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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] [MESH Headings] [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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Hamilton KM, Bakhit R, Schneyer R, Levin G, Milad M, Truong M, Wright KN, Siedhoff MT, Meyer R. Race, Ethnicity, and Sex Representation Trends Among Minimally Invasive Gynecologic Surgery Fellowship Trainees and Graduates. J Minim Invasive Gynecol 2024; 31:761-768. [PMID: 38772438 DOI: 10.1016/j.jmig.2024.05.015] [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: 02/01/2024] [Revised: 05/09/2024] [Accepted: 05/10/2024] [Indexed: 05/23/2024]
Abstract
STUDY OBJECTIVE To study the race, ethnicity, and sex representation and annual trends of AAGL FMIGS fellows and graduates. DESIGN A retrospective cross-sectional study. SETTING AAMC databases were queried for demographic information between 2011 and 2023. PATIENTS/SUBJECTS AAGL FMIGS fellows and graduates. INTERVENTIONS N/A MEASUREMENTS AND MAIN RESULTS: Descriptive statistical analysis and the actual-to-expected (AE) ratio of each race, ethnicity, and sex were performed. AE ratio was calculated by dividing the 13-year average actual percentage of FMIGS trainees and graduates by the expected percentage based demographics of OBGYN residents and the US general population. 477 fellows graduated or were in training between 2011 and 2023; race and ethnicity information was obtained for 347 (72.7%) individuals, and sex information was available for 409 (85.7%). Representation of females ranged from 66.7% in 2017 to 93.3% in 2022. There was a significantly increasing slope for the representation of females (+1.3% per year; 95% CI 0.00-0.03; p = .027). Compared to their distribution among US OBGYN residents, White fellows' representation was lower [AE ratio, 95% CI 0.60 (0.44-0.81)] and of Asian fellows was higher [AE ratio, 95% CI 2.17 (1.47-3.21)]. Female fellows' representation was lower than expected [AE ratio, 95% CI 0.68 (0.48-0.96)] compared to their distribution among US OBGYN residents. Compared to the general US population, White fellows [AE ratio, 95% CI 0.65 (0.48-0.87)] and Hispanic fellows [AE ratio, 95% CI 0.53 (0.34-0.83)] representation was lower. Asian fellows' representation was higher compared to the general US population [AE ratio, 95% CI 5.87 (3.48-9.88)]. CONCLUSION White and Hispanic fellows' representation was lower than expected, while Asian fellows' representation was higher in AAGL-accredited FMIGS programs. Female representation increased throughout the years, but overall, female fellows' representation was lower than expected compared to their distribution among OBGYN residents. These findings may help develop equitable recruitment strategies for FMIGS programs and reduce health disparities within complex gynecology.
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Affiliation(s)
- Kacey M Hamilton
- Department of Obstetrics and Gynecology (Hamilton, Schneyer, Truong, Wright, Siedhoff), Cedars Sinai Medical Center, Los Angeles, California.
| | - Rhiana Bakhit
- University of California (Bakhit), Riverside School of Medicine, Riverside, California
| | - Rebecca Schneyer
- Department of Obstetrics and Gynecology (Hamilton, Schneyer, Truong, Wright, Siedhoff), Cedars Sinai Medical Center, Los Angeles, California
| | - Gabriel Levin
- Lady Davis Institute for Cancer Research (Levin), Jewish General Hospital, McGill University, Quebec, Canada
| | - Magdy Milad
- Department of Obstetrics and Gynecology (Milad), Northwestern Medicine, Chicago, Illinois
| | - Mireille Truong
- Department of Obstetrics and Gynecology (Hamilton, Schneyer, Truong, Wright, Siedhoff), Cedars Sinai Medical Center, Los Angeles, California
| | - Kelly N Wright
- Department of Obstetrics and Gynecology (Hamilton, Schneyer, Truong, Wright, Siedhoff), Cedars Sinai Medical Center, Los Angeles, California
| | - Matthew T Siedhoff
- Department of Obstetrics and Gynecology (Hamilton, Schneyer, Truong, Wright, Siedhoff), Cedars Sinai Medical Center, Los Angeles, California
| | - Raanan Meyer
- Department of Obstetrics and Gynecology (Hamilton, Schneyer, Truong, Wright, Siedhoff), Cedars Sinai Medical Center, Los Angeles, California; The Dr. Pinchas Bornstein Talpiot Medical Leadership Program (Meyer), Sheba Medical Center, Tel Hashomer, Ramat-Gan, Israel
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GiglioAyers P, Foley CE, Cronin B, Burrell D. Investigating racial/ethnic differences in procedure experience in obstetrics & gynecology trainees at a single academic institution: a retrospective cohort study. BMC MEDICAL EDUCATION 2024; 24:561. [PMID: 38783287 PMCID: PMC11118719 DOI: 10.1186/s12909-024-05363-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 03/28/2024] [Indexed: 05/25/2024]
Abstract
BACKGROUND Discrimination is common in medical education. Resident physicians of races and ethnicities underrepresented in medicine experience daily discrimination which has been proven to negatively impact training. There is limited data on the impact of resident race/ethnicity on OB/GYN surgical training. The objective of this study was to investigate the impact of race/ethnicity on procedural experience in OB/GYN training. METHODS A retrospective analysis of graduated OB/GYN resident case logs from 2009 to 2019 was performed at a single urban academic institution. Self-reported race/ethnicity data was collected. Association between URM and non-URM were analyzed using t-tests. Trainees were categorized by self-reported race/ethnicity into underrepresented in medicine (URM) (Black, Hispanic, Native American) and non-URM (White, Asian). RESULTS The cohort consisted of 84 residents: 19% URM (N = 16) and 79% non-URM (n = 66). Difference between URM and non-URM status and average case volume was analyzed using t-tests. There was no difference between non-URM and URM trainees and reported mean number of Total GYN (349 vs. 334, p = 0.31) and Total OB (624 vs. 597, P = 0.11) case logs. However, compared with non-URM, on average URM performed fewer Total procedures (1562 vs. 1469, P = 0.04). Analyzing individual procedures showed a difference in average number of abortions performed between URM and non-URM (76 vs. 53, P = 0.02). There were no other statistically significant differences between the two groups. CONCLUSIONS This single institution study highlights potential differences in trainee experience by race/ethnicity. Larger national studies are warranted to further explore these differences to identify bias and discrimination, and to ensure equitable experience for all trainees.
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Affiliation(s)
- Patricia GiglioAyers
- Department of Obstetrics and Gynecology, Women and Infants Hospital, 101 Dudley St, 02905, Providence, RI, USA.
- The Warren Alpert Medical School of Brown University, 222 Richmond Street, 02903, Providence, RI, USA.
| | - Christine E Foley
- Department of Obstetrics and Gynecology, Women and Infants Hospital, 101 Dudley St, 02905, Providence, RI, USA
- The Warren Alpert Medical School of Brown University, 222 Richmond Street, 02903, Providence, RI, USA
| | - Beth Cronin
- Department of Obstetrics and Gynecology, Women and Infants Hospital, 101 Dudley St, 02905, Providence, RI, USA
- The Warren Alpert Medical School of Brown University, 222 Richmond Street, 02903, Providence, RI, USA
| | - Dayna Burrell
- Department of Obstetrics and Gynecology, Women and Infants Hospital, 101 Dudley St, 02905, Providence, RI, USA
- The Warren Alpert Medical School of Brown University, 222 Richmond Street, 02903, Providence, RI, USA
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Glover A, Holman C, Boise P. Patient-centered respectful maternity care: a factor analysis contextualizing marginalized identities, trust, and informed choice. BMC Pregnancy Childbirth 2024; 24:267. [PMID: 38605316 PMCID: PMC11010273 DOI: 10.1186/s12884-024-06491-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Accepted: 04/07/2024] [Indexed: 04/13/2024] Open
Abstract
BACKGROUND Increasing rates of maternal mortality and morbidity, coupled with ever-widening racial health disparities in maternal health outcomes, indicate that radical improvements need to be made in the delivery of maternity care. This study explored the provision of patient-centered maternity care from the perspective of pregnant and postpartum people; experiences of respect and autonomy were examined through the multi-dimensional contexts of identity, relational trust, and protection of informed choices. METHODS We conducted primary data collection among individuals who experienced a pregnancy in the five years preceding the survey (N = 484) using the validated Mothers on Respect Index (MORi) and Mothers Autonomy in Decision Making (MADM) scale. We conducted an exploratory factor analysis (EFA) which produced three factor variables: trust, informed choice, and identity. Using these factor variables as dependent variables, we conducted bivariate and multivariate analysis to examine the relationship between these factor variables and social marginalization, as measured by race, disability, justice-involvement, and other social risk factors, such as food and housing insecurity. RESULTS Results of our bivariate and multivariate models generally confirmed our hypothesis that increased social marginalization would be associated with decreased experiences of maternity care that was perceived as respectful and protective of individual autonomy. Most notably, AI/AN individuals, individuals who are disabled, and individuals who had at least one social risk factor were more likely to report experiencing identity-related disrespect and violations of their autonomy. CONCLUSIONS In light of the findings that emphasize the importance of patient identity in their experience in the healthcare system, patient-centered and respectful maternity care must be provided within a broader social context that recognizes unequal power dynamics between patient and provider, historical trauma, and marginalization. Provider- and facility-level interventions that improve patient experiences and health outcomes will be more effective if they are contextualized and informed by an understanding of how patients' identities and traumas shape their healthcare experience, health-seeking behaviors, and potential to benefit from clinical interventions and therapies.
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Affiliation(s)
- Annie Glover
- University of Montana Rural Institute for Inclusive Communities, Missoula, US.
- University of Montana School of Public & Community Health Sciences, Missoula, US.
| | - Carly Holman
- University of Montana Rural Institute for Inclusive Communities, Missoula, US
- University of Montana School of Public & Community Health Sciences, Missoula, US
| | - Patrick Boise
- University of Montana Rural Institute for Inclusive Communities, Missoula, US
- University of Montana School of Public & Community Health Sciences, Missoula, US
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Galhotra S, Smith RB, Norton T, Mahnert ND. The surgical gender gap: the impact of surgeon gender in medicine and gynecologic surgery. Curr Opin Obstet Gynecol 2022; 34:256-261. [PMID: 35895969 DOI: 10.1097/gco.0000000000000788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW The purpose of this review is to summarize the current literature evaluating the effect of surgeon gender on patient outcomes and satisfaction, and the impact of gender bias on female surgeons. RECENT FINDINGS The proportion of female physicians has increased in recent years, especially in Obstetrics and Gynecology. Recent literature assessing this impact supports equivalent or superior medical and surgical outcomes for women surgeons and physicians. It also reveals superior counseling and communication styles as perceived by patients. However, women in medicine receive lower patient ratings in competence, medical knowledge, and technical skills despite the existing evidence. Additionally, female physicians experience pay inequality, limited advancement opportunities, higher prevalence of microaggressions, and higher rates of burnout. SUMMARY Recognition of gender bias is essential to correcting this issue and improving the negative impact it has on female physicians, our patients, and the field of women's health.
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Affiliation(s)
- Sheena Galhotra
- Banner University Medical Center Phoenix, University of Arizona College of Medicine Phoenix, Phoenix, Arizona, USA
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Roque DR, Hinchcliff E, Alter R, Barber EL, Marcus J, Tanner E. Surgical Training in Gynecologic Oncology:A Sea Change. J Gynecol Surg 2022. [DOI: 10.1089/gyn.2022.0025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Dario R. Roque
- Department of Obstetrics and Gynecology, Northwestern University, Chicago, Illinois, USA
- Robert H Lurie Comprehensive Cancer Center Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Emily Hinchcliff
- Department of Obstetrics and Gynecology, Northwestern University, Chicago, Illinois, USA
- Robert H Lurie Comprehensive Cancer Center Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Raanan Alter
- Northwestern Medicine Central DuPage Hospital, Winfield, Illinois, USA
| | - Emma L. Barber
- Department of Obstetrics and Gynecology, Northwestern University, Chicago, Illinois, USA
- Robert H Lurie Comprehensive Cancer Center Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Jenna Marcus
- Department of Obstetrics and Gynecology, Northwestern University, Chicago, Illinois, USA
- Robert H Lurie Comprehensive Cancer Center Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
- Northwestern Medicine Central DuPage Hospital, Winfield, Illinois, USA
| | - Edward Tanner
- Department of Obstetrics and Gynecology, Northwestern University, Chicago, Illinois, USA
- Robert H Lurie Comprehensive Cancer Center Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
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