In this study of self-reported conflict-of-interest disclosure by physicians at a large annual meeting, the rate of disclosure was 79.3% for directly related payments and 50.0% for indirectly related payments.

Most medical journals practice single-blind review 1 (authors' identities known to reviewers), but double-blind review (authors' identities masked to reviewers) may improve the quality of reviews. 2 Bias with single-blind review might be greatest in the setting of author or institutional prestige. 2 Methods | This study was approved by the University of Washington institutional review board and conducted at Clinical Orthopaedics and Related Research (CORR), an orthopedic journal (2015 impact factor, 3.127; acceptance rate, 20%) that allows authors to select single-blind or double-blind peer review. Potential reviewers (based on expertise) were identified from the journal's database, informed that a study on peer review would occur in the coming year, and allowed to opt out. To avoid influencing behavior, the details and timing of the study were not described and the trial was registered after completion. The protocol appears in the Supplement. Between June 2014 and August 2015, reviewers were randomized via random number table (1:1 ratio in blocks of 8) to receive single-blind or double-blind versions of an otherwise identical fabricated manuscript, which was putatively writ

Orthopedic procedures represent a large expense to the Medicare program, and costs of implantable medical devices account for a large proportion of those procedures’ costs. Physicians have been encouraged to consider costs in the selection of devices, but several factors make acquiring information about costs difficult. To assess physicians’ levels of knowledge about costs, we asked orthopedic attending physicians and residents at seven academic medical centers to estimate the costs of thirteen commonly used orthopedic devices between December 2012 and March 2013. The actual cost of each device was determined at each institution; estimates within 20 percent of the actual cost were considered correct. Among the 503 physicians who completed our survey, attending physicians correctly estimated the cost of the device 21 percent of the time, and residents did so 17 percent of the time. Thirty-six percent of physicians and 75 percent of residents rated their knowledge of device costs “below average” or “poor.” However, more than 80 percent of all respondents indicated that cost should be “moderately,” “very,” or “extremely” important in the device selection process. Surgeons need increased access to information on the relative prices of devices and should be incentivized to participate in cost-containment efforts.

Minority representation in orthopaedic residency programs has increased over time for Asians, Hispanics, and African-Americans. In spite of these gains, orthopaedic surgery has remained the least diverse of the specialty training programs considered in this study. While further efforts are needed to determine the factors underlying this lack of representation, we suggest a series of interventions that can be expected to enhance diversity in orthopaedic residencies as well as in the profession as a whole.