United States

Introduction
The Journal of the American Academy of Orthopaedic Surgeons (JAAOS) is a high-impact journal that publishes crucial research to inform surgeons’ clinical decision-making. Recent studies examining orthopaedic surgery journals have found a median time to acceptance of 119 days and have found little evidence of nonscientific factors affecting time to publication. The purpose of this study was to determine the median time from submission to acceptance for articles published by the JAAOS and to evaluate factors which may influence time to acceptance.

Methods
All studies published in JAAOS from 2020-2022 were obtained. Abstracts were screened for submission and acceptance dates, and time to acceptance was calculated. Studies were excluded if dates were unavailable. Data extracted included article type, main topic, and sex of the first author. Univariate and multivariate analyses were used to assess time to acceptance. Simple linear regression, analysis of variance (ANOVA), and independent samples t-test were utilized for univariate analysis. For multivariate analyses, a standard least squares regression was applied. 

Results
We analyzed 754 articles. Over the past 3 years, time to acceptance has not significantly changed (p = 0.894). Regarding article type, letters had the shortest time to acceptance (median 5 days, IQR 2-10, p&lt;0.0001), followed by guidelines (median 63.5 days, IQR 20.75-178.25). Interventional studies had the longest time to acceptance (median 171.5 days, IQR 106-309.5), followed by review articles (median 147.5 days, IQR 91.25-214) and observational articles (median 127 days, IQR 87.5-191.5). Articles pertaining to COVID-19 (median 62 days, IQR 2-121), diversity (median 90 days, IQR 24-156), and training (median 92 days, IQR 63.5-150) had the shortest times to acceptance. Articles pertaining to radiology (median 189.5 days, IQR 100-309.5), trauma (median 183 days, IQR 126.5-269.5), and sports (median 157.5 days, IQR 100-269.5) had the longest times to acceptance (p&lt;.0008). Time to acceptance was not significantly different between male and female first authors. 

Conclusion
This study provides a tool for authors to estimate their mean time from submission to acceptance based on the characteristics of their study. With literature submissions constantly increasing each year with unknown times to acceptance, authors may make a more informed decision with journal selection based on the qualities of their study.

AMA Research Challenge 2024 

Factors for Predicting Time to Acceptance in the JAAOS

Introduction
The Journal of the American Academy of Orthopaedic Surgeons (JAAOS) is a high-impact journal that publishes crucial research to inform surgeons’ clinical decision-making. Recent studies examining orthopaedic surgery journals have found a median time to acceptance of 119 days and have found little evidence of nonscientific factors affecting time to publication. The purpose of this study was to determine the median time from submission to acceptance for articles published by the JAAOS and to evaluate factors which may influence time to acceptance.

Methods
All studies published in JAAOS from 2020-2022 were obtained. Abstracts were screened for submission and acceptance dates, and time to acceptance was calculated. Studies were excluded if dates were unavailable. Data extracted included article type, main topic, and sex of the first author. Univariate and multivariate analyses were used to assess time to acceptance. Simple linear regression, analysis of variance (ANOVA), and independent samples t-test were utilized for univariate analysis. For multivariate analyses, a standard least squares regression was applied. 

Results
We analyzed 754 articles. Over the past 3 years, time to acceptance has not significantly changed (p = 0.894). Regarding article type, letters had the shortest time to acceptance (median 5 days, IQR 2-10, p<0.0001), followed by guidelines (median 63.5 days, IQR 20.75-178.25). Interventional studies had the longest time to acceptance (median 171.5 days, IQR 106-309.5), followed by review articles (median 147.5 days, IQR 91.25-214) and observational articles (median 127 days, IQR 87.5-191.5). Articles pertaining to COVID-19 (median 62 days, IQR 2-121), diversity (median 90 days, IQR 24-156), and training (median 92 days, IQR 63.5-150) had the shortest times to acceptance. Articles pertaining to radiology (median 189.5 days, IQR 100-309.5), trauma (median 183 days, IQR 126.5-269.5), and sports (median 157.5 days, IQR 100-269.5) had the longest times to acceptance (p<.0008). Time to acceptance was not significantly different between male and female first authors. 

Conclusion
This study provides a tool for authors to estimate their mean time from submission to acceptance based on the characteristics of their study. With literature submissions constantly increasing each year with unknown times to acceptance, authors may make a more informed decision with journal selection based on the qualities of their study.

poster

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Background
Historically, women are underrepresented in the field of orthopedic surgery. To evaluate progress in this area, it is important to assess not only representation but also activity at high profile orthopedic conferences in the field.
Methods
Poster presentations from the 2023 and 2024 AAOS annual meetings were identified via the AAOS ePoster archive. First, second and last authors were recorded for each poster that met inclusion criteria. For each author included in the data, gender was determined and recorded. In addition gender, degree title (as listed on the AAOS website) was recorded, including authors’ AAOS membership status if listed. The Elsevier database, Scopus, was used to determine each authors’ academic influence at the time of data collection. H-indexes, an author specific metric that evaluates scientific output based on publications and citations, were recorded for each author.
Results
Chi-squared analysis for independence revealed a statistically significant difference in distribution of authorship positions by sex (P=0.03). Using a student's T-test, H-index for male first authors (M = 9, SD = 8) were found to be significantly higher than that for female first authors (M = 5, SD = 6), P < .001. Similar trends were observed for second authors (male: M = 10, SD = 8; female: M = 8, SD = 7), P < .001, and senior authors (male: M = 27, SD = 19; female: M = 17, SD = 18), P < .001. There was also a statistically significant difference in the proportion of male and female authors between the two years (P=0.03). Finally, there was an increase in the proportion of female authors from 14.3% in 2023 to 16.3% in 2024.
Conclusion
In our analysis of the two most recent AAOS summit authorship data, male authors dominate all authorship positions—first author, second author, and senior author. This disparity is most pronounced in the senior author role, where only 9.6% of senior authors are female. These findings further underscore a persistent gender imbalance in authorship positions at the AAOS annual meeting. Additionally, male authors generally have higher citation impacts than their female counterparts across all author positions. An increase in the proportion of female authors from 14.3% in 2023 to 16.3% in 2024 indicates a positive trend toward greater female representation in orthopedic presentations at the AAOS annual meeting. This significant increase suggests ongoing efforts to promote gender diversity in the field, which remains predominantly male.

Representation of Female Authorship to Evaluate Gender Diversity in Orthopedics

Background
Lumbar fusion has long been the gold standard operation for degenerative disc disease; however, lumbar disc replacement has recently gained popularity due to its motion-sparing benefits and increasing patient demand influenced by social media. The social media platform X (formerly Twitter) is widely used in healthcare for sharing patient experiences, and sentiment analysis can assess the emotional tone of these tweets to gauge public perception of medical procedures. The aim of this study was to analyze tweets referencing lumbar fusion and lumbar disc replacement to evaluate the tone of the content and to assess the trend of patient preference for disc replacement over fusion.

Methods
All tweets containing keywords most frequently adopted in discussions related to lumbar fusion and disc replacement were collected from January 2013 through August 2023. These phrases included: lumbar fusion, lumbar arthrodesis, lumbar interbody fusion, lumbar disc replacement, lumbar disk replacement, total disc replacement, total disk replacement, lumbar disc arthroplasty, lumbar disk arthroplasty, total disc arthroplasty, and total disc arthroplasty. Sentiment analysis was then performed using TweetNLP, a cutting-edge natural language processing library, and sentiment analysis time series plots were created. ANOVA was used for combined sentiment analysis, and the Wilcoxon Rank-Sum test for time series plots.

Results
There were 7377 and 1572 tweets mentioning lumbar fusion and lumbar disc replacement, respectively. Sentiment analysis demonstrated 1254 positive, 1389 negative, and 4734 neutral lumbar fusion related tweets (p < 0.001). For lumbar disc replacement, there were 248 positive, 113 negative, and 1211 neutral tweets (p < 0.001). The percentage of positive tweets each month was slightly higher for lumbar fusion (16.16% ± 7.28%) compared to disc replacement (15.20% ± 14.41%), while negative sentiment was 2.6 times higher for lumbar fusion (17.79% ± 8.42%) than disc replacement (6.77% ± 7.89%) (p < 0.001), with a continued rise over the past 5 years.

Conclusion
Over the past decade, patients have increasingly used X to share opinions on lumbar fusion vs. disc replacement. Though the number of tweets discussing lumbar fusion outnumber those of disc replacement, there has been considerably more negative sentiment across tweets discussing lumbar fusion. This trend may reflect the growing preference for disc replacement among patients, and spine surgeons should recognize the influence of social media on patient perceptions and its potential impact on their practice.

Understanding Public Perception Through Natural Language Processing: Lumbar Fusion vs. Disc Replacement

Strong physician communication skills are an essential component to physician training that help strengthen patient satisfaction and health outcomes. Our study will analyze how implementation of a communication training program into standard medical education conferences will improve physician-patient communication skills and overall patient satisfaction. Our study has three goals: to improve physician-patient relations through a strong communication curriculum focused on relationship centered care and empathy, to build a strong foundation in physician-patient communication skills using communication tools, and to assess resident comfort level before and after interventions with education on physician communication skills. Our QI project followed a group of pediatric residents and attendings through a 10-month, block-based curriculum with each month catered towards a specific communication goal. Participants completed monthly surveys throughout the intervention to assess for efficacy and a post-intervention survey was administered to assess for changes in resident comfort in utilizing communication techniques. Through the mid-intervention survey’s, an increased number of individuals began utilizing these techniques and subjective level of comfort with these phrases was widely noted. Our study reinforces the importance of integrating hands-on, cumulative communication education and emphasizes how helpful techniques can create stronger doctor-patient relationships and more confident, empathetic physicians.

Pediatric Implementation of a Standardized Physician Communication
Curriculum

Background: Positional plagiocephaly, characterized by cranial asymmetry, has increased significantly following the implementation of the Back-to-Sleep campaign. While this initiative successfully reduced the incidence of Sudden Infant Death Syndrome, it inadvertently led to a 5-fold increase in plagiocephaly cases. This condition can result in aesthetic concerns, psychosocial issues, and functional challenges, including difficulties with headgear fitting. Despite its prevalence, many parents and caregivers remain unaware of plagiocephaly and its prevention strategies. This study aims to assess the impact of targeted parental education on plagiocephaly prevention and to provide evidence-based recommendations for clinical practice.

Methods: Our prospective, randomized control trial included full-term newborns (≤14 days old) without congenital craniofacial anomalies. Subjects were randomly assigned to intervention (n=75) or control (n=75) groups using a computer-generated randomization sequence. The intervention group received a comprehensive educational package consisting of an informative pamphlet and a 3-minute video on plagiocephaly awareness, risk factors, and prevention strategies. The control group received standard care without additional educational materials.

Cephalic index, calculated from head circumference, biparietal diameter, and anteroposterior diameter, was assessed at enrollment and subsequent 2, 4, and 6-month well-child visits. The primary outcome measure was the difference in cephalic index between groups at the 6-month follow-up. 

Results: Our institution's previous pilot study (n=39) demonstrated a statistically significant difference in cephalic index between intervention and control groups. The intervention group showed a smaller average cephalic index, indicating reduced plagiocephaly incidence. The interim findings are limited by gaps in the 2, 4, and 6-month follow-up data. Our goal is to complete data collection for all 150 patients by year-end, which will reinforce the statistical significance of the study and allow for more robust conclusions. Currently, forty new subjects have been enrolled (n=79) and 18 two-month follow-ups have been completed. While preliminary analysis of this additional data is ongoing, it is premature to draw definitive conclusions about its statistical impact on the overall study results.

Conclusion: Our interim findings indicate that targeted parental education may effectively reduce plagiocephaly incidence and improve long-term cranial development outcomes. This study underscores the importance of preventive education in pediatric care and its potential to mitigate an avoidable condition with long-term implications. The educational intervention appears to enhance parental knowledge and promote adherence to preventive measures.


Impact of Parental Education on Positional Plagiocephaly Prevention: A Randomized Controlled Trial

Background
Annually, close to 290,000 adult patients experience in-hospital cardiac arrest in the United States. Internal medicine residents in our program felt the need for code blue training and simulation sessions to run in-hospital cardiac arrest. We conducted a quality improvement project to enhance residents’ knowledge, readiness, and confidence in leading code blue.

Methods
Residents had mock code simulation sessions every three months over 9 months (July/2023-April/2024) at Northwestern Medicine Huntley Hospital's simulation lab. In each session, residents were divided into two teams. These sessions aimed to be interactive, one team performed a scenario during each session while the other team observed, followed by a debriefing session to discuss what went well and what could be improved. The simulations focused on the roles of code blue leaders, rhythm recognition, and ACLS protocols. Pre-mock code session surveys were emailed to residents to assess their overall knowledge of ACLS protocol (medications, doses, ability to do other tasks like chest compressions, recording...) and confidence in leading code blue. Surveys included questions with a rating scale from (1-5). Following the mock code sessions, we sent post-session surveys that mirrored the initial ones, to reevaluate residents’ knowledge after the intervention.
We used McNemar’s test to determine the significance of change between the 2 surveys before and after intervention. 

Results
Of the 39 residents in our internal medicine residency program, 86.8% felt that code blue simulations significantly helped them. A significant increase was observed in residents' knowledge of code blue leader roles with 42.1% feeling "Very knowledgeable" compared to 3% before (p = 0.05). Confidence in leading code blue also rose significantly with 44.7% feeling "Confident" compared to 18.1% before the intervention (p = 0.008). Knowledge of the ACLS algorithm improved significantly with 44.7% feeling "Very Knowledgeable" compared to 18.1% before (p = 0.025). Knowledge of ACLS medications and doses also increased significantly with 29% feeling "Very Knowledgeable" compared to none before (p = 0.011). While there was no significant change in interpreting rhythm strips during a code blue, more residents reported running code more frequently post-intervention (42% vs 30.3%).

Conclusion
Most residents believed that code blue simulation sessions helped them run code blue confidently. Residents' confidence in leading code blue and knowledge of the ACLS algorithm increased after mock code simulation sessions. We anticipate that this project will positively impact patients’ outcomes following in-hospital cardiac arrest. Therefore, we plan to continue conducting these sessions annually for incoming interns.

Optimizing Internal Medicine Residents Response to In-Hospital Cardiac
Arrest: A Quality Improvement Project

Appropriate use of radiological studies is of utmost importance in medical practice, guiding care and reimbursement. The American College of Radiology Appropriateness Criteria (ACR-AC) is a free, online evidence-based resource dedicated to supporting practitioners with radiology decision-making. However, this resource has historically been underutilized by physicians and medical students, with those groups often opting to use alternative resources such as UpToDate
(UTD). Increasing awareness and user-friendliness of the ACR-AC within medical education is necessary to integrate regular use of this resource in practice. This study seeks to investigate medical student performance with and perception of the ACR-AC and UpToDate when presented with radiology decision-making cases.

Methods
First-year osteopathic medical students were presented with a clinical case and utilized either UpToDate or ACR to assist in determining the most appropriate imaging modality for the case. Following the case, students were surveyed to assess their familiarity with each resource, its effectiveness in establishing a differential diagnosis, ease of selecting the appropriate imaging, perceived usefulness, impact on confidence in imaging selection, and likelihood of future utilization. The accuracy of their decisions was also evaluated based on which resource they used. 

Results
Our survey had 82 respondents for the UTD group, and 83 respondents for the ACR group. The results showed that more students have used UTD over ACR coming into the study (20% vs 8%, p=0.01). The students also more strongly agreed that UTD was more helpful in establishing a differential diagnosis for the cases (56.1% vs 49.4%, p= 0.04). However, students found that ACR was easier to use as a resource for determining the appropriate imaging modality (3.9 vs 4.2, p=0.02). The accuracy of the tests showed a trent towards significance with case one showing 92.1% correct vs 82.6% with UTD (p=0.06) and 84.9% vs 75.6% on case two (p=0.13). 

Conclusion
The awareness of imagining resources among first year medical students is generally low. Following a case presentation, students more strongly agreed that UTD is a more helpful resource in establishing a differential diagnosis. However, students found that ACR was easier to use to determine the appropriate imaging modality. The results also showed a trend towards significance with students making more accurate decisions utilizing ACR over UTD.

Comparing ACR Appropriateness Criteria and UpToDate in Medical Student Radiology Decision Making

Introduction
While the proportion of women in surgery has grown, more than 90% of practicing cardiothoracic surgeons are men. The 2010s and early 2020s have witnessed a heightened awareness of gender disparity, with increased focus placed on career mentorship. We sought to examine the current landscape of female representation at different points along the cardiothoracic surgery training and career path.

Methods
Medical student, resident, and active practice surgeon demographics were obtained from the AAMC. We identified five major U.S. cardiothoracic surgical societies, noting members of all committees. Gender was probabilistically determined using Gender Guesser (NamSsor SAC LLC, France), a commercially available artificial intelligence tool.

Results
We identified 456 individuals occupying both junior and senior level committee positions across five major US cardiothoracic surgical societies. Of committee members, 78 (26%) were identified as likely female. Among committee chairs and executive leadership boards, 48 individuals (31%) were likely female. Gender probability ranged from​​ 0.52-0.99 across the cohort, with average probability of 0.95. Female ACGME thoracic surgery residents represented 29.5% of the incoming class in 2023. Comparatively, women were noted to account for only 8.3% of active thoracic surgeons. Across a composite of ACS recognized surgical subspecialties with AAMC data (General, Neurological, Orthopedic, Plastic, Thoracic and Vascular, Obstetrics and Gynecology, Ophthalmology, Otolaryngology, Urology, Sports Medicine (Orthopedic Surgery)) women accounted for 29.1% of all practicing surgeons in the US.

Conclusion

While gender distribution in cardiothoracic surgery shows balance at early career stages, current practice remains skewed. Despite this, women are present and active at junior and senior levels within major cardiothoracic societies. The presence of women in leadership roles from which they may provide mentorship and guidance may be positively influencing career choices of trainees.


Gender Trends in Cardiothoracic Surgery: Examining Female Participation in Training, Practice, and Leadership Roles

Medical students' involvement in research is crucial for their professional development, yet challenges often hinder their access to meaningful opportunities. Mentorship and connection with research personnel enhance student research involvement, but facilitating these connections poses a common obstacle for students.
A committee comprising six medical students and four faculty advisors created a cutting-edge Microsoft database, compiling contact details, areas of expertise, and projects of researchers open to mentoring medical students. This platform serves as a bridge, connecting faculty needing research assistance with students seeking experience. Powered through the Microsoft Universe, it empowers students to select mentors aligned with their objectives and skills.
The committee also crafted student researcher online profiles, illuminating the pathways of success for underclassmen. Moreover, in-person mentorship sessions led by upperclassmen became hubs of knowledge exchange by imparting research skills and insider insight.
Emphasizing continuous improvement, the committee embraced feedback loops and surveys, including collaborative efforts with faculty-administered surveys, to capture the nuanced perspectives of students on the accessibility of research.
The creation of a Microsoft database, mentorship sessions, and student researcher profiles has generated a catalog of over fifty established researchers eager to mentor students. A list of 45 projects across six different departments has been compiled, each spearheaded by a faculty member who is ready to invest in student success. Three student-led mentorship sessions have been held, covering topics such as research methodology and its impact on specialty choice, with plans to continue events monthly. Surveys indicated all attendees found the events beneficial and hoped to attend more. Additionally, nearly 20 student researcher profiles have been published on an institution-associated website, promoting collaboration and transparency. Profiles include contact details, enabling other students to have increased approaches to research-based networking and knowledge.
Three avenues, a Microsoft Universe powered database, student-led mentorship sessions, and student research profiles, each offer a unique route of mentorship that together make medical student research easier to navigate. The database distinctly connects students and faculty, fostering long-lasting relationships with added faculty expertise. Mentorship sessions allow upperclassmen to disburse insight to a large group, while student profiles promote one-on-one mentorship, encouraging conversation and tailored collaboration. Together, these three cornerstones, each offering a unique form of mentorship, synchronize to create a strong foundation for medical students to navigate and succeed in research.


A Student-Led Database and Mentorship Model for Facilitating High Quality Research

Background
Biostatistics is an increasing focus in current medical school curricula, even appearing as a topic on the United States Medical Licensing Exam Steps 1, 2, and 3 (USMLE). Physicians already in practice who did not have the benefit of biostatistics training in medical school likely can benefit from clarification and instruction of statistical methods. The goal of the study is to document and evaluate statistical methods utilized in a high-impact factor Journal, then to develop a guide to those statistics that can be applied to facilitate the interpretation of statistics for practicing physicians, fellows, residents, and medical students. 

Methods 
In Part I of our tandem manuscripts, the 100 most recent primary articles, dating from February 2021 to December 2021, were extracted and analyzed from the Journal of Intensive Care Medicine. The evaluation consisted of study temporality, study design, types of descriptor variables, and types of statistical tests. Statistical analyses was conducted using the Fisher’s Exact test with p-values <0.05 considered statistically significant.

Results
Retrospective studies were most common (75/100, 75%), followed by prospective (23/100, 23%), and cross-sectional studies (2/100, 2%). The most popular designs were cohort (82/100, 82%), followed by case series (9/100, 9%), randomized control trials (4/100, 4%), and case-control (3/100, 3%). The most commonly utilized descriptor variables were frequency and proportion (100/100, 100%), followed by both median (74/100, 74%), average (71/100, 71%), and interquartile range (68/100, 68%). The chi-square test was the most frequently used statistical test (59/100, 59%), while logistic regression (48/100, 48%), Mann-Whitney-U (46/100, 46%), and two-sample independent t-test (40/100, 40%) also were popular. A subgroup analysis of cohort studies showed higher use of the chi-square test (44/63, 70% vs 8/19, 42%; p = 0.03) and logistic regression (40/63, 63% vs 5/19, 26%; p = 0.008) in retrospective compared to prospective studies.

Conclusion 
This review of statistics used in 100 primary journal articles revealed that retrospective and cohort studies were utilized most frequently. The chi-square test was used in the majority of studies, particularly in retrospective cohort studies. This information can help determine areas in which supplemental training will be most beneficial to improve the understanding of statistical methods in medical journals by practicing physicians, fellows, residents, and students. As an outgrowth of this study, we have developed a practical guide to relevant statistical methods serving as part 2 of this double manuscript, and plan to conduct a larger study based on this methodology.

Analysis of Statistics Utilized in Primary Articles in the Journal of Intensive Care Medicine: A Prelude to Practical Pedagogy in Biostatistics

Abstract Title:
Addressing Training for Medical Students to Cope with Traumatic Situations
Background:
‘Second victim phenomenon’ refers to feelings of guilt or failure following an unanticipated outcome or error. This phenomenon is prevalent in the medical field, with some articles stating that over half of healthcare workers experience a ‘second victim phenomenon’ at least once in their career.
Within medical school curriculums, students learn to identify many diseases and disorders. Despite this extensive coverage, there remains a significant gap in preparing medical students for the inevitable trauma they will face as physicians. 
Methods:
A systematic literature review was performed. Informal and small group discussions from professional meetings were conducted. We then created an IRB-approved survey to send to medical students of all four years at six MD/DO schools throughout Virginia. The survey is open for two weeks and includes questions that ask how prepared students feel to cope with traumatic events, whether their school currently has a curriculum that teaches healthy coping mechanisms, and whether they believe a formal curriculum should be implemented.
Results:
Our preliminary data revealed 86.1% of 2287 newly graduated residents in 2015 reported feeling comfortable presenting physical exams, and 92.3% felt prepared to take patient histories. Only 46.3% of these residents felt prepared to cope with death, and only 34.1% felt capable of managing their fatigue. In a 2019 study, 534 internal medicine residents were surveyed. 90% reported that they had never heard of ‘second victim phenomenon’ prior to the study. After learning what it was, 59% of these residents reported experiencing at least one or multiple ‘second victim’ events during their careers. 12% (n=287) either required more than a year to recover or never recovered.
At a professional meeting in April 2024, several topic experts agreed that a curriculum is necessary, and one resident agreed that he and his colleagues have experienced ‘second victim phenomenon.’
Preliminary data from our survey is showing that 95.7% of medical students voted to include educational resources on healthy coping mechanisms during their time in school, with 60.9% of these students responding that they would prefer a mandatory course.
Conclusion:
This study aims to not only bring awareness to mental health challenges associated with a career in medicine but to also work with topic experts to implement a curriculum within medical schools. Addressing this issue is crucial, as the well-being of physicians directly impacts patient care. Providing students with a curriculum is a strong step forward in preparing physicians for the psychological demands of this profession.

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Factors for Predicting Time to Acceptance in the JAAOS

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Representation of Female Authorship to Evaluate Gender Diversity in Orthopedics

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