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Dejenie R, Fannon EE, Persky J, Gaeta E, Soufi K, Howard B, Stadeli KM, Godoy LA. Dissecting Diversity: A Comprehensive Look at the Present Landscape and Future Challenges in Surgical Specialties. JOURNAL OF SURGICAL EDUCATION 2024; 81:1004-1011. [PMID: 38760190 DOI: 10.1016/j.jsurg.2024.04.003] [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: 11/01/2023] [Revised: 03/20/2024] [Accepted: 04/03/2024] [Indexed: 05/19/2024]
Abstract
BACKGROUND As the US demographic evolves, surgical fields must adapt to ensure equitable healthcare. Healthcare disparities notably affect minority populations, with communities of color often facing physician shortages and higher rates of diseases such as coronary disease, stroke, and cancer. Research shows that minority physicians significantly improve patient satisfaction and outcomes in underserved communities, highlighting the need for increased physician diversity to enhance cultural competency and patient centered care. Data from the Association of American Medical Colleges (AAMC) reveals minimal increases in underrepresented minorities (URM) in surgical residency and academic careers over the past thirty-six years, with little change URM applicants and matriculants in the nine surgical specialties recognized by the American College of Surgeons from 2010 to 2018. OBJECTIVE This review aims to critically evaluate the current landscape of racial and gender diversity in six out of the nine defined surgical specialties (general surgery, plastic surgery, neurosurgery, orthopedic surgery, cardiothoracic surgery, and vascular surgery) in the US. DESIGN We conducted a comprehensive literature review to assess of the state of diversity within surgical specialties in the United States. By analyzing the benefits of diversity in surgical fields, evaluating the effectiveness of various diversity programs and initiatives, examining the comparative diversity between surgical subspecialties, and assessing the impact of diversity on patient outcomes, our aim is to highlight the critical importance of enhancing diversity in surgical fields. RESULTS While nuances in representation and diversity vary across surgical specialties, all fields persistently exhibit underrepresentation of certain racial/ethnic groups and persistent gender disparities. These disparities manifest throughout various phases, including in residency, and in the recruitment and retention of URM individuals in surgery and surgical subspecialties. While interventions over the past decade have contributed to improving diversity in surgical fields, significant disparities persist. Limitations include the time required for recent interventions to show significant impacts and the inability of established interventions to eliminate disparities. CONCLUSIONS Despite the clear benefits, diversity within surgical specialties remains an uphill battle. Addressing the diversity gap in surgical fields is crucial for improving patient outcomes, healthcare access, and workplace environments, requiring strategies such as targeted recruitment, mentorship programs, and addressing systemic biases. This review highlights the undeniable imperative for change and serve a call to action.
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Affiliation(s)
- Rebeka Dejenie
- University of California, Davis Medical Center. Department of Surgery. 4301 X St, Sacramento, California 95817, USA
| | - Elise Eh Fannon
- University of California, Davis Medical Center. Department of Surgery. 4301 X St, Sacramento, California 95817, USA; David Grant Medical Center. Department of Surgery. 101 Bodin Cir, Fairfield, California 94533, USA.
| | - Julia Persky
- University of California, Davis Medical Center. Department of Surgery. 4301 X St, Sacramento, California 95817, USA
| | - Emmanuel Gaeta
- University of California, Davis Medical Center. Department of Surgery. 4301 X St, Sacramento, California 95817, USA
| | - Khadija Soufi
- University of California, Davis Medical Center. Department of Surgery. 4301 X St, Sacramento, California 95817, USA
| | - Brian Howard
- University of California, Davis Medical Center. Department of Surgery. 4301 X St, Sacramento, California 95817, USA
| | - Kathryn M Stadeli
- University of California, Davis Medical Center. Department of Surgery. 4301 X St, Sacramento, California 95817, USA
| | - Luis A Godoy
- University of California, Davis Medical Center. Department of Surgery. 4301 X St, Sacramento, California 95817, USA
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Ma AC, Hu J, Zheng E, Levine JS, Schwaitzberg SD, Guo WA. The Changing Faces of Leadership in Surgery: Study on Presidents of Major Surgical Organizations. J Surg Res 2024; 295:340-349. [PMID: 38061239 DOI: 10.1016/j.jss.2023.11.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 10/04/2023] [Accepted: 11/09/2023] [Indexed: 02/25/2024]
Abstract
INTRODUCTION To gain an understanding of the changing faces of leadership in surgery, we examined trends in the demographics, additional degrees pursued, and scientific publication characteristics of the past presidents of three major surgery organizations. METHODS We queried the BoardCertifiedDocs and Web of Science databases for the demographics, as well as the quantity and quality of publications, of the past presidents of the Association for Academic Surgery, Society of University Surgeons, and American College of Surgeons from 1970 to 2020. Data were analyzed by decade to identify any trends. RESULTS We identified a total of 140 presidents from the organizations. The proportion of female presidents significantly increased from the 1990s to the 2010s (10% versus 33%, P < 0.05). The percentage of non-White presidents increased from the 1970s to the 2010s (3.33% versus 21.2%, P = 0.024). The percentage of presidents with additional degrees also increased from the 1970s to the 2010s (10.0% versus 48.8%, P = 0.039). During this same time period, the most common area of expertise of presidents shifted from cardiothoracic surgery to surgical oncology. The ratio of presidents' postinduction to preinduction publications was significantly increased among all three organizations in the 2010s compared to the 1970s (P < 0.05). Co-cluster analysis revealed a research topic change from the 1970s to the 2010s. CONCLUSIONS The faces of surgical leadership have changed in terms of gender equality, racial diversity, surgical subspecialty, and additional degrees held. Such a transformation mirrors evolving diversity, equity, and inclusion initiatives, and it further highlights the adaptability of surgical leadership to the ever-changing landscape of surgery.
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Affiliation(s)
- Alison C Ma
- Department of Surgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York
| | - Jinwei Hu
- Department of Surgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York
| | - Erika Zheng
- Department of Surgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York
| | - Jordan S Levine
- Department of Surgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York
| | - Steven D Schwaitzberg
- Department of Surgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York
| | - Weidun Alan Guo
- Department of Surgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York.
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Trikha R, Laubach L, Sharma V, Thompson R, Bernthal N, Williams RJ, Jones KJ. Are our actions matching our words? A review of trainee ethnic and gender diversity in orthopaedic surgery. Surg Open Sci 2024; 18:62-69. [PMID: 38419945 PMCID: PMC10901127 DOI: 10.1016/j.sopen.2024.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Revised: 02/05/2024] [Accepted: 02/14/2024] [Indexed: 03/02/2024] Open
Abstract
Background There is a lack of physician ethnic and gender diversity amongst surgical specialties. This study analyzes the literature that promotes diversity amongst surgical trainees. Specifically, this study sought to answer (i) how the number of publications regarding diversity in orthopaedic surgery compares to other surgical specialties, (ii) how the number of publications amongst all surgical subspecialties trends over time and (iii) which specific topics regarding diversity are discussed in the surgical literature. Methods The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were used to query articles from PubMed, Web of Science, Embase and the Cumulative Index to Nursing and Allied Health Literature. Broad inclusion criteria for both ethnic and gender diversity of any surgical specialty were utilized. Results Our query resulted 1429 publications, of which 408 duplicates were removed, and 701 were excluded on title and abstract screening, leaving 320 to be included. The highest number of related publications was in orthopaedic surgery (n = 73) followed by general surgery (n = 56). Out of 320 total articles, 260 (81.3 %) were published after 2015, and 56 of 73 (76.7 %) orthopaedic-specific articles were published after 2015. Conclusion Orthopaedic surgery published the most about ethnic and gender diversity, however, still remains one of the least diverse surgical specialties. With the recent increase in publications on diversity in surgical training, close attention should be paid to ethnic and gender diversity amongst surgical trainees over the coming years. Should diversity remain stagnant, diversification efforts may need to be restructured to achieve a diverse surgeon workforce. Key message Orthopaedic surgery is the surgical subspecialty that publishes the most about trainee ethnic and gender diversity followed by general surgery. With most of this literature being published over the last eight years, it is imperative to pay close attention to the ethnic and gender landscape of the surgeon workforce over the coming years.
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Affiliation(s)
- Rishi Trikha
- UCLA Department of Orthopaedic Surgery, 10833 Le Conte Avenue, Los Angeles, CA 90095, USA
| | - Logan Laubach
- Virginia Commonwealth University, School of Medicine, 1201 E Marshall St #4-100, Richmond, VA 23298, USA
| | - Viraj Sharma
- Virginia Commonwealth University, School of Medicine, 1201 E Marshall St #4-100, Richmond, VA 23298, USA
| | - Rachel Thompson
- UCLA Department of Orthopaedic Surgery, 10833 Le Conte Avenue, Los Angeles, CA 90095, USA
| | - Nicholas Bernthal
- UCLA Department of Orthopaedic Surgery, 10833 Le Conte Avenue, Los Angeles, CA 90095, USA
| | - Riley J. Williams
- Sports Medicine and Shoulder Service, Hospital for Special Surgery, 535 East 70th St, New York, NY 10021, USA
| | - Kristofer J. Jones
- UCLA Department of Orthopaedic Surgery, 10833 Le Conte Avenue, Los Angeles, CA 90095, USA
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Verran DJ. Re: Women in surgery: trends in nine surgical specialties. ANZ J Surg 2024; 94:278. [PMID: 38185998 DOI: 10.1111/ans.18861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 12/31/2023] [Indexed: 01/09/2024]
Affiliation(s)
- Deborah J Verran
- Division of Surgery, Ramsay Healthcare, Sydney, New South Wales, Australia
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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.
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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
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Kalyanasundaram G, Mener A, DiCaprio MR. What are the Trends in Racial Diversity Among Orthopaedic Applicants, Residents, and Faculty? Clin Orthop Relat Res 2023; 481:2354-2364. [PMID: 37220184 PMCID: PMC10642869 DOI: 10.1097/corr.0000000000002700] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Revised: 02/28/2023] [Accepted: 04/24/2023] [Indexed: 05/25/2023]
Abstract
BACKGROUND Orthopaedic surgery has recruited fewer applicants from underrepresented in medicine (UIM) racial groups than many other specialties, and recent studies have shown that although applicants from UIM racial groups are competitive for orthopaedic surgery, they enter the specialty at lower rates. Although previous studies have measured trends in orthopaedic surgery applicant, resident, or attending diversity in isolation, these populations are interdependent and therefore should be analyzed together. It is unclear how racial diversity among orthopaedic applicants, residents, and faculty has changed over time and how it compares with other surgical and medical specialties. QUESTIONS/PURPOSES (1) How has the proportion of orthopaedic applicants, residents, and faculty from UIM and White racial groups changed between 2016 and 2020? (2) How does representation of orthopaedic applicants from UIM and White racial groups compare with that of other surgical and medical specialties? (3) How does representation of orthopaedic residents from UIM and White racial groups compare with that of other surgical and medical specialties? (4) How does representation of orthopaedic faculty from UIM and White racial groups compare with that of other surgical and medical specialties? METHODS We drew racial representation data for applicants, residents, and faculty between 2016 and 2020. Applicant data on racial groups was obtained for 10 surgical and 13 medical specialties from the Association of American Medical Colleges Electronic Residency Application Services report, which annually publishes demographic data on all medical students applying to residency through Electronic Residency Application Services. Resident data on racial groups were obtained for the same 10 surgical and 13 medical specialties from the Journal of the American Medical Association Graduate Medical Education report, which annually publishes demographic data on residents in residency training programs accredited by the Accreditation Council for Graduate Medical Education. Faculty data on racial groups were obtained for four surgical and 12 medical specialties from the Association of American Medical Colleges Faculty Roster United States Medical School Faculty report, which annually publishes demographic data of active faculty at United States allopathic medical schools. UIM racial groups include American Indian or Alaska Native, Black or African American, Hispanic or Latino, and Native American or Other Pacific Islander. Chi-square tests were performed to compare representation of UIM and White groups among orthopaedic applicants, residents, and faculty between 2016 and 2020. Further, chi-square tests were performed to compare aggregate representation of applicants, residents, and faculty from UIM and White racial groups in orthopaedic surgery to aggregate representation among other surgical and medical specialties with available data. RESULTS The proportion of orthopaedic applicants from UIM racial groups increased between 2016 to 2020 from 13% (174 of 1309) to 18% (313 of 1699, absolute difference 0.051 [95% CI 0.025 to 0.078]; p < 0.001). The proportion of orthopaedic residents (9.6% [347 of 3617] to 10% [427 of 4242]; p = 0.48) and faculty (4.7% [186 of 3934] to 4.7% [198 of 4234]; p = 0.91) from UIM racial groups did not change from 2016 to 2020. There were more orthopaedic applicants from UIM racial groups (15% [1151 of 7446]) than orthopaedic residents from UIM racial groups (9.8% [1918 of 19,476]; p < 0.001). There were also more orthopaedic residents from UIM groups (9.8% [1918 of 19,476]) than orthopaedic faculty from UIM groups (4.7% [992 of 20,916], absolute difference 0.051 [95% CI 0.046 to 0.056]; p < 0.001). The proportion of orthopaedic applicants from UIM groups (15% [1151 of 7446]) was greater than that of applicants to otolaryngology (14% [446 of 3284], absolute difference 0.019 [95% CI 0.004 to 0.033]; p = 0.01), urology (13% [319 of 2435], absolute difference 0.024 [95% CI 0.007 to 0.039]; p = 0.005), neurology (12% [1519 of 12,862], absolute difference 0.036 [95% CI 0.027 to 0.047]; p < 0.001), pathology (13% [1355 of 10,792], absolute difference 0.029 [95% CI 0.019 to 0.039]; p < 0.001), and diagnostic radiology (14% [1635 of 12,055], absolute difference 0.019 [95% CI 0.009 to 0.029]; p < 0.001), and it was not different from that of applicants to neurosurgery (16% [395 of 2495]; p = 0.66), plastic surgery (15% [346 of 2259]; p = 0.87), interventional radiology (15% [419 of 2868]; p = 0.28), vascular surgery (17% [324 of 1887]; p = 0.07), thoracic surgery (15% [199 of 1294]; p = 0.94), dermatology (15% [901 of 5927]; p = 0.68), internal medicine (15% [18,182 of 124,214]; p = 0.05), pediatrics (16% [5406 of 33,187]; p = 0.08), and radiation oncology (14% [383 of 2744]; p = 0.06). The proportion of orthopaedic residents from UIM groups (9.8% [1918 of 19,476]) was greater than UIM representation among residents in otolaryngology (8.7% [693 of 7968], absolute difference 0.012 [95% CI 0.004 to 0.019]; p = 0.003), interventional radiology (7.4% [51 of 693], absolute difference 0.025 [95% CI 0.002 to 0.043]; p = 0.03), and radiation oncology (7.9% [289 of 3659], absolute difference 0.020 [95% CI 0.009 to 0.029]; p < 0.001), and it was not different from UIM representation among residents in plastic surgery (9.3% [386 of 4129]; p = 0.33), urology (9.7% [670 of 6877]; p = 0.80), dermatology (9.9% [679 of 6879]; p = 0.96), and diagnostic radiology (10% [2215 of 22,076]; p = 0.53). The proportion of orthopaedic faculty from UIM groups (4.7% [992 of 20,916]) was not different from UIM representation among faculty in otolaryngology (4.8% [553 of 11,413]; p = 0.68), neurology (5.0% [1533 of 30,871]; p = 0.25), pathology (4.9% [1129 of 23,206]; p = 0.55), and diagnostic radiology (4.9% [2418 of 49,775]; p = 0.51). Compared with other surgical and medical specialties with available data, orthopaedic surgery had the highest proportion of White applicants (62% [4613 of 7446]), residents (75% [14,571 of 19,476]), and faculty (75% [15,785 of 20,916]). CONCLUSION Orthopaedic applicant representation from UIM groups has increased over time and is similar to that of several surgical and medical specialties, suggesting relative success with efforts to recruit more students from UIM groups. However, the proportion of orthopaedic residents and UIM groups has not increased accordingly, and this is not because of a lack of applicants from UIM groups. In addition, UIM representation among orthopaedic faculty has not changed and may be partially explained by the lead time effect, but increased attrition among orthopaedic residents from UIM groups and racial bias likely also play a role. Further interventions and research into the potential difficulties faced by orthopaedic applicants, residents, and faculty from UIM groups are necessary to continue making progress. CLINICAL RELEVANCE A diverse physician workforce is better suited to address healthcare disparities and provide culturally competent patient care. Representation of orthopaedic applicants from UIM groups has improved over time, but further research and interventions are necessary to diversify orthopaedic surgery to ultimately provide better care for all orthopaedic patients.
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Affiliation(s)
| | - Amanda Mener
- Department of Orthopaedic Surgery, Albany Medical Center, Albany, NY, USA
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Ofshteyn A, Steinhagen E. Surgical Education: Disparities in Education May Impact the Quality and Likelihood of Completion of Training. Clin Colon Rectal Surg 2023; 36:315-320. [PMID: 37564350 PMCID: PMC10411215 DOI: 10.1055/s-0043-1763519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/12/2023]
Abstract
Female surgical trainees experience bias that begins at the preclinical stages of medical school, extending into their surgery clerkships, and then into their residency training. There are important implications in terms of training opportunities and career advancement, mentorship, sponsorship, and ultimately burnout. Childbearing and lactation also impact the experiences and perceptions of female trainees who have children. There are limited interventions that have improved the experience of women in surgical training. Mentorship appears to play an important role in ameliorating some of the negative consequences of the training environment and improving outcomes for women surgeons.
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Affiliation(s)
- Asya Ofshteyn
- Division of Colon and Rectal Surgery, Department of Surgery, Mayo Clinic, Rochester, Minnesota
| | - Emily Steinhagen
- Division of Colorectal, Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio
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Jung S, Rosser AA, Alagoz E. Cultural Change, Community, and Belonging: Supporting the Next Generation of Surgeons From Groups Historically Excluded From Medicine. ANNALS OF SURGERY OPEN 2023; 4:e291. [PMID: 37601472 PMCID: PMC10431357 DOI: 10.1097/as9.0000000000000291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 04/24/2023] [Indexed: 08/22/2023] Open
Affiliation(s)
- Sarah Jung
- From the Department of Surgery, University of Wisconsin-Madison, Madison, WI
| | | | - Esra Alagoz
- From the Department of Surgery, University of Wisconsin-Madison, Madison, WI
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Kirksey L, Sorour AA, Duson S, Osman MF, Downing LJ, Ayman A, Rowe V. Racial Diversity and Black Vascular Surgeons in Vascular Surgery Workforce. J Vasc Surg 2023; 77:1322-1329. [PMID: 36791895 DOI: 10.1016/j.jvs.2023.01.211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 01/02/2023] [Accepted: 01/31/2023] [Indexed: 02/16/2023]
Abstract
OBJECTIVES The precise number of actively practicing vascular surgeons who self-identify as Black and the historical race composition trends within the overall profession of vascular surgery are unknown. Limited demographic data has been collected and maintained at the societal or national board level. Vascular Surgery Societal reports suggest that less than 2% of vascular surgeons identify as Black. Blacks make up 13.4% of the American population yet for disorders such as peripheral arterial disease and end stage renal disease, Black communities are disproportionately impacted, and the prevalence of disease is greater on an age adjusted basis. Significant body of research showed that clinical outcomes like medication adherence, shared decision making, and research trial participation are positively impacted by racial concordance especially for communities in whom distrust is high as a consequence of historic experiences. This survey aims to characterize practice and career variables within a network of Black vascular surgeons. METHODS A cross sectional survey was conducted via a questionnaire sent to all participants of a Society of Black Vascular Surgeons (SBVS) that began to convene monthly during the COVID-19 pandemic and experienced subsequent organic growth. The survey included 20 questions with variables quantified including the surgeon's demographics, clinical experience, practice setting, patient demographics and professional society engagement. RESULTS Fifty-nine percent of the SBVS members completed the survey. Males compromised 81% of the responding vascular surgeons. The majority (62%) of respondents are involved in academic practice. Less than 25% percent of the total medical staff was Black in 77% of the respondents' current work practice. The patient racial composition within their respective practice settings: White (47%), Black (34%), Hispanic (13%), Asian (3%), Middle Eastern or North African (2%) and American Indian and Alaskan Natives (0.4%). Forty three percent of respondents have a current active membership in the Society of Vascular Surgery and 24% have regional society membership. Fifty-eight percent of respondents reported that they experienced workplace event that they felt were racially or ethically driven in the 12 months prior to the survey. CONCLUSION This survey describes an underrepresented in medicine (URM) vascular surgeon subgroup that has not heretofore been characterized. Racial and ethnic demographic data are essential to better understand the current demographic makeup of our specialty, and to develop benchmark goals of race composition that mirrors our society at large. In this group of Black vascular surgeons, their patients were more likely to represent a racial minority. Efforts to increase race diversity in vascular surgery have the potential benefit of enhancing care of patients with vascular disease.
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Affiliation(s)
- Levester Kirksey
- Department of Vascular Surgery, Heart Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH; Walter W. Buckley Endowed Chair, Department of Vascular Surgery, Cleveland Clinic, Cleveland, OH.
| | - Ahmed A Sorour
- Department of Vascular Surgery, Heart Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH
| | - Sira Duson
- University of Maryland School of Medicine, Department of Vascular Surgery, Baltimore, MD
| | - Mohamed F Osman
- University of Toledo, Department of Vascular Surgery, Toledo, OH
| | | | - Ahmad Ayman
- University of Toledo, Department of Vascular Surgery, Toledo, OH
| | - Vincent Rowe
- Carilion New River Valley Medical Center, Carilion Clinic, VA
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McNeill IT, Carrasquilla A, Asfaw ZK, Barthélemy EJ, Mehr A, Townsend KD, Joseph A, Bederson JB, Butts GC, Germano IM. Breaking boundaries through Doctors Reaching Minority Men Exploring Neuroscience: a mentorship model to foster a pipeline for underrepresented minorities. J Neurosurg 2023; 138:533-539. [PMID: 35901743 DOI: 10.3171/2022.5.jns22196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Accepted: 05/04/2022] [Indexed: 02/04/2023]
Abstract
OBJECTIVE In 2015, the Association of American Medical Colleges report titled "Altering the Course: Black Males in Medicine" showed a decline in the number of Black men matriculating into medical school. To alter this trend, the authors' hypothesis was that formally exposing Black men to the clinical neurosciences during high school would enhance their chances of entering the physician workforce. For this reason, in 2007, the Doctors Reaching Minority Men Exploring Neuroscience (DR. MMEN) program was established at the Icahn School of Medicine at Mount Sinai. The program aimed to provide early exposure, mentorship, and inspiration to high school-age Black and Latinx men. The aim of this study was to evaluate the impact of the DR. MMEN program in the context of the recent race and ethnicity trends among medical school matriculants (MSMs). METHODS Association of American Medical Colleges data on MSMs stratified by race and ethnicity were reviewed for the period between 2015 and 2020. Data pertinent to the academic achievements of DR. MMEN participants, such as matriculation to college and/or medical school, were prospectively tracked and incorporated with mixed-methods exit assessment data. Qualitative responses were coded and analyzed using a thematic concept analysis method. RESULTS Over the study period, the increase of MSMs in the US was 1.0% and 1.7% for Black and Latinx individuals, respectively. Changes for the male MSM cohort were negligible: 0.3% for Black and 0.7% for Latinx. With respect to DR. MMEN, 42% of participants from 2017 to 2019 earned college scholarships, and 25% of students from the 2017-2018 cohort matriculated to a combined college-medical program. Survey data showed that 100% of DR. MMEN participants found the program useful. Analysis of qualitative data revealed that participants considered pursuing a career in neurosurgery or in another medical field. Diligence and a passion for medicine were identified as the top two most important lessons in the program, and witnessing patient satisfaction and observing a neurosurgery operation were described as the most important experiences. Participants considered availability to give advice and feedback and a passion for teaching as the principal attributes of their mentors. CONCLUSIONS Over the past 6 years, the slight increase in Black and Latinx MSMs has not been significant enough to remedy ethnoracial disparities among MSMs. In particular, Black male matriculation to medical school has remained stagnant. The DR. MMEN program is a promising model to inspire young scholars and improve diversity within neuroscience and medicine at large.
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Affiliation(s)
- Ian T McNeill
- 1Division of Neurosurgery, Department of Surgery, University of Connecticut, Farmington, Connecticut
| | - Alejandro Carrasquilla
- 2Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Zerubabbel K Asfaw
- 2Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Ernest J Barthélemy
- 3Department of Neurological Surgery, University of California, San Francisco, California; and
| | - Alyson Mehr
- 4Office for Diversity and Inclusion, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Kenya D Townsend
- 4Office for Diversity and Inclusion, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Alexander Joseph
- 4Office for Diversity and Inclusion, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Joshua B Bederson
- 2Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Gary C Butts
- 4Office for Diversity and Inclusion, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Isabelle M Germano
- 2Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York
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Carter BD, Badejo MA, Ogola GO, Waddimba AC, Fleshman JW, Harrington MA. National trends in distribution of underrepresented minorities within United States general surgery residency programs: A longitudinal panel study. Am J Surg 2023; 225:1000-1008. [PMID: 36646598 DOI: 10.1016/j.amjsurg.2023.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Revised: 12/25/2022] [Accepted: 01/08/2023] [Indexed: 01/13/2023]
Abstract
BACKGROUND Cultural affinity with a provider improves satisfactoriness of healthcare. We examined 2005-2019 trends in racial/ethnic diversity/inclusion within general surgery residency programs. METHODS We triangulated 2005-2019 race/ethnicity data from Association of American Medical Colleges surveys of 4th-year medical students, the Electronic Residency Application Service, and Accreditation Council for Graduate Medical Education-affiliated general surgery residencies. Temporal trends in minority representation were tested for significance. RESULTS Underrepresented racial/ethnic minorities in medicine (URiMs) increased among graduating MDs from 7.6% in 2005 to 11.8% in 2019 (p < 0.0001), as did their proportion among surgery residency applicants during 2005-2019 (p < 0.0001). However, proportions of URiMs among general surgery residents (≈8.5%), and of programs without URiMs (≈18.8%), stagnated. CONCLUSIONS Growing URiM proportions among medical school graduates and surgery residency applicants did not improve URiM representation among surgery trainees nor shrink the percentage of programs without URiMs. Deeper research into motivators underlying URiMs' residency program preferences is warranted.
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Affiliation(s)
- Brittany D Carter
- General Medical Education, Department of Surgery, Baylor University Medical Center, Dallas, TX, USA.
| | - Megan A Badejo
- College of Medicine, Texas A & M University Health Science Center, Dallas Campus, Texas, USA.
| | - Gerald O Ogola
- Division of Surgical Research, Department of Surgery, Baylor University Medical Center, Dallas, Texas, USA; Baylor Scott and White Research Institute, Dallas, Texas, USA.
| | - Anthony C Waddimba
- Division of Surgical Research, Department of Surgery, Baylor University Medical Center, Dallas, Texas, USA; Baylor Scott and White Research Institute, Dallas, Texas, USA.
| | - James W Fleshman
- Division of Colorectal Surgery, Department of Surgery, Baylor University Medical Center, Dallas, Texas, USA.
| | - Melvyn A Harrington
- Department of Orthopedic Surgery, Baylor College of Medicine, Houston, Texas, USA.
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12
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Thompson BN, Colbert K, Nussbaum MS, Paget CJ. Practical Strategies for Underrepresented Minority Recruitment in General Surgery Residency. JOURNAL OF SURGICAL EDUCATION 2022; 79:e130-e136. [PMID: 36266229 DOI: 10.1016/j.jsurg.2022.09.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 08/19/2022] [Accepted: 09/10/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVE To analyze the effects of diversification efforts on underrepresented minority in medicine (URiM) resident recruitment in general surgery residency at a single large southeastern United States academic institution with five categorical positions. METHODS A retrospective review of applications from the 2016 to 2022 ACGME match cycles was conducted. In an effort to diversify resident recruitment, multiple new strategies were enacted in 2021. URiM candidates were identified via a more laborious review of individual applications to the program. In addition, a holistic review process was conducted, URiM faculty and residents were prominently featured, previous underperformance in diversity was openly addressed, and URiM applicants were contacted with follow up emails. Cohorts pre- and post-implementation of these strategies were analyzed. The proportion of URiM applicants invited, interviewed, ranked, and matched were compared. RESULTS Pre-intervention during the 2016to 20 match cycles, URiM candidates represented 4% of total applicants invited. Post-intervention during the 2021to 22 match cycles, URiM candidates represented 27% of total applicants invited. Over the past 5 years under the present program director, 1 URiM resident of 24 (4%) matched into the categorical program. Over the past 15 years under the direction of 3 program directors, a total of 6 out of 69 matched residents (9%) identified as URiM. Post intervention, the program matched on average 30% of its incoming categorical class from URiM candidates. CONCLUSION Recruitment and selection of diverse medical school applicants is an ongoing concern of general surgery residency program directors. Historically, URiM candidates are underrepresented in applicants selected for interview. Interventions aimed at increasing the matriculation of URiM include concentrated efforts to identify more URiM candidates for interview. However, importantly, transparency of ongoing diversity efforts and diversifying both faculty and trainees involved in the selection process may also improve general surgery URiM recruitment.
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Affiliation(s)
- Britany N Thompson
- Virginia Tech Carilion School of Medicine, Carilion Clinic, Department of Surgery, Roanoke, Virginia
| | - Kendra Colbert
- Virginia Tech Carilion School of Medicine, Carilion Clinic, Department of Surgery, Roanoke, Virginia
| | - Michael S Nussbaum
- Virginia Tech Carilion School of Medicine, Carilion Clinic, Department of Surgery, Roanoke, Virginia
| | - Charles J Paget
- Virginia Tech Carilion School of Medicine, Carilion Clinic, Department of Surgery, Roanoke, Virginia.
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13
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Aguilera V, Andacoglu O, Francoz C, Berlakovich G, Pai SL, Adelmann D, Ghosh S, Lunsford KE, Montenovo M, Mrzljak A, Scalera I, Xie Q, Becchetti C, Berenguer M, Selzner N. Gender and Racial Disparity Among Liver Transplantation Professionals: Report of a Global Survey. Transpl Int 2022; 35:10506. [PMID: 36052173 PMCID: PMC9426639 DOI: 10.3389/ti.2022.10506] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Accepted: 07/07/2022] [Indexed: 11/13/2022]
Abstract
Equality, diversity, and inclusion (EDI) are fundamental principles. Little is known about the pattern of practice and perceptions of EDI among liver transplant (LT) providers. International Liver Transplant Society (ILTS) EDI Committee survey around topics related to discrimination, mentorship, and gender. Answers were collected and analyzed anonymously. Worldwide female leadership was also queried via publicly available data. The survey was e-mailed to 1312 ILTS members, 199 responses (40.7% female) were collected from 38 countries (15.2% response rate). Almost half were surgeons (45.7%), 27.6% hepatologists and 26.6% anesthetists. Among 856 LT programs worldwide, 8.2% of leadership positions were held by females, and 22% of division chiefs were female across all specialties. Sixty-eight of respondents (34.7%) reported some form of discrimination during training or at their current position, presumably related to gender/sexual orientation (20.6%), race/country of origin (25.2%) and others (7.1%). Less than half (43.7%) received mentorship when discrimination occurred. An association between female responses and discrimination, differences in compensation, and job promotion was observed. This survey reveals alarmingly high rate of experience with racial and gender disparity, lack of mentorship, and very low rates of female leadership in the LT field and calls to action to equity and inclusion.
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Affiliation(s)
- Victoria Aguilera
- Hepatology and Liver Transplant Unit, IIS La Fe and CIBER-EHD, Universitary and Politecnic Hospital La Fe, Valencia, Spain
- Department of Medicine, University of Valencia, Valencia, Spain
| | - Oya Andacoglu
- Division of Transplantation, Department of Surgery, The University of Oklahoma College of Medicine, University of Oklahoma, Oklahoma City, OK, United States
- Transplant Surgery, International Liver Center, Istanbul, Turkey
| | - Claire Francoz
- Liver Intensive Care Unit and Transplantation, Hepatology, Hospital Beaujon, Clichy, France
| | | | - Sher-Lu Pai
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic College of Medicine, Jacksonville, FL, United States
| | - Dieter Adelmann
- Department of Anesthesia and Perioperative Care, University of California, San Francisco, San Francisco, CA, United States
| | - Simantika Ghosh
- Department of Anesthesiology, Narayana Health, Narayana, India
| | - Keri E. Lunsford
- Department of Surgery, Division of Transplant and HPB Surgery, Rutgers New Jersey Medical School, Rutgers, The State University of New Jersey, Newark, NJ, United States
| | - Martin Montenovo
- Division of Hepatobiliary Surgery and Liver Transplant, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Anna Mrzljak
- Department of Gastroenterology and Hepatology, University Hospital Center Zagreb, Zagreb, Croatia
| | - Irene Scalera
- Division of Hepatobiliary Surgery and Liver Transplant, University Hospital Policlinic of Bari, Bari, Italy
| | - Qinfen Xie
- Department of Hepatobiliary and Pancreatic Surgery, Shulan (Hangzhou) Hospital, Hangzhou, China
| | - Chiara Becchetti
- University Clinic for Visceral Surgery and Medicine, Inselspital, University Hospital of Bern, Bern, Switzerland
| | - Marina Berenguer
- Hepatology and Liver Transplant Unit, IIS La Fe and CIBER-EHD, Universitary and Politecnic Hospital La Fe, Valencia, Spain
- Department of Medicine, University of Valencia, Valencia, Spain
| | - Nazia Selzner
- Multiorgan Transplant Program, University of Toronto, Toronto, ON, Canada
- *Correspondence: Nazia Selzner,
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14
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Nieblas-Bedolla E, El-Ghazali F, Qadri S, Williams JR, Quadri N, Lee A, Ferreira M. Racial, ethnic, and gender diversity of applicants and matriculants to neurological surgery residency programs. J Neurosurg 2022; 137:266-272. [PMID: 34798610 DOI: 10.3171/2021.7.jns21906] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 07/27/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The aim of this study was to identify trends in the demographic constitution of applicants and matriculants to neurological surgery based on race, ethnicity, and gender. METHODS The authors conducted a cross-sectional study using compiled demographic data obtained from the Association of American Medical Colleges. Trends analyzed included proportional changes in race, ethnicity, and gender of applicants and matriculants to neurosurgical residency programs from academic years 2010-2011 to 2018-2019. RESULTS A total of 5100 applicants and 2104 matriculants to neurosurgical residency programs were analyzed. No significant change in the percentage of overall women applicants (+0.3%, 95% CI -0.7% to 1.3%; p = 0.77) or in the percentage of women matriculants (+0.3%, 95% CI -2.2% to 2.9%; p = 0.71) was observed. For applicants, no change over time was observed in the percentages of American Indian or Alaska Native (AI/AN) men (0.0%, 95% CI -0.3% to 0.3%; p = 0.65); Asian men (-0.1%, 95% CI -1.2% to 1.1%; p = 0.97); Black or African American men (-0.2%, 95% CI -0.7% to 0.4%; p = 0.91); Hispanic, Latino, or of Spanish Origin men (+0.4%, 95% CI -0.8% to 1.7%; p = 0.26); White men (+0.5%, 95% CI -2.1% to 3.0%; p = 0.27); Asian women (+0.1,% 95% CI -0.9% to 1.1%; p = 0.73); Black or African American women (0.0%, 95% CI -0.6% to 0.5%; p = 0.30); Hispanic, Latino, or of Spanish Origin women (0.0%, 95% CI -0.4% to 0.4%; p = 0.71); and White women (+0.3%, 95% CI -1.1% to 1.7%; p = 0.34). For matriculants, no change over time was observed in the percentages of AI/AN men (0.0%, 95% CI -0.6% to 0.6%; p = 0.56); Asian men (0.0%, 95% CI -2.7% to 2.7%; p = 0.45); Black or African American men (-0.3%, 95% CI -1.4% to 0.8%; p = 0.52); Hispanic, Latino, or of Spanish Origin men (+0.6%, 95% CI -0.8 to 2.0%; p = 0.12); White men (-1.0%, 95% CI -5.3% to 3.3%; p = 0.92); Asian women (+0.1%, 95% CI -1.3% to 1.5%; p = 0.85); Black or African American women (0.0%, 95% CI -0.6% to 0.7%; p = 0.38); Hispanic, Latino, or of Spanish Origin women (-0.1%, 95% CI -0.7% to 0.5%; p = 0.46); and White women (+0.3%, 95% CI -2.4% to 3.0%; p = 0.70). CONCLUSIONS Despite efforts to diversify the demographic constitution of incoming neurosurgical trainees, few significant advances have been made in recent years. This study suggests that improved strategies for recruitment and cultivating early interest in neurological surgery are required to further increase the diversification of future cohorts of neurosurgical trainees.
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Affiliation(s)
| | | | - Saman Qadri
- 1University of Washington School of Medicine, Seattle
| | - John R Williams
- 2Department of Neurological Surgery, University of Washington, Seattle, Washington; and
| | - Nabiha Quadri
- 3Department of Neurological Surgery, Saint Louis University, Saint Louis, Missouri
| | - Amy Lee
- 2Department of Neurological Surgery, University of Washington, Seattle, Washington; and
| | - Manuel Ferreira
- 2Department of Neurological Surgery, University of Washington, Seattle, Washington; and
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15
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Iwai Y, Lenze NR, Becnel CM, Mihalic AP, Stitzenberg KB. Evaluation of Predictors for Successful Residency Match in General Surgery. JOURNAL OF SURGICAL EDUCATION 2022; 79:579-586. [PMID: 34852956 DOI: 10.1016/j.jsurg.2021.11.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 10/30/2021] [Accepted: 11/06/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE To determine predictive factors for a successful residency match among general surgery applicants from 2018 to 2021. DESIGN A retrospective cross-sectional study of general surgery applicants who matched and went unmatched in match years 2018 to 2021. Applicant characteristics, geographic connections to a program, and away rotations were compared among matched and unmatched applicants. SETTING Data were sourced from the Texas Seeking Transparency in Applications to Residency initiative for general surgery applicants. PARTICIPANTS All fourth-year medical students applying in the 2018 to 2021 cycles at participating U.S. medical schools were eligible to respond to the Texas Seeking Transparency in Applications to Residency survey. This study included a total of 1,425 general surgery applicants. RESULTS Of 1,425 general surgery applicants, 88% matched and 12% went unmatched. Significant predictors for a successful match included Step 1 Score ≥237 (odds ratio (OR) 1.59 [95% CI 1.15-2.19]; p = 0.005); Step 2 CK Score ≥252 (OR 1.88 [95% CI 1.36-2.60]; p < 0.001); ≥3 Honored Clerkships (OR 1.84 [95% CI 1.33-2.53]; p < 0.001); Honors in General Surgery Clerkship (OR 1.73 [95% CI 1.33-2.53]; p = 0.001); AOA membership (OR 2.14 [95% CI 1.34-3.42]; p = 0.001); ≥4 abstracts, posters, or publications (OR 1.66 [95% CI 1.20-2.30]; p=0.002); and ≥1 peer-reviewed publications (OR 1.52 [95% CI 1.09-2.12]; p = 0.014). On average, matched applicants completed more away rotations than unmatched applicants (p = 0.004). Overall, 36% of matched applicants reported a geographic connection to the program where they matched. CONCLUSIONS We found that Step 2 CK score, research productivity, honored clerkships, AOA status, and away rotations are significant predictors for successfully matching into general surgery residency. Medical schools can encourage students to prepare a holistic application incorporating variables quantified in this study in preparation for the Step 1 reporting change.
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Affiliation(s)
- Yoshiko Iwai
- The University of North Carolina School of Medicine, Chapel Hill, North Carolina.
| | - Nicholas R Lenze
- The University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Chad M Becnel
- Department of General Surgery, Tulane University School of Medicine, New Orleans, Louisiana
| | - Angela P Mihalic
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Karyn B Stitzenberg
- Department of Surgery, University of North Carolina School of Medicine, Chapel Hill, North Carolina
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16
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Diversity, equity, and inclusion in presidential leadership of academic medical and surgical societies. Am J Surg 2022; 224:1028-1031. [DOI: 10.1016/j.amjsurg.2022.03.028] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 03/02/2022] [Accepted: 03/22/2022] [Indexed: 11/24/2022]
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17
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Cortina CS, Williamson AJ, Goulet ND. Progress, barriers, and the future of LGBTQ+ surgeons in academic surgery. Am J Surg 2022; 224:294-295. [DOI: 10.1016/j.amjsurg.2022.02.037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 02/10/2022] [Indexed: 11/29/2022]
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18
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Racial disparities in operative management of localized, non-functional pancreatic neuroendocrine tumors in surgically fit patients. HPB (Oxford) 2022; 24:217-225. [PMID: 34247942 DOI: 10.1016/j.hpb.2021.06.418] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 05/16/2021] [Accepted: 06/11/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Guidelines recommend resection of non-functional neuroendocrine tumors of the pancreas (NF-pNETs) that are ≥2 cm in size. We compared utilization of surgery based on race. METHODS We identified non-Hispanic White and Black patients with localized NF-pNETs ≥2 cm and Charlson-Deyo score 0-1 in the NCDB (2004-2016). We compared utilization of surgery by race, adjusting for clinicodemographic variables. Overall survival was compared based on management. RESULTS A total of 3459 patients were included (White = 3005; Black = 454). Black patients were younger (58vs63 years) and more often treated at academic facilities (65.3%vs60.3%). Overall, Black and White patients underwent surgery at similar rates (77.3%vs79.6%). When stratified by primary site, Black patients with body/tail tumors were less likely to undergo surgery (78.5%vs84.7%). On multivariable analysis, Black race was associated with a lower likelihood of surgery overall (OR 0.74,p = 0.034) and in patients with body/tail tumors (OR 0.56,p = 0.001). Non-operative management was associated with a higher risk of death (HR 3.19,p < 0.001). CONCLUSION In a national cohort of patients with NF-pNETs meeting criteria for resection, Black race is associated with lower frequency of surgery. Operative intervention is associated with prolonged survival. Persistent racial disparities in management of a surgically curable disease should be targeted for improvement.
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19
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Smith CB, Purcell LN, Charles A. Cultural Competence, Safety, Humility, and Dexterity in Surgery. CURRENT SURGERY REPORTS 2022; 10:1-7. [PMID: 35039788 PMCID: PMC8756410 DOI: 10.1007/s40137-021-00306-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/29/2021] [Indexed: 11/18/2022]
Abstract
Purpose of Review As the United States’ population diversifies, urgent action is required to identify, dismantle, and eradicate persistent health disparities. The surgical community must recognize how patients’ values, beliefs, and behaviors are influenced by race, ethnicity, nationality, language, gender, socioeconomic status, physical and mental ability, sexual orientation, and occupation. Recent Findings Lately, health disparities have been highlighted during the COVID-19 pandemic. Surgery is no exception, with notable disparities occurring in pediatric, vascular, trauma, and cardiac surgery. In response, numerous curricula and training programs are being designed to increase cultural competence and safety among surgeons. Summary Cultural competence, safety, humility, and dexterity are required to improve healthcare experiences and outcomes for minorities. Various opportunities exist to enhance cultural competency and can be implemented at the medical student, resident, attending, management, and leadership levels.
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Affiliation(s)
- Charlotte B Smith
- University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, CB USA
| | - Laura N Purcell
- Department of Surgery, University of North Carolina at Chapel Hill, Chapel Hill, CB USA
| | - Anthony Charles
- Department of Surgery, University of North Carolina at Chapel Hill, Chapel Hill, CB USA.,Department of Surgery, University of north Carolina at Chapel Hill, 4008 Burnett Womack Building, Chapel Hill, CB 7228 USA
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20
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Iwai Y, Lenze NR, Mihalic AP, Becnel CM, Stitzenberg KB. Effect of the COVID-19 pandemic on the residency match among surgical specialties. Surgery 2022; 171:1512-1518. [PMID: 34972590 PMCID: PMC8648584 DOI: 10.1016/j.surg.2021.11.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 11/09/2021] [Accepted: 11/15/2021] [Indexed: 11/05/2022]
Abstract
Background Despite unprecedented changes to undergraduate medical education and the residency selection process during the COVID-19 pandemic, there is little objective evidence on how the pandemic affected match outcomes such as matched applicant characteristics, interview distribution, geographic clustering, and associated costs. We investigated COVID-19’s impact on the residency match by comparing surgery applicants’ characteristics, interview distribution, and related costs from 2018 to 2020 to 2021. Methods Data from the Texas Seeking Transparency in Applications to Residency initiative were analyzed. Descriptive statistics, bivariate testing, and sensitivity analysis were performed to compare matched applicants in surgical specialties from 2018–2020 to 2021. Results This study included 5,258 applicants who matched into 10 surgical specialties from 2018 to 2021. In 2021, there was a decrease in proportion of students who reported a geographic connection to their matched program (38.4% vs 42.1%; P = .021) and no significant difference in number of interviews attended (mean [SD], 13.1 [6.2] vs 13.3 [4.7]; P = .136) compared to prior years. Applicants in 2021 had more research experiences and fewer honored clerkships (both P < .001), and these associations persisted in sensitivity analysis. Matched applicants in 2021 reported significantly lower total costs associated with the residency application process compared to 2018 to 2020 (mean [SD] $1,959 [1,275] vs $6,756 [4,081]; P < .001). Conclusion Although COVID-19 appeared to result in a reduction in number of honored clerkships, it may have provided more opportunities for students to engage in research. Overall, the adoption of virtual interviews and away rotations may have successfully mitigated some of the adverse consequences of the pandemic on the residency match for surgical specialties.
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Affiliation(s)
- Yoshiko Iwai
- The University of North Carolina School of Medicine, Chapel Hill, NC.
| | - Nicholas R Lenze
- The University of North Carolina School of Medicine, Chapel Hill, NC. https://twitter.com/NRLenze
| | - Angela P Mihalic
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX. https://twitter.com/UMichSurgery
| | - Chad M Becnel
- Department of General Surgery, Tulane University School of Medicine, New Orleans, LA. https://twitter.com/cmbecnel
| | - Karyn B Stitzenberg
- Department of Surgery, University of North Carolina School of Medicine, Chapel Hill, NC. https://twitter.com/UNCSurgery
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21
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The current status of the diversity pipeline in surgical training. Am J Surg 2021; 224:250-256. [PMID: 34776239 DOI: 10.1016/j.amjsurg.2021.11.006] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 10/24/2021] [Accepted: 11/08/2021] [Indexed: 01/21/2023]
Abstract
OBJECTIVE Recent initiatives have emphasized the importance of diversity, equity, and inclusion in academic surgery. Racial/ethnic disparities remain prevalent throughout surgical training, and the "diversity pipeline" in resident recruitment and retention remains poorly defined. METHODS Data was retrospectively collected using two separate datasets. The Association of American Medical Colleges database was used to obtain demographic data on US medical school graduates. The US Graduate Medical Education annual report was used to obtain demographic data on surgical residents. Wilcoxon signed-rank test was used to compare racial/ethnic distribution within surgical residency programs with graduating medical students. Linear regression analysis was performed to analyze population trends over time. RESULTS The study population included 184,690 surgical residents from 2011 to 2020. Nine resident cohorts were created according to surgical specialty - general surgery, neurosurgery, ophthalmology, orthopedic surgery, otolaryngology, plastic surgery, cardiothoracic surgery, urology, and vascular surgery. Among surgical programs, White residents were overrepresented in 8 of 9 specialties compared to the concurrent graduating medical student class for all years (p < 0.01 each, no difference in ophthalmology). Black residents were underrepresented in 8 of 9 specialties (p < 0.01 each, no difference in general surgery). Asian representation was mixed among specialties (4 overrepresented, 1 equal, 4 underrepresented), as was Hispanic representation (5 overrepresented, 4 equal) (p < 0.01 each). CONCLUSIONS These data suggest that racial/ethnic disparities are inherent to the process of recruitment and retention of surgical residents. Efforts to improve the "diversity pipeline" should focus on mentorship and development of minority medical students and creating an equitable learning environment.
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22
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Feldman AG, Squires JE, Hsu EK, Lobritto S, Mohammad S. The current state of pediatric transplant hepatology fellowships: A survey of recent graduates. Pediatr Transplant 2021; 25:e14065. [PMID: 34120405 PMCID: PMC10155256 DOI: 10.1111/petr.14065] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 05/03/2021] [Accepted: 05/17/2021] [Indexed: 12/20/2022]
Abstract
BACKGROUND The number of programs offering a PTH fellowship has grown rapidly over the last 10 years. This study aimed to describe the clinical, didactic, procedural, and research experiences of recent PTH fellowship graduates. In addition, we sought to understand graduates' post-fellowship professional responsibilities and their perception about the utility of the PTH fellowship. METHODS An anonymous survey was distributed from February to October 2020 through REDCap to all recent graduates (2015-2019) of an ACGME-approved PTH fellowship program. The survey consisted of 49 questions focused on the PTH fellowship experience. Results were summarized using descriptive statistics. RESULTS Thirty-eight of 43 graduates (88%) responded to the survey representing 12 PTH fellowship programs. The didactic experience varied; 97% received pathology lectures, 81% radiology lectures, 54% organ allocation lectures, 54% procedural lectures, 57% immunology lectures, and 43% live donation lectures. During the PTH fellowship, the majority of fellows performed >10 liver biopsies (82%) and >5 variceal bandings (58%); however, 63%, 32%, 8%, and 8% never performed paracentesis, variceal sclerotherapy, variceal banding, and liver biopsies, respectively. The majority of fellows (95%) completed a research project during PTH fellowship. Currently, 84% of graduates are employed at a transplant academic institution. All graduates recommended the fellowship. CONCLUSIONS There is variability in the didactic, clinical, and procedural training among PTH fellowship programs. Although uniformly viewed as a beneficial fellowship year, there is an opportunity to collaborate to create a more standardized training experience.
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Affiliation(s)
- Amy G Feldman
- Section of Gastroenterology, Hepatology and Nutrition, The Digestive Health Institute, Children's Hospital Colorado, University of Colorado Denver School of Medicine, Aurora, CO, USA
| | - James E Squires
- Division of Gastroenterology, Hepatology and Nutrition, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
| | - Evelyn K Hsu
- Division of Gastroenterology, Hepatology and Nutrition, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, WA, USA
| | - Steven Lobritto
- Center for Liver Disease and Transplantation, NY Presbyterian-Morgan Stanley Children's Hospital, New York, NY, USA
| | - Saeed Mohammad
- Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
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Sola R, Roberts S, Thomas TJ, Dickerson TA, Soriano IS, Cook TFA, Barksdale EM. Impact of Mentoring on Diversity and Inclusion in Surgery. Am Surg 2021; 87:1739-1745. [PMID: 34645333 DOI: 10.1177/00031348211047486] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Richard Sola
- Department of Surgery, 1374Morehouse School of Medicine, Atlanta, GA, USA
| | - Sanford Roberts
- Department of Surgery, Perelman School of Medicine, 14640University of Pennsylvania, Philadelphia, PA, USA
| | - Tito J Thomas
- Department of Surgery, 24575Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Theresa A Dickerson
- Department of Surgery, 24575Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Ian S Soriano
- Department of Surgery, Perelman School of Medicine, 14640University of Pennsylvania, Philadelphia, PA, USA
| | | | - Edward M Barksdale
- Division of Pediatric Surgery, 159284Rainbow Babies & Children's Hospital/University Hospitals, Cleveland, OH, USA
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24
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Nguyen M, Cerasani M, Dinka LA, Rodriguez JA, Omoruan M, Acosta E, Alder KD, Brutus NN, Termuhlen PM, Dardik A, Mason HRC, Stain SC. Association of Demographic Factors and Medical School Experiences With Students' Intention to Pursue a Surgical Specialty and Practice in Underserved Areas. JAMA Surg 2021; 156:e214898. [PMID: 34613342 DOI: 10.1001/jamasurg.2021.4898] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance The surgical workforce shortage is a threat to promoting health equity in medically underserved areas. Although the Health Resources and Services Administration and the American College of Surgeons have called to increase the surgical pipeline for trainees to mitigate this shortage, the demographic factors associated with students' intention to practice in underserved areas is unknown. Objective To evaluate the association between students' demographics and medical school experiences with intention to pursue surgery and practice in underserved areas. Design, Setting, and Participants This cross-sectional study surveyed graduating US allopathic medical students who matriculated between 2007-2008 and 2011-2012. Analysis began June 2020 and ended December 2020. Main Outcomes and Measures Intention to pursue surgery and practice in underserved areas were retrieved from the Association of American Medical Colleges graduation questionnaire. Logistic regression models were constructed to evaluate (1) the association between demographic factors and medical students' intention to pursue surgical specialties vs medical specialties and (2) the association between demographic factors and medical school electives with intention to practice in underserved areas. Results Among 57 307 students who completed the graduation questionnaire, 48 096 (83.9%) had complete demographic data and were included in the study cohort. The mean (SD) age at matriculation was 23.4 (2.5) years. Compared with students who reported intent to pursue nonsurgical careers, a lower proportion of students who reported intent to pursue a surgical specialty identified as female (3264 [32.4%] vs 19 731 [51.9%]; χ2 P < .001). Multiracial Black and White students (adjusted odds ratio [aOR], 1.72; 95% CI, 1.11-2.65) were more likely to report an intent for surgery compared with White students. Among students who reported an intention to pursue surgery, Black/African American students (aOR, 3.24; 95% CI, 2.49-4.22), Hispanic students (aOR, 2.00; 95% CI, 1.61-2.47), multiracial Black and White students (aOR, 2.27; 95% CI, 1.03-5.01), and Indian/Pakistani students (aOR, 1.31; 95% CI, 1.02-1.69) were more likely than White students to report an intent to practice in underserved areas. Students who reported participating in community health (aOR, 1.61; 95% CI, 1.42-1.83) or global health (aOR, 1.83; 95% CI, 1.61-2.07) experiences were more likely to report an intention to practice in underserved areas. Conclusions and Relevance This study suggests that diversifying the surgical training pipeline and incorporating health disparity and community health in undergraduate or graduate medical education may promote students' motivation to practice in underserved areas.
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Affiliation(s)
| | | | | | | | - Moje Omoruan
- SUNY Upstate Medical University, Syracuse, New York
| | | | - Kareme D Alder
- Yale School of Medicine, New Haven, Connecticut.,Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | | | - Paula M Termuhlen
- Homer Stryker MD School of Medicine, Western Michigan University, Kalamazoo, Michigan
| | - Alan Dardik
- Department of Surgery, Yale School of Medicine, New Haven, Connecticut.,Department of Surgery, VA Connecticut Healthcare System, West Haven, Connecticut
| | - Hyacinth R C Mason
- Tufts University School of Medicine, Boston, Massachusetts.,Department of Family and Community Medicine, Albany Medical College, Albany, New York
| | - Steven C Stain
- Lahey Hospital and Medical Center, Boston, Massachusetts
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25
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Smith CB, Saillant NN, Mendoza AE. Perceptions of differences in graduated autonomy between male and female surgical residents. Surgery 2021; 170:1281-1284. [PMID: 33775394 DOI: 10.1016/j.surg.2021.02.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 02/01/2021] [Indexed: 11/25/2022]
Affiliation(s)
- Charlotte B Smith
- University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC. https://twitter.com/cblythesmith
| | | | - April E Mendoza
- Department of Surgery, Massachusetts General Hospital, Boston, MA.
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26
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Surgical research journals - Under review: An assessment of diversity among editorial boards and outcomes of peer review. Am J Surg 2021; 222:1104-1111. [PMID: 34625204 PMCID: PMC9508661 DOI: 10.1016/j.amjsurg.2021.09.027] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 09/15/2021] [Accepted: 09/24/2021] [Indexed: 11/22/2022]
Abstract
Background The COVID-19 pandemic exposed racism as a public health crisis embedded in structural processes. Editors of surgical research journals pledged their commitment to improve structure and process through increasing diversity in the peer review and editorial process; however, little benchmarking data are available. Methods A survey of editorial board members from high impact surgical research journals captured self-identified demographics. Analysis of manuscript submissions from 2016 to 2020 compared acceptance for diversity, equity, and inclusion (DEI)-focused manuscripts to overall rates. Results 25.6% of respondents were female, 2.9% Black, and 3.3% Hispanic. There was variation in the diversity among journals and in the proportion of DEI submissions they attract, but no clear correlation between DEI acceptance rates and board diversity. Conclusions Diversity among board members reflects underrepresentation of minorities seen among surgeons nationally. Recruitment and retention of younger individuals, representing more diverse backgrounds, may be a strategy for change. DEI publication rates may benefit from calls for increasing DEI scholarship more so than changes to the peer review process.
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27
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Lenze NR, Mihalic AP, Kovatch KJ, Thorne MC, Kupfer RA. Impact of the COVID-19 Pandemic on the 2021 Otolaryngology Residency Match: Analysis of the Texas STAR Database. Laryngoscope 2021; 132:1177-1183. [PMID: 34515992 PMCID: PMC8661614 DOI: 10.1002/lary.29860] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Revised: 08/14/2021] [Accepted: 09/01/2021] [Indexed: 11/17/2022]
Abstract
Objectives/Hypothesis To estimate the impact of the coronavirus disease 2019 (COVID‐19) pandemic on the 2021 otolaryngology match with regard to geographic clustering, interview distribution, applicant‐reported costs, and matched applicant characteristics. Study Design Retrospective cohort study. Methods Survey data from applicants to otolaryngology residency programs were obtained from the Texas Seeking Transparency in Applications to Residency database. Applicant differences between the 2021 match year and prior match years (2018, 2019, and 2020) were analyzed using two‐sided t‐tests, Chi‐square tests, and Fisher's exact tests. Results A total of 442 otolaryngology residency applicants responded to the survey, including 329 from the match years 2018 to 2020 and 113 from match year 2021. In 2021, 30.7% of responding applicants reported matching at a program where they had a geographic connection, compared to 40.0% in prior years (P = .139). Matched applicants in 2021 reported attending less interviews than applicants in prior years (mean 12.2 vs. 13.3, P = .040), and 26.1% of responding applicants reported matching at a program where they sent a preference signal. Applicants in the 2021 match reported significantly lower total costs than applicants in prior years (mean difference −$5,496, 95% confidence interval −$6,234 to −$4,759; P < .001). Compared to prior match years, matched applicants in 2021 had no meaningful differences in characteristics such as United States Medical Licensing Exam board scores, clerkship grades, honors society memberships, research output, volunteer experiences, or leadership experiences. Conclusion Based on this sample, there was no evidence of significant interview hoarding or increased geographic clustering in the 2021 otolaryngology match, and the COVID‐19 pandemic did not appear to result in significantly different matched applicant characteristics. Level of Evidence 4 Laryngoscope, 132:1177–1183, 2022
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Affiliation(s)
- Nicholas R Lenze
- Department of Otolaryngology - Head & Neck Surgery, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, U.S.A.,Department of Otolaryngology-Head & Neck Surgery, University of Michigan, Ann Arbor, Michigan, U.S.A
| | - Angela P Mihalic
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas, U.S.A
| | - Kevin J Kovatch
- Department of Otolaryngology-Head & Neck Surgery, Geisinger Health System, Danville, Pennsylvania, U.S.A
| | - Marc C Thorne
- Department of Otolaryngology-Head & Neck Surgery, University of Michigan, Ann Arbor, Michigan, U.S.A
| | - Robbi A Kupfer
- Department of Otolaryngology-Head & Neck Surgery, University of Michigan, Ann Arbor, Michigan, U.S.A
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28
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Santos-Parker JR, Santos-Parker KS, Caceres J, Vargas GM, Kwakye G, Englesbe MJ, Valbuena VSM. Building an Equitable Surgical Training Pipeline: Leadership Exposure for the Advancement of Gender and Underrepresented Minority Equity in Surgery (LEAGUES). JOURNAL OF SURGICAL EDUCATION 2021; 78:1413-1418. [PMID: 33664009 DOI: 10.1016/j.jsurg.2021.01.017] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 01/12/2021] [Accepted: 01/23/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE Underrepresented minority (URM) medical students face many educational challenges. Barriers include lack of equitable representation, scarce mentorship, and the effects of systemic racism. For students interested in diversity and health equity, perceptions of surgical culture may discourage pursuing surgical specialties. We describe a national pilot for a novel surgical pipeline program, Leadership Exposure for the Advancement of Gender and Underrepresented Minority Equity in Surgery (LEAGUES), which utilizes early exposure, mentorship, and community building to empower URM students in pursuit of academic surgical careers. DESIGN A 4-week virtual program included pairing students with faculty research mentors, virtual skills sessions, and seminars on leadership, advocacy, and career development. Participants underwent semi-structured interviews before and after participation, assessing experiences with mentorship and research, interest in surgery, career aspirations, and perceived barriers to career goals. SETTING Department of Surgery, Michigan Medicine, Ann Arbor, Michigan. PARTICIPANTS Rising second-year medical students. RESULTS All 3 participants were Latinx; 2 were first-generation college students. Participants had no surgical mentorship and limited research exposure, citing a desire to learn research methodology, connect with mentors, and build towards a career working with underserved communities as motivating factors for participation. Perceived barriers to a surgical career included surgical culture, burnout, and lack of research expertise or academic network necessary for success. At completion of the program, participants described several themes: (1) new positive perspective on academic surgical culture, (2) interest and confidence in research, (3) hope for improving health disparities, (4) networking and longitudinal mentorship connections contributing to a sense of surgical community, and (5) eagerness to share resources with colleagues at their home institutions. CONCLUSIONS LEAGUES program participants acquired tools and motivation to pursue careers in surgery, and established valuable longitudinal network and mentor relationships. LEAGUES is a novel model for national surgical pipeline programs.
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Affiliation(s)
| | | | - Juan Caceres
- University of Michigan Medical School, Ann Arbor, Michigan
| | | | - Gifty Kwakye
- Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | | | - Valeria S M Valbuena
- Department of Surgery, University of Michigan, Ann Arbor, Michigan; National Clinician Scholars Program, Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan; Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, Michigan.
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Racial disparities in vascular surgery: An analysis of race and ethnicity among U.S. medical students, general surgery residents, vascular surgery trainees, and the vascular surgery workforce. J Vasc Surg 2021; 74:33S-46S. [PMID: 34303458 DOI: 10.1016/j.jvs.2021.03.046] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 03/13/2021] [Indexed: 11/21/2022]
Abstract
The ever-increasing diversity of the U.S. population has resulted in a challenge to a vascular surgery workforce that does not represent the national demographics. Educational institutions, medical organizations, and medical agencies, through initiatives and programs, have attempted to increase the number of underrepresented minorities, with, however, only modest changes during the past 30 years. Several obstacles have been identified, some of which include racism, issues of finances, lack of mentors and scholarly activities, and inequity in promotion. In the present study, we have reviewed the reported data addressing these concerns and provided guidance toward the amelioration of these issues with the hope of constructive change toward encouraging a diverse vascular surgery workforce.
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30
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Moreira CC. Developing cultural competency and maximizing its effect in vascular surgery. J Vasc Surg 2021; 74:76S-85S. [PMID: 34303463 DOI: 10.1016/j.jvs.2021.03.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Accepted: 03/13/2021] [Indexed: 10/20/2022]
Affiliation(s)
- Carla C Moreira
- Department of Surgery, Warren Alpert Medical School of Brown University, Providence, RI.
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31
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Riner AN, Herremans KM, Neal DW, Johnson-Mann C, Hughes SJ, McGuire KP, Upchurch GR, Trevino JG. Diversification of Academic Surgery, Its Leadership, and the Importance of Intersectionality. JAMA Surg 2021; 156:748-756. [PMID: 33950242 DOI: 10.1001/jamasurg.2021.1546] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Diversity in academic surgery is lacking, particularly among positions of leadership. Objective To evaluate trends among racial/ethnical minority groups stratified by gender along the surgical pipeline, as well as in surgical leadership. Design, Setting, and Participants This cross-sectional and longitudinal analysis assessed US surgical faculty census data obtained from the Association of American Medical Colleges faculty roster in the Faculty Administrative Management Online User System database. Surgical faculty members captured in census data from December 31, 2013, to December 31, 2019, were included in the analysis. Faculty were identified from the surgery category of the faculty roster, which includes general surgeons and subspecialists, neurosurgeons, and urologists. Main Outcomes and Measures Gender and race/ethnicity were obtained for surgical faculty stratified by rank. Descriptive statistics with annual percentage of change in representation are reported based on faculty rank. Results A total of 15 653 US surgical faculty, including 3876 women (24.8%), were included in the data set for 2019. Female faculty from racial/ethnic minority groups experienced an increase in representation at instructor and assistant and associate professorship appointments, with a more favorable trajectory than male faculty from racial/ethnic minority groups across nearly all ranks. White faculty maintain most leadership positions as full professors (3105 of 3997 [77.7%]) and chairs (294 of 380 [77.4%]). The greatest magnitude of underrepresentation along the surgical pipeline has been among Black (106 of 3997 [2.7%]) and Hispanic/Latinx (176 of 3997 [4.4%]) full professors. Among full professors, although Black and Hispanic/Latinx male representation increased modestly (annual change, 0.07% and 0.10%, respectively), Black female representation remained constant (annual change, 0.00004%) and Hispanic/Latinx female representation decreased (annual change, -0.16%). Overall Hispanic/Latinx (20 of 380 [5.3%]) and Black (13 of 380 [3.4%]) representation as chairs has not changed, with only 1 Black and 1 Hispanic/Latinx woman ascending to chair from 2013 to 2019. Conclusions and Relevance A disproportionately small number of faculty from minority groups obtain leadership positions in academic surgery. Intersectionality may leave female members of racial/ethnic minority groups more disadvantaged than their male colleagues in achieving leadership positions. These findings highlight the urgency to diversify surgical leadership.
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Affiliation(s)
- Andrea N Riner
- Department of Surgery, University of Florida College of Medicine, Gainesville
| | - Kelly M Herremans
- Department of Surgery, University of Florida College of Medicine, Gainesville
| | - Daniel W Neal
- Department of Surgery, University of Florida College of Medicine, Gainesville
| | | | - Steven J Hughes
- Department of Surgery, University of Florida College of Medicine, Gainesville
| | - Kandace P McGuire
- Division of Surgical Oncology, Department of Surgery, Virginia Commonwealth University, Richmond
| | - Gilbert R Upchurch
- Department of Surgery, University of Florida College of Medicine, Gainesville
| | - Jose G Trevino
- Division of Surgical Oncology, Department of Surgery, Virginia Commonwealth University, Richmond
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32
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McGrail M, O'Sullivan B, Gurney T. Critically reviewing the policies used by colleges to select doctors for specialty training: A kink in the rural pathway. Aust J Rural Health 2021; 29:272-283. [DOI: 10.1111/ajr.12707] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 11/25/2020] [Accepted: 12/03/2020] [Indexed: 11/29/2022] Open
Affiliation(s)
- Matthew McGrail
- University of Queensland Rural Clinical School Rockhampton QLD Australia
| | | | - Tiana Gurney
- University of Queensland Rural Clinical School Toowoomba QLD Australia
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33
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Fraher EP. The evolving sex, race, and ethnic composition of the surgical workforce: North Carolina is a bellwether of national change. Surgery 2021; 170:1285-1287. [PMID: 33757647 DOI: 10.1016/j.surg.2021.02.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 02/04/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND North Carolina, as a state with a significant Black population and fast-growing Hispanic population, serves as bellwether of demographic changes nationally and the challenges facing the nation to recruit and retain a general surgery workforce that mirrors the population. METHODS Annual licensure data from the North Carolina Medical Board were analyzed between 2004 and 2019. Physicians self-reporting a specialty of abdominal surgery, critical care surgery, colon and rectal surgery, general surgery, trauma surgery, proctology, and surgical oncology were categorized as general surgeons. RESULTS Female surgeons made the most gains from 2004, at just 8% of the workforce in 2004 to 26% of the workforce in 2019. Over the same period, Black surgeons increased from just 5% to 6% of the workforce, with those gains largely represented by Black female surgeons. Almost half of North Carolina's Black physicians are aged 46 and 55 and will be nearing retirement in the coming decade. Nearly two-thirds (64%) of Hispanic general surgeons were 45 or younger, and one-third of these young surgeons were international medical graduates. CONCLUSION Although the general surgery workforce in North Carolina is slowly diversifying, growth in the Black surgeon workforce has stagnated in the last 15 years at levels much lower than their representation in the population. More research is needed on the individual and life course phenomena that drive this underrepresentation.
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Affiliation(s)
- Erin P Fraher
- Departments of Family Medicine and Surgery, Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, NC.
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34
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Nieblas-Bedolla E, Williams JR, Christophers B, Kweon CY, Williams EJ, Jimenez N. Trends in Race/Ethnicity Among Applicants and Matriculants to US Surgical Specialties, 2010-2018. JAMA Netw Open 2020; 3:e2023509. [PMID: 33136131 PMCID: PMC7607442 DOI: 10.1001/jamanetworkopen.2020.23509] [Citation(s) in RCA: 103] [Impact Index Per Article: 25.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
IMPORTANCE Surgical programs across the US continue to promote and invest in initiatives aimed at improving racial/ethnic diversity, but whether this translates to changes in the percentage of applicants or matriculants from racial/ethnic minority groups remains unclear. OBJECTIVE To examine trends in the percentage of applicants and matriculants to US surgical specialties who identified as part of a racial/ethnic group underrepresented in medicine from the 2010-2011 to 2018-2019 academic years. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study examined trends in self-reported racial/ethnic identity among applicants and matriculants to US residency programs to evaluate demographic changes among surgical programs from 2010 to 2018. Data were obtained from the Association of American Medical Colleges. RESULTS The study population consisted of a total of 737 034 applicants and 265 365 matriculants to US residency programs, including 134 158 applicants and 41 347 matriculants to surgical programs. A total of 21 369 applicants (15.9%) and 5704 matriculants (13.8%) to surgical specialties identified as underrepresented in medicine. There was no statistically significant difference in the percentage of applicants underrepresented in medicine based on race/ethnicity for all surgical specialties combined in 2010 vs 2018 (15.3% [95% CI, 14.7%-15.9%] vs 17.5% [95% CI, 16.9%-18.1%]; P = .63). Thoracic surgery was the only surgical specialty in which there was a statistically significant change in the percentage of applicants (8.1% [95% CI, 4.9%-13.2%] vs 14.6% [95% CI, 10.2%-20.4%]; P = .02) or matriculants (0% [95% CI, 0%-19.4%] vs 10.0% [95% CI, 4.0%-23.1%]; P = .01) underrepresented in medicine based on race/ethnicity. Obstetrics and gynecology had the highest mean percentage of applicants (20.2%; 95% CI, 19.4%-20.8%) and matriculants (19.0%; 95% CI, 18.2%-19.8%) underrepresented in medicine among surgical specialties. Thoracic surgery had the lowest mean percentage of applicants (12.5%; 95% CI, 9.46%-15.4%) and otolaryngology the lowest mean percentage of matriculants (8.5%; 95% CI, 7.2%-9.9%) underrepresented in medicine. CONCLUSIONS AND RELEVANCE In this cross-sectional study, overall US surgical programs had no change in the percentage of applicants or matriculants who self-identified as underrepresented in medicine based on race/ethnicity, but the proportion remained higher than in nonsurgical specialties. Reevaluation of current strategies aimed at increasing racial/ethnic representation appear to be necessary to help close the existing gap in medicine and recruit a more racially/ethnically diverse surgical workforce.
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Affiliation(s)
| | - John R. Williams
- Department of Neurological Surgery, University of Washington, Seattle
| | - Briana Christophers
- Weill Cornell Medicine–Rockefeller–Sloan Kettering Tri-Institutional MD-PhD Program, New York, New York
| | - Christopher Y. Kweon
- Department of Orthopaedics and Sports Medicine, University of Washington, Seattle
| | | | - Nathalia Jimenez
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle
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