Hand Surgery in the next millennium

新的千年预示着更大的进步和希望。新观点和新技术的引入，将对未来的手外科学产生巨大的影响。(1)　生物相容性物质的进展　新的移植物如假关节有诸多优点，如生物相容性、稳定性、活动性好，更个体化，更快整合以利于早期活动。骨折内固定物具有可吸收性而无须取出。骨替代物含有特异的生长因子，能定时释放促进血管的长入。(2)　非侵入性或低侵入性手术的广泛应用　如关节镜变得更小而影像质量更高，手术入路日趋变小，小切口手术的适应证日渐扩大。(3)　安全的异体移植　由于免疫排异反应的控制，异体组合组织、部分或全部肢体移植将很安全。(4)　骨、肌腱、神经和复合组织的组织工程再造　随着人类基因解码，可以利用自体干细胞“建造”人体任何组织，这些合成物因与受体在基因上完全相同而不存在免疫排斥问题。(5)　患者个体化计算机模型的应用　利用患者个体化计算机模型，可模拟各种手术并评价其效果，以选择最佳术式。(6)　信息技术的应用　利用其来获取知识，甚至可随时查询出某一特定病例的治疗方案。(7)　计算机辅助下的外科教育和培训　利用计算机辅助模拟系统，如三维实时外科模拟器来学习、训练及评价外科手术技术。(8)　虚拟现实在手术中的应用　随着计算机处理能力和速度的大幅度提高，可将任何数字化的影像转成实时虚拟现实，使手外科医生能在术中看到任何解剖结构，使手术更精确，并避免发生副损伤。新世纪手外科专家真正的将来不在于上述技术的进展，而在于现在这一代手外科专家去吸引最优秀最聪明的大学生、医学生和住院医生去学习这个专业，这可通过手外科领导的模范作用来实现。正如爱因斯坦所说树立榜样不是影响他人的主要方式，而是唯一方式。     

Is the Distribution of Awards Gender-balanced in Orthopaedic Surgery Societies?

BackgroundSociety awards provide visibility and national recognition for physicians. Several studies have found that women were underrepresented as award recipients when compared with subspecialty workforce data. However, to our knowledge no studies have examined the gender distribution of award recipients in orthopaedic societies. Orthopaedic surgery remains among the least gender-diverse specialties in medicine. Particularly in academic practice, the increasing paucity of women with progressive rank may reflect unequal access to the currency for promotion, including national reputation and visibility. Therefore, information on orthopaedic awarding practices may help to identify and address challenges associated with recruiting, retaining, and promoting women in orthopaedics.Questions/purposes(1) Since the year 2000, have women orthopaedic surgeons received awards in proportion to their society membership? (2) Are the awards granted to women equally distributed across the categories of leadership, humanitarianism, education, scientific investigation, resident/fellow scientific investigation, and diversity? (3) Does the gender distribution of award recipients differ for awards bestowed through a blinded process versus an unblinded process?MethodsEighteen national, clinically focused orthopaedic societies in the United States were included. These societies offer a combined total of 69 awards; each award was studied from its earliest record through December 2018, resulting in a study period from 1973 to 2018. Each society provided the gender demographics of their membership in 2018. The proportion of women award recipients from 2000 to 2018 was compared with the proportion of women members in 2018 for each society. Awards were also categorized based on the six types of accomplishment they recognized (leadership, humanitarianism, education, scientific investigation, resident/fellow scientific investigation, and diversity), and whether they were granted through a blinded or unblinded selection process. Chi-square tests were used to compare the proportion of women receiving awards in various categories, and to compare the proportion of women who received awards through blinded selection processes versus unblinded selection processes.ResultsFrom 2000 to 2018, women received 8% (61 of 794) of all awards and represented 9% (5359 of 59,597) of all society members. Two societies had an underrepresentation of women award recipients compared with their society membership. We found that women were not represented proportionally across award categories. Women were more likely to receive a diversity award than a leadership award (odds ratio 12.0 [95% CI 3.1 to 45.7]; p < 0.001), and also more likely to receive an education award than a leadership award (OR 4.1 [95% CI 1.3 to 12.7]). From 1973 to 2018, 17 of 22 the leadership awards offered by societies have never been granted to a woman. Finally, women were more likely to receive awards bestowed through a blinded process than an unblinded process. Women earned 11% (30 of 285) of awards bestowed through a blinded award process and 6% (31 of 509) of awards bestowed through an unblinded award process (OR 1.8 [95% CI 1.1 to 3.1]; p = 0.03).ConclusionThe percent of women award recipients was generally proportional to membership overall and in most societies. However, on a national workforce level, the proportion of women award recipients is lower than the proportion of women in academic orthopaedics, which has been reported by others to be about 13%, suggesting that women in academic orthopaedics may be underrepresented as award recipients. Additionally, women were less likely to receive leadership awards than awards of other types, which suggests that women are not being recognized as leaders in orthopaedics. Women were also more likely to receive awards granted through unblinded processes, which raises concern that there may be implicit bias in orthopaedic awarding practices.Clinical RelevanceWe encourage societies to examine the inclusiveness of their awards selection processes and to track the demographic information of award recipients over time to measure progress toward equal representation. Creating standardized award criteria, including women on selection committees, requiring the consideration of diverse nominees, and implicit bias training for selection committees may help to reduce bias in awarding practices.