Impact of fellowship training on clinical practice of orthopaedic sports medicine.
BACKGROUND
Approximately 90% of current orthopaedic graduates are engaging in fellowship training, with sports medicine being the most commonly chosen specialty. The purpose of this study was to evaluate the impact of fellowship training on clinical decision-making by fellowship-trained sports medicine surgeons.


METHODS
A survey was designed to assess the importance of fellowship on common clinical decisions made in the nonoperative and surgical treatment of knee, shoulder, and elbow disorders. The survey also included questions for the respondents on their comfort level with a variety of routine and complex surgical procedures. The survey was sent to alumni of 113 orthopaedic sports medicine programs across the United States.


RESULTS
Completed surveys were returned by 310 surgeons who had been in practice for an average of 9.0 years. They represented alumni of twenty-nine orthopaedic sports medicine fellowship programs across sixteen states. Fellowship was considered very important for surgical decision-making in the knee and shoulder. For nonoperative treatment, fellowship had a greater impact on shoulder disorders than on knee or elbow disorders. Fellowship was significantly more important than residency (p < 0.001) for determining preferred surgical equipment, implants, and braces. Among the surgical procedures assessed, respondents were least comfortable with the treatment of multi-ligamentous knee injuries, posterior cruciate ligament injuries, and shoulder instability with bone loss.


CONCLUSIONS
Fellowship has a significantly higher impact than residency on industry-related decision-making. Fellowship-trained sports surgeons should consider seeking additional training in the treatment of multi-ligamentous knee injuries, posterior cruciate ligament injuries, shoulder instability with bone loss, and elbow disorders. The current findings were limited by the relatively small respondent pool, which represented only 26% of sports medicine fellowship programs in the United States.
Kerlan-Jobe Orthopaedic Clinic, 6801 Park Terrace, Suite 500, Los Angeles, CA 90045. E-mail address for B. Yin: bobyin@gmail.com.
Bob
B
Yin
Coastal Orthopedics, 77 Herrick Street, Suite 201, Beverly, MA 01915.
Jaipal
J
Gandhi
Kerlan-Jobe Orthopaedic Clinic, 6801 Park Terrace, Suite 500, Los Angeles, CA 90045. E-mail address for B. Yin: bobyin@gmail.com.
Orr
O
Limpisvasti
Kerlan-Jobe Orthopaedic Clinic, 6801 Park Terrace, Suite 500, Los Angeles, CA 90045. E-mail address for B. Yin: bobyin@gmail.com.
Karen
K
Mohr
Kerlan-Jobe Orthopaedic Clinic, 6801 Park Terrace, Suite 500, Los Angeles, CA 90045. E-mail address for B. Yin: bobyin@gmail.com.
Neal S
NS
ElAttrache
D002983:Clinical Competence / Q000706:statistics & numerical data*; D004503:Education, Medical, Graduate / Q000191:economics*; D005257:Fellowships and Scholarships / Q000706:statistics & numerical data*; D006301:Health Services Needs and Demand / Q000706:statistics & numerical data; D006801:Humans; D007592:Joint Diseases / Q000175:diagnosis / Q000628:therapy; D007717:Knee / Q000601:surgery; D019637:Orthopedic Procedures / Q000379:methods; D009985:Orthopedics / Q000193:education* / Q000706:statistics & numerical data; D011159:Population Surveillance; D015397:Program Evaluation; D012782:Shoulder / Q000601:surgery; D012785:Shoulder Joint / Q000601:surgery; D013178:Sports Medicine / Q000193:education* / Q000706:statistics & numerical data; D014481:United States