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Academic Metrics Do Not Explain the Underrepresentation of Women in Orthopaedic Training Programs

Poon, Selina, MD, MPH1; Nellans, Kate, MD, MPH2,3; Crabb, Rocío A.L., BS3; Rothman, Alyssa, BS3; Wendolowski, Stephen F., BS4; Kiridly, Daniel, MD2; Gecelter, Rachel, BS4; Akerman, Meredith, MS5; Chahine, Nadeen O., PhD6

doi: 10.2106/JBJS.17.01372
Topics in Training

Background: 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.

Methods: 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.

Results: 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 (p < 0.0001). Volunteer experiences of female applicants and enrolled candidates were 12% higher compared with male applicants (p < 0.0001). There was no significant difference in USMLE Step-2 CK scores, number of publications, or AΩA status by sex.

Conclusions: 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.

1Orthopaedic Surgery, Shriners for Children Medical Center, Pasadena, California

2Department of Orthopaedic Surgery, Long Island Jewish Medical Center, Northwell Health, New York, NY

3Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, East Garden City, New York

4Department of Pediatric Orthopaedics, Cohen Children’s Medical Center, Northwell Health, New York, NY

5Biostatistics Unit, Feinstein Institute for Medical Research, Northwell Health, New York, NY

6Department of Orthopedic Surgery and Biomedical Engineering, Columbia University, New York, NY

E-mail address for S. Poon:

E-mail address for N.O. Chahine:

Investigation performed at Northwell Health and Columbia University, New York, NY, and Shriners for Children Medical Center, Pasadena, California

Disclosure: This study was partially supported by a National Science Foundation (NSF) grant (NSF CAREER 1763281). On the Disclosure of Potential Conflicts of Interest forms, which are provided with the online version of the article, one or more of the authors checked “yes” to indicate that the author had a relevant financial relationship in the biomedical arena outside the submitted work (

Copyright © 2019 by The Journal of Bone and Joint Surgery, Incorporated
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