The 2020-2021 Canadian Residency Matching Service (CaRMS) match year was altered on an unprecedented scale. Visiting electives were cancelled at a national level, and the CaRMS interview tour was moved to a virtual model. These changes posed a significant challenge to both prospective students and program directors (PDs), requiring each party to employ alternative strategies to distinguish themselves throughout the match process. For a variety of reasons, including a decline in applicant interest secondary to reduced job prospects, the field of orthopaedic surgery was identified as vulnerable to many of these changes, creating a window of opportunity to evaluate their impacts on students and recruiting residency programs.

This longitudinal survey study was disseminated to match-year medical students (3rd and 4th year) with an interest in orthopaedic surgery, as well as orthopaedic surgery program directors. Responses to the survey were collected using an electronic form designed in Qualtrics (Qualtrics, 2021, Provo, Utah, USA). Students were contacted through social media posts, as well as by snowball sampling methods through appropriate medical student leadership intermediates. The survey was disseminated to all 17 orthopedic surgery program directors in Canada.

A pre-match and post-match iteration of this survey were designed to identify whether expectations differed from reality regarding the effect of the COVID-19 pandemic on the CaRMS match 2020-2021 process. A similar package was disseminated to Canadian orthopaedic surgery program directors pre-match, with an option to opt-in for a post-match survey follow-up. This survey had a focus on program directors’ opinions of various novel communication, recruitment, and assessment strategies, in the wake of the COVID-19 pandemic.

Students’ responses to the loss of visiting electives were negative. Despite a reduction in financial stress associated with reduced need to travel (p=0.001), this was identified as a core component of the clerkship experience. In the case of virtual interviews, students’ initial trepidation pre-CaRMS turned into a positive outlook post-CaRMS (significant improvement, p=0.009) indicating an overall satisfaction with the virtual interview format, despite some concerns about a reduction in their capacity to network. Program directors and selection committee faculty also felt positively about the virtual interview format. Both students and program directors were overwhelmingly positive about virtual events put on by both school programs and student-led initiatives to complement the CaRMS tour.

CaRMS was initially developed to facilitate the matching process for both students and programs alike. We hope to continue this tradition of student-led and student-informed change by providing three evidence-based recommendations. First, visiting electives should not be discontinued in future iterations of CaRMS if at all possible. Second, virtual interviews should be considered as an alternative approach to the CaRMS interview tour moving forward. And third, ongoing virtual events should be associated with a centralized platform from which programs can easily communicate virtual sessions to their target audience.

The purpose of this population-based study was to determine the association between morbid obesity and 10-year mortality and complications in patients undergoing primary THA.

A cohort study of 22,251 patients, aged 45–74 years old, treated with primary THA between 2002 and 2007 for osteoarthritis, was conducted using Ontario administrative healthcare databases. Patients were followed for 10 years. Risk ratios (RRs) of mortality, reoperation, revision, and dislocation in patients with body mass index (BMI) > 45 kg/m2(morbidly obese patients) compared with BMI ≤45 kg/m2 (non-morbidly obese) were estimated.

3.3% of the cohort (726) was morbidly obese. Morbidly obese patients were younger (mean age 60.6 vs. 63.3, P-value < 0 .001) and more likely to be female (63.9% vs. 52.2%, P-value < 0 .001), compared with non-morbidly obese patients. Morbid obesity was associated with higher 10-year risk of death (RR 1.38, 95% CI 1.18, 1.62). Risks of revision (RR 1.43, 95% CI 0.96, 2.13) and dislocation (RR 2.38, 95% CI 1.38, 4.10) were higher in morbidly obese men, compared with non-morbidly obese men, there were no associations between obesity and revision or dislocation in women. Risk of reoperation was higher in morbidly obese women, compared to non-morbidly obese women (RR 1.60, 95% CI 1.05, 2.40), there was no association between obesity and reoperation in men.

Morbidly obese patients undergoing primary THA are at higher risks of long-term mortality and complications. There were differences in complication risk by sex. Results should inform evidence-based perioperative counseling of morbidly obese patients considering THA.

Introduction

Computer-assisted methods for acetabulum cup navigation have shown to be able to improve the accuracy of the procedure, but are time-consuming and difficult to use. The goal of this project was to develop an easy-to-use navigation technique, requiring minimal equipment for acetabular cup alignment.