Update on workforce diversity in vascular surgery

The Diversity of Surgical Trainees Index identifies racial and ethnic disparities among surgical specialties

OBJECTIVE

Racial and ethnic disparities have been well-described among surgical specialties; however, variations in underrepresented in medicine (URiM) representation between these specialties have not previously been quantified.

METHODS

Data collected from Accreditation Council for Graduate Medical Education (ACGME) annual reports were used to derive the Diversity of Surgical Trainee Index (DoSTI), which was calculated as the proportion of URiM residents and fellow physicians within a given surgical specialty, relative to the overall proportion of URiM trainees within all surgical and non-surgical ACGME-accredited programs in the same academic year.

RESULTS

From 2013 to 2022, a total of 108,193 ACGME-accredited residency programs trained 1,296,204 residents and fellows in the United States. Of these, 14.1% (n = 182,680) of trainees self-identified as URiM over the study period. The mean DoSTI among all surgical specialties was 0.80 (standard error, 0.01) compared with all ACGME-accredited programs. High DoSTI specialties incorporated significantly higher proportions of trainees who identify as Hispanic (8.7% vs 6.3%) and Black or African American (5.2% vs 2.5%) when compared with low DoSTI specialties (P < .0001 each). General surgery (1.06 ± 0.01), plastic surgery (traditional) (1.12 ± 0.06), vascular surgery (integrated) (0.96 ± 0.03), and vascular surgery (traditional) (0.94 ± 0.06) had the highest DoSTI (P < .05 each vs composite). On linear regression analysis, only ophthalmology (+0.01/year; R2 = 0.41; P = .019), orthopedic surgery (+0.01/year; R2 = 0.33; P = .047), otolaryngology (+0.02/year; R2 = 0.86; P < .001), and pediatric surgery (+0.06/year; R2 = 0.33; P = .048) demonstrated an annual increase in DoSTI.

CONCLUSIONS

The DoSTI is a novel metric used to quantify the degree of URiM representation among surgical specialties. DoSTI has revealed specialty-specific variations in racial/ethnic minority representation among surgical training programs. This metric may be used to improve provider awareness and identify high performing DoSTI specialties to highlight best practices to ultimately recruit a more diverse surgical workforce.

The evolution and impact of the Society for Vascular Surgery Resident and Student Program

OBJECTIVE

There is an ongoing national shortage in the vascular surgery (VS) workforce. To increase interest in the specialty, the Society for Vascular Surgery (SVS) Resident and Student Outreach Committee (RSOC) developed a dedicated general surgery (GS) resident and medical student (MS) program at the Vascular Annual Meeting (VAM) and invested in a scholarship program to help reduce attendee expenses. This study assesses the program's effectiveness, correlating recipient feedback with the likelihood of matching into a VS training program.

METHODS

Records related to the SVS VAM GS resident and MS program from 2013 to 2023 were reviewed, focusing on attendee evaluations of the program. The program included a simulation session from 2013 to 2019. VS training program match rates among scholarship recipients were determined. The annual average match rate in VS was used to divide the survey responses into two groups: below average (BA) and above average (AA) match rate groups. Survey responses were based on a 5-point Likert scale and allowed for comments. Responses were divided into high value, strongly favoring the activity (scores 4-5), and low value (scores 1-3) categories. The survey responses from the group of years with AA match rates were compared with the group of years with BA rates.

RESULTS

The SVS awarded 1040 GS resident and MS travel scholarships over the 10 years assessed. Overall, applicants had a 43% success rate in receiving a scholarship. During the study period, the annual number of applicants increased, whereas the number of scholarships and match success rates significantly decreased. The average match rate into VS among scholarship recipients was 50.2%. The survey response rate was 33%. During AA match rate years, evaluations for simulation allotted time and lectures were significantly more likely to be high value compared with BA years. Simulation content and the residency fair consistently had the most favorable evaluations (>90% high value), and overall, the program had a consistently positive impact on recipients' interest in VS (>90% high value). Trainees in the AA group were significantly more likely to provide positive comments (73% vs 55%; P < .001). Numerous recipients commented on the need for a dedicated space to interact with faculty and mentors and highlighted simulation as the standout aspect of the program.

CONCLUSIONS

The SVS VAM RSOC program is positively correlated with attendee interest in VS, with approximately 50% of scholarship recipients matching into the field. The quality of the program and the number of scholarships correlate with VS match rates. Additional investments in similar programs could help close the workforce gap.

A comprehensive analysis of leadership attributes, discrepancies, and implications for gender equity in vascular surgery

OBJECTIVE

Well-developed leadership skills have been associated with a better understanding of health care context, increased team performance, and improved patient outcomes. Surgeons, in particular, stand to benefit from leadership development. Although studies have focused on investigating knowledge gaps and needs of surgeons in leadership roles, there is a noticeable gap in the literature concerning leadership in vascular surgery. The goal of this study was to characterize current leadership attributes of vascular surgeons and understand demographic influences on leadership patterns.

METHODS

This retrospective cohort study was a descriptive analysis of vascular surgeons and their observers who took the Leadership Practices Inventory (LPI) from 2020 to 2023. The LPI is a 30-question inventory that measures the frequency of specific leadership behaviors across five practices of leadership.

RESULTS

A total of 110 vascular surgeons completed the LPI. The majority of participants were White (56%) and identified as male (60%). Vascular surgeons most frequently observed the "enabling others to act" leadership practice style (8.90 ± 0.74) by all evaluators. Vascular surgeons were most frequently above the 70th percentile in the "challenge the process" leadership practice style (49%) compared with the average of other leaders worldwide. Observers rated vascular surgeons as displaying significantly more frequent leadership behaviors than vascular surgeons rated themselves in every leadership practice style (P < .01). The only demographic variable associated with a significantly increased occurrence of achieving 70th percentile across all five leadership practice styles was the male gender: a multivariable model adjusting for objective experience showed that men were at least 3.5 times more likely to be rated above the 70th percentile than women.

CONCLUSIONS

Vascular surgeons under-report the frequency at which they practice leadership skills across all five leadership practice styles and should recognize their strengths of enabling others to act and challenging the process. Men are recognized as exhibiting all five leadership practices more frequently than women, regardless of current position or experience level. This observation may reflect the limited leadership positions available for women, thereby restricting their opportunities to demonstrate leadership practices as frequently or recognizably as their male counterparts.

Workforce diversity in cardiothoracic surgery: An examination of recent demographic changes and the training pathway

INTRODUCTION

The purpose of our study was to examine changes in the demographic makeup of resident physicians in integrated 6-year cardiothoracic surgery and traditional thoracic surgery residency programs from 2013 to 2022 compared with other surgical subspecialties and determine potential leaks in the training pathway.

METHODS

Data from US Graduate Medical Education reports from 2013 to 2022 and medical student enrollment data from the Association of American Medical Colleges were obtained. Average percentages of women and underrepresented minorities were calculated in 2 5-year intervals: 2013 to 2017 and 2018 to 2022. Average percentages of women, Black, and Hispanic medical students and residents were calculated for the 2019 to 2022 period. Pearson χ2 tests were conducted to determine significant differences in proportions of women, Black/African American, and Hispanic trainees across time (α = 0.05).

RESULTS

Thoracic surgery and I6 residents saw a significant increase in the proportion of women trainees across the 2 time periods (19.9% (210 out of 1055) to 24.6% (287 out of 1169) (P < .01) and 24.1% (143 out of 592) to 28.9% (330 out of 1142) (P < .05)), respectively. There was no significant change in the proportion of Black and Hispanic trainees in thoracic surgery fellowship or integrated 6-year cardiothoracic residency programs. Hispanic trainees were the only group whose proportion of cardiothoracic surgery trainees was not significantly lower than their medical school proportion. Women and Black trainees had significantly lower proportions of thoracic surgery residents and integrated 6-year cardiothoracic residency program residents than their proportions in medical school (P < .01).

CONCLUSIONS

Cardiothoracic surgery has not significantly increased the number of Black and Hispanic trainees during the past decade. The lower proportion of Blacks and women in thoracic surgery residency and fellowship programs compared with their proportion in medical schools is concerning and is an opportunity for intervention.

The Role of Inclusion in Increasing Diversity and Retention Across Surgical Residencies: a Literature Review

PURPOSE OF REVIEW

Across surgical specialties, residencies are incentivized to improve program diversity, most often through recruitment of underrepresented minority (URM), women, LGBTQ, and disabled applicants. However, residency attrition remains high in these groups, highlighting the need for specific inclusion initiatives to improve retention and support for these cohorts. A better understanding of previous efforts at retention is paramount. This paper reviews the existing literature on inclusion and retention efforts in surgical residencies.

RECENT FINDINGS

A literature search was conducted using PubMed Central. Published articles were filtered based on date (2018-2023) and relevancy. Articles were evaluated holistically and focused on methods in increasing diversity and inclusion in residency retention. Through formal literature review focusing on pertinent research topic terms (i.e., inclusion, diversity, residency, surgery, retention), efforts that included inclusion initiatives, improving residency retention, and diversifying leadership were overarching themes. In recent years, there have been marked strides and improvements in encouraging resident diversity and inclusion. However, more widespread efforts with proven efficacy are needed in order to improve residency retention and to increase and maintain diversity in leadership in surgery.

A Systematic Review and Meta-Analysis on Sex-Based Disparities in Patients with Chronic Limb Threatening Ischemia Undergoing Revascularization

BACKGROUND

This systematic review and meta-analysis sought to describe the prognostic implications of sex on the clinical outcomes of patients undergoing interventions for chronic limb threatening ischemia (CLTI).

METHODS

Studies were systematically searched across 7 databases from inception to August 25, 2021 and rerun on October 11, 2022. Studies focusing on patients with CLTI undergoing open surgery, endovascular treatment (EVT), or hybrid procedures were included if sex-based differences were associated with a clinical outcome. Two independent reviewers screened studies for inclusion, extracted data, and assessed risk of bias using the Newcastle-Ottawa scale. Primary outcomes included inpatient mortality, major adverse limb events (MALE), and amputation-free survival (AFS). Meta-analyses were performed using random effects models and reported pooled odds ratio (pOR) and 95% confidence interval (CI).

RESULTS

A total of 57 studies were included in the analysis. A meta-analysis of 6 studies demonstrated that female sex was associated with statistically higher inpatient mortality compared to male sex undergoing open surgery or EVT (pOR, 1.17; 95% CI: 1.11-1.23). Female sex also demonstrated a trend toward increased limb loss in those undergoing EVT (pOR, 1.15; 95% CI: 0.91-1.45) and open surgery (pOR 1.46; 95% CI: 0.84-2.55). Female sex also had a trend toward higher MALE (pOR, 1.06; 95% CI, 0.92-1.21) in 6 studies. Finally, female sex had a trend toward worse AFS (pOR, 0.85; 95% CI, 0.70-1.03) in 8 studies.

CONCLUSIONS

Female sex was significantly associated with higher inpatient mortality and a trend toward higher MALE following revascularization. Female sex trended toward worse AFS. The reasons for these disparities are likely multifaceted on patient, provider, and systemic levels and should be explored to identify solutions for decreasing these health inequities across this vulnerable patient population.

Assessment of Demographic Changes of Workforce Diversity in Otolaryngology, 2013 to 2022

Importance

Given the growth of minoritized groups in the US and the widening racial and ethnic health disparities, improving diversity remains a proposed solution in the field of otolaryngology. Evaluating current trends in workforce diversity may highlight potential areas for improvement.

Objective

To understand the changes in gender, racial, and ethnic diversity in the otolaryngology workforce in comparison with changes in the general surgery and neurosurgery workforces from 2013 to 2022.

Design, Setting, and Participants

This cross-sectional study used publicly available data from the Accreditation Council for Graduate Medical Education and the Association of American Medical Colleges for 2013 to 2022, and included medical students and trainees in all US medical residency programs and allopathic medical schools.

Main Outcomes and Measures

Average percentages of women, Black, and Latino trainees during 2 intervals of 5 years (2013-2017 and 2018-2022). Pearson χ2 tests compared demographic information. Normalized ratios were calculated for each demographic group in medical school and residency. Piecewise linear regression assessed linear fit for representation across time periods and compared rates of change.

Results

The study population comprised 59 865 medical residents (43 931 [73.4%] women; 6203 [10.4%] Black and 9731 [16.2%] Latino individuals; age was not reported). The comparison between the 2 study intervals showed that the proportions of women, Black, and Latino trainees increased in otolaryngology (2.9%, 0.7%, and 1.6%, respectively), and decreased for Black trainees in both general surgery and neurosurgery (-0.4% and -1.0%, respectively). In comparison with their proportions in medical school, Latino trainees were well represented in general surgery, neurosurgery, and otolaryngology (normalized ratios [NRs]: 1.25, 1.06, and 0.96, respectively); however, women and Black trainees remained underrepresented in general surgery, neurosurgery, and otolaryngology (women NRs, 0.76, 0.33, and 0.68; Black NRs, 0.63, 0.61, and 0.29, respectively). The percentage of women, Black, and Latino trainees in otolaryngology all increased from 2020 to 2022 (2.5%, 1.1%, and 1.1%, respectively). Piecewise regression showed positive trends across all 3 specialties.

Conclusions and Relevance

The findings of this cross-sectional study indicate a positive direction but only a modest increase of diversity in otolaryngology, particularly in the context of national demographic data. Novel strategies should be pursued to supplement existing efforts to increase diversity in otolaryngology.

Continued underrepresentation of historically excluded groups in the neurosurgery pipeline: an analysis of racial and ethnic trends across stages of medical training from 2012 to 2020

OBJECTIVE

US allopathic medical schools have experienced improvements in racial and ethnic diversity among matriculants in the past decade. It is not clear, however, whether better representation of historically excluded racial and ethnic groups at medical school entry impacts subsequent stages of the medical training pipeline leading into a specific field. The aim of this study was to examine these trends as they relate to the neurosurgical medical education pipeline and consider the drivers that sustain barriers for underrepresented groups.

METHODS

Race and ethnicity reports from the American Association of Medical Colleges were obtained on allopathic medical school applicants, acceptees, and graduates and applicants to US neurosurgical residency programs from 2012 to 2020. The representation of groups categorized by self-reported race and ethnicity was compared with their US population counterparts to determine the representation quotient (RQ) for each group. Annual racial composition differences and changes in representation over time at each stage of medical training were evaluated by estimating incidence rate ratios (IRRs) and 95% confidence intervals (CIs) using non-Hispanic Whites as the reference group.

RESULTS

On average, Asian and White individuals most frequently applied and were accepted to medical school, had the highest graduation rates, and applied to neurosurgery residency programs more often than other racial groups. The medical school application and acceptance rates for Black individuals increased from 2012 to 2020 relative to Whites by 30% (95% CI 1.23-1.36) and 42% (95% CI 1.31-1.53), respectively. During this same period, however, inequities in neurosurgical residency applications grew across all non-Asian racialized groups relative to Whites. While the incidence of active Black neurosurgery residents increased from 2012 to 2020 (0.6 to 0.7/100,000 Black US inhabitants), the prevalence of White neurosurgery residents grew in the active neurosurgery resident population by 16% more.

CONCLUSIONS

The increased racial diversity of medical school students in recent years is not yet reflected in racial representation among neurosurgery applicants. Disproportionately fewer Black relative to White US medical students apply to neurosurgery residency, which contributes to declining racial representation among all active neurosurgery resident physicians. Hispanic individuals are becoming increasingly represented in neurosurgery residency but continue to remain underrepresented relative to the US population. Ongoing efforts to recruit medical students into neurosurgery who more accurately reflect the diversity of the general US population are necessary to ensure equitable patient care.

Paradigm Shift in Vascular Surgery Training: Independent versus Integrated Match Outcomes

BACKGROUND

Currently, 2 predominant pathways exist for vascular surgery training: integrated and independent training pathways. We hypothesized that match rates would increase with time and be higher in the independent pathway than in the integrated pathway.

METHODS

The National Resident Matching Program provided data from the Vascular Surgery Match (VSM) (2008-2021). Match rates were defined as the percentage of applicants who matched. Chi-squared tests were used to evaluate temporal trends and interpathway differences.

RESULTS

Over the study period, the annual number of training positions increased for both the independent (119 to 129, 8% increase) and integrated (9 to 79, 778% increase) training pathways. From 2008 to 2021, the annual match rate was stable in the independent pathway (97% to 96%, P > 0.05). In the integrated pathway, the annual match rate increased from 29% to 44% (P < 0.001). During each year, match rates in the independent pathway exceeded those in the integrated pathway (P < 0.001). US allopathic graduates had higher match rates than non-US allopathic graduates in both the independent (92% vs. 82%, P < 0.001) and the integrated pathway (70% vs. 17%, P < 0.001). In the independent pathway, the percentage of applicants that matched at 1 of their top 3 choices decreased from 67% to 58% (P < 0.001). Over the study period, more training positions went unmatched in the Independent (n = 130, 8%) versus the Integrated (n = 17, 3%) pathway (P < 0.001).

CONCLUSIONS

VSM match rates have increased for the integrated pathway and remains competitive especially for non-US allopathic graduates. More research is needed to understand applicant variables that modulate match rates.

Who are the Vascular Society Presidents?

BACKGROUND

We noted distinct differences between the demographics among the presidents of various vascular societies. To help characterize these among the present United States, Canadian, and European vascular societies, we queried the websites for the United States, Canadian, and European vascular societies in a systematic review for the names of their presidents since their respective inceptions.

METHODS

Age and ethnicity were determined by a search on healthgrades.com, Google, and online obituaries. The year of ascendency to the presidency and the year of birth were used as identifying time points.

RESULTS

There are significant differences between the ages of the presidents of the various vascular societies. While the presidents of Vascular and Endovascular Surgical Society were significantly younger than those of every other vascular society examined, Midwestern Vascular Surgical Society, Canadian Society for Vascular Surgery, and Society of Vascular Medicine were also significantly younger than the remainder of the societies examined (P < 0.0001). The presidents of the remaining societies were not significantly different in age from each other. When comparing the ages of the presidents in the first and last decades of each society, 2 were found to have significantly increased (Society of Vascular Medicine [P = 0.0029] and Vascular and Endovascular Surgical Society [P < 0.0001]), while 2 others were found to have significantly decreased (New England Society for Vascular Surgery [P = 0.0092] and Eastern Vascular Society [P = 0.0085]). Of the 532 total entries for these presidents examined over these 13 societies, 19 (3.6%) of these were filled by women and 37 (7%) with minorities.

CONCLUSIONS

There was a great deal of variability in terms of age, gender, and minority representation of the presidents among the vascular societies examined. While the share of women and minorities to serve as presidents in vascular societies varied between societies, both groups were under-represented across the board. However, in recent years, the number of women and minorities elected as presidents of vascular societies has been trending upwards.

Sentiment Analysis of Online Patient-Written Reviews of Vascular Surgeons

BACKGROUND

Online patient reviews influence a patient's choice of a vascular surgeon. The aim of this study is to examine underlying factors that contribute to positive and negative patient reviews by leveraging sentiment analysis and machine learning methods.

METHODS

The Society of Vascular Surgeons publicly accessible member directory was queried and cross-referenced with a popular patient-maintained physician review website, healthgrades.com. Sentiment analysis and machine learning methods were used to analyze several parameters. Demographics (gender, age, and state of practice), star rating (of 5 stars), and written reviews were obtained for corresponding vascular surgeons. A sentiment analysis model was applied to patient-written reviews and validated against the star ratings. Student's t-test or one-way analysis of variance assessed demographic relationships with reviews. Word frequency assessments and multivariable logistic regression analyses were conducted to identify common and determinative components of written reviews.

RESULTS

A total of 1,799 vascular surgeons had public profiles with reviews. Female gender of surgeon was associated with lower star ratings (male = 4.19, female = 3.95, P < 0.01) and average sentiment score (male = 0.50, female = 0.40, P < 0.01). Younger physician age was associated with higher star rating (P = 0.02) but not average sentiment score (P = 0.12). In the Best reviews, the most commonly used one-words were Care (N = 999), Caring (N = 767), and Kind (N = 479), while the most commonly used two-word pairs were Saved/Life (N = 189), Feel/Comfortable (N = 106), and Kind/Caring (N = 104). For the Worst reviews, the most commonly used one-words were Pain (N = 254) and Rude (N = 148), while the most commonly used two-word pairs were No/One (N = 27), Waste/Time (N = 25), and Severe/Pain (N = 18). In a multiple logistic regression, satisfactory reviews were associated with words such as Confident (odds ratio [OR] = 8.93), Pain-free (OR = 4.72), Listens (OR = 2.55), and Bedside Manner (OR = 1.70), while unsatisfactory reviews were associated with words such as Rude (OR = 0.01), Arrogant (OR = 0.09), Infection (OR = 0.20), and Wait (OR = 0.48).

CONCLUSIONS

Female surgeons received significantly worse reviews and younger surgeons tended to receive better reviews. The positivity and negativity of reviews were largely related to words associated with the patient-doctor experience and pain. Vascular surgeons should focus on these 2 areas to improve patient experiences and their own reviews.

An Analysis of Underrepresented in Medicine Away Rotation Scholarships in Surgical Specialties

BACKGROUND

Underrepresented in medicine (UIM) visiting student clerkship scholarships provide an opportunity for supporting diversity. Although these scholarships have become a popular initiative to recruit diverse surgical applicants, they have not been thoroughly analyzed regarding which programs offer scholarships and the characteristics of the scholarships. UIM scholarship opportunity disparities may exist depending on location, funding, reputation, and program size among different specialties.

OBJECTIVE

To describe the characteristics and prevalence of UIM visiting student scholarships by examining institutional and program websites for the surgical specialties.

METHODS

Using the Accreditation Council for Graduate Medical Education (ACGME) Accreditation Data System for 2021, residency training and diversity websites were identified and evaluated for the availability of UIM visiting student scholarships in July 2021. Eight surgical specialties were examined. Scholarships were categorized by how UIM was defined, the funding amount provided, and scholarship application requirements. We analyzed the association of the program's National Institutes of Health funding, size, type, region, reputation, and population density of the program's area via Doximity on scholarship availability using chi-square and multivariate analysis.

RESULTS

Of the 1058 analyzed programs, 314 (29.7%) had a UIM visiting student scholarship. There were 4 different definitions of UIM used among the analyzed programs. The average scholarship amount offered was $1,852.25 ($500-$4,000). Depending on the specialty, different variables were associated with whether a program had a UIM scholarship.

CONCLUSIONS

Currently, UIM scholarship offerings were variable between programs and surgical specialties.

Perceptions of Canadian vascular surgeons toward artificial intelligence and machine learning

Background

Artificial intelligence (AI) and machine learning (ML) are rapidly advancing fields with increasing utility in health care. We conducted a survey to determine the perceptions of Canadian vascular surgeons toward AI/ML.

Methods

An online questionnaire was distributed to 162 members of the Canadian Society for Vascular Surgery. Self-reported knowledge, attitudes, and perceptions with respect to potential applications, limitations, and facilitators of AI/ML were assessed.

Results

Overall, 50 of the 162 Canadian vascular surgeons (31%) responded to the survey. Most respondents were aged 30 to 59 years (72%), male (80%), and White (67%) and practiced in academic settings (72%). One half of the participants reported that their knowledge of AI/ML was poor or very poor. Most were excited or very excited about AI/ML (66%) and were interested or very interested in learning more about the field (83.7%). The respondents believed that AI/ML would be useful or very useful for diagnosis (62%), prognosis (72%), patient selection (56%), image analysis (64%), intraoperative guidance (52%), research (88%), and education (80%). The limitations that the participants were most concerned about were errors leading to patient harm (42%), bias based on patient demographics (42%), and lack of clinician knowledge and skills in AI/ML (40%). Most were not concerned or were mildly concerned about job replacement (86%). The factors that were most important to encouraging clinicians to use AI/ML models were improvements in efficiency (88%), accurate predictions (84%), and ease of use (84%). The comments from respondents focused on the pressing need for the implementation of AI/ML in vascular surgery owing to the potential to improve care delivery.

Conclusions

Canadian vascular surgeons have positive views on AI/ML and believe this technology can be applied to multiple aspects of the specialty to improve patient care, research, and education. Current self-reported knowledge is poor, although interest was expressed in learning more about the field. The facilitators and barriers to the effective use of AI/ML identified in the present study can guide future development of these tools in vascular surgery.

Improving Equity, Diversity, and Inclusion in Plastic, Reconstructive, and Aesthetic Surgery in Canada: A Call to Action

The global COVID-19 pandemic has brought to light the significant inequities in the delivery of healthcare, vaccine inequity, and differential access to life-saving treatments, which have disproportionately impacted marginalized and racialized populations. In this article, we acknowledge and recognize the centuries-old legacies perpetuating inequity, injustice, and oppression, we discuss the principles of Equity, Diversity, and Inclusion (EDI) and we call our Canadian plastic surgery colleagues and trainees to action. We propose a plan for (1) Education, (2) Mitigating Disparities in the Clinical Setting, and (3) Policy, Societies, and Leadership Education.

Cultural Competence, Safety, Humility, and Dexterity in Surgery

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.

A Gender-Based Analysis of Predictors and Sequelae of Burnout Amongst Practicing American Vascular Surgeons

OBJECTIVE

Surgeons report higher burnout and suicidal ideation (SI) rates than the general population. This study sought to identify the prevalence and gender-specific risk factors for burnout and SI among men and women vascular surgeons to guide future interventions.

METHODS

In 2018, active Society for Vascular Surgery (SVS) members were surveyed confidentially using the Maslach Burnout Index embedded in a questionnaire that captured demographic and practice-related characteristics. Results were stratified by gender. Univariate and multivariate logistic regression models were developed to identify predictors for the end points of burnout and SI.

RESULTS

Overall survey response rate was 34.3% (N=878) of practicing vascular surgeons. A higher percentage of women responded (19%) than compose SVS membership (13.7%). Women respondents were significantly younger, with fewer years in practice, and were less likely to be in private practice than the men who responded. Women were also less likely to be married/partnered, or to have children. The prevalence of burnout was similar for women and men (42.3% and 40.9% [NS]); however, the prevalence of SI was significantly higher in women (12.9% vs 6.6%; P < .007). Whereas there was no difference in mean hours worked or call taken, women were more likely to have had a recent conflict between work and home responsibilities and to have resolved this conflict in favor of work. Although men and women had the same incidence of reported recent medical errors, women were less likely to self-report a recent malpractice suit or to think that a fair resolution was reached. There was no gender difference in reported work-related pain. Multivariable analysis revealed that not enough family time and work-related pain were predictors for burnout in both men and women. Additional factors were associated with burnout in men, such as malpractice and EMR dissatisfaction. Multivariable analysis revealed that work-related pain was an independent predictor for SI for the entire cohort.

CONCLUSION

The prevalence of burnout among vascular surgeons is high. Women vascular surgeons have double the rates of SI compared to male vascular surgeons. Taken together, this study demonstrated that many of the same factors are associated with burnout in women and men, which include not enough family time, conflict between work and personal life, and work-related pain. Additional factors in men included conflict between work and family, work-related pain, and EMR dissatisfaction.

Gender and racial disparities in the transplant surgery workforce

PURPOSE OF REVIEW

This review explores trends in the United States (US) transplant surgery workforce with a focus on historical demographics, post-fellowship job market, and quality of life reported by transplant surgeons. Ongoing efforts to improve women and racial/ethnic minority representation in transplant surgery are highlighted. Future directions to create a transplant workforce that reflects the diversity of the US population are discussed.

RECENT FINDINGS

Representation of women and racial and ethnic minorities among transplant surgeons is minimal. Although recent data shows an improvement in the number of Black transplant surgeons from 2% to 5.5% and an increase in women to 12%, the White to Non-White transplant workforce ratio has increased 35% from 2000 to 2013. Transplant surgeons report an average of 4.3 call nights per week and less than five leisure days a month. Transplant ranks 1st among surgical sub-specialties in the prevalence of three well-studied facets of burnout. Concerns about lifestyle may contribute to the decreasing demand for advanced training in abdominal transplantation by US graduates.

SUMMARY

Minimal improvements have been made in transplant surgery workforce diversity. Sustained and intentional recruitment and promotion efforts are needed to improve the representation of women and minority physicians and advanced practice providers in the field.