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Khedr S, Hong J, Forter-Chee-A-Tow N, Cygiel G, Heffernan DS, Lee BE, Chao SY. Reporting Minority Race and Ethnicity in Cardiovascular and Thoracic Journals. J Surg Res 2024; 301:352-358. [PMID: 39024714 DOI: 10.1016/j.jss.2024.06.027] [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: 03/01/2024] [Revised: 05/25/2024] [Accepted: 06/24/2024] [Indexed: 07/20/2024]
Abstract
INTRODUCTION Currently, there is no mandatory standard for reporting race and ethnicity in medical journals, presenting significant barriers to studying disparities in medical outcomes. We seek to investigate whether greater recent awareness of diversity and inclusion reflects in reporting of race and ethnicity by peer-reviewed cardiothoracic articles. METHODS Pubmed was queried for clinical outcomes articles published from January 2017 to June 2023 in the Journal of Thoracic and Cardiovascular Surgery, Annals of Thoracic Surgery, Journal of Heart and Lung Transplantation, and CHEST Journal. Basic science, translational studies, and international studies were excluded. SAS Studio was used for statistical analysis. RESULTS 817 papers were reviewed, 378 reported race/ethnicity with 354 (93%) reporting White, 267 (71%) reporting Black, 128 (34%) reporting Hispanic, and 119 (31%) reporting Asian. Over 8-y, there were no statistically significant changes in percent of articles that included White (odds ratio 0.808 95% confidence interval [0.624-1.047], P = 0.1068), Black (1.125 [0.984-1.288], P = 0.0857), or Asian (1.096 [0.960-1.250], P = 0.1751) groups. Hispanics were more likely to be reported in recent years (1.147 [1.006-1.307], P = 0.0397). Subset analysis was performed on cardiac (n = 157) and thoracic articles (n = 157) with no significant trends for race reporting in these subsets. CONCLUSIONS Minorities remain underrepresented in reported patient populations in peer-reviewed cardiothoracic journals. Future efforts should prioritize accurately representing these populations in the literature. Inaccurate data and exclusion of minority populations can contribute to disparities observed in overall outcomes.
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Affiliation(s)
- Shahenda Khedr
- Department of General Surgery, New York Presbyterian-Queens, Queens, New York.
| | - Julie Hong
- Department of General Surgery, New York Presbyterian-Queens, Queens, New York
| | | | - Gala Cygiel
- Department of General Surgery, New York Presbyterian-Queens, Queens, New York
| | | | - Benjamin E Lee
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, New York
| | - Steven Y Chao
- Department of General Surgery, New York Presbyterian-Queens, Queens, New York; Department of Surgery, Weill Cornell Medicine, New York, New York
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2
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Lee JKH, McGuire C, Raîche I, Domecq MC, Tudorache M, Gawad N. Underrepresented in medicine (URiM) residents: A scoping review on prevalence trends & improving recruitment. Am J Surg 2024; 237:115924. [PMID: 39208503 DOI: 10.1016/j.amjsurg.2024.115924] [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: 04/10/2024] [Revised: 07/31/2024] [Accepted: 08/21/2024] [Indexed: 09/04/2024]
Abstract
BACKGROUND Disparities exist in underrepresented in medicine (URiM) resident representation. This review examines recent trends in resident diversity, URiM recruitment strategies, and identifies research gaps in equity, diversity, and inclusion (EDI) for URiM residents. METHODS MEDLINE, EMBASE, Web of Science, and ERIC databases were searched for studies published from 2017 to 2022 on URiM resident prevalence and recruitment initiatives. RESULTS 3634 abstracts were reviewed, and 52 articles were included. 35 (67 %) studies reported on prevalence of URiM residents, demonstrating URiM resident composition is lower than residency applicant demographics, particularly in surgery. Seventeen (33 %) studies reported on URiM recruitment interventions, such as visiting clerkship programs, holistic review, and targeted outreach, and demonstrated success in increasing recruitment of URiM candidates to programs. CONCLUSIONS URiM residents remain disproportionately underrepresented, and markedly so among surgical residency programs. Further research should focus on implementing EDI interventions in surgery and assess URiM resident attrition post-matriculation.
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Affiliation(s)
- Jeremy K H Lee
- Division of General Surgery, Department of Surgery, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada; The Ottawa Hospital, Civic Campus, 737 Parkdale Ave, Ottawa, ON, Canada K1Y 4M9.
| | - Catherine McGuire
- Faculty of Medicine, University of Ottawa, Roger Guindon Hall, 451 Smyth Rd, Ottawa, ON, Canada, K1H 8M5.
| | - Isabelle Raîche
- Division of General Surgery, Department of Surgery, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada; The Ottawa Hospital, Civic Campus, 737 Parkdale Ave, Ottawa, ON, Canada K1Y 4M9.
| | - Marie-Cécile Domecq
- Health Sciences Library, University of Ottawa, 451 Smyth Road (1020F), Ottawa, ON, Canada, K1H 8M5.
| | - Mihaela Tudorache
- Faculty of Medicine, University of Ottawa, Roger Guindon Hall, 451 Smyth Rd, Ottawa, ON, Canada, K1H 8M5.
| | - Nada Gawad
- Division of General Surgery, Department of Surgery, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada; The Ottawa Hospital, Civic Campus, 737 Parkdale Ave, Ottawa, ON, Canada K1Y 4M9.
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Contreras N, Essig R, Magarinos J, Pereira S. Abuse, Bullying, Harassment, Discrimination, and Allyship in Cardiothoracic Surgery. Thorac Surg Clin 2024; 34:239-247. [PMID: 38944451 DOI: 10.1016/j.thorsurg.2024.04.001] [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] [Indexed: 07/01/2024]
Abstract
Abuse, bullying, harassment, and discrimination are prominent workplace occurrences within cardiothoracic (CT) surgery that cause burnout and threaten the well-being of surgeons. Under-represented and marginalized groups experience higher incidences of these negative events, and CT surgery is one of the least diverse specialties. The CT surgery workforce and institutional leadership must prioritize mentorship, sponsorship, and allyship to promote a diverse and healthy specialty for surgeon recruitment, growth, and job satisfaction.
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Affiliation(s)
- Nicolas Contreras
- Division of Cardiothoracic Surgery, University of Utah and Huntsman Cancer Institute, 1950 Circle of Hope Drive, Salt Lake City, UT 84112, USA
| | - Rachael Essig
- Department of Surgery, Georgetown University Hospital, 3800 Reservoir Road, PHC4, Washington, DC 20007, USA. https://twitter.com/RachaelEssig
| | - Jessica Magarinos
- Department of Surgery, Temple University, 3401 North Broad Street, Philadelphia, PA 19147, USA
| | - Sara Pereira
- Division of Cardiothoracic Surgery, Department of Surgery, University of Utah, 30 North Mario Capecchi Drive, 4N133, Salt Lake City, UT 84112, USA.
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Scott SS, Gouchoe DA, Azap L, Henn MC, Choi K, Mokadam NA, Whitson BA, Pawlik TM, Ganapathi AM. Racial and Ethnic Disparities in Peri-and Post-operative Cardiac Surgery. CURRENT CARDIOVASCULAR RISK REPORTS 2024; 18:95-113. [PMID: 39100592 PMCID: PMC11296970 DOI: 10.1007/s12170-024-00739-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/02/2024] [Indexed: 08/06/2024]
Abstract
Purpose of Review Despite efforts to curtail its impact on medical care, race remains a powerful risk factor for morbidity and mortality following cardiac surgery. While patients from racial and ethnic minority groups are underrepresented in cardiac surgery, they experience a disproportionally elevated number of adverse outcomes following various cardiac surgical procedures. This review provides a summary of existing literature highlighting disparities in coronary artery bypass surgery, valvular surgery, cardiac transplantation, and mechanical circulatory support. Recent Findings Unfortunately, specific causes of these disparities can be difficult to identify, even in large, multicenter studies, due to the complex relationship between race and post-operative outcomes. Current data suggest that these racial/ethnic disparities can be attributed to a combination of patient, socioeconomic, and hospital setting characteristics. Summary Proposed solutions to combat the mechanisms underlying the observed disparate outcomes require deployment of a multidisciplinary team of cardiologists, anesthesiologists, cardiac surgeons, and experts in health care equity and medical ethics. Successful identification of at-risk populations and the implementation of preventive measures are necessary first steps towards dismantling racial/ethnic differences in cardiac surgery outcomes.
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Affiliation(s)
- Shane S. Scott
- Medical Scientist Training Program, Biomedical Sciences Graduate Program, The Ohio State University, Columbus, OH USA
- Division of Cardiac Surgery, Department of Surgery, The Ohio State University Wexner Medical Center, N-809 Doan Hall, 410 W. 10th Ave, Columbus, OH 43210 USA
| | - Doug A. Gouchoe
- Division of Cardiac Surgery, Department of Surgery, The Ohio State University Wexner Medical Center, N-809 Doan Hall, 410 W. 10th Ave, Columbus, OH 43210 USA
- COPPER Laboratory, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH 43210 USA
| | - Lovette Azap
- Division of Cardiac Surgery, Department of Surgery, The Ohio State University Wexner Medical Center, N-809 Doan Hall, 410 W. 10th Ave, Columbus, OH 43210 USA
| | - Matthew C. Henn
- Division of Cardiac Surgery, Department of Surgery, The Ohio State University Wexner Medical Center, N-809 Doan Hall, 410 W. 10th Ave, Columbus, OH 43210 USA
| | - Kukbin Choi
- Division of Cardiac Surgery, Department of Surgery, The Ohio State University Wexner Medical Center, N-809 Doan Hall, 410 W. 10th Ave, Columbus, OH 43210 USA
| | - Nahush A. Mokadam
- Division of Cardiac Surgery, Department of Surgery, The Ohio State University Wexner Medical Center, N-809 Doan Hall, 410 W. 10th Ave, Columbus, OH 43210 USA
| | - Bryan A. Whitson
- Division of Cardiac Surgery, Department of Surgery, The Ohio State University Wexner Medical Center, N-809 Doan Hall, 410 W. 10th Ave, Columbus, OH 43210 USA
- COPPER Laboratory, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH 43210 USA
| | - Timothy M. Pawlik
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH USA
| | - Asvin M. Ganapathi
- Division of Cardiac Surgery, Department of Surgery, The Ohio State University Wexner Medical Center, N-809 Doan Hall, 410 W. 10th Ave, Columbus, OH 43210 USA
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Jindani R, Olivera J, Rodriguez-Quintero JH, Friedmann P, Vimolratana M, Chudgar N, Antonoff MB, Stiles B. The Representation of Women Moderators at The Society of Thoracic Surgeons Annual Meeting. Ann Thorac Surg 2024:S0003-4975(24)00584-8. [PMID: 39067634 DOI: 10.1016/j.athoracsur.2024.07.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2024] [Revised: 06/19/2024] [Accepted: 07/15/2024] [Indexed: 07/30/2024]
Abstract
BACKGROUND Recently, there has been an increase in the representation of women within the cardiothoracic surgery workforce, with discussions about gender equity garnering interest. We sought to identify whether this increase is accompanied by commensurate selection for representation at national meetings. METHODS Online archives of The Society of Thoracic Surgeons (STS) Annual Meetings were reviewed from 2015 to 2024. Data regarding the moderator's gender were abstracted. The gender distribution of moderators across the various session categories was surveyed, and subgroup analyses were performed. RESULTS During the years of study, the STS Annual Meeting Taskforce selected 983 moderators to participate in the conference, including 218 women. The representation of women moderators demonstrated a favorable, upward trend. In 2015, 12.1% of moderators were women, with a consistent rate from 2015 to 2018. There was a noticeable rise in invited women moderators in 2019, with 25.4% of moderators being women. This proportion increased to 36.9% women in 2024. General Thoracic sessions have consistently included a greater percentage of women moderators compared with other sessions. Other topic areas, such as Education and Quality Improvement and Critical Care, transitioned to greater representation of women in recent years. CONCLUSIONS There has been an increase over time in women moderators selected for participation in the STS Annual Meeting, with progress in gender diversity seen in most session types. Although the overall proportion of women within cardiothoracic surgery remains low, the STS has increasingly worked toward encouraging inclusivity. Efforts to further support well-rounded representation are of important benefit.
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Affiliation(s)
- Rajika Jindani
- Department of Cardiothoracic and Vascular Surgery, Montefiore Medical Center, Bronx, New York
| | - Justin Olivera
- Department of Cardiothoracic and Vascular Surgery, Montefiore Medical Center, Bronx, New York
| | | | - Patricia Friedmann
- Department of Cardiothoracic and Vascular Surgery, Montefiore Medical Center, Bronx, New York
| | - Marc Vimolratana
- Department of Cardiothoracic and Vascular Surgery, Montefiore Medical Center, Bronx, New York
| | - Neel Chudgar
- Department of Cardiothoracic and Vascular Surgery, Montefiore Medical Center, Bronx, New York
| | - Mara B Antonoff
- Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Brendon Stiles
- Department of Cardiothoracic and Vascular Surgery, Montefiore Medical Center, Bronx, New York.
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6
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Perdomo D, Pebworth R, Lawton JS, Kilic A, Reddy RM, David EA, Odell DD, Yang SC. The Society of Thoracic Surgeons Looking to the Future Scholarship Program: A 15-Year Review. Ann Thorac Surg 2024; 117:866-872. [PMID: 37739113 DOI: 10.1016/j.athoracsur.2023.09.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 08/29/2023] [Accepted: 09/05/2023] [Indexed: 09/24/2023]
Abstract
BACKGROUND It has been postulated that a possible barrier to pursuing cardiothoracic surgery is a lack of exposure and mentorship during training. In 2006, The Society of Thoracic Surgeons began the Looking to the Future Scholarship to expand interest in the field. Undecided trainees with limited exposure were prioritized in the selection process. This report summarizes the career outcomes of general surgery resident and medical student recipients. METHODS Scholarship recipients and nonrecipients (control) were queried in a Google search. The percentage of those who were cardiothoracic surgeons or in cardiothoracic training (%CTS) was calculated, as well as the percentage of female surgeons in cardiothoracic surgery. RESULTS From 2006 to 2021, there were 669 awardees. The %CTS was 63.7% for resident recipients and 31.4% for students, respectively. There was no significant difference in %CTS between resident and student recipients compared to nonrecipients. Notably, the percentage of female cardiothoracic surgeons was significantly greater for both resident and student recipients. CONCLUSIONS The majority of resident recipients are now in cardiothoracic surgery, comparable to nonrecipients. While there was no significant difference between the percentage of recipients and non-recipients in cardiothoracic surgery, these groups differed substantially as nonrecipients had greater exposure and commitment to the field at the time of application.
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Affiliation(s)
- Dianela Perdomo
- Division of Thoracic Surgery, Department of Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland.
| | | | - Jennifer S Lawton
- Division of Cardiac Surgery, Department of Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Ahmet Kilic
- Division of Cardiac Surgery, Department of Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Rishindra M Reddy
- Department of Thoracic Surgery, University of Michigan, Ann Arbor, Michigan
| | - Elizabeth A David
- Division of Cardiothoracic Surgery, Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - David D Odell
- Department of Surgery, Canning Thoracic Institute, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
| | - Stephen C Yang
- Division of Thoracic Surgery, Department of Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland
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7
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Wilder FG, Han JJ. Finding the Right Mentor. Thorac Surg Clin 2024; 34:1-7. [PMID: 37953046 DOI: 10.1016/j.thorsurg.2023.08.010] [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] [Indexed: 11/14/2023]
Abstract
Quality mentorship is essential for a successful career in cardiothoracic surgery. From the premedical phase to the position of senior faculty, there are many benefits to having mentors who can provide insight, promote career advancement and facilitate professional opportunities. It is important to distinguish between a mentor and sponsor in seeking this career guidance because both are beneficial but serve different purposes. By being clear about one's professional goals, the mentor-mentee relationship can be optimized and lead to a fulfilling and productive career.
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Affiliation(s)
- Fatima G Wilder
- Division of Thoracic Surgery, Department of Surgery, Brigham and Women's Hospital, 15 Francis Street, Boston, MA 02115, USA.
| | - Jason J Han
- Division of Cardiovascular Surgery, Department of Surgery, University of Pennsylvania, 3400 Civic Center Boulevard East Pavilion, 2nd Floor, Philadelphia, PA 19104, USA
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8
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Edwards MA. Diversity in the Cardiothoracic Surgery Workforce: What I Can Do. Thorac Surg Clin 2024; 34:89-97. [PMID: 37953057 DOI: 10.1016/j.thorsurg.2023.08.011] [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] [Indexed: 11/14/2023]
Abstract
Within the cardiothoracic surgery workforce, there are significant gaps in the numbers of women and underrepresented in medicine minorities, but some progress has been made in gender diversity at the resident level. Individual surgeons play an important role in combatting discrimination and harassment, while also promoting women and minorities through mentorship and sponsorship. More importantly, a multifaceted and structured approach is needed to increase diversity at the institutional level with strategies to create a culture of inclusion, working to retain underrepresented minority and female surgeons, and eliminating bias in the recruitment process.
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Affiliation(s)
- Melanie A Edwards
- Cardiovascular & Thoracic Surgery, Trinity Medical Group Ann Arbor, 5325 Elliott Drive, Suite 102, Ypsilanti, MI 48197, USA.
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Wagner CM, Watt TMF, Ailawadi G, Romano JC. Supporting Cardiothoracic Surgery Trainees Building Families: Creation of a Departmental Perinatal Policy. Ann Thorac Surg 2023; 116:865-867. [PMID: 37454785 DOI: 10.1016/j.athoracsur.2023.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 06/26/2023] [Accepted: 07/11/2023] [Indexed: 07/18/2023]
Affiliation(s)
- Catherine M Wagner
- Department of Cardiac Surgery, Michigan Medicine, Ann Arbor, Michigan; National Clinician Scholars Program, Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan.
| | - Tessa M F Watt
- Department of Cardiac Surgery, Michigan Medicine, Ann Arbor, Michigan
| | - Gorav Ailawadi
- Department of Cardiac Surgery, Michigan Medicine, Ann Arbor, Michigan
| | - Jennifer C Romano
- Department of Cardiac Surgery, Michigan Medicine, Ann Arbor, Michigan; Department of Pediatrics, Mott Children's Hospital, Michigan Medicine, Ann Arbor, Michigan
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Yong V, Rostmeyer K, Deng M, Chin K, Graves EKM, Ma GX, Erkmen CP. Gender differences in cardiothoracic surgery letters of recommendation. J Thorac Cardiovasc Surg 2023; 166:1361-1370. [PMID: 37156362 PMCID: PMC10592592 DOI: 10.1016/j.jtcvs.2023.03.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 02/20/2023] [Accepted: 03/27/2023] [Indexed: 05/10/2023]
Abstract
OBJECTIVE To investigate whether or not gender influences letters of recommendation for cardiothoracic surgery fellowship. METHODS From applications to an Accreditation Council Graduate Medical Education cardiothoracic surgery fellowship program between 2016 and 2021, applicant and author characteristics were examined with descriptive statistics, analysis of variance, and Pearson χ2 tests. Linguistic software was used to assess communication differences in letters of recommendation, stratified by author and applicant gender. An additional higher-level analysis was then performed using a generalized estimating equations model to examine linguistic differences among author-applicant gender pairs. RESULTS Seven hundred thirty-nine recommendation letters extracted from 196 individual applications were analyzed; 90% (n = 665) of authors were men and 55.8% (n = 412) of authors were cardiothoracic surgeons. Compared with women authors, authors who are men wrote more authentic (P = .01) and informal (P = .03) recommendation letters. When writing for women applicants, authors who are men were more likely to display their own leadership and status (P = .03) and discuss women applicants' social affiliations (P = .01), like occupation of applicant's father or husband. Women authors wrote longer letters (P = .03) and discussed applicants' work (P = .01) more often than authors who are men. They also mentioned leisure activities (P = .03) more often when writing for women applicants. CONCLUSIONS Our work identifies gender-specific differences in letters of recommendation. Women applicants may be disadvantaged because their recommendation letters are significantly more likely to focus on their social ties, leisure activities, and the status of the letter writer. Author and reviewer awareness of gender-biased use of language will aid in improvements to the candidate selection process.
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Affiliation(s)
- Valeda Yong
- Department of Surgery, Temple University Hospital, Philadelphia, Pa
| | - Kaleb Rostmeyer
- Lewis Katz School of Medicine at Temple University, Philadelphia, Pa
| | - Mengying Deng
- Fox Chase Cancer Center, Temple University Health Systems, Philadelphia, Pa
| | - Kristine Chin
- Lewis Katz School of Medicine at Temple University, Philadelphia, Pa
| | - Erin K M Graves
- Department of Neurosurgery, Temple University Hospital, Philadelphia, Pa
| | - Grace X Ma
- Center for Asian Health, Lewis Katz School of Medicine at Temple University, Philadelphia, Pa
| | - Cherie P Erkmen
- Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, Pa.
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Fortich S, Molena D, Antonoff M. Unequal No More. Ann Thorac Surg 2023; 116:863-864. [PMID: 37146785 DOI: 10.1016/j.athoracsur.2023.04.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 04/23/2023] [Indexed: 05/07/2023]
Affiliation(s)
- Susana Fortich
- Department of General Surgery, University of Texas Medical Branch, Galveston, Texas
| | - Daniela Molena
- Department of Thoracic Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Mara Antonoff
- Department of Thoracic and Cardiovascular Surgery, MD Anderson Cancer Center, 1400 Pressler St, Unit 1489, Houston, TX 77030.
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12
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Bonner SN, Lagisetty K, Reddy RM, Engeda Y, Griggs JJ, Valley TS. Clinical Implications of Removing Race-Corrected Pulmonary Function Tests for African American Patients Requiring Surgery for Lung Cancer. JAMA Surg 2023; 158:1061-1068. [PMID: 37585181 PMCID: PMC10433136 DOI: 10.1001/jamasurg.2023.3239] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 05/20/2023] [Indexed: 08/17/2023]
Abstract
Importance Removal of race correction in pulmonary function tests (PFTs) is a priority, given that race correction inappropriately conflates race, a social construct, with biological differences and falsely assumes worse lung function in African American than White individuals. However, the impact of decorrecting PFTs for African American patients with lung cancer is unknown. Objectives To identify how many hospitals providing lung cancer surgery use race correction, examine the association of race correction with predicted lung function, and test the effect of decorrection on surgeons' treatment recommendations. Design, Setting, and Participants In this quality improvement study, hospitals participating in a statewide quality collaborative were contacted to determine use of race correction in PFTs. For hospitals performing race correction, percent predicted preoperative and postoperative forced expiratory volume in 1 second (FEV1) was calculated for African American patients who underwent lung cancer resection between January 1, 2015, and September 31, 2022, using race-corrected and race-neutral equations. US cardiothoracic surgeons were then randomized to receive 1 clinical vignette that differed by the use of Global Lung Function Initiative equations for (1) African American patients (percent predicted postoperative FEV1, 49%), (2) other race or multiracial patients (percent predicted postoperative FEV1, 45%), and (3) race-neutral patients (percent predicted postoperative FEV1, 42%). Main Outcomes and Measures Number of hospitals using race correction in PFTs, change in preoperative and postoperative FEV1 estimates based on race-neutral or race-corrected equations, and surgeon treatment recommendations for clinical vignettes. Results A total of 515 African American patients (308 [59.8%] female; mean [SD] age, 66.2 [9.4] years) were included in the study. Fifteen of the 16 hospitals (93.8%) performing lung cancer resection for African American patients during the study period reported using race correction, which corresponds to 473 African American patients (91.8%) having race-corrected PFTs. Among these patients, the percent predicted preoperative FEV1 and postoperative FEV1 would have decreased by 9.2% (95% CI, -9.0% to -9.5%; P < .001) and 7.6% (95% CI, -7.3% to -7.9%; P < .001), respectively, if race-neutral equations had been used. A total of 225 surgeons (194 male [87.8%]; mean [SD] time in practice, 19.4 [11.3] years) were successfully randomized and completed the vignette items regarding risk perception and treatment outcomes (76% completion rate). Surgeons randomized to the vignette with African American race-corrected PFTs were more likely to recommend lobectomy (79.2%; 95% CI, 69.8%-88.5%) compared with surgeons randomized to the other race or multiracial-corrected (61.7%; 95% CI, 51.1%-72.3%; P = .02) or race-neutral PFTs (52.8%; 95% CI, 41.2%-64.3%; P = .001). Conclusions and Relevance Given the findings of this quality improvement study, surgeons should be aware of changes in PFT testing because removal of race correction PFTs may change surgeons' treatment decisions and potentially worsen existing disparities in receipt of lung cancer surgery among African American patients.
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Affiliation(s)
- Sidra N. Bonner
- Department of Surgery, University of Michigan, Ann Arbor
- Center for Health Outcomes and Policy, University of Michigan, Ann Arbor
- National Clinician Scholars Program, University of Michigan, Ann Arbor
| | - Kiran Lagisetty
- Section of Thoracic Surgery, Department of Surgery, University of Michigan, Ann Arbor
- Veterans Affairs Ann Arbor Healthcare System, Department of Veterans Affairs, Ann Arbor, Michigan
| | - Rishindra M. Reddy
- Veterans Affairs Ann Arbor Healthcare System, Department of Veterans Affairs, Ann Arbor, Michigan
- Michigan Society of Thoracic and Cardiovascular Surgeons General Thoracic Quality Collaborative, Ann Arbor
| | | | - Jennifer J. Griggs
- Department of Internal Medicine, Division of Hematology and Oncology, Department of Health Management and Policy, School of Public Health University of Michigan, Ann Arbor
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
| | - Thomas S. Valley
- Veterans Affairs Ann Arbor Healthcare System, Department of Veterans Affairs, Ann Arbor, Michigan
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
- Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor
- Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor
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Chikwe J. Unequal Treatment: An Introduction to The Annals Reprint Collection. Ann Thorac Surg 2023; 115:e87-e88. [PMID: 36966008 DOI: 10.1016/j.athoracsur.2023.02.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Indexed: 03/27/2023]
Affiliation(s)
- Joanna Chikwe
- Department of Cardiac Surgery, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California.
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Hamilton BCS, Nguyen D, Grondin SC, Sadaba JR, Myers PO, Young CM, Calhoon JH, Moon MR, Colson YL, Keshavjee S, Nguyen TC. Global Makeup of Cardiothoracic Surgeons as Represented by Our Major Societies and Associations. Ann Thorac Surg 2023; 115:1052-1060. [PMID: 35934066 DOI: 10.1016/j.athoracsur.2022.07.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Revised: 07/02/2022] [Accepted: 07/19/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Prior efforts to capture the cardiothoracic surgery community rely on survey data with potentially biased or low response rates. Our goal is to better understand our community by assessing the membership directories from The Society of Thoracic Surgeons (STS), American Association for Thoracic Surgery (AATS), European Association for Cardio-Thoracic Surgery (EACTS), and Asian Society for Cardiovascular and Thoracic Surgery (ASCVTS). METHODS Membership data were obtained from membership directories. Data for STS and EACTS were supplemented by the associations from their internal databases. The inclusion criterion was active membership; trainees and wholly incomplete profiles were excluded. RESULTS A total of 12 053 membership profiles were included (STS, 6365; EACTS, 3661; AATS, 1495; ASCVTS, 532). Membership is 7% female overall (EACTS, 9%; STS, 6%; AATS, 5%; ASCVTS, 3%), with a median age of 57 years (STS, 60 years; EACTS, 52 years). All societies had a broad scope of practice including members who practiced both adult cardiac and thoracic (20% overall), but most members practiced adult cardiac (31% overall; ASCVTS, 48%; AATS, 36%; EACTS, 30%; STS, 28%) and were in the late stage of their careers. CONCLUSIONS We present the makeup of our 4 major societies. We are global with a diversity of careers but concerning factors that require immediate attention. The future of our specialty depends on our ability to evolve, to promote the specialty, to attract trainees, and to include and promote female surgeons. It is crucial that we wake up to these issues, change the narrative, and create action on both individual and leadership levels.
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Affiliation(s)
- Barbara C S Hamilton
- Division of Cardiothoracic Surgery, Department of Surgery, University of California, San Francisco, San Francisco, California.
| | - Dang Nguyen
- Department of Biomedical Engineering, University of South Florida, Tampa, Florida
| | - Sean C Grondin
- Department of Surgery, Foothills Medical Center, University of Calgary, Calgary, Alberta, Canada
| | - J Rafael Sadaba
- Department of Cardiac Surgery, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - Patrick O Myers
- Department of Cardiovascular Surgery, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Carolyn M Young
- Department of Psychiatry, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - John H Calhoon
- Department of Cardiothoracic Surgery, University of Texas Health Science Center, San Antonio, Texas
| | - Marc R Moon
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St Louis, Missouri; Division of Cardiothoracic Surgery, Department of Surgery, Baylor College of Medicine, Houston, Texas; Texas Heart Institute, Houston, Texas
| | - Yolonda L Colson
- Division of Thoracic Surgery, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Shaf Keshavjee
- Division of Thoracic Surgery, Department of Surgery, Toronto General Hospital, Toronto, Ontario, Canada
| | - Tom C Nguyen
- Division of Cardiothoracic Surgery, Department of Surgery, University of California, San Francisco, San Francisco, California
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Olive JK, Yost CC, Robinson JA, Brescia AA, Han JJ, Haney JC, Forbess JM, Varghese TK, Backhus LM, Cooke DT, Cornwell LD, Preventza OA. Demographics of Current and Aspiring Integrated Six-year Cardiothoracic Surgery Trainees. Ann Thorac Surg 2023; 115:771-777. [PMID: 35934069 DOI: 10.1016/j.athoracsur.2022.06.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 04/16/2022] [Accepted: 06/27/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND The integrated 6-year thoracic surgery (I-6) residency model was developed in part to promote early interest in cardiothoracic surgery in diverse trainees. To determine gaps in and opportunities for recruitment of women and minority groups in the pipeline for I-6 residency, we quantified rates of progression at each training level and trends over time. METHODS We obtained 2015 to 2019 medical student, I-6 applicant, and I-6 resident gender and race/ethnicity demographic data from the American Association of Medical Colleges and Electronic Residency Application Service public databases and Accreditation Council for Graduate Medical Education Data Resource Books. We performed χ2, Fisher exact, and Cochran-Armitage tests for trend to compare 2015 and 2019. RESULTS Our cross-sectional analysis found increased representation of women and all non-White races/ethnicities, except Native American, at each training level from 2015 to 2019 (P < .001 for all). The greatest trends in increases were seen in the proportions of women (28% vs 22%, P = .46) and Asian/Pacific Islander (25% vs 15%, P = .08) applicants. There was also an increase in the proportions of women (28% vs 24%, P = .024) and White (61% vs 58%, P = .007) I-6 residents, with a trend for Asian/Pacific Islanders (20% vs 17%, P = .08). The proportions of Hispanic (5%) and Black/African American (2%) I-6 residents in 2019 remained low. CONCLUSIONS I-6 residency matriculation is not representative of medical student demographics and spotlights a need to foster early interest in cardiothoracic surgery among all groups underrepresented in medicine while ensuring that we mitigate bias in residency recruitment.
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Affiliation(s)
- Jacqueline K Olive
- Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University, Durham, North Carolina
| | - Colin C Yost
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Justin A Robinson
- Division of Cardiac Surgery, Department of Surgery, University of Maryland, Baltimore, Maryland
| | | | - Jason J Han
- Division of Cardiovascular Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - John C Haney
- Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University, Durham, North Carolina
| | - Joseph M Forbess
- Division of Cardiac Surgery, Department of Surgery, University of Maryland, Baltimore, Maryland
| | - Thomas K Varghese
- Division of Cardiothoracic Surgery, University of Utah, Salt Lake City, Utah
| | - Leah M Backhus
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, California
| | - David T Cooke
- Division of General Thoracic Surgery, Department of Surgery, University of California, Davis Health, Sacramento, California
| | - Lorraine D Cornwell
- Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Ourania A Preventza
- Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas; Department of Cardiovascular Surgery, Texas Heart Institute, Houston, Texas.
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Coyan GN, Kilcoyne M, Castro-Medina M, Viegas M, Da Fonseca Da Silva L, Romano JC, Fuller SM, Morell VO. Congenital Heart Surgery Training Experiences and Perceptions Among Cardiothoracic Surgery Residents. Semin Thorac Cardiovasc Surg 2023; 35:148-155. [PMID: 35278667 DOI: 10.1053/j.semtcvs.2022.03.004] [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: 03/01/2022] [Accepted: 03/03/2022] [Indexed: 11/11/2022]
Abstract
Interest and core training in congenital heart surgery (CHS) has not been characterized among current cardiothoracic surgical trainees. This study aimed to evaluate perceptions, interest, exposure, and experience among current trainees. A 22 question survey was distributed to all cardiothoracic surgical trainees in ACGME-accredited thoracic surgery residencies. Questions included demographics, exposure to CHS during, perceptions of, participation in and quality assessment of CHS training. There were 106 responses (20.1% response rate) of which 31 (29.0%) were female and 87 (81.3%) were cardiothoracic track. While 69 (64.5%) reported having an interest in CHS at some point during training, only 24 (22.4%) were actively pursuing CHS. All but 7 (6.5%) residents reported having easy access to congenital mentorship, with 35 (32.7%) actively participating in CHS research. Three months was the median duration of congenital rotations. Residents reported less operative participation on CHS compared to adult cardiac surgery. Several residents noted the need for earlier exposure and increased technical/operative experience as areas in need of improvement. The most cited primary influences to pursue CHS included: mentorship, breadth of pathology, and technical nature of the specialty. Lack of consistent job availability and length of additional training were reported as negative influences. Cardiothoracic residents report adequate exposure to obtain case requirements and knowledge for board examinations in CHS but highly variable operative involvement. Mentorship and early exposure remain important for those interested in CHS, while additional training time and limited job availability remain hurdles to CHS.
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Affiliation(s)
- Garrett N Coyan
- Department of Cardiothoracic Surgery, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
| | - Maxwell Kilcoyne
- Department of Surgery, Mercy Catholic Medical Center, Darby, Pennsylvania
| | - Mario Castro-Medina
- Department of Cardiothoracic Surgery, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Melita Viegas
- Department of Cardiothoracic Surgery, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Luciana Da Fonseca Da Silva
- Department of Cardiothoracic Surgery, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Jennifer C Romano
- Departments of Cardiac Surgery and Pediatrics, University of Michigan, Ann Arbor, Michigan
| | - Stephanie M Fuller
- Division of Cardiac Surgery, Department of Surgery, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Victor O Morell
- Department of Cardiothoracic Surgery, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
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Mueller L, Morenas R, Loe M, Toraih E, Turner J. Gender and Race Demographics of Fellowships After General Surgery Training in the United States: A Five-Year Analysis in Applicant and Resident Trends. Am Surg 2022:31348221146945. [PMID: 36565153 DOI: 10.1177/00031348221146945] [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: 12/25/2022]
Abstract
INTRODUCTION The gender and minority gap in general surgery residency is narrowing; however, literature lacks comprehensive data regarding the demographics of fellowship programs following general surgery training. METHODS Data from 2017 to 2021 for gender, ethnicity, and surgical subspecialty are publicly available from the ERAS database and ACGME yearly data reports. Cochran-Armitage trend tests were used to determine statistical significance in trends for female and minority applicants and trainees. RESULTS The overall trend of female applicants to surgical specialties remained stagnant. However, female applicants to vascular surgery increased significantly from 25% to 35% (P = .045). There was no significant increase in female trainees in any surgical specialties evaluated. Furthermore, the overall trend of minority applicants to surgical specialties also remained stagnant, except for pediatric surgery, which showed significantly fewer minority applicants. Despite pediatric surgery having fewer applicants, minority trainees in this specialty increased significantly from 8% to 19% (P = .008). CONCLUSION Several current initiatives, such as intentional mentorship, are being reported to promote diverse and equal representation among female and minority applicants and trainees. However, the current overall margin of increase in diversity among surgical specialty applicants and trainees is minimal, indicating that continued efforts are needed to diversify surgical specialty training programs.
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Affiliation(s)
- Lauren Mueller
- School of Medicine, 12255Tulane University, New Orleans, LA, USA
| | - Rohan Morenas
- School of Medicine, 12255Tulane University, New Orleans, LA, USA
| | - Mallory Loe
- School of Medicine, 12255Tulane University, New Orleans, LA, USA
| | - Eman Toraih
- Division of Endocrine and Oncologic Surgery, Department of Surgery, School of Medicine, 12255Tulane University, New Orleans, LA, USA.,Genetics Unit, Department of Histology and Cell Biology, 12255Suez Canal University, Ismailia, Egypt
| | - Jacquelyn Turner
- Department of Surgery, Division of Colon and Rectal Surgery, 12255Tulane University School of Medicine, New Orleans, LA, USA
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Chikwe J. Editor's Choice: Inflection Points. Ann Thorac Surg 2022; 114:1-4. [PMID: 35753708 DOI: 10.1016/j.athoracsur.2022.05.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Indexed: 11/01/2022]
Affiliation(s)
- Joanna Chikwe
- Department of Cardiac Surgery, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California.
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Trends in Diversity in Integrated Cardiothoracic Surgery Residencies. Ann Thorac Surg 2022; 114:1044-1048. [DOI: 10.1016/j.athoracsur.2022.01.041] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Revised: 12/18/2021] [Accepted: 01/23/2022] [Indexed: 11/20/2022]
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