On the Unequal Burden of Obesity: Obesity's Adverse Consequences Are Contingent on Regional Obesity Prevalence.

Obesity has adverse consequences for those affected. We tested whether the association between obesity and its adverse consequences is reduced in regions in which obesity is prevalent and whether lower weight bias in high-obese regions can account for this reduction. Studies 1 and 2 used data from the United States (N = 2,846,132 adults across 2,546 counties) and United Kingdom (N = 180,615 adults across 380 districts) that assessed obesity's adverse consequences in diverse domains: close relationships, economic outcomes, and health. Both studies revealed that the association between obesity and its adverse consequences is reduced (or absent) in high-obese regions. Study 3 used another large-scale data set (N = 409,837 across 2,928 U.S. counties) and revealed that lower weight bias in high-obese regions seems to account for (i.e., mediate) the reduction in obesity's adverse consequences. Overall, our findings suggest that obesity's adverse consequences are partly social and, thus, not inevitable.

Implementation of a Urologic Surgery Skills Fair for Medical Students.

OBJECTIVES: To increase the proportion of applicants to urology residencies, we created a surgical skills fair to introduced urology early in undergraduate medical education. DESIGN: Funded by the Department of Urology, the fair was designed to have student rotations through 12 hands-on practice stations supervised by faculty and an advanced care practitioner or resident physicians. At conclusion, medical students completed a voluntary survey about their experience. SETTING: Surgical skills fairs were organized at Yale School of Medicine (New Haven, CT) in 2022 and 2023. PARTICIPANTS: The fair was designed to encourage interaction between medical students, urology residents, and urology faculty by highlighting common urologic procedures and skills. RESULTS: The fair was well received by medical students at all levels of training. Over 2 years, 155 medical students attended, including 67 (43%) first-year and 60 (39%) second-year medical students. Eighty-two medical students completed the survey. An average of 19 attendings, advanced care practitioners and residents attended each event. Of the survey respondents, 42.7% reported prior interest in a surgical specialty but had not considered urology. Students reported increased interest in urology and greater confidence in urologic skills after the event (p < 0.001). CONCLUSIONS: We demonstrate that creating a surgical fair in urology is feasible and enhances early exposure and interest in urology. For students who do not pursue urology, the fair provides knowledge of urological pathologies and valuable skills for all physicians.

Geographical Distribution of Osteopathic Neurosurgery Residents.

INTRODUCTION: The neurosurgery residency match has grown increasingly competitive, especially for osteopathic (DO) medical students, amidst the transition to a single accreditation system in 2020. This shift required former American Osteopathic Association (AOA) programs to apply for Accreditation Council for Graduate Medical Education (ACGME) accreditation, leading to a notable reduction in programs with a history of accepting DO applicants. This study aims to explore both potential geographical trends in residency match among recent DO neurosurgical residents and in the number of DO neurosurgical residents pre- and post-ACGME merger. METHODS: Neurosurgery residency programs during the 2023-2024 academic year were identified, and each program's residents, resident degrees, and resident post-graduate years were collected from residency programs' websites. Descriptive statistics were used to analyze the ratios of DO and allopathic (MD) residents, while regression analyses were used to determine the trends in DO residents between 2017 and 2024. DO residents were also collated by state to observe their geographical distribution. RESULTS: A comprehensive cross-sectional analysis of 115 neurosurgery residency programs across the United States from 2016 to 2024 reveals a significant decrease in DO residents, from 14 in 2016 to four in 2024, with an average of six DO residents per year post-merger. A geographical heatmap analysis pinpointed New Jersey, Michigan, and California as states with the highest proportions and numbers of DO neurosurgery residents. CONCLUSION: These findings show the geographical distribution of DO neurosurgery residents in the US. Recognizing and understanding these geographical trends could be essential in the strategic application planning for DO candidates and the need for residency programs to reassess selection criteria to be more inclusive of DO applicants.

The colour stability of 3D-printed, non-invasive restorations after 24 months in vivo - esthetically pleasing or not?

OBJECTIVES: The aim of the present prospective study was to evaluate the colour stability of 3D-printed non-invasive restorations after 24 months in vivo. METHODS: The study included 29 patients, who received 3D-printed restorations made of a computer-aided design (CAD) / computer aided-manufacturing (CAM) hybrid material (n=354). Restoration colour of 190 restorations was measured using a spectrophotometer. By applying the CIELAB system, *L (lightness), a* (red-green) and b* (blue-yellow) values were recorded. An evaluation of the colour differences (ΔE) after 6, 12 and 24 months was conducted. RESULTS: Analysis of colour differences of 3D-printed restorations showed continuous discolouration of the restorations. After one year 34% and after two years 18% of the restorations were rated alpha or bravo, indicating no or hardly visible colour change. After two years, 54% of the evaluated restorations yielded a colour difference with ΔE > 6.8 (delta). More than 82% of the evaluated restorations showed values between ΔE 3.8 - 6.8 (charlie) and ΔE ˃ 6.8 (delta) after two years. CONCLUSIONS: 3D-printed non-invasive restorations showed an overall reduced colour stability after 24 months in vivo. CLINICAL SIGNIFICANCE: The present study provides first clinical data regarding 3D-printed restorations. These restorations are recommended for a wearing time of about 6 months.

Obstetrics and Gynecology Residency Geographic Match Location Patterns: Comparison of Pre and Post Virtual Interviews.

OBJECTIVE: To evaluate the impact of virtual interviews on geographic trends for applicants and programs in the obstetrics and gynecology (OBGYN) resident match. DESIGN: Cross-sectional study of a random 50% sample of all OBGYN residency programs listed by the Accreditation Council for Graduate Medical Education (ACGME) for the 2023 to 2024 academic year. Data collected from each program included geographic location, number of residents per year, and total number of residents. Residents were categorized into 4 mutually exclusive geographic match categories: matched into the same institution, matched into same state (but different institution), matched into the same US Census region but a different state/institution, or matched into a different US Census region. RESULTS: A total of 148 of 295 (50.2%) residency programs were included (known total number of residents = 2,928 from four US census regions and Puerto Rico). Most programs were considered small (≤16 residents; n = 52, 35.1%). In general, 43.9% (1148 of 2617) residents matched in a different region from their medical school training. For the primary outcome, no differences in the geographic placement in the previrtual (2020) and virtual application cycles (2021-2023) were observed (p = 0.51). When analyzed by program size or program region, there was no difference in the geographic placement in the previrtual and virtual application cycles. CONCLUSIONS: This study suggests that the virtual interview process did not demonstrate an impact on geographical placement of OBGYN residents, regardless of the size of the residency program or the program's geographic region.

How Match-Related Variables Influence the Physical Demands of Professional Female Soccer Players during the Regular Season.

To investigate how contextual or environmental factors may influence the athletic performance of female soccer players during competitions, this study aimed to assess the impact of match-related variables (playing surface; opponent levels; opponent result trends; match status, and match outcomes) on the athletic performance of professional female soccer athletes. Seventeen athletes (25.5 ± 4.3 years of age) from the same team competing in the Italian second division were divided into two groups according to their roles and athletic characteristics: Group A (central defenders and forwards) and Group B (right/left full-backs and midfielders). Total distance (TD) and sprint distance (SD); high-speed running (HSR), acceleration (ACC), and deceleration numbers (DEC); average and maximal heart rate (HR_avg; HR_max); and match-related factors were collected during the 22 regular season matches. A T-test and ANOVA were used to calculate the differences between groups in GPS and HR variables and the effects of match-related factors, respectively. Results showed higher running performance in the B group compared to the A group during matches. Increased ACC number was seen in matches played on artificial turf; winning was associated with decreased HR_max and increased DEC number. Athletes covered higher TD reaching lower HR_max when playing against lower-ranking opponents while matches lost/drawn resulted in higher HSR. High HRs (max and avg) were found when playing against a team with a positive performance trend. In summary, match-related factors and opponents' characteristics can affect athletic performance in female soccer athletes. These factors should be considered during in-seasonal training to personalize match preparation and optimize athlete performance.

Basiliximab induction alone vs a dual ATG-basiliximab approach in first live-donor non-sensitized kidney transplant recipients with low HLA matching.

Background: Individualizing induction therapy based on immunological risk is crucial for optimizing outcomes in kidney transplantation. Methods: A retrospective analysis included 157 first live-donor non-sensitized kidney transplant recipients (KTRs). Within this cohort, 96 individuals exhibited low human leukocyte antigen (HLA) matching (5-6 HLA mismatches). The low HLA match subgroup was categorized into 52 KTRs receiving basiliximab alone and 44 recipients treated with a combined single ATG dose of 1.5 mg/kg and basiliximab. The primary endpoint was early acute cellular rejection (ACR) within 6 months post-transplant while secondary outcomes encompassed infection rates, renal allograft function, length of stay (LOS) and readmissions post-transplant. Results: The incidence of early ACR was decreased for low HLA match KTRs, who received ATG-basiliximab, when compared with low HLA-matched KTRs who received basiliximab alone (9.1% vs 23.9%, P = .067). Age was a predictor for rejection, and subgroup analysis showed consistent rejection reduction across age groups. No significant differences were observed in admission for transplant LOS or in peri-operative complications, nor in infections rate including BK and cytomegalovirus viremia, allograft function and number of readmissions post-transplant up to 6 months post-transplant. Conclusion: In non-sensitized first live-donor KTRs with low HLA matching, a dual ATG-basiliximab induction approach significantly reduced early ACR without compromising safety.

Variation in Accelerometer-Derived Instantaneous Acceleration Distribution Curves of Elite Male Soccer Players According to Playing Position: A Pilot Study.

The incorporation of triaxial accelerometers into Global Positioning Systems (GPS) has significantly advanced our understanding of accelerations in sports. However, inter-positional differences are unknown. This study aimed to explore the variability of acceleration and deceleration (Acc) distribution curves according to players' positions during soccer matches. Thirty-seven male players from a national-level Portuguese club were monitored using 10 Hz GPS with an embedded accelerometer during the 2021/2022 season. Resultant Acc was obtained from the x (lateral), y (frontal/back), and z (vertical) axes and expressed in gravitational units (g). Statistical Parametric Mapping was employed to compare playing positions: central defenders (CD), fullbacks (FB), central midfielders (CM), wide midfielders (WM), and strikers (ST). All positions exhibited a decreasing Acc distribution curve, very similar in shape, with a high frequency of events in the lower ranges (i.e., 0 to 1 g) and a lower frequency of events in the higher values (2 to 10 g). Post hoc comparisons revealed significant differences between all positions, except between FB and WM. Out of 1000 points in the curve, CD had 540, 535, 414, and 264 different points compared to FB, CM, WM, and ST, respectively. These findings indicate that players in different positions face distinct demands during matches, emphasizing the need for position-specific Acc analysis and training programming. By analyzing Acc as a continuous variable, this study highlights the importance of individualized monitoring to ensure the comprehensive and precise tracking of all player activities, without overlooking or omitting critical information.

Exploring the gender gap in neurosurgery: A cross-sectional analysis of preresidency publications among neurosurgery residents.

Background and Aims: While the number of female physicians has increased since the 1970s, there continues to be a lack of female surgeons compared to their male counterparts, with the gender gap more prominent in surgical subspecialties such as neurosurgery. While surgical subspecialities have accelerated initiatives to close the gap, potential disparities in research opportunities may position women at a disadvantage, particularly in neurosurgery, where academic publications are an indicator of residency match success. In this paper, we sought to investigate whether gender disparities exist in preresidency neurosurgery publications among current neurosurgery residents. Methods: The present study selected residency programs from the top 25 neurology and neurosurgery hospitals in US News & World Report's 2022 Ranking. A database of neurosurgery residents and their publications was created using PubMed, neurosurgery residency program websites, and supplementary search. Articles published between the time of birth and December 31st of the year of graduation (medical degree) were used to determine publications before residency. Results: Our research indicates that 25.7% (n = 135/526) of US neurosurgery residents at top 25 hospitals are women and 74.3% (n = 391/526) are men. Men (n = 391) had a median of 7 (interquartile range [IQR], 3-14.5; range, 0-129) publications before residency, and women (n = 135) had a median of 7 (IQR, 4-11.0; range, 0-74) publications before residency. There were no significant differences in the median number of publications between genders (p = 0.65). Conclusion: In conclusion, our research indicates there is no gender disparity in preresidency publications among neurosurgery residents. To improve women's representation in the field, further study is needed to better understand gender inequality among neurosurgeons, particularly in the earlier stages of medical training.

A Novel Urology Preliminary Residency Curriculum Within a Department of Surgery for Unmatched Applicants.

OBJECTIVE: Traditional options for unmatched applicants in urology include pursuing a research fellowship or completing a preliminary general surgery training year. We aimed to create a novel urology-focused preliminary curriculum. DESIGN: The general surgery program commits three preliminary positions for urology-focused interns. These interns complete six months of urology rotations and six months of general surgery rotations. Additionally, they are paired with a urology faculty member to participate in a longitudinal coaching and mentorship program. SETTING: The curriculum is situated within a Department of Surgery, which includes the Division of Urology, at one academic institution. PARTICIPANTS: Eight residents have completed the urology-focused preliminary curriculum in three academic years (2022-2023). RESULTS: Six residents have obtained categorical urology positions. Four matched via the American Urological Association Urology Match into a post-graduate year 1 (PGY1) position, and two matched outside of a formal matching process into a PGY2 position. CONCLUSION: This urology-focused preliminary curriculum presents a novel strategy to address the growing number of unmatched applicants in competitive surgical subspecialties such as urology.

Portability of IMRT QA between matched linear accelerators.

PURPOSE: To determine if patient-specific IMRT quality assurance can be measured on any matched treatment delivery system (TDS) for patient treatment delivery on another. METHODS: Three VMAT plans of varying complexity were created for each available energy for head and neck, SBRT lung, and right chestwall anatomical sites. Each plan was delivered on three matched Varian TrueBeam TDSs to the same Scandidos Delta4 Phantom+ diode array with only energy-specific device calibrations. Dose distributions were corrected for TDS output and then compared to TPS calculations using gamma analysis. Round-robin comparisons between measurements from each TDS were also performed using point-by-point dose difference, median dose difference, and the percent of point dose differences within 2% of the mean metrics. RESULTS: All plans had more than 95% of points passing a gamma analysis using 3%/3 mm criteria with global normalization and a 20% threshold when comparing measurements to calculations. The tightest gamma analysis criteria where a plan still passed > 95% were similar across delivery systems-within 0.5%/0.5 mm for all but three plan/energy combinations. Median dose deviations in measurement-to-measurement comparisons were within 0.7% and 1.0% for global and local normalization, respectively. More than 90% of the point differences were within 2%. CONCLUSION: A set of plans spanning available energies and complexity levels were delivered by three matched TDSs. Comparisons to calculations and between measurements showed dose distributions delivered by each TDS using the same DICOM RT-plan file meet tolerances much smaller than typical clinical IMRT QA criteria. This demonstrates each TDS is modeled to a similar accuracy by a common class (shared) beam model. Additionally, it demonstrates that dose distributions from one TDS show small differences in median dose to the others. This is an important validation component of the common beam model approach, allowing for operational improvements in the clinic.

Effect of the Step-Jump Approach in Infected Pancreatic Necrosis: A Propensity Score-Matched Study.

Purpose: The effects of the step-jump approach on the survival and prognosis of infected pancreatic necrosis (IPN) patients have not yet been determined. Patients and Methods: Between November 2018 and June 2023, 188 patients were included in this study. There were 144 patients in the step-up group (the SU group) and 44 in the step-jump group (the SJ group). In the SU group, patients successfully treated with percutaneous catheter drainage (PCD) alone were classified into the SU-1 group (n=101), while those requiring additional surgery after PCD were categorized into the SU-2 group (n=43). In the SJ group, patients who underwent minimally invasive necrosectomy (MIN) without PCD were assigned to the SJ-1 group (n=34), whereas those who initially underwent PCD followed by immediate open surgery were placed in the SJ-2 group (n=10). Propensity score matching (PSM) was used to mitigate bias. Results: After PSM, a total of 34 pairs were successfully matched. A comparison of the SU group with the SJ-1 group (upfront MIN without PCD) revealed similar mortality rates (P=0.239); however, the incidences of multiple drug-resistant organisms (MDROs) (P=0.029) and surgical complications (P<0.001) were significantly lower in the SJ-1 group. After comparing the SU-2 and SJ-2 groups (patients who underwent direct open necrosectomy without MIN after PCD failure), the incidences of surgical complications and MDRO in the SJ-2 group were significantly lower (P<0.05). Conclusion: Compared with the step-up approach, the step-jump approach is safer and more effective and can significantly reduce the incidence of MDRO and surgical complications.

Robotic arm-assisted versus conventional total knee arthroplasty: comparing complications, costs, and postoperative opioid use in propensity-matched cohorts.

PURPOSE: Limited literature exists substantiating benefits of robotic arm-assisted total knee arthroplasty (raTKA) over conventional total knee arthroplasty (cTKA). This study compared postoperative pain, complications, and costs between patients undergoing raTKA and cTKA using large, propensity score-matched cohorts. We hypothesize that the raTKA cohort will be associated with lower pain, lower anemia, and similar cost and other complications. METHODS: A commercially available patient database was used for this study. Patients with raTKA and cTKA were identified with current procedural terminology and international classification of diseases (ICD-9/ICD-10) codes. Exclusions and propensity score matching were applied to mitigate confounding bias. Complication rates, costs, and postoperative opioid uses were then compared between groups. RESULTS: Compared with patients with cTKAs (n = 31,105), patients with raTKAs (n = 6,221) had less postoperative opioid use (p < 0.01), lower rates of postoperative acute renal failure (OR 0.71; p < 0.01), anemia (OR 0.75; p < 0.01), and periprosthetic joint infection (OR 0.59; p = 0.04), and lower index costs ($875 vs. $1,169, p < 0.01). CONCLUSION: RaTKA was associated with less postoperative pain and complications compared with cTKA.

Submission to Stem Cells Reviews and Reports.

The use of allogeneic induced pluripotent stem cell (iPSC)-derived cell therapies for regenerative medicine offers an affordable and realistic alternative to producing individual iPSC lines for each patient in need. Human Leukocyte Antigens (HLA)-homozygous iPSCs matched in hemi-similarity could provide cell therapies with reduced immune rejection covering a wide range of the population with a few iPSC lines. Several banks of HLA-homozygous iPSCs (haplobanks) have been established worldwide or are underway, to provide clinical grade starting material for cell therapies covering the most frequent HLA haplotypes for certain populations. Harmonizing quality standards among haplobanks and creating a global registry could minimize the collective effort and provide a much wider access to HLA-compatible cell therapies for patients with less frequent haplotypes. In this review we present all the current haplobank initiatives and their potential benefits for the global population.

Decreasing Resident Vascular Case Volumes Have Not Changed National Numbers of Vascular Fellowship Applications in US General Surgery Residents Over the Past Twenty Years.

OBJECTIVES: With an aging workforce and high prevalence of vascular disease, the US is expected to face a pronounced shortage of vascular surgeons over the next 2 decades. This has driven initiatives to expand vascular surgery training positions leading to the rise of integrated residency programs (0 + 5) and the expansion of traditional fellowships (VSFs, 5 + 2). Given the increase in dedicated vascular surgery training positions, there has been a growing concern that general surgery residents (GSRs) are experiencing decreased vascular case volumes. We aim to evaluate trends in vascular surgery specialty choice relative to vascular case volumes for US GSRs over the last 20 years. DESIGN: Using the Accreditation Council for Graduate Medical Education (ACGME) Case Log Graduate Statistics National Report, a retrospective analysis of ACGME-accredited GSR vascular case volumes was performed from academic year 1999-2000 to 2021-2022. Fellowship data was retrospectively reviewed using the available National Resident Matching Program (NRMP) Fellowship Match Data & Reports for 2004-2023. RESULTS: Graduating GSRs logged increasing numbers of major cases between AY 1999-2000 and AY 2021-2022 (p < 0.001) with 2022 graduates logging on average 98 more cases per resident compared to 2000 graduates. Mean total vascular cases decreased (p = 0.005) with 2022 graduates logging approximately 78 fewer vascular cases on average compared to the 2000 graduates, a 40% decrease in vascular case volume. Despite the decrease, US GSRs have applied to VSF at a relatively consistent rate: 8.5% in 2001-2002, 8% in 2011-2012, and 6% in 2021-2022. 2023 demonstrated an increase to 8.3%. CONCLUSION: Over the past 2 decades, GSRs have experienced a substantial decrease in exposure to vascular surgery cases during their training; however, residents continue to apply for VSF at a relatively constant rate suggesting that interest in the specialty may be related to factors other than exposure to vascular cases.

Impact of Gift Giving During General Surgery Resident Match Interviewing Since Initiation of Virtual Interviews.

OBJECTIVE: Following the transition to virtual interviews in 2021, interviewees began receiving gifts as a recruitment strategy in lieu of the preinterview dinner. This study characterizes quantity, type, and frequency of gift receipt in relation to program perception and ranking. DESIGN: An anonymous survey study was conducted. Variables included demographics, interview modality, gift type, frequency of gift receipt, monetary value, and changes in program perception and ranking. Descriptive analyses and Pearson's chi-square testing were performed. SETTING: Single institution with a medium to large general surgery program size. PARTICIPANTS: All general surgery residents at the single institution without exclusion. RESULTS: About 25 residents responded (60% response). Two respondents (8%) participated in both in-person (IPIs) and virtual interviews (VIs). About 72% (n = 18) participated in VIs, 36% (n = 9) IPIs. About 68% matched in 2021 or later. Overall, 76% received a gift during interviews. 100% of IPIs received a gift, while 67% of VIs received a gift. 88.9% of IPIs received a meal. VIs received: meal shared (28.6%), meal not shared (14.3%), food-specific gift card (28.6%), other food items (21.4%), or other (7.1%). About 66.7% of IPIs (n = 6) reported 76% to100% of programs offered a meal, whereas no VIs reported 76% to 100% of programs offering (p = 0.0002). VIs were less likely to have a shared meal experience (p = 0.017). About 55.5% of IPIs and VIs received nonfood gifts. Residents' perception of a program's interest, resources, and ranking of the program were not significantly different based on gifting. CONCLUSION: Virtual interviews introduced heterogeneity in the receipt of gifts. The impact of a variable gifting experience is uncertain but raises concern for a potential new source of bias in the recruitment process.

The Effect of Numeric Versus Pass/Fail USMLE Step 1 Scores in the Integrated Plastic Surgery 2023-2024 Match Cycle: A Single Institution Study.

OBJECTIVE: The USMLE Step 1 exam, an important metric in the integrated plastic surgery match, transitioned to pass/fail scoring in January 2022. No previous studies have investigated the impact of this new scoring system on the process of ranking applicants in the integrated plastic surgery match. DESIGN: 330 Plastic Surgery Common Applications (PSCAs) were submitted to a single academic center in the 2023-2024 match cycle. Applicants were sorted into tiers via a holistic review process, and quantifiable data, including USMLE Step 1 scores, were then compared between tiers. SETTING: Our Institution's Integrated Plastic Surgery Residency Program. PARTICIPANTS: Integrated Plastic Surgery applicants in the 2023-2024 match cycle. RESULTS: 317 of 330 PSCAs were analyzed in this study, excluding applicants who did an elective rotation at our institution. Applicants were sorted into 3 tiers: high (n = 100), middle (n = 118) and low (n = 99), with a significant difference in match rate per tier, respectively (88.0%, 58.5%, 30.3%, p < 0.0001). The majority of USMLE Step 1 scores were reported as pass/fail (186/317, 58.7%). There was a significant difference (p < 0.0001) between the average USMLE Step 1 score between the high (mean 250.5, SD 10.4), middle (mean 241, SD 14.6), and low tiers (mean 235.5, SD 16.5). More applicants in the low tier (50%) and high tier (40%) reported numeric USMLE Step 1 scores than those in the middle tier (35%, p = 0.0734). Stepwise logistic regression revealed USMLE Step 1 score to be an independent predictor of tier placement between the high and middle tier (p = 0.0030) and high and low tier (p = 0.0001). Lastly, 3 applicants reported their USMLE Step 1 score as 'pass' instead of their given numeric score. CONCLUSIONS: Comparing applicants with numeric USMLE Step 1 scores to those with pass/fail scores can have a significant impact on the ranking of those applicants and should be carefully considered during the plastic surgery match process.

"The Association of a Research Year With Matching Into an Integrated Plastic Surgery Residency".

INTRODUCTION: The relationship between pursuing a research year (RY) and plastic surgery match outcomes is unclear. The present study investigated the association between a dedicated RY and the odds of matching into an integrated Plastic and Reconstructive Surgery (PRS) residency program. METHODS: Electronic Residency Application Service applications to an integrated PRS residency program from 2017 to 2021 were evaluated. Match results were determined using online public sources. Students who had taken a RY were compared with those who had not (traditional). The relationship between pursuing a RY and matching was determined with logistic regression analyses. RESULTS: In total, 974 applicants were included, of which 191 (20%) completed an RY. The RY group had significantly higher match rates (83% versus 74%, P = 0.008), more presentations (13 versus 5, P < 0.001), and more publications (11 versus 4, P < 0.001) than the traditional group. The RY group was 80% more likely to match than the traditional group (adjusted odds ratio [OR] = 1.8, P = 0.016). However, this benefit was eliminated after controlling for the number of publications. Subgroup analysis revealed that applicants who completed an RY had increased odds of matching into a top 20 PRS residency program (OR = 2.2, P < 0.001), with the strongest association observed among applicants with 15+ (OR = 2.6, P < 0.001) or 20+ publications (OR = 4.1, P < 0.001). CONCLUSIONS: An RY is associated with 80% higher odds of matching and an increased number of publications. RYs seem to be most associated with benefits for applicants aiming to increase their publication numbers or to match into a top 20 residency program.

International medical graduates (IMGs) matching into US orthopaedic surgery residency: a fifteen year analysis of trends in applications and geographical distribution.

PURPOSE: International Medical Graduates (IMGs) face challenges in securing orthopaedic surgery residencies in the U.S. This study examines residency matching trends and geographic distribution for U.S. and non-U.S. citizen IMGs. METHODS: The National Resident Matching Program (NRMP) data from 2008 to 2022 were analyzed for USMLE scores, publication counts, and match rates, using linear regression. The proportion of non-US IMGs in orthopaedic surgery residency was compared with the foreign-born population of each region based on the 2021 American Community Survey. RESULTS: The overall IMG fill rate decreased significantly from 2.04% in 2008 to 1.26% in 2022 (P = 0.002). The number of publications for matched US IMGs was at least three times that of matched MD seniors and about two times that of unmatched US IMGs. Matched non-US IMGs had approximately five and three times the number of publications as matched MD seniors and unmatched non-US IMGs, respectively. Mississippi had the highest IMG-to-all-filled-position ratio (6.7%) and New York matched the most IMGs (36 residents). Although the foreign-born population comprises approximately 13.72% of the US population, non-US IMGs accounted for less than 1% of total matched residents. When compared to the foreign-born population, non-US IMGs were underrepresented in the US. This underrepresentation was observed in all nine geographic divisions, particularly in the West South Central and Pacific regions. CONCLUSIONS: While IMGs constitute a low percentage of matched MDs in orthopaedic surgery, they show three to five times more publications than MD seniors. IMGs should recognize the importance of higher publication numbers in the matching process as well as states with higher IMG matching rates.