Gender Disparity in Composition and Compensation Among Maryland Hospital Executives

Introduction: Senior executive positions in hospitals have traditionally been held by men, and do not reflect the gender, racial, ethnic, and cultural diversities of the communities they serve. Despite sex parity in medical school graduates, women remain underrepresented in hospital executive leadership positions. In this study, the authors examined differences in gender composition and compensation of Maryland hospital executives. Methods: The authors examined 47 Maryland hospitals’ publicly available tax forms from 2013-2018. Data collected included hospital revenue and executive positions’ count, salary, and gender. Executive positions included President and/or Chief Executive Officer (P/CEO), Chief Financial Officer (CFO), Chief Medical Officer (CMO), Chief Nursing Officer (CNO), and Chief Operating Officer (COO). All monetary values were inflation-adjusted to the 2017 dollar. Results: Women executives were underrepresented across most roles: P/CEO (41/272, 15%), CFO (72/260, 28%), CMO (28/182, 15%), and COO (44/147, 30%). CNO showed a higher proportion of women executives (129/140, 92%). There were no significant changes in the proportion of women executives over the study period (p=0.19). Men CNO’s had significantly higher salaries as a percentage of hospital revenue (0.16% vs 0.12%, p=0.04) and men COOs had significantly higher salaries as a percentage of hospital positive profit (3.65% vs 2.24%, p\u3c0.01). Conclusion: Data from Maryland hospitals suggest that women remain underrepresented in healthcare executive roles. Further, women executives are generally undercompensated compared to men in similar roles. This study further highlights the need for mentorship and dedicated career pathways to improve women representation in leadership roles in healthcare

Use of the Behavior Assessment Tool in 18 Pilot Residency Programs

Background: The purpose of this study was to determine the feasibility and evaluate the effectiveness of the American Board of Orthopaedic Surgery Behavior Tool (ABOSBT) for measuring professionalism. Methods: Through collaboration between the American Board of Orthopaedic Surgery and American Orthopaedic Association\u27s Council of Residency Directors, 18 residency programs piloted the use of the ABOSBT. Residents requested assessments from faculty at the end of their clinical rotations, and a 360° request was performed near the end of the academic year. Program Directors (PDs) rated individual resident professionalism (based on historical observation) at the outset of the study, for comparison to the ABOSBT results. Results: Nine thousand eight hundred ninety-two evaluations were completed using the ABOSBT for 449 different residents by 1,012 evaluators. 97.6% of all evaluations were scored level 4 or 5 (high levels of professional behavior) across all of the 5 domains. In total, 2.4% of all evaluations scored level 3 or below reflecting poorer performance. Of 431 residents, the ABOSBT identified 26 of 32 residents who were low performers (2 or more \u3c level 3 scores in a domain) and who also scored below expectations by the PD at the start of the pilot project (81% sensitivity and 57% specificity), including 13 of these residents scoring poorly in all 5 domains. Evaluators found the ABOSBT was easy to use (96%) and that it was an effective tool to assess resident professional behavior (81%). Conclusions: The ABOSBT was able to identify 2.4% low score evaluations ( Level of Evidence: Level II

Resident Selection: An Orthopaedic Program Director Survey

As the competitiveness of orthopaedic surgery residency increases, we sought to determine whether program and Program Director (PD) characteristics influence candidate selection. This novel 19-question survey reviews PDs\u27 opinions and practices in resident selection. Response rate was 31% (63/203). Performance during orthopaedic rotations, United States Medical Licensing Examination (USMLE) scores, and clerkship honors were the top three ranked criteria, with USMLE scores used to screen candidates for interviews (70%) and rotations (43%). PDs practicing \u3c 10 years felt USMLE scores reflect resident quality, while those practicing \u3e10 years felt they reflect ability to pass the American Board of Orthopaedic Surgery exam. Most (81%) accept applicants with low scores. PDs \u3e 66 years old emphasized academic honors and Dean\u27s letters, PDs 46-55 emphasized conscientiousness, and PDs practicing \u3e21 years emphasized dexterity. PD demographics such as age, time in practice, and geographic location affect how they approach candidate selection. (Journal of Surgical Orthopaedic Advances 31(1):042-047, 2022)

Orthopaedic Surgery Residency Application, and Selection Criteria Adaptations, in Times of COVID-19 A Survey Study

Amid the COVID-19 pandemic, medical education and residency application have faced unprecedented changes. This has forced residency directors to alter their selection criteria in the absence of away rotations and the implementation of nationwide virtual interviews. PURPOSE: The purpose of this study was to assess how residency directors have adapted their selection criteria in light of this unique application cycle and to look at the effect, and future, of the different changes. METHODS: A 16-question online survey was disseminated to 31 residency programs gathering data about new opportunities offered this cycle, changes to selection criteria, match outcomes, as well as the number of applicants to their program. RESULTS: Twenty-nine respondents completed the survey (94% response rate). There was a significant rise in the number of applications received by programs this cycle (p < 0.05). Programs have unanimously altered their selection processes. The biggest changes in selection criteria were putting more weight into communication from mentors, emails from the applicants, home applicant status, and virtual information session attendance. Some programs used additional application requirements beyond Electronic Residency Application Service, which were often uncompleted, and cut the number of eligible applications by up to 46%. Among the new opportunities offered this cycle, virtual information sessions and social media platforms seem to be the most commonly offered and are anticipated to grow. DISCUSSION AND CONCLUSION: Orthopaedic surgery residency continues to become more competitive with a significant rise in the number of applications during the COVID-19 pandemic. Amid this increasingly demanding virtual application cycle, a holistic application review was more challenging. More weight was put that cycle into communication from faculty mentors, emails from the applicants, home applicant status, and virtual information session attendance. Supplementary applications and virtual informative opportunities are likely to last and change the future of the orthopaedic surgery residency application process

Do Resident Surgical Volumes and Level of Training Correlate with Improved Performance on Psychomotor Skills Tasks: Construct Validity Testing of an ASSH Training Platform (STEP)?

Background:. The Surgical Training and Educational Platform (STEP) was developed by the American Society for Surgery of the Hand (ASSH) as a cost-effective set of surgical simulation modules designed to assess critical skills in hand surgery. Previous study demonstrated that STEP can differentiate between novice trainees and board-certified, certificate of added qualification hand surgeons. The purpose of this study was to assess construct validity of STEP by testing its ability to differentiate psychomotor skill level among intermediate trainees. Methods:. We evaluated 30 residents from 2 orthopaedic residency programs on 8 modules: (1) lag screw fixation, (2) depth of plunge during bicortical drilling, (3) flexor tendon repair, (4) phalangeal fracture pinning, (5) central axis scaphoid fixation, (6) full-thickness skin graft harvest, (7) microsurgery, and (8) wrist arthroscopy. Spearman correlation was used to correlate total and task-specific scores to case log numbers, months in training, and number of hand surgery rotations. Results:. Senior residents had significantly higher mean number of total cases in their total case log (mean difference 96.2, 95% confidence interval [CI] 67.5-124.8, p < 0.01) and number of task-specific cases. Moderate correlation was observed between case log numbers and scaphoid fixation score (rs = 0.423, 95% CI 0.07-0.69) and total score (rs = 0.584, 95% CI 0.25-0.79). Moderate correlation was observed between months in training with: scaphoid fixation (rs = 0.377, 95% CI 0.01-0.66) and microsurgery (rs = 0.483, 95% CI 0.13-0.73); strong correlation was seen with total score (rs = 0.656, 95% CI 0.35-0.83). Moderate correlation with number of hand surgery rotations was observed with tendon repair (rs = 0.362, 95% CI −0.01 to 0.65), skin graft (rs = 0.385, 95% CI 0.01-0.66), wrist arthroscopy (rs = 0.391, 95% CI 0.02-0.67), microsurgery (rs = 0.461, 95% CI 0.10-0.71), and scaphoid fixation (rs = 0.578, 95% CI 0.25-0.79); and strong correlation was seen with total score (rs = 0.670, 95% CI 0.37-0.84). Discussion/Conclusion:. The STEP is a validated ASSH education tool that provides a cost-effective simulation for the assessment of fundamental psychomotor skills in hand surgery. Total STEP score correlated with total task-related case volumes as well as months in training and number of hand rotations. Scoring could be modified to improve the fidelity of assessing surgical performance. And, while both time and human resource consuming to perform, administer, and score, this study demonstrates construct validity of STEP in assessing the progression of surgical skill through residency