Katherine M Gerull

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This review summarizes current challenges in peripheral nerve surgery and rehabilitation after nerve injury or amputation. Nerve allografts show promise for short gaps but remain controversial for larger injuries, nerve wraps lack strong evidence, and bionic limb technology is advancing but costly. Progress will require multicenter randomized trials, standardized outcome measures, and coordinated interdisciplinary research.

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A mixed-methods study combining surveys and interviews examined why women orthopaedic surgeons do or do not pursue careers in sports medicine. Perceived sex discrimination was common across all orthopaedic subspecialties and did not directly explain career choice toward or away from sports medicine. The factors that actually shaped women's decisions were the scope of practice and cultural features specific to sports medicine as a field.

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A survey of 66 general surgery residents across four institutions found that introverted residents preferred anonymous participation formats in lectures and disliked required skills competitions, while extraverted residents had opposite preferences. Across all personality types, receiving operative feedback was rated the most educational and motivating intraoperative activity. These findings support designing flexible training environments that account for resident personality differences.

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Seven patients living with traumatic brachial plexus injury used a photovoice method—participant-directed photography and discussion—to document and share their life experiences after injury over 10 weeks. The process built community among participants and produced patient-facing e-magazines covering topics from pain management to practical daily tips. Participant-led research methods like photovoice generate authentic support materials and give patients agency to communicate their experiences to providers.

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Twenty-six women orthopaedic surgeons, including some who had left academia, were interviewed to identify what workplace culture factors support or undermine inclusion. The resulting model identified two pillars: supportive structures controlled by department leaders (career development, transparent policies, valuing diverse contributions) and social inclusion requiring effort from all members (male allyship, respect, women supporting women). Both pillars must be present for women to succeed and stay in academic orthopaedics.

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A prospective cohort study at Washington University compared medical students who completed an orthopaedic clerkship to those who did not, measuring sense of belonging and gender stereotype threat before and after rotation. Students who rotated reported stronger belonging than non-rotators, and belonging increased significantly after the rotation, though gender stereotypes were unchanged. Women reported lower belonging than men both before and after the clerkship.

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A multi-institutional survey of 441 medical students measured sense of belonging, stereotype threat, and confidence in orthopaedic surgery across gender, race, and LGBTQIA identity. Women, Asian students, underrepresented minorities, and LGBTQIA students all reported significantly lower belonging than their majority-group peers. Students perceived that faculty, residents, and the public believe men and white surgeons are more competent—beliefs that likely discourage diverse students from entering the field.

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A national cohort study of over 53,000 US medical graduates examined who gained or lost interest in orthopaedic surgery between matriculation and graduation. Twice as many students lost interest as gained it, and women and Asian students were significantly more likely to have diminishing interest. Several of the risk factors identified—such as research participation and institutional type—are modifiable, suggesting targeted interventions could make the specialty more attractive to diverse students.

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Analyzing data from 4,319 US medical graduates who entered orthopaedic residency, researchers found that 5.4% did not achieve board certification. Women, Asian graduates, first-generation college students, and residents who completed research during training were all more likely to leave orthopaedics. This attrition pattern suggests the specialty is losing underrepresented groups and surgeon-scientists, warranting active retention efforts.

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Six orthopaedic surgery residents were interviewed about their experiences using virtual reality (VR) in training. Residents saw VR as most useful for interns and junior residents learning anatomy and procedure steps in a low-stakes environment, but described a ceiling effect at current technology levels. Barriers like limited hardware, software instability, and time cost made residents prefer VR as an optional supplement rather than a required assessment tool.

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A survey of 211 orthopaedic residents across 17 programs found that women were over twice as likely as men to report emotional exhaustion and reported stereotype threat about their identity as surgeons. Women were 7.2 times more likely to report mistreatment overall, and significantly more likely to report gender discrimination, pregnancy-based discrimination, and sexual harassment. Women were also 4.5 times more likely than men to consider leaving residency.

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Forty-three patients with bothersome tinnitus completed up to 200 daily surveys each, and their responses were analyzed using dynamic structural equation modeling to explore whether group-level patterns applied to individuals. The group-level model showed a reciprocal relationship between tinnitus bother and anxiety, but this pattern did not hold for most individuals when analyzed separately. Individual-level modeling reveals that standardized group findings can mask meaningful variation between patients.

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A survey of 93 orthopaedic residents from 16 programs found that women and men had similar interest in adult reconstruction as a subspecialty and similar self-confidence. However, women were less likely to have been encouraged to pursue the subspecialty by faculty, and both genders perceived that others view male surgeons as better at the procedure. Social barriers and negative stereotypes—not lack of interest or ability—are the main obstacle for women considering adult reconstruction.

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A survey of 151 women and underrepresented minority orthopaedic surgeons found that 85% had a mentor in the field, and mentorship was widely valued for career development and exposure to role models. Underrepresented minorities placed greater importance on having a mentor who shares their racial or ethnic identity. Mentorship carries a disproportionate burden on women and URMs who serve as mentors, and institutional support is needed to distribute this responsibility more equitably.

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This symposium article discusses structural barriers to racial and gender diversity in orthopaedic surgery and mechanisms for improving diversity through program-level and national-level interventions. Despite years of attention, demographic representation in orthopaedics has changed little. Effective strategies must target both the pipeline of applicants and the culture and policies within training programs.

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Interviews with 23 medical students identified that students' sense of belonging in orthopaedics depended on how closely their identity matched stereotypes about orthopaedic surgeons—predominantly white, male, and athletic. Students who felt they fit this image reported more positive experiences that reinforced their interest; those who did not fit reported experiences that pushed them away. Interrupting this cycle requires actively addressing stereotypes and fostering positive identity alignment for students from diverse backgrounds.

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This perspective article argues that the COVID-19 pandemic's disruptions to residency recruitment offer an opportunity to apply inclusive excellence principles—using an equity lens in all decision-making and targeted outreach to underrepresented applicants. Surgical specialties with the greatest diversity gaps have the most to gain. Every program should treat this moment as a chance to build more equitable practices that persist beyond the pandemic.

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Examining 69 awards across 18 national orthopaedic societies from 2000 to 2018, women received 8% of awards despite comprising 9% of members, roughly proportional overall. Women were overrepresented in diversity and education awards but received very few leadership awards. Awards selected through blinded processes went to women at twice the rate of unblinded awards, suggesting that implicit bias affects recognition in orthopaedics.

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Letters of recommendation for 730 orthopaedic residency applicants were analyzed for word use by gender and race. In traditional narrative letters, standout words appeared more often in letters for women, while letters for white applicants contained more standout words than those for underrepresented candidates. Standardized letter templates eliminated these word-use differences, pointing to a practical intervention for reducing implicit bias in applicant evaluation.

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Women made up 14% of speakers at national orthopaedic society annual meetings in 2018, roughly matching their 13% membership share overall, but representation varied widely across societies and was concentrated in nontechnical sessions. Societies with women in leadership and stated diversity efforts had significantly more women speakers. Monitoring speaker diversity and placing women in leadership roles are effective levers for achieving equitable representation at conferences.

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Across 16 national surgical society annual meetings in 2011 and 2016, women made up about 22% of members but 21.7% of session speakers and 19.4% of plenary speakers, with 43% of panels having no women at all. The proportion of women on organizing committees was the strongest predictor of women's representation as speakers. Despite overall numbers appearing close to membership proportions, structural inequities in high-visibility roles persist.

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Thirty adults with chronic bothersome tinnitus completed ecological momentary assessment surveys up to seven times daily for 12 weeks, including during a cognitive brain training intervention period. Compliance was high (median 87% of surveys completed) and participants did not report that frequent surveying worsened their tinnitus. Intensive real-time experience sampling is feasible in tinnitus research and enables tracking of symptom fluctuations in daily life.

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Written evaluations of surgical residents were analyzed for language differences between evaluations of men and women. Comments about men were more positive overall and included more standout words, while women's evaluations were less favorable in overall tone and professional competency descriptions. These patterns suggest implicit gender bias in how surgical residents are assessed, which may disadvantage women in advancement decisions based on these evaluations.