A Cross-Sectional Study of Factors Influencing Orthopedic Surgery Application, Diversity, and Trainee Experiences

Background: Women and racial and ethnic minorities remain underrepresented in orthopedic surgery. Exploring factors that draw individuals from these demographics to pursue orthopedic surgery and their experiences during training can provide valuable insights into this disparity. We aimed to quantify the current state of diversity in terms of race, ethnicity, gender, and sexual orientation among orthopedic surgery residents and fellows, and to identify factors that influenced their decision to pursue orthopedic surgery. Methods: An institutionally validated survey was delivered via Qualtrics to national orthopedic surgery residency programs from January to April 2023. Topics addressed included gender identity, sexual orientation, racial and ethnic background, reasons for pursuing orthopedic surgery, and medical training experiences. Differences between gender and racial discrimination were assessed via Chi-square test. Results: A total of 119 orthopedic surgery residents and fellows responded. Of these, 62.2% (n = 74) identified as non-Hispanic White, 60.5% (n = 72) were male, and 86.6% (n = 103) identified as straight or heterosexual. Mentorship was cited by 79.9% (n = 95) of respondents as a critical factor in their decision to pursue orthopedic surgery. Additionally, 23% of female respondents and 4.2% of male respondents highlighted the presence of women and diverse faculty as very important. Gender identity negatively impacted the decision to pursue orthopedic surgery in 15.4% of female and 1.4% of male respondents (p = 0.004). Among underrepresented minorities (URMs), 24.4% reported negative experiences during training compared to 4.1% of non-Hispanic White participants (p = 0.002). Discrimination experiences ranged from 2.6% due to sexual orientation, 20.7% due to race and ethnicity, and 26.3% due to gender and gender identity. Conclusions: Discrimination based on race, ethnicity, and gender continues to pose significant challenges for orthopedic surgery trainees. The presence of mentors, particularly women and individuals from diverse backgrounds, remains crucial in fostering interest in orthopedic surgery among underrepresented groups. Sustained efforts are needed to create a more inclusive and supportive environment all trainees.

Resident Learning Styles: Are We Maximizing Learning Opportunities for Today’s Resident Learner?

Medical education is in constant evolution. It is important to continuously evaluate how residents are being taught in order to improve, and to maximize didactic time while improving standardized test scores. The aim of this study is to assess how residents prefer to learn, which factors preclude residents from studying, the prevalence of certain teaching methods at our institutions, and how this affects standardized exam scores. In order to gather this data, residents across the three Mayo Clinic campuses were anonymously surveyed regarding their preferred study habits, factors that affect their ability to study, how they are most frequently taught within their program, and their most recent in training exam (ITE) scores. Residents are frequently encountering didactic lessons that are consistent with their preferred study methods. However, there seems to be a number of preferred study methods that may not be represented by standard didactic sessions. There are many other factors that affect a resident’s ability to study and those should be taken into consideration by the department when deciding how to teach their residents.

Administering Anesthesia for Patients with ALS Having a Diaphragmatic Pacemaker Placed: Special Considerations

Amyotrophic lateral sclerosis (ALS) also known as Lou Gehrig’s disease is a relentlessly progressive, fatal disease. Progression of the disease results 3 - 5 years after diagnosis, often from respiratory failure. The diaphragm pacing system (DPS) is a device that stimulates the diaphragm to maximally contract so patients can breathe more effectively. It has been used in patients with neurologic injuries such as spinal cord injury and ALS. From an anesthetic perspective, both the surgery and the patient population present several unique challenges. This case series describes three patients with ALS who had the diaphragmatic pacemaker placed and the anesthetic management during those surgeries.

A Retrospective Study of Anesthetic Considerations in Hip Arthroscopy: Regional versus General

Purpose: Hip arthroscopy is a surgery with favorable outcomes to treat labral tears of the hip. This retrospective review was conducted to identify an optimal anesthetic technique for hip arthroscopy to minimize postoperative pain and decrease opioid consumption. Methods: A retrospective analysis was performed for 92 patients who underwent hip arthroscopy for femoroacetabular impingement (FAI) with labral tear under general anesthesia (G) with fascia-iliaca block (64 patients) or regional anesthesia (R) with fascia-iliaca block (28 patients) from March 9, 2016 to April 9, 2018. Data collected included: demographics, diagnosis, ASA status, time in surgery, medications administered, type of anesthesia administered, pain scores, use of straight catheter, and time in PACU. Results: Patients who underwent hip arthroscopy under regional anesthesia reported significantly less first (G: 3.4 (3.9), R: 1.3 (3.0), p = 0.0085) and average (G: 3.8 (2.5), R: 2.0 (2.2), p = 0.0038) pain post-operatively. Patients under regional anesthesia also received less total morphine milligram equivalents (MME) intraoperatively and post-operatively (G: 40.8 (21.7) MME, R: 24.9 (17.8), p = 0.004 MME). Patients under regional anesthesia had a significantly higher incidence of urinary retention (G: 3.1%, R: 28.6%, p = 0.009) and increased time spent in PACU (G = 181.9 (86.3), R: 251.4 (80.4), p = 0.0001). Conclusions: The administration of regional anesthesia resulted in significantly lower pain scores and perioperative opioid consumption compared to general anesthesia in patients undergoing hip. This may be the optimal anesthetic technique for pain control;however, incidence of urinary retention and time to discharge are significantly increased. Prospective randomized control trials are needed to compare general anesthesia and regional anesthesia for hip arthroscopy.

Efficacy of Perioperative Intravenous Lidocaine for Multimodal Analgesia

Given the rising incidence of opioid misuse and opioid-related deaths worldwide, it is imperative to find nonopioid analgesic adjuncts for perioperative pain management. Perioperative opioid exposure in opioid-naïve patients for even minor surgical procedures may result in significant opioid dependence. Although the use of intravenous lidocaine in the perioperative period is not novel, recently it has been proposed as an important adjunct to multimodal analgesia. In addition to improving acute pain, lidocaine may reduce the incidence of chronic post-operative pain syndrome (CPPS), improve bowel function, and decrease post-operative nausea and vomiting (PONV) thereby speeding up the post-operative recovery process. Furthermore, lidocaine has efficacy in a variety of procedures including abdominal, gynecological, and urological surgeries. The aim of this narrative review is to evaluate the effects of intravenous lidocaine compared to traditional analgesic methods on post-operative pain control and recovery for various surgical procedures.

Effective Communication in the Pre-Operative Environment

Introduction: Building a strong patient rapport is a founding principle instilled early on in medical education. For many specialties, this relationship can be developed through repeated encounters. However, anesthesiologists are limited in opportunity for which such rapport can be built. Therefore, it is critical that the pre-operative visit is used effectively to develop a strong patient-physician relationship and help relieve patient anxiety. Methods: The primary objective of this study was to determine what communication aspects are most important to patients in the pre-operative period. Secondary objectives were to evaluate the effectiveness of our current communication practices and their impact on patient’s anxiety. This study was an anonymous and voluntary survey conducted in the pre-operative area prior to elective surgical cases at Mayo Clinic Arizona from Dec. 2018-Jan. 2019. Patients completed a one-page questionnaire ranking the importance of various communication aspects and its subsequent impact on their anxiety level. Results: Of the communication qualities evaluated, patients most valued their physician’s thoroughness and ability to describe their anesthetic plan. Greater than 95% of patients felt “very satisfied” with their anesthesia provider encounter and on a 1 - 5 point scale, with 5 being the highest, there was an average reduction of 0.75 in anxiety level after completion of the anesthesia interview. Conclusion: Incorporation of and improving these communication aspects during your pre-operative evaluation can help improve rapport, reduce patient anxiety, and improve the patient’s overall experience. Implementing a communication-focused curriculum during training may prove beneficial in improving resident’s effectiveness in communicating.

Anesthetic Management of a Patient with Hermansky-Pudlak Syndrome

Hermansky-Pudlak Syndrome (HPS) is a rare genetic condition characterized by platelet function abnormalities and oculocutaneous albinism. Other systemic manifestations of the disease include pulmonary fibrosis, granulomatous colitis, impaired renal function, and cardiomyopathy. Due to the systemic extent of the disease, HPS has multiple anesthetic concerns and requires a detailed preoperative evaluation and close perioperative monitoring.