Background:

The term “pipelining” refers to the phenomenon that applicants from certain residency programs frequently match at the same fellowship programs. However, it is unclear how prevalent pipelining is amongst the top orthopaedic sports medicine fellowship programs. The purpose of this study was to determine the prevalence of pipelining at the top orthopaedic sports medicine fellowships in the United States.

Methods:

The fellowship programs included in this study came from a recent survey study that determined the top 10 programs as perceived by fellowship applicants over the past 5 years. The residency programs of current and former fellows at each of these fellowship programs over the last 5-10 years was determined by searching program websites and/or contacting program coordinators/directors. For each program, we determined the number of occurrences of more than 2, 3, and 4 fellows from the same residency program. We also calculated a “pipelining ratio”, defined as the ratio of the total number of fellows at the program over the duration of the study to the number of different residency programs represented within the fellowship program.

Results:

Data was obtained from 7 of the top 10 fellowship programs. Of the remaining 3 programs, 1 declined to provide the information and 2 did not respond. Pipelining was found to be highly prevalent at one program (Program 1), with a pipelining ratio of 1.9 (Table 1). Two different residency programs had at least 5 residents match at Program 1 over 10 years. Although not as prevalent, there was also found to be evidence of pipelining at Programs 2 and 3, with one residency program matching 5 residents over 5 years at Program 2, and 2 residency programs matching at least 2 residents at Programs 2 and 3 over 5 and 10 years, respectively. Conclusion:

This study highlights the prevalence of pipelining at the top orthopaedic sports medicine fellowship programs. The practice of pipelining may present a disadvantage for residents from residency programs without previous connections to certain fellowship programs. Future studies may seek to determine methods of minimizing the practice of pipelining and to provide a fair assessment of all fellowship applicants.

References

1. Parsons M, Caldwell MT, Alvarez A, et al. Physician Pipeline and Pathway Programs: An Evidence-based Guide to Best Practices for Diversity, Equity, and Inclusion from the Council of Residency Directors in Emergency Medicine. West J Emerg Med. 2022;23(4):514-524. PMID: 35980420
2. Clark SC, Kraeutler MJ, McCarty EC, Mulcahey MK. Virtual Interviews for Sports Medicine Fellowship Positions Save Time and Money but Don’t Replace In-Person Meetings. Arthrosc Sports Med Rehabil. 2022;4(2):e607-e615. PMID: 35494269

3. Peebles LA, Kraeutler MJ, Waterman BR, Sherman SL, Mulcahey MK. The Impact of COVID-19 on the Orthopaedic Sports Medicine Fellowship Application Process. Arthrosc Sports Med Rehabil. 2021;3(4):e1237-e1241. PMID: 34430904