The Importance of Mentorship and Interest Group Involvement for the Orthopedic Surgery Applicant

Abstract

Background

Mentorship in medical education is important for students’ professional development career planning. Orthopedic Surgery Interest Groups (OSIG) exist as formal organizations and serve as a conduit for undergraduate mentorship, though the role of mentorship via OSIGs within orthopedic medicine has not been thoroughly evaluated. Similarly, OSIGs within institutions are not standardized nor well defined. We sought to answer: (1) What offerings does OSIG provide for students interested in orthopaedic surgery? (2) How does OSIG involvement impact the orthopaedic surgery residency applicant? (3) Does OSIG involvement increase match rates for orthopaedic surgery residency applicants?

Methods

An online survey was distributed to faculty advisors at all allopathic US medical schools with available contact information. Results were analyzed using SPSS.

Results

Of the 28 respondent organizations, the majority (53.6%) have between 1-25 student members. On average, OSIGS offer 3.64 + 1.59 (mode = 4) executive positions. The most important initiative for OSIG groups was clinical/surgical shadowing, followed by faculty mentorship, and guidance for the residency application. OSIG involvement does impact the applicant, as all faculty mentors believed this to be an important component of the residency application. Leadership positions within OSIG was not perceived as being equally important. OSIG involvement did increase match rates; the match rate for all students at the schools surveyed (n=17) was 81.21% while the match rate for students within OSIG (n=17) was 82.39% (p<0.05). Of all students who applied to orthopedic surgery residency programs, 98.9% were members of OSIG, and of all students who successfully matched into orthopedic surgery residency programs in the 2019-2020 cycle, 100% (p<0.05) of students (n=17) were involved in OSIG.

Conclusion

This study indicates the importance of involvement in OSIG as a conduit for clinical exposure and mentorship throughout medical education, and is especially relevant for applicants given the impact of the COVID-19 pandemic on the residency application process. Data suggests that participation in an OSIG is a valuable experience for the medical student interested in orthopedics and that students involved in OSIGs are more likely to match into orthopedic residency programs.

Level of Evidence: V

Introduction

Mentorship in undergraduate medical education is important for professional development and career planning. Orthopedic Surgery Interest Groups (OSIG) exist as formal organizations within medical schools across the country and often serve as a conduit for formal undergraduate mentorship. Several publications in medical literature have highlighted the importance of mentorship, however, the role of OSIGs as a conduit for formal mentorship within orthopedic medicine has not been thoroughly studied. OSIGs are not standardized nor well defined, leaving a level of heterogeneity when considering student opportunities at medical institutions across the country.

Orthopedic surgery is an increasingly competitive specialty and has a demanding residency application process. Medical students must develop a multi-dimensional application with an extensive array of strengths and high-ranking metrics in order to set themselves apart from their peers. Success in matching into competitive residency programs is in part attributed by students to their prior mentorship, as mentors help students navigate the application process.¹⁶ To display the benefit of organized student groups, students who participated in a Professional Student Mentored Research Fellowship reported a significantly higher average score on the United States Medical Licensing Exam (USMLE) Step 1 as well as a significantly higher match rate into highly ranked residency programs.² Similarly, students interested in the field of Neurology showed greater productivity, increased publications, and significantly higher interest in the field after the implementation of a student interest group.¹⁹

Among the existing literature regarding OSIG and orthopedic mentorship, the potential role of mentorship for medical students has been identified in various ways. Personal mentor-mentee relationships are an established positive predictor of retaining trainee interest in orthopedics. One study determined that focused mentorship is the strongest modifiable factor particularly for female students pursuing a career in orthopedics.³ Additionally, when identifying driving factors for pursuing orthopedic medicine, female orthopedic residents are more likely to be positively influenced by mentorship and clinical exposures during medical school than their male counterparts.¹² These findings reinforce the belief that interest group involvement and formal mentorship are integral components for student interest, particularly diverse student interest, in orthopedic surgery. Despite its clear value, undergraduate mentorship in orthopedics has not been discretely defined, nor has it been extensively studied in order to stratify the impact of varying levels of mentorship on parameters of student success.¹¹ A thorough understanding of the latter is necessary to allow for improvements in the realm of mentorship in medical education. Therefore, this pilot study aims to utilize survey methods to answer the following: (1) What standard offerings does the typical OSIG provide for medical students interested in orthopedic surgery? (2) How does OSIG involvement impact the orthopedic surgery residency applicant? (3) Does OSIG involvement increase match rates for orthopedic surgery residency applicants?

The authors of this study aim to use these findings to establish the role of formal mentorship and student interest group involvement when considering the development of a competitive residency applicant. We hypothesized that there will be a higher match rate among students involved with OSIG when compared to the national average. We also hypothesized mentorship will be a significant factor for improving match rates of students applying to orthopedic surgery residency.

Methods

We utilized survey methods in order to (1) define the characteristics of the Orthopedic Surgery Interest Group (OSIG), and (2) identify the importance of mentorship and OSIG involvement on the residency application process. The survey was sent to faculty advisors at all allopathic US medical schools with publicly available contact information. All responses were anonymous and were included for final data analysis. The individuals were informed that participation was strictly voluntary and that no compensation would be provided. Exclusion criteria included all schools with no available contact information of faculty leaders of OSIG or student body/ government.

Upon IRB approval, faculty leaders were invited to participate in the study via an email sent by the investigators. The email contained a brief study description and a link to an anonymous electronic survey conducted via Qualtrics. Follow-up emails were sent two and four weeks after initial communication to encourage participation. The survey was available for completion for a total of eight weeks.

Data was collected in Qualtrics anonymously with no identifying information included or coded. Statistical analyses were completed using the Independent T-Test and Chi Square function of SPSS Version 26.0 for Macintosh (IBM Corp., Armonk, N.Y., USA).

Results

A total of 28 responses were recorded. Of the subjects who responded, 12 (42.8%) were faculty advisors for their orthopedic student interest group, 7 (25%) were program directors or associate program directors, 7 (25%) were professors or faculty members, and 2 (7.1%) held unspecified positions within their programs. The representatives for each respective orthopedic surgery student organization then answered a series of questions regarding the membership, activities, executive positions, and residency applicants within their programs.

One of the goals of this survey was to identify and compare the demographics and structure of each organization. Of the 28 respondent organizations, 15 (53.6%) have between 1-25 student members, 7 (25%) have 26-50 student members, 5 (17.9%) have 51-75 student members, and 1 (3.6%) have 76-100 student members. On average, the student organizations have 3.64 + 1.59 (mode = 4) executive board positions available for their members and have 3.83 + 1.63 (mode = 3.5) members holding executive positions, including co-positions. Across all organizations, the most commonly offered executive positions were president (96.4%, n=27), vice president (78.6%, n=22), secretary (64.3%, n=18), treasurer (57.1%, n=16), and events coordinator (25%, n=7). Research coordinator was offered as a position in only 10.7% (n=3) of organizations. Other positions including shadowing coordinator, mentorship coordinator, and class representative which were offered in less than 10% of organizations surveyed.

In assessing the activities and initiatives of each organization, results show that executive boards meet 2.81 + 1.42 times per academic semester, and each organization holds 3.84 + 2.19 events for OSIG members per semester. Representatives from each organization were asked to rank in order of importance the initiatives which their organizations focus on (1 = most important, 13 = least important). The most important initiative for OSIG groups was found to be clinical/surgical shadowing, with an average rank of 3.05 + 2.36 (range = 1-11). Faculty mentorship was found to be the second most important initiative, with an average rank of 3.55 + 2.22 (range =1-10), and residency application guidance ranked as the third most important, averaging 4.5 + 3.09 (range = 1-12) (Table 1).

Table 1.

Evaluation of Overall Importance of OSIG Initiatives Based on a Scale of 1-13 (1= most important, 13=least important)

Field	Minimum	Maximum	Mean	Std Deviation	Variance
Clinical/Surgical Shadowing	1	11	3.05	2.36	5.55
Faculty Mentorship	1	10	3.55	2.22	4.95
Residency Application Guidance	1	12	4.5	3.09	9.55
Resident Panels/Information Sessions	1	9	4.55	2.31	5.35
Research Involvement	1	10	4.75	2.49	6.19
Surgical Techniques/Training Sessions	1	10	5.05	2.22	4.95
Peer Mentorship	1	11	5.95	2.62	6.85
Anatomy Assistance/Tutoring	2	12	7.9	2.51	6.29
Post-Match Panels	4	10	8.4	1.74	3.04
USMLE Step 1 Preparation	7	12	9.35	1.24	1.53
Combined meetings with other interest groups (i.e neurosurgery for spine)	5	12	10.55	2.13	4.55
Athlete Physicals	2	13	10.6	2.35	5.54
Other	10	13	12.8	0.68	0.46

Follow up questions were targeted toward assessing national initiatives outside of the realm of their respective medical schools. Of the follow up 19 responses recorded, 16 (84.21%) organizations do not participate in national initiatives, and only 3 (15.79%) do. Of those who do, the specified initiatives included the Perry Initiative, Nth Dimensions, and the Ruth Jackson Orthopedic Society. These initiatives have been successful in helping recruitment of diverse groups.^7,8,17

The primary goal of this survey was to determine the role that faculty mentorship and student involvement in OSIGs may or may not have in determining the match rates of students applying to orthopedic surgery residency programs. Each faculty member was asked about their individual perception on the importance of involvement in OSIG as a component of the residency application. Of 20 responses recorded for this specific question, 8 (40%) believe involvement in OSIG to be extremely important, 2 (10%) feel that involvement in OSIG is very important, 7 (35%) feel that involvement in OSIG is moderately important, and 3 (15%) feel that it is slightly important. All advisors believed OSIG involvement to hold some level of importance in students’ match success (Figure 1.1). With regards to the importance of holding executive positions within OSIG, only 1 (5%) of 19 advisors who responded believe this to be extremely important, while 6 (32%) deem this very important, 7 (37%) deem this moderately important, 4 (21%) believe this to be slightly important, and 1 (5%) believes this to be not at all important (Figure 1.2). With regards to mentorship, 20 advisor responses were recorded, with 12 (57.9%) reporting that students within their OSIG group are paired directly with faculty mentors, with 3 (27%) of schools pairing their students in the 1st year of medical school, 5 (45%) pairing in the 2nd year, and 3 (27%) pairing in the 3rd year.

Figure 1.1.

Importance of membership in OSIG as a component of the residency application, reported as the number of faculty advisors who selected each answer.

Importance of membership on executive board as a component of residency application.

Figure 1.2.

Importance of OSIG executive position membership component of the residency application, reports as the number of faculty advisors who selected each answer.

Importance of membership on executive board as a component of residency application.

In assessing the application and match rates within each program, there were 17 responses total. On average, the schools surveyed had 5.41 + 2.53 students from the class of 2020 apply to orthopedic surgery residency programs during the 2019-2020 application cycle (Table 2). There were 4.76+2.82 from each school who successfully matched into orthopedic residency programs in the 2019-2020 application cycle (Table 2). Specifically within OSIG, faculty advisors reported an average of 5.35+2.58 students who applied to orthopedic surgery residency, with an average of 4.76+ 2.82 students within OSIG successfully matching into orthopedic residency programs in the 2019-2020 application cycle (Table 2). When comparing rates between overall student applications and OSIG applications, the match rate for all students at the schools surveyed (n=17) was determined to be 81.21% (sd = 27.041) while the match rate for all students within OSIG was slightly higher at 82.39% (sd = 27.471, p<0.05) (Table 3). Importantly, there was insufficient representation of applicants who were not involved in their school’s OSIG; only one student who applied to orthopedic residency with no involvement in their OSIG program failed to match into orthopedic surgery residency.

Table 2.

T-Test Statistics Evaluating the Number of Applications and Matches Among Each Program, As Well as Each Individual OSIG

	N	Mean	Std. Deviation	Std. Mean Error
Number Applied	17	5.41	2.526	.613
Number Matched	17	4.76	2.818	.683
Number in OSIG who Applied	17	5.35	2.548	.618
Number in OSIG who Matched	17	4.76	2.818	.683

Table 3.

T-Test Statistics Evaluating the Match Rate (%) Among Each School, Each OSIG Program, As Well as the Percentage of Applicants and Percentage of Successfully Matched Students Who Were Involved With Their School’s OSIG

	N	Mean	Std. Deviation	Std. Mean Error
School Match Rate	17	81.21	27.041	6.558
OSIG Match Rate	17	82.39	27.417	6.650
Percentage Applied and involved in OSIG	17	98.82	4.851	1.176
Percentage Matched and Inolved in OSIG	17	100.00	.000a	.000

a. t cannot be computed because the standard deviation is 0

Of all the students who applied to orthopedic surgery residency programs C across all schools surveyed, 98.9% (sd = 4.851) were members of orthopedic surgery interest groups, and of all the students who successfully matched into orthopedic surgery residency programs in the 2019-2020 cycle, 100% (p<0.05) of students were involved in OSIG (Table 3). Among the OSIG groups that paired students with faculty mentors, the match rate was found to be 88.93%. The match rate among those groups that did not pair students with faculty mentors was found to be 88.0%. There was no statistically significant difference between the two (p=0.55).

Discussion

The authors of this study set out to establish the role that faculty mentorship and involvement in OSIG may play in the orthopedic surgery residency application process, and evaluate OSIG as an avenue for providing formal mentorship to students. In doing so, we ascertained a general understanding of the structure and initiatives of OSIGs across various allopathic and osteopathic medical programs in the United States. The majority of groups consist of less than 25 student members, with relatively small executive boards setting up numerous OSIG events and initiatives. Clinical/surgical shadowing, faculty mentorship, and residency application guidance proved to be the most commonly emphasized initiatives, suggesting that faculty members and students within OSIG believe these to be the vital components of meaningful undergraduate medical education. Alpha Omega Alpha (AOA) status, USMLE step 2 CK score, and Step 1 score are known to be criteria most strongly associated with receiving interview offers for students applying to orthopedic surgery residency.¹⁴ On the surface, this may suggest some limitation in the role that an OSIG can play in determining a student’s success as an applicant. However, this could also suggest that OSIG groups use a targeted approach in order to maximize students’ ability to achieve success; namely, by improving clinical skills and knowledge via shadowing and mentorship initiatives.

The results of this study suggest that faculty mentors believe student involvement in OSIG is an important component of the residency application and a successful match. Leadership positions within OSIG, however, are not perceived as being equally important. While involvement within OSIG may not be a heavily emphasized component for program directors assessing applications, the leadership experience and knowledge gained may indirectly provide benefit to a student’s application. One study of medical students involved with an OSIG reported that OSIG members had increased interest in musculoskeletal medicine, confidence in their ability to perform orthopedic related exams, and better relationships with residents and attendings after joining the group.⁹ The latter may contribute to a student’s ability to successfully rotate as a third year medical student, collect strong letters of recommendation, and leave a positive impression during away rotations. Data has shown that spending time on an away rotation improves a student’s chance of matching into that program by a factor of 1.5.⁵ While the results of our study demonstrate faculty advisors believe involvement in OSIG to be an important component of the application process, this is likely related to the skills and knowledge that a student can gain from the initiatives set forth by OSIG more so than just the reporting of the involvement alone. With COVID-19, there are universal rules regarding no away rotations for 2020 applicants and consideration for only one away rotation for the 2021 applicant. Thus, the importance of meaningful clinical exposure through OSIG is increasingly important.

Regarding mentorship, 57.9% of the organizations surveyed directly pair their students with faculty mentors for guidance throughout undergraduate medical education. This seems to align well with established research. Prior studies have shown that orthopedic surgery residents believe mentorship to be superior to online resources for navigating the application process, and that they achieved highest satisfaction with their mentor-mentee experience when there was a formal program in place.^6,18 Although only 50% of orthopedic surgeons reported formal mentorship in their undergraduate medical education, 84.2% believed that their mentor played an integral role in determining their subspecialty.⁴ The importance of mentorship has even been found to extend beyond the undergraduate level; strong mentorship is one of the most important factors in an applicant’s decision when picking a residency program.¹⁵ Another study proves that mentorship is important for trainees in multiple specialties, as the majority of internal medicine residents described their experience with mentorship as having a meaningful impact on their professional development.¹³

This in mind, using OSIG as a conduit for formal mentorship programs can maximize student satisfaction throughout the application process and help students find success during their years as a resident. Our findings within this OSIG survey suggest that mentorship is a highly emphasized initiative but that formal mentorship is only utilized by slightly above 50% of OSIG programs we surveyed. This would be an important initiative to develop. Furthermore, there was no statistically significant difference between the match rates of students in OSIG who were paired with a mentor and students who were not paired with a mentor. As a result, we fail to accept our hypothesis that mentorship would significantly improve a student’s chances of matching into orthopedic surgery residency programs. The lack of significance may be attributed to this pilot study’s small sample size. Despite this, it is still worth considering the implementation of formal mentorship programs within OSIGs in order to maximize student satisfaction and success throughout the application process.

With regards to overall match rates, our findings suggest the benefit of OSIGs within medical school extracurricular offerings. Specifically, the match rate among students within OSIGs was significantly higher than the national average, suggesting an important benefit of OSIG membership. According to the National Resident Matching Program (NRMP), the 2020 national match rate for orthopedic surgery residency was 70.8% compared to 82.4% for the students involved in OSIG reported by our study.¹⁰ Though this is striking, our study only found a 1% difference in match rates between students involved in OSIG and those who were not. The small difference found is likely due to the present study’s small sample size, however, this study still indicates that OSIG involvement has value. Another interesting point is the comparison between OSIG match rates and that of interest groups for other subspecialties within medicine. For example, 75% of neurosurgery student interest group (NSIG) members matched into neurosurgery residency.¹ While these two fields are inherently different, it is worth noting the relatively higher match rate among students within OSIG vs NSIG. This could indicate a greater impact on student interest group involvement within the field of orthopedics compared to other subspecialties or could be a result of uniquely strong mentorship in orthopedics. Another intriguing finding is that 100% of students in our study who matched into orthopedic residency programs during the 2019-2020 application cycle were involved in their schools orthopedic surgery interest group. This further adds to the suggestion that involvement within OSIG does play a role in students’ success in the residency application process.

There were several limitations to this study. First, the study’s survey design likely limited the final sample size. This survey was sent to over 140 medical programs across the country and received 28 responses. Of those responses, some short-answer questions were unanswered. The sample size must be taken into account when considering the generalizability of the study’s findings. However, we cannot confirm the existence of OSIG at each institution or that the survey was received by an individual who could answer the questions. Furthermore, several of the survey questions did not offer an option for 0 (zero) or a numerical option greater than 10 (ten), thus some values may be slightly skewed due to lack of applicable options.

Further studies may utilize this study’s results to broaden the range of knowledge to a greater number of schools. This also suggests a potential for comparison between undergraduate student interest groups within different subspecialties of medicine. Studies can investigate match rates among groups, as well as other metrics of successful matching into one’s desired subspecialty.

Conclusion

In review, this pilot study indicates the importance of student involvement in OSIG as a conduit for clinical exposure and formal mentorship throughout their undergraduate medical education. Despite a small sample size, the data suggests that students are more likely to match into orthopedic residency programs when involved in OSIG. This can be used to increase the integration of mentorship programs within medical schools throughout the United States with the hopes of improving student preparedness throughout the application process. It can also improve the initiatives that OSIGs emphasize to create a targeted approach that maximizes their members’ chances of becoming a competitive residency applicant.