Journal of the American Academy of Orthopaedic Surgeons最新文献

{"title":"The Challenges of Using ChatGPT for Clinical Decision Support in Orthopaedic Surgery: A Pilot Study.","authors":"Michael A McNamara, Brandon G Hill, Peter L Schilling","doi":"10.5435/JAAOS-D-24-01072","DOIUrl":"10.5435/JAAOS-D-24-01072","url":null,"abstract":"<p><strong>Background: </strong>Artificial intelligence (AI) technologies have recently exploded in both accessibility and applicability, including in health care. Although studies have demonstrated its ability to adequately answer simple patient issues or multiple-choice questions, its capacity for deeper complex decision making within health care is relatively untested. In this study, we aimed to delve into AI's ability to integrate multiple clinical data sources and produce a reasonable assessment and plan, specifically in the setting of an orthopaedic surgery consultant.</p><p><strong>Methods: </strong>Ten common fractures seen by orthopaedic surgeons in the emergency department were chosen. Consult notes from patients sustaining each of these fractures, seen at a level 1 academic trauma center between 2022 and 2023, were stripped of patient data. The history, physical examination, and imaging interpretations were then given to ChatGPT4 in raw and semistructured formats. The AI was asked to determine an assessment and plan as if it were an orthopaedic surgeon. The generated plans were then compared with the actual clinical course of the patient, as determined by our multispecialty trauma conference.</p><p><strong>Results: </strong>When given both raw and semistructured formats of clinical data, ChatGPT4 determined safe and reasonable plans that included the final clinical outcome of the patient scenario. Evaluating large language models is an ongoing field of research without an established quantitative rubric; therefore, our conclusions rely on subjective comparison.</p><p><strong>Conclusion: </strong>When given history, physical examination, and imaging interpretations, ChatGPT is able to synthesize complex clinical data into a reasonable and most importantly safe assessment and plan for common fractures seen by orthopaedic surgeons. Evaluating large language models is an ongoing challenge; however, using actual clinical courses as a \"benchmark\" for comparison presents a possible avenue for further research.</p>","PeriodicalId":51098,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons","volume":" ","pages":"618-622"},"PeriodicalIF":2.6,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143735777","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Letter to the Editor: Perioperative Dexamethasone Use in Diabetic Patients Undergoing TJA: Considerations for Dosage, Timing, and Long-Term Outcomes.","authors":"Shangxian Pan, Kuangyang Yang, Kexin Wang","doi":"10.5435/JAAOS-D-24-01322","DOIUrl":"10.5435/JAAOS-D-24-01322","url":null,"abstract":"","PeriodicalId":51098,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons","volume":" ","pages":"e612-e613"},"PeriodicalIF":2.6,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144038304","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Differential Risk Profiles for Slipped Capital Femoral Epiphysis in Pediatric Patients: A Comparative Analysis of Normal and Elevated BMI Groups.","authors":"Jad J Lawand, David Momtaz, Hallie B Remer, Blaire Peterson, Quinn T Ehlen, Abdullah Ghali, Pooya Hosseinzadeh","doi":"10.5435/JAAOS-D-24-01298","DOIUrl":"https://doi.org/10.5435/JAAOS-D-24-01298","url":null,"abstract":"<p><strong>Introduction: </strong>Slipped capital femoral epiphysis (SCFE) is a common hip disorder in adolescents that primarily affects those with higher body mass index (BMI). This study aimed to compare risk factors between pediatric patients with normal BMI (<85th percentile, normal-weight group) and obese BMI (≥85th percentile, classic group) in the context of SCFE.</p><p><strong>Methods: </strong>In this multi-institution case-control study, data from 1,200 pediatric patients diagnosed with SCFE from 2003 to 2023 were analyzed. Patients were dichotomized based on their BMI percentiles into normal-weight and classic groups. Multivariate logistic regression models that adjusted for various demographic and other patient characteristics were employed to calculate adjusted odds ratios (ORs) for the target risk factors.</p><p><strong>Results: </strong>The study included 172 patients in the normal-weight group and 1,028 in the classic group. Notable differences were noted in age (P < 0.001), thyrotropin levels (P < 0.001), and calcidiol levels (P < 0.001) between the two groups. Regression analysis revealed that patients in the normal-weight group had higher odds of being White (OR = 2.10; 95% CI: 1.49 to 2.95; P < 0.001) compared with the classic group. Additional findings indicated increased odds of hypothyroidism (OR = 1.86; P = 0.01) and lower odds of vitamin D deficiency (OR = 0.51; P = 0.02) in the normal-weight group compared with the classic group.</p><p><strong>Conclusion: </strong>This study highlights notable differences in risk factors between normal-weight and overweight pediatric patients with SCFE. Race and ethnicity, thyroid function, and vitamin D levels emerged as differential risk factors with normal-weight patients having two times higher the risk of hypothyroidism (incidence 19.85% in normal-weight vs. 10.89% classic). These findings suggest that risk profiles for SCFE are more complex than previously understood and vary markedly with BMI. We recommend evaluation of hypothyroidism in normal weight patients with SCFE because one in every five patients in this group was diagnosed with hypothyroidism.</p><p><strong>Level of evidence: </strong>Level III.</p>","PeriodicalId":51098,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144163838","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Time to Minimal Clinically Important Difference in Patients Undergoing Conversion Total Hip Arthroplasty After Femoral Neck Fracture: A Propensity Score Matched Study.","authors":"Jacob S Borgida, Perry Lim, Lara L Cohen, Nicholas Sauder, Thuan V Ly, Hany S Bedair, Christopher M Melnic","doi":"10.5435/JAAOS-D-24-01493","DOIUrl":"https://doi.org/10.5435/JAAOS-D-24-01493","url":null,"abstract":"<p><strong>Background: </strong>Conversion total hip arthroplasty (cTHA) is commonly used for patients with persistent osteoarthritis or failed fixation following femoral neck fracture (FNF). There are limited data comparing patient-reported outcomes between patients undergoing cTHA after FNF and primary THA (pTHA) patients. This study aimed to compare the time to reach the minimal clinically important difference for improvement (MCID) for the Hip Disability and Osteoarthritis Outcomes Score-Physical Function Short Form, Patient-Reported Outcomes Measurement Information System (PROMIS) Global Physical, and PROMIS Physical Function short form 10a (PF-10a).</p><p><strong>Methods: </strong>Patients undergoing cTHA for FNF between 2016 and 2022 were identified from an institutional database and propensity score matched 1:4 to pTHA patients by age, sex, body mass index, and Charlson Comorbidity Index. Demographic and MCID achievement rates were compared. To assess the time to achieve MCID, survival curves with and without interval censoring were used.</p><p><strong>Results: </strong>A total of 258 THAs (52 FNF cTHA and 206 pTHA) were analyzed. All FNFs were managed surgically. The rate of achieving MCID was similar between the FNF cTHA and pTHA cohorts for all three PROMs. For PROMIS PF-10a, FNF cTHA had a markedly longer median time to MCID at 9.8 months (95% confidence interval [CI], 6.5 to 12.1) compared with 4.2 months (95% CI, 3.3 to 6.0) for pTHA (P < 0.001). Interval censoring revealed that FNF cTHA achieved MCID for PROMIS PF-10a between 5.07 and 5.34 months, whereas pTHA achieved MCID between 1.37 and 1.37 months (P < 0.001).</p><p><strong>Conclusion: </strong>The time to achieve MCID was markedly slower for FNF cTHA patients compared with pTHA patients. This delay in achieving MCID should be factored into shared decision-making discussions to enhance preoperative expectation management and patient education. Future research is needed to identify modifiable factors that could improve recovery outcomes for FNF cTHA patients.</p>","PeriodicalId":51098,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144163840","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluating the Accuracy, Clarity, and Safety of Artificial Intelligence-Generated Information on Clubfoot.","authors":"Akram Al Ramlawi, Daniel J Over, Daniel Weltsch, Michael Assayag, Philip K McClure, Renee J Hunter","doi":"10.5435/JAAOS-D-24-01274","DOIUrl":"https://doi.org/10.5435/JAAOS-D-24-01274","url":null,"abstract":"<p><strong>Background: </strong>Clubfoot is a congenital foot deformity treated primarily by the Ponseti method. Despite its effectiveness, challenges such as delayed treatment and nonadherence persist, leading parents to seek information online. With the rise of artificial intelligence (AI) chatbots as medical information sources, concerns have emerged regarding the accuracy, clarity, and safety of AI-generated content.</p><p><strong>Objective: </strong>To evaluate the accuracy, clarity, and safety of AI-generated responses to common parental questions about clubfoot.</p><p><strong>Methods: </strong>Nineteen frequently asked questions by parents of children with clubfoot were identified. Three AI language models-Google's Gemini, OpenAI's ChatGPT-4.0, and Meta AI-were each queried twice with these questions. Two pediatric orthopaedic surgeons independently assessed the AI responses for clarity, accuracy, and safety using a four-point scale (1 = lowest, 4 = highest). Statistical analyses were conducted using chi-square and t-tests with a significance level of P < 0.05.</p><p><strong>Results: </strong>A total of 228 evaluations were obtained (76 per AI model). The overall average scores were 3.5 for clarity, 3.0 for accuracy, and 3.3 for safety. ChatGPT scored highest in clarity (mean = 3.5), Gemini in accuracy (mean = 3.2) and safety (mean = 3.4). No statistically significant differences were found among the models. Approximately 25% of responses were limited or inaccurate, and only 30% were deemed entirely safe.</p><p><strong>Conclusion: </strong>Although AI chatbots generally provide adequate information on clubfoot, notable concerns about accuracy and patient safety remain. It is recommended that patients consult healthcare professionals rather than rely solely on AI-generated advice. Developing AI models that access up-to-date, evidence-based medical databases could enhance the reliability and safety of health information provided to the public.</p>","PeriodicalId":51098,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144163839","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Connecting Underrepresented Medical Students to Resources and Role Models in Orthopaedic Surgery: A Virtual Diversity, Equity, Inclusion, and Accessibility Summit.","authors":"Shayom Debopadhaya, Christopher Saker, Maike van Niekerk, Amil R Agarwal, Amy Zhao, Sheena Amin, Vincenzo Bonaddio, Lauren Bracey, Elizabeth Cho, Natalia Czerwonka, Alexander Dawes, Alex Gu, Isaiah Hughes, Maria Kammire, Tammy Phillips, Rachel Ranson, Christina Stach, Lisa K Cannada, Kevin Shea, Mary K Mulcahey","doi":"10.5435/JAAOS-D-24-00949","DOIUrl":"10.5435/JAAOS-D-24-00949","url":null,"abstract":"<p><strong>Introduction: </strong>Limited access to resources and stereotypes about orthopaedic surgeons may contribute to the low percentage of women and people of underrepresented in medicine (URiM) backgrounds in orthopaedic surgery. Several organizations have created resources to address these barriers, but medical students are unlikely to be exposed to the initiatives through traditional curricula. The purpose of this study was to (1) evaluate the ability of a 1-day virtual Diversity, Equity, Inclusion, and Accessibility (DEIA) summit to effectively reach URiM medical students, (2) increase medical students' knowledge of DEIA resources, and (3) augment the perception of diverse backgrounds in orthopaedic surgery.</p><p><strong>Methods: </strong>A 1-day nationwide virtual summit was convened in October 2023. The summit invited residents and faculty leaders of diversity-focused orthopaedic organizations to speak with students in panel discussions and topic-focused breakout rooms. Pre- and postsummit surveys were used to determine whether the summit met the three goals.</p><p><strong>Results: </strong>One hundred ninety-six medical students attended the summit. One hundred seventy-four surveys were received presummit, 106 surveys were received postsummit, and 60 students completed both. Most of the participants were female (n = 109, 63.0%), and many represented URiM backgrounds (n = 70, 41.7%). Postsummit, a notable number of survey respondents increased their knowledge about diversity-related opportunities (3.3% to 40%, P < 0.001). Participants who felt that their identity was welcome in orthopaedics nearly quadrupled from presummit (16.7%) to postsummit (63.3%) ( P < 0.001), and the likelihood of recommending orthopaedic surgery to another medical student from an URiM demographic increased by 58.6% ( P < 0.001). Among the 135 students who did not initially feel that their identity was welcome in the field of orthopaedic surgery, 124 (91.9%) rated changing stereotypes of the field as important to their decision to pursue a career in orthopaedics.</p><p><strong>Conclusions: </strong>This study supports the ability for virtual summits to reach URiM students, increase their knowledge of DEIA resources, and augment their perceptions of diversity in orthopaedics.</p><p><strong>Level of evidence: </strong>IV.</p>","PeriodicalId":51098,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons","volume":" ","pages":"e572-e582"},"PeriodicalIF":2.6,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143617710","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Perioperative Pain Management in Patients Being Treated for Opioid Use Disorder: The Orthopaedic Surgeon's Role and Strategies for Comprehensive Care.","authors":"Emily Benson, Tipu Khan, Hillary Rolfs, Niaz Ahankoob","doi":"10.5435/JAAOS-D-24-00786","DOIUrl":"10.5435/JAAOS-D-24-00786","url":null,"abstract":"<p><p>Approximately 280,000 deaths in this country were attributed to opioid overdose between 1999 and 2021, increasing fivefold within this period. Orthopaedic surgeons have had a large contribution to this epidemic; they have been found to be the third highest prescribers of opioid medications. Multiple pharmacologic and nonpharmacologic treatment options for opioid use disorder (OUD) have been developed. The three most commonly used medications are methadone, buprenorphine, and naltrexone. In part owing to the use of these medications, states such as Oregon have seen a 20% decrease in opioid abuse and a 30% decrease in fatal overdoses. Historically, orthopaedic surgeons receive minimal formal training on managing postoperative pain in patients with OUD. Patients with OUD may experience neuroplastic changes from long-term exposure to opioids, which, in turn, diminish the analgesic effect of opioid medications in the acute postoperative period. Patients become more sensitive to painful stimuli, ultimately leading to loss of opioid efficacy. Undertreating pain may contribute to unnecessary patient suffering and can lead to mistrust within the patient-physician relationship. Overtreating pain may have catastrophic consequences such as disruption of sobriety, respiratory compromise, and death. It is recommended to include a pain management specialist or service during the perioperative period, if possible. This article clarifies the orthopaedic surgeon's role in the perioperative care of this patient population by providing an overview of medications used to treat OUD, pain control strategies, psychosocial concerns, and legal considerations, with the goal of streamlining care to improve patient safety and outcomes.</p>","PeriodicalId":51098,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons","volume":" ","pages":"527-533"},"PeriodicalIF":2.6,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143702065","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Femur Fractures Distal to Long and Short Cephalomedullary Nails: A Comparative Multicenter Study.","authors":"Aleksander P Mika, Ridge Maxson, Andres F Moreno-Diaz, Robert B Ponce, Sean P Wrenn, Cade A Morris, Jonathan C Savakus, Matthew Yeager, Atticus Coscia, Lyle Johnson, Nathaniel Schaffer, Jacquelyn S Pennings, Claudia A Maki, Mark Hake, Joey P Johnson, Phillip M Mitchell","doi":"10.5435/JAAOS-D-24-01052","DOIUrl":"https://doi.org/10.5435/JAAOS-D-24-01052","url":null,"abstract":"<p><strong>Introduction: </strong>Cephalomedullary nails (CMNs) are commonly used to treat intertrochanteric hip fractures. Subsequent fractures distal to an existing CMN are a challenging complication with patterns and management that vary based on nail length. Whether short or long CMNs allow for less complicated surgical revision or better postoperative outcomes is unknown. The aim of this study was to compare the treatment strategies and outcomes of fractures distal to short versus long CMNs.</p><p><strong>Methods: </strong>This multicenter retrospective study identified 58 patients who underwent surgical management of a fracture distal to a short CMN (n = 30) or long CMN (n = 28) following low-energy trauma between 2005 and 2022. Demographics, injury characteristics, and perioperative outcomes were compared between the cohorts. Multivariable linear regression was used to compare outcomes of exchange CMN versus open reduction and internal fixation (ORIF).</p><p><strong>Results: </strong>Most fractures below short CMNs were managed with exchange CMN or a nail-plate combination (58%), whereas most fractures below long CMNs were treated with ORIF (89%). No differences were found between short and long CMN revision surgery in terms of surgical time, estimated blood loss, use of fluoroscopy, transfusion, length of stay, or postoperative complications. Compared with ORIF, exchange CMN was associated with similar odds of needing a transfusion and experiencing a postoperative complication but a greater likelihood of being permitted to bear weight as tolerated after surgery (odds ratio 43.1; 95% confidence interval 4.1 to 457.6) and being discharged home (odds ratio 27.3; 95% confidence interval 2.0 to 367.6).</p><p><strong>Discussion: </strong>This is the largest series of fractures distal to a CMN to date. Surgical morbidity, surgical time, and use of fluoroscopy were similar in patients with short and long CMNs. Although managing these injuries with exchange CMN was associated with comparable morbidity to ORIF, a notable functional advantage was observed with exchange CMN by facilitating earlier full weight-bearing and discharge home.</p>","PeriodicalId":51098,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144129602","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Gender-Based Disparities in Academic Orthopaedic Surgery Physician Compensation in 2023.","authors":"Dhun Chauhan, Joshua K DeYoung, Ezra Goodrich, Kimberly Templeton, Charles S Day","doi":"10.5435/JAAOS-D-24-01256","DOIUrl":"10.5435/JAAOS-D-24-01256","url":null,"abstract":"<p><strong>Background: </strong>Orthopaedic surgery remains one of the least diverse specialties in medicine. Parity in opportunity and recognition are key factors in attracting and retaining a diverse group of individuals in the field. The primary purpose of this study was to assess gender-based discrepancies in total salary compensation by rank for academic orthopaedic surgery faculty.</p><p><strong>Methods: </strong>Aggregate data were obtained from the Association of American Medical Colleges for fiscal year 2023. Mean compensation was compared for orthopaedic surgery faculty and total surgery faculty at all academic ranks based on gender and race.</p><p><strong>Results: </strong>Men received markedly higher total compensation for all ranks except chair within orthopaedic surgery. At the instructor level, men earned an average annual income of $554,245 while women received $229,204, demonstrating a significant pay gap ( P = 0.0019). At the assistant professor (men: $628,346; women: $475,857), associate professor (men: $732,381; women: $575,877), and professor (men: $743,822; women: $472,140) levels, there existed significant pay disparities ( P < 0.0001 for all three academic levels, respectively). At the chief position, men earned an average of $1,185,873 annually while women received $596,270 ( P = 0.0006). Aggregate data for other surgical specialties demonstrated similar results, with women receiving lower total compensation at all ranks compared with men.</p><p><strong>Conclusion: </strong>This analysis of the 2023 American Medical Colleges Faculty Salary Report demonstrates a notable pay differential between men and women in orthopaedic surgery and surgical specialties, in general, across multiple academic levels including instructor, assistant professor, associate professor, professor, and chief of division. Although there has been increasing awareness of gender-based compensation disparities within surgical specialties, particularly in orthopaedic surgery, these disparities are still clearly present.</p>","PeriodicalId":51098,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons","volume":" ","pages":"e563-e571"},"PeriodicalIF":2.6,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143617714","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Writing a Letter of Recommendation Without Bias.","authors":"Brian Feeley, Katherine Bach, Andrew Gatto, Nesa Milan","doi":"10.5435/JAAOS-D-24-00827","DOIUrl":"10.5435/JAAOS-D-24-00827","url":null,"abstract":"<p><p>Letters of recommendation (LORs) play a pivotal role in the highly competitive orthopaedic surgery residency and fellowship applications, with increasing influence amid evolving evaluation metrics. LORs are crucial in providing nuanced insights into applicants' clinical competencies, personal qualities, and potential fit within programs, complementing standardized test scores and academic achievements. However, despite their importance, LORs are susceptible to implicit biases, particularly affecting women and underrepresented minorities. Research underscores disparities in language use, with gender and racial stereotypes influencing adjectival choices and narrative emphasis. Strategies to mitigate bias include adopting a consistent outline, emphasizing agentic and standout adjectives over communal and grindstone traits, and using precise language and specific examples. We advocate for LORs that are detailed, specific, equitable, and avoid stereotypes, aiming to support fair evaluation practices and promote diversity within orthopaedics. By examining current biases and proposing best practices, this review contributes to ongoing efforts to enhance equity in the residency and fellowship selection process.</p>","PeriodicalId":51098,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons","volume":" ","pages":"503-509"},"PeriodicalIF":2.6,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143735841","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}