1
|
Yudien MA, Brooks AD, Aarons CB. Medical Student Perceptions of Academic Surgery: Rose-Colored Glasses or Jaded Prism? JOURNAL OF SURGICAL EDUCATION 2024; 81:373-381. [PMID: 38177035 DOI: 10.1016/j.jsurg.2023.11.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 10/25/2023] [Accepted: 11/26/2023] [Indexed: 01/06/2024]
Abstract
OBJECTIVE Stereotypes of surgeons are pervasive and play a role in medical students' decisions about pursuing a surgical career. This study aimed to determine: (1) how medical students' perceptions of surgery and surgeons changed following exposure to surgery during clerkship rotations; and (2) if gender and racial/ethnic identification played a role in this process. DESIGN, SETTING, AND PARTICIPANTS In this mixed-method study, clerkship students at one U.S. medical school were asked to anonymously contribute words and phrases that they associated with surgery to an online "word cloud" at the beginning and end of their 12-week surgery clerkship. In addition, an end-of-year, anonymous survey of their perceptions was administered and analyzed using a Grounded Theory approach. RESULTS Of 154 students invited to complete the online survey, analysis of 24 completed surveys suggested that students believe surgical culture to be toxic, with unfriendly attitudes, strict hierarchy, and lack of work-life balance. Analysis of 678 Word Cloud responses, however, indicated that the frequency of complimentary responses increased following surgery clerkships (25% vs 36%; z = -3.26; p = 0.001), while the proportion of responses describing surgery/surgeons as male-dominated, egotistical, and scary decreased (5% vs 1%, z = 2.86, p = 0.004; 9% vs 4%, z = 2.78, p = 0.005; 3% vs 0.3%, z = 2.56, p = 0.011, respectively). The association between surgeons and being White disappeared entirely. Female students were more likely than male students to state that their perceptions did not change following exposure (40% vs 0%; z = 2.19; p = 0.029). CONCLUSIONS With exposure to surgery, students' preconceived notions may be positively influenced. However, students continue to hold negative perceptions, and this effect may be stratified by gender identification. Institutions should work to address these perceptions in pre-clerkship years to attract a more diverse pool of future surgeons.
Collapse
Affiliation(s)
- Mikhal A Yudien
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.
| | - Ari D Brooks
- Department of Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Cary B Aarons
- Department of Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| |
Collapse
|
2
|
Nguyen M, Gonzalez L, Stain SC, Dardik A, Chaudhry SI, Desai MM, Boatright D, Butler PD. Association of Socioeconomic Status, Sex, Racial, and Ethnic Identity With Sustained and Cultivated Careers in Surgery. Ann Surg 2024; 279:367-373. [PMID: 37470162 PMCID: PMC10799171 DOI: 10.1097/sla.0000000000006029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/21/2023]
Abstract
OBJECTIVE Examine the association between sex, race, ethnicity, and family income, and the intersectionality between these identities, and sustained or cultivated paths in surgery in medical school. METHODS This retrospective cohort study examines US medical students who matriculated in academic years 2014-2015 and 2015-2016. Data were provided by the Association of American Medical Colleges, including self-reported sex, race, ethnicity, family income, interest in surgery at matriculation, and successful placement into a surgical residency at graduation. This study examined 2 outcomes: (1) sustained path in surgery between matriculation and graduation for students who entered medical school with an interest in surgery and (2) cultivated path in surgery for students who entered medical school not initially interested in surgery and who applied to and were successfully placed into a surgical residency at graduation. RESULTS Among the 5074 students who reported interest in surgery at matriculation, 2108 (41.5%) had sustained path in surgery. Compared to male students, female students were significantly less likely to have sustained path in surgery [adjusted relative risk (aRR): 0.92 (0.85-0.98)], while Asian (aRR: 0.82, 95% CI: 0.74-0.91), Hispanic (aRR: 0.70, 95% CI: 0.59-0.83), and low-income (aRR: 0.85, 95% CI: 0.78-0.92) students were less likely to have a sustained path in surgery compared to their peers. Among the 17,586 students who reported an initial interest in a nonsurgical specialty, 1869 (10.6%) were placed into a surgical residency at graduation. Female students, regardless of race/ethnic identity and income, were significantly less likely to have cultivated paths in surgery compared to male students, with underrepresented in medicine female students reporting the lowest rates. CONCLUSIONS AND RELEVANCE This study demonstrates the significant disparity in sustained and cultivated paths in surgery during undergraduate medical education. Innovative transformation of the surgical learning environment to promote surgical identity development and belonging for females, underrepresented in medicine, and low-income students is essential to diversify the surgical workforce.
Collapse
Affiliation(s)
| | | | - Steven C. Stain
- Department of Surgery, Lahey Hospital and Medical Center, Boston, MA, USA
| | - Alan Dardik
- Department of Surgery, Yale School of Medicine, New Haven, CT, USA
- Department of Surgery, VA Connecticut Healthcare System, West Haven, CT, USA
| | - Sarwat I. Chaudhry
- Section of General Internal Medicine, Department of Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Mayur M Desai
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT
| | - Dowin Boatright
- Department of Emergency Medicine, New York University School of Medicine, New York, NY, USA
| | - Paris D. Butler
- Department of Surgery, Yale School of Medicine, New Haven, CT, USA
| |
Collapse
|
3
|
Iwai Y, Yu AYL, Thomas SM, Downs-Canner S, Beasley GM, Sudan R, Fayanju OM. At the Intersection of Intersectionality: Race and Gender Diversity Among Surgical Faculty and Trainees. Ann Surg 2024; 279:77-87. [PMID: 37436874 PMCID: PMC10787047 DOI: 10.1097/sla.0000000000005992] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/14/2023]
Abstract
OBJECTIVE To compare the representation of intersectional (ie, racial/ethnic and gender) identities among surgical faculty versus medical students. BACKGROUND Health disparities are pervasive in medicine, but diverse physicians may help the medical profession achieve health equity. METHODS Data from the Association of American Medical Colleges for 140 programs (2011/2012-2019/2020) were analyzed for students and full-time surgical faculty. Underrepresented in medicine (URiM) was defined as Black/African American, American Indian/Alaskan Native, Hispanic/Latino/Spanish Origin, or Native Hawaiian/Other Pacific Islander. Non-White included URiM plus Asian, multiracial, and non-citizen permanent residents. Linear regression was used to estimate the association of year and proportions of URiM and non-White female and male faculty with proportions of URiM and non-White students. RESULTS Medical students were comprised of more White (25.2% vs 14.4%), non-White (18.8% vs 6.6%), and URiM (9.6% vs 2.8%) women and concomitantly fewer men across all groups versus faculty (all P < 0.01). Although the proportion of White and non-White female faculty increased over time (both P ≤ 0.001), there was no significant change among non-White URiM female faculty, nor among non-White male faculty, regardless of whether they were URiM or not. Having more URiM male faculty was associated with having more non-White female students (estimate = +14.5% students/100% increase in faculty, 95% CI: 1.0% to 8.1%, P = 0.04), and this association was especially pronounced for URiM female students (estimate = +46.6% students/100% increase in faculty, 95% CI: 36.9% to 56.3%, P < 0.001). CONCLUSIONS URiM faculty representation has not improved despite a positive association between having more URiM male faculty and having more diverse students.
Collapse
Affiliation(s)
- Yoshiko Iwai
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Alice Yunzi L Yu
- Department of Pediatrics, Ann and Robert Lurie Children's Hospital of Chicago, Chicago, IL
| | - Samantha M Thomas
- Duke Cancer Institute, Duke University School of Medicine, Durham, NC
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC
| | - Stephanie Downs-Canner
- Department of Surgery, Breast Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Georgia M Beasley
- Duke Cancer Institute, Duke University School of Medicine, Durham, NC
- Department of Surgery, Duke University School of Medicine, Durham, NC
| | - Ranjan Sudan
- Department of Surgery, Duke University School of Medicine, Durham, NC
| | - Oluwadamilola M Fayanju
- Department of Surgery, Perelman School of Medicine, The University of Pennsylvania, Philadelphia, PA
- Breast Surgery, Rena Rowan Breast Center, Abramson Cancer Center, The University of Pennsylvania, Philadelphia, PA
- Health Equity Innovation, Penn Center for Cancer Care Innovation (PC3I), Abramson Cancer Center, The University of Pennsylvania, Philadelphia, PA
- Leonard Davis Institute of Health Economics (LDI), The University of Pennsylvania, Philadelphia, PA
| |
Collapse
|
4
|
Suraju MO, McElroy L, Moten A, Obeng-Gyasi S, Alimi Y, Carter D, Foretia DA, Stapleton S, Yilma M, Reid VJ, Tetteh HA, Khabele D, Rodriguez LM, Campbell A, Newman EA. A framework to improve retention of Black surgical trainees: A Society of Black Academic Surgeons white paper. Am J Surg 2023; 226:438-446. [PMID: 37495467 DOI: 10.1016/j.amjsurg.2023.07.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 06/19/2023] [Accepted: 07/11/2023] [Indexed: 07/28/2023]
Abstract
Attrition is high among surgical trainees, and six of ten trainees consider leaving their programs, with two ultimately leaving before completion of training. Given known historically and systemically rooted biases, Black surgical trainees are at high risk of attrition during residency training. With only 4.5% of all surgical trainees identifying as Black, underrepresentation among their peers can lend to misclassification of failure to assimilate as clinical incompetence. Furthermore, the disproportionate impact of ongoing socioeconomic crisis (e.g., COVID-19 pandemic, police brutality etc.) on Black trainees and their families confers additional challenges that may exacerbate attrition rates. Thus, attrition is a significant threat to medical workforce diversity and health equity. There is urgent need for surgical programs to develop proactive approaches to address attrition and the threat to the surgical workforce. In this Society of Black Academic Surgeons (SBAS) white paper, we provide a framework that promotes an open and inclusive environment conducive to the retention of Black surgical trainees, and continued progress towards attainment of health equity for racial and ethnic minorities in the United States.
Collapse
Affiliation(s)
- Mohammed O Suraju
- Department of Surgery, University of Iowa Hospitals and Clinics, Iowa City, IA, United States
| | - Lisa McElroy
- Department of Surgery, Duke University Hospital, Durham, NC, United States
| | - Ambria Moten
- Department of Surgery, The University of Tennessee Health Science Center, Memphis, TN, United States
| | - Samilia Obeng-Gyasi
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Yewande Alimi
- Department of Surgery, Georgetown University School of Medicine, Washington, DC, United States
| | - Damien Carter
- Department of Surgery, Maine Medical Center, Portland, ME, United States
| | - Denis A Foretia
- Department of Surgery, The University of Tennessee Health Science Center, Memphis, TN, United States
| | - Sahael Stapleton
- Department of Surgery, Kaiser Permanente Vacaville Medical Center, Vacaville, CA, United States
| | - Mignote Yilma
- Department of Surgery, University of California San Francisco, San Francisco, CA, United States
| | - Vincent J Reid
- Department of Surgery, University of Iowa Hospitals and Clinics, Iowa City, IA, United States; Department of Surgery, Mercy Medical Center Cedar Rapids, Cedar Rapids, IA, United States
| | - Hassan A Tetteh
- Department of Surgery, Uniformed Services University, Bethesda, MD, United States
| | - Dineo Khabele
- Division of Gynecologic Oncology, Washington University School of Medicine, And Alvin J. Siteman Cancer Center, St Louis, MO, United States
| | - Luz M Rodriguez
- Gastrointestinal and Other Cancers Research Group, Division of Cancer Prevention, NCI, NIH, Bethesda, MD, United States; Department of Surgery, Walter Reed National Military Medical Center (WRNMM) Uniformed Services University (USU), Bethesda, MD, United States
| | - Andre Campbell
- Department of Surgery, University of California San Francisco, San Francisco, CA, United States
| | - Erika A Newman
- Section of Pediatric Surgery, Department of Surgery, CS Mott Children's Hospital, The University of Michigan Medical School, United States.
| |
Collapse
|
5
|
Collins RA, Sheriff SA, Yoon C, Cobb AN, Kothari AN, Newman LA, Dossett LA, Willis AI, Wong SL, Clarke CN. Assessing the Complex General Surgical Oncology Pipeline: Trends in Race and Ethnicity Among US Medical Students, General Surgery Residents, and Complex General Surgical Oncology Trainees. Ann Surg Oncol 2023; 30:4579-4586. [PMID: 37079205 DOI: 10.1245/s10434-023-13499-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Accepted: 03/06/2023] [Indexed: 04/21/2023]
Abstract
BACKGROUND Cancer incidence is expected to increase in coming decades, disproportionately so among minoritized communities. Racially and ethnically concordant care is essential to addressing disparities in cancer outcomes within at-risk groups. Here, we assess trends in racial and ethnic representation of medical students (MS), general surgery (GS) residents, and complex general surgical oncology (CGSO) fellows. METHODS This is a retrospective review of data from the American Association of Medical Colleges and the Accreditation Council of Medical Education (ACGME) from 2015 to 2020. Self-reported race and ethnicity was obtained for MS, GS, and CGSO trainees. Race and ethnicity proportions were compared with respective representation in the 2020 US Census. Mann-Kendall, Wilcoxon rank sum, and linear regression were used to assess trends, as appropriate. RESULTS A total of 316,448 MS applicants, 128,729 MS matriculants, 27,574 GS applicants, 46,927 active GS residents, 710 CGSO applicants, and 659 active CGSO fellows were included. With every progressive stage in training, there was a smaller proportion of URM active trainees than applicants. Further, URM, Hispanic/Latino, and Black/African American trainees were significantly underrepresented compared with 2020 Census data. While the proportion of White CGSO fellows increased over time (54.5-69.2%, p = 0.009), the proportion of Black/African American and Hispanic/Latino (URM) CGSO fellows did not significantly change over the study period, though URM representation was lower in 2020 as compared with 2015. DISCUSSION From 2015 to 2020, minority representation decreased at every advancing stage in surgical oncology training. Efforts to address barriers for URM applicants to CGSO fellowships are needed.
Collapse
Affiliation(s)
- Reagan A Collins
- Institute for Technology Assessment, Massachusetts General Hospital, Boston, MA, USA
| | - Salma A Sheriff
- Division of Surgical Oncology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Christopher Yoon
- Division of Surgical Oncology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Adrianne N Cobb
- Division of Surgical Oncology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Anai N Kothari
- Division of Surgical Oncology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Lisa A Newman
- Division of Surgical Oncology, New York-Presbyterian/Weill Cornell Medical Center, New York, NY, USA
| | - Lesly A Dossett
- Division of Surgical Oncology, University of Michigan Medicine, Ann Arbor, MI, USA
| | - Alliric I Willis
- Division of Surgical Oncology, Thomas Jefferson University College, Philadelphia, PA, USA
| | - Sandra L Wong
- Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Callisia N Clarke
- Division of Surgical Oncology, Medical College of Wisconsin, Milwaukee, WI, USA.
| |
Collapse
|
6
|
Zheng H, Al-Refaie W, Chou J, Galli F, Lai V, Felger EA. Gender Disparity in Earliest Phase of Academic Surgical Training: An Area for Intervention. J Am Coll Surg 2023; 236:687-694. [PMID: 36744799 DOI: 10.1097/xcs.0000000000000641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND To overcome persistent gender disparities in academic surgery, it is critical to examine the earliest phase of surgical training. This national study sought to assess whether gender disparities also existed among surgical interns, as a proxy for medical school research experience in both quantity and quality. STUDY DESIGN Using the 2021 to 2022 public information of 1,493 US-graduated categorical general surgery interns, a bibliometric evaluation was conducted to assess medical school research experience. Multivariable linear regressions with response log-transformed were performed to evaluate the impact of intern gender on (1) total number of peer-reviewed publications, (2) total impact factor (TIF), and (3) adjusted TIF based on authorship placement (aTIF). Back-transformed estimates were presented. RESULTS Of these interns, 52.3% were female. Significant differences were observed in TIF (male 6.4 vs female 5.3, p = 0.029), aTIF (male 10.8 vs female 8.7, p = 0.035), gender concordance with senior authors (male 79.9% vs female 34.1%, p < 0.001), Hirsch index (male 21.0 vs female 18.0, p = 0.026), and the geographic region of their medical schools (p = 0.036). Multivariable linear regressions revealed that female interns were associated with lower TIF (0.858, p = 0.033) and aTIF (0.851, p = 0.044). Due to a significant gender-by-region interaction, adjusted pairwise comparisons showed that male interns in the Northeast had approximately 70% higher TIF (1.708, p = 0.003) and aTIF (1.697, p = 0.013) than female interns in the South. CONCLUSIONS Gender disparities existed in the quality of research experience in the earliest phase of surgical training. These timely results call for additional interventions by the stakeholders of graduate medical education.
Collapse
Affiliation(s)
- Hui Zheng
- From the Department of Surgery, MedStar Washington Hospital Center/Georgetown University Hospital, Washington, DC (Zheng)
| | - Waddah Al-Refaie
- MedStar Health, Georgetown University Medical Center, Georgetown Lombardi Comprehensive Cancer Center, Washington, DC (Al-Refaie, Galli)
| | - Jiling Chou
- Center of Biostatistics, Informatics and Data Science, Medstar Health Research Institute, Rockville, MD (Chou)
| | - Francesca Galli
- MedStar Health, Georgetown University Medical Center, Georgetown Lombardi Comprehensive Cancer Center, Washington, DC (Al-Refaie, Galli)
| | - Victoria Lai
- the Division of Endocrine Surgery, MedStar Washington Hospital Center, Washington, DC (Lai, Felger)
| | - Erin A Felger
- the Division of Endocrine Surgery, MedStar Washington Hospital Center, Washington, DC (Lai, Felger)
| |
Collapse
|