of medical school. In correlation with available national application data, residency application data were obtained for those Orthopaedic Summer Internship Program participants who applied to the match between 2011 through 2014. For these 4 cohort years, we evaluated whether this program was associated with increased odds of applying to orthopaedic surgery residency compared with national controls. For the same four cohorts, we evaluated whether underrepresented minority students who completed the program had increased odds of applying to an orthopaedic surgery residency compared with national controls. Results Fifty Orthopaedic Summer Internship scholars applied for an orthopaedic residency position. For women, completion of the Orthopaedic Summer Internship was associated with increased odds of applying to orthopaedic surgery residency (after summer internship: nine of 17 [35%]; national controls: 800 of 78,316 [1%]; odds ratio [OR], 51.3; 95% confidence interval [CI], 21.1–122.0; p < 0.001). Similarly, for underrepresented minorities, Orthopaedic Summer Internship completion was also associated with increased odds of orthopaedic applications from 2011 to 2014 (after Orthopaedic Summer Internship: 15 of 48 [31%]; non-Orthopaedic Summer Internship applicants nationally: 782 of 25,676 [3%]; OR, 14.5 [7.3–27.5]; p < 0.001). Conclusions Completion of the Nth Dimensions Orthopaedic Summer Internship Program has a positive impact on increasing the odds of each student participant applying to an orthopaedic surgery residency program. This program may be a key factor in contributing to the pipeline of women and underrepresented minorities into orthopaedic surgery. Level of Evidence Level III, therapeutic study.

Background Orthopaedic surgery now has the lowest percentage of women in residency programs of any surgical specialty. Understanding factors, particularly those related to the medical school experience, that contribute to the specialty’s inability to draw from the best women students is crucial to improving diversity in the profession. Questions/purposes (1) Does required medical school exposure to orthopaedic surgery increase the proportion of women choosing the specialty? (2) Do negative perceptions deter women from choosing orthopaedic surgery? (3) What proportion of orthopaedic faculty members are women, and what proportion of residents are women? (4) To what degree has gender bias been identified in the application/interview process? Methods Two PubMed searches of articles between 2005 and 2015 were performed using a combination of medical subject headings. The first search combined “Orthopaedics” with “Physicians, women” and phrases “women surgeons” or “female surgeons” and the second combined “Orthopedics” with “Internship & Residency” or “exp Education, Medical” and “Sex Ratio” or “Sex Factors”, resulting in 46 publications of which all abstracts were reviewed resulting in 11 manuscripts that were related to the research questions. The Google Scholar search of “women in orthopaedic surgery” identified one additional publication. These 12 manuscripts were read and bibliographies of each reviewed with two additional publications identified and included. Results Required exposure to orthopaedics was found to be positively associated with the number of women applicants to the field, whereas negative perceptions have been reported to deter women from choosing orthopaedic surgery. Orthopaedics has the lowest percentage of women faculty and women residents (14%) compared with other specialties; this suggests that same gender mentorship opportunities are limited. For women applying to orthopaedics, gender bias is most evident through illegal interview questions, in which women are asked such questions more often than men (such as family planning questions, asked to 61% of women versus 8% of men). Conclusions Successful recruitment of women to orthopaedic surgery may be improved by early exposure and access to role models, both of which will help women students’ perceptions of their role in field of orthopaedic surgery.

In the dynamic, non-linear world of medical education, balancing patient care and trainee learning is a complex task. This commentary responds to the original article by Noble et al. ( 2023 ), which challenges the perceived tension between patient care and trainee learning in the surgical environment and advocates for their co-occurrence across various medical specialties. The article explores supervisory practices across disciplines and proposes a holistic reconceptualization of clinical supervision in surgery. From various perspectives, the importance of hands-on opportunities in the operation theatre and the challenges trainees encounter in gaining practical experience are emphasized. Strategies aimed at improving clinical supervision and enhancing surgical education are suggested. By addressing these challenges and providing more opportunities for hands-on training across specialties, surgical education programs can better prepare trainees for the demands of their future careers while ensuring high-quality patient care.

There are notable disparities in the training, recruitment, promotion, and evaluation of men and women in surgery. The qualitative assessment of surgical residents may be implicitly gender biased. We used inductive analysis to identify themes in written evaluations of residents. We also performed a content analysis of words fitting previously defined communal, grindstone, ability, and standout categories. Differences in themes that emerged from evaluations of male and female residents were notable regarding overall performance, references to the future, professional competency, job domains, disposition and humanism, and overall tone of evaluations. Comments about men were more positive than those about women, and evaluations of men included more standout words. The more positive evaluations of men may handicap women if they are seen as less likely to perform well based on these evaluations. These differences suggest that implicit bias may play a role in the qualitative evaluation of surgical residents. •There are gendered differences in the content of resident performance evaluations.•The overall tone of evaluations was more positive for men than women.•Evaluations of men included more standout words than did evaluations of women.