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Gilbert SR, Torrez T, Jardaly AH, Templeton KJ, Ode GE, Coe K, Patt JC, Schenker ML, McGwin G, Ponce BA. A Shadow of Doubt: Is There Implicit Bias Among Orthopaedic Surgery Faculty and Residents Regarding Race and Gender? Clin Orthop Relat Res 2024; 482:1145-1155. [PMID: 38214651 PMCID: PMC11219165 DOI: 10.1097/corr.0000000000002933] [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: 03/23/2022] [Accepted: 10/27/2023] [Indexed: 01/13/2024]
Abstract
BACKGROUND Orthopaedic surgery continues to be one of the least diverse medical specialties. Recently, increasing emphasis has been placed on improving diversity in the medical field, which includes the need to better understand existing biases. Despite this, only about 6% of orthopaedic surgeons are women and 0.3% are Black. Addressing diversity, in part, requires a better understanding of existing biases. Most universities and residency programs have statements and policies against discrimination that seek to eliminate explicit biases. However, unconscious biases might negatively impact the selection, training, and career advancement of women and minorities who are underrepresented in orthopaedic surgery. Although this is difficult to measure, the Implicit Association Test (IAT) by Project Implicit might be useful to identify and measure levels of unconscious bias among orthopaedic surgeons, providing opportunities for additional interventions to improve diversity in this field. QUESTIONS/PURPOSES (1) Do orthopaedic surgeons demonstrate implicit biases related to race and gender roles? (2) Are certain demographic characteristics (age, gender, race or ethnicity, or geographic location) or program characteristics (geographic location or size of program) associated with the presence of implicit biases? (3) Do the implicit biases of orthopaedic surgeons differ from those of other healthcare providers or the general population? METHODS A cross-sectional study of implicit bias among orthopaedic surgeons was performed using the IAT from Project Implicit. The IAT is a computerized test that measures the time required to associate words or pictures with attributes, with faster or slower response times suggesting the ease or difficulty of associating the items. Although concerns have been raised recently about the validity and utility of the IAT, we believed it was the right study instrument to help identify the slight hesitation that can imply differences between inclusion and exclusion of a person. We used two IATs, one for Black and White race and one for gender, career, and family roles. We invited a consortium of researchers from United States and Canadian orthopaedic residency programs. Researchers at 34 programs agreed to distribute the invitation via email to their faculty, residents, and fellows for a total of 1484 invitees. Twenty-eight percent (419) of orthopaedic surgeons and trainees completed the survey. The respondents were 45% (186) residents, 55% (228) faculty, and one fellow. To evaluate response biases, the respondent population was compared with that of the American Academy of Orthopaedic Surgeons census. Responses were reported as D-scores based on response times for associations. D-scores were categorized as showing strong (≥ 0.65), moderate (≥ 0.35 to < 0.65), or slight (≥ 0.15 to < 0.35) associations. For a frame of reference, orthopaedic surgeons' mean IAT scores were compared with historical scores of other self-identified healthcare providers and that of the general population. Mean D-scores were analyzed with the Kruskal-Wallis test to determine whether demographic characteristics were associated with differences in D-scores. Bonferroni correction was applied, and p values less than 0.0056 were considered statistically significant. RESULTS Overall, the mean IAT D-scores of orthopaedic surgeons indicated a slight preference for White people (0.29 ± 0.4) and a slight association of men with career (0.24 ± 0.3), with a normal distribution. Hence, most respondents' scores indicated slight preferences, but strong preferences for White race were noted in 27% (112 of 419) of respondents. There was a strong association of women with family and home and an association of men with work or career in 14% (60 of 419). These preferences generally did not correlate with the demographic, geographic, and program variables that were analyzed, except for a stronger association of women with family and home among women respondents. There were no differences in race IAT D-scores between orthopaedic surgeons and other healthcare providers and the general population. Gender-career IAT D-scores associating women with family and home were slightly lower among orthopaedic surgeons (0.24 ± 0.3) than among the general population (0.32 ± 0.4; p < 0.001) and other healthcare professionals (0.34 ± 0.4; p < 0.001). All of these values are in the slight preference range. CONCLUSION Orthopaedic surgeons demonstrated slight preferences for White people, and there was a tendency to associate women with career and family on IATs, regardless of demographic and program characteristics, similar to others in healthcare and the general population. Given the similarity of scores with those in other, more diverse areas of medicine, unconscious biases alone do not explain the relative lack of diversity in orthopaedic surgery. CLINICAL RELEVANCE Implicit biases only explain a small portion of the lack of progress in improving diversity, equity, inclusion, and belonging in our workforce and resolving healthcare disparities. Other causes including explicit biases, an unwelcoming culture, and perceptions of our specialty should be examined. Remedies including engagement of students and mentorship throughout training and early career should be sought.
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Affiliation(s)
- Shawn R. Gilbert
- Department of Orthopedic Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Timothy Torrez
- Department of Orthopedic Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Achraf H. Jardaly
- Department of Orthopedic Surgery, The Hughston Foundation/Hughston Clinic, Columbus, GA, USA
- Department of Orthopedic Surgery, St. Louis University, St. Louis, MO, USA
| | - Kimberly J. Templeton
- Department of Orthopedic Surgery, The University of Kansas Medical Center, Kansas City, KS, USA
| | | | - Kelsie Coe
- Department of Orthopaedic Surgery, Carolinas Medical Center - Atrium Health Musculoskeletal Institute, Charlotte, NC, USA
| | - Joshua C. Patt
- Department of Orthopaedic Surgery, Carolinas Medical Center - Atrium Health Musculoskeletal Institute, Charlotte, NC, USA
| | - Mara L. Schenker
- Deprtmant of Orthopedic Surgery, Emory University, Atlanta, GA, USA
| | - Gerald McGwin
- Department of Orthopedic Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Brent A. Ponce
- Department of Orthopedic Surgery, The Hughston Foundation/Hughston Clinic, Columbus, GA, USA
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Pershad AR, Kidwai MS, Lugo CA, Lee E, Tummala N, Thakkar P. Factors Influencing Underrepresented Medical Students' Career Choice in Surgical Subspecialties. Laryngoscope 2024; 134:1498-1506. [PMID: 37787431 DOI: 10.1002/lary.31094] [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: 07/06/2023] [Revised: 08/29/2023] [Accepted: 09/22/2023] [Indexed: 10/04/2023]
Abstract
OBJECTIVES Surgical subspecialties rank among the least racially and gender diverse of the medical specialties. The purpose of this systematic review is to evaluate the current factors that influence female, gender and sexual minority (GSM), and underrepresented in medicine (URiM)-identifying medical students' decision to pursue a career in a surgical subspecialty. DATA SOURCES A structured literature search of PubMed, Scopus, Web of Science, and Medline was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Criteria for eligibility included surveys and interviews assessing factors and barriers influencing underrepresented medical students' career choices. REVIEW METHODS Two independent researchers screened the articles' titles and abstracts for relevance; three performed full-text reviews. RESULTS Of 343 studies identified, 17 met the inclusion criteria. Fourteen (82%) were survey-based studies; three (18%) were qualitative interviews. Represented minorities included females (14), URiM (13), and GSM (4). Female medical students were most influenced by (1) exposure to surgery, (2) mentorship, and (3) surgical lifestyle. URiM medical students were most influenced by (1) mentorship, (2) culture and diversity, (3) research opportunities, and (4) personality fit. GSM medical students were most influenced by identity acceptance and instances of discrimination and bias. CONCLUSIONS Our review provides granular data on positive and negative factors influencing career choice among underrepresented medical students to facilitate the development of a more diverse surgical workforce. Female medical students were more positively influenced by increased exposure to surgical subspecialties, whereas URiM medical students were more positively influenced by race-concordant mentorship. Laryngoscope, 134:1498-1506, 2024.
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Affiliation(s)
- Alisha R Pershad
- Department of Otolaryngology-Head and Neck Surgery, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Mohammad S Kidwai
- Department of Otolaryngology-Head and Neck Surgery, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Ciara A Lugo
- Department of Otolaryngology-Head and Neck Surgery, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Esther Lee
- Department of Otolaryngology-Head and Neck Surgery, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Neelima Tummala
- Department of Otolaryngology-Head and Neck Surgery, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Punam Thakkar
- Department of Otolaryngology-Head and Neck Surgery, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
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Johnson EE, Ode GE, Ireland ML, Middleton K, Hammoud S. Gender Equity Efforts in Sports Medicine. Clin Sports Med 2024; 43:221-232. [PMID: 38383105 DOI: 10.1016/j.csm.2023.06.020] [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: 02/23/2024]
Abstract
Great progress has been made toward gender equality in athletics, whereas true equality has not yet been realized. Concurrently, women orthopedists along with advocate men have paved the way toward gender equity in orthopedics as a whole and more specifically in sports medicine. The barriers that contribute to gender disparities include lack of exposure, lack of mentorship, stunted career development, childbearing considerations and implicit gender bias and overt gender discrimination.
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Affiliation(s)
| | - Gabriella E Ode
- Department of Orthopaedics, Hospital for Special Surgery, New York, NY, USA
| | | | - Kellie Middleton
- Northside Hospital Orthopaedic Institute, Lawrenceville, GA, USA
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van Niekerk M, O'Mara A, Kha S, Zhou J, McAdams TA, Ladd A, Shea K, Frick S, Maloney WJ, Chu CR. Strengthening the Pipeline: Promoting Diversity into Orthopedic Surgery. Clin Sports Med 2024; 43:253-270. [PMID: 38383108 DOI: 10.1016/j.csm.2023.07.007] [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: 02/23/2024]
Abstract
The United States is a nation of diverse racial and ethnic origins. Athletes represent the full spectrum of the nation's population. However, the orthopedic surgeons who serve as team physicians are Caucasian and male with staggeringly few exceptions. This manuscript provides an overview of the current status and barriers to diversity among orthopedic team physicians, along with strategies to address the issue. Specifically, pipeline initiatives implemented at one academic medical school and orthopedic surgery department are summarized as potential models that can be further developed by other institutions to enhance diversity in orthopedic surgery.
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Affiliation(s)
- Maike van Niekerk
- Department of Orthopedic Surgery, Stanford University, Stanford, CA, USA
| | - Alana O'Mara
- Department of Orthopedic Surgery, Stanford University, Stanford, CA, USA
| | - Stephanie Kha
- Department of Orthopedic Surgery, Stanford University, Stanford, CA, USA
| | - Joanne Zhou
- Department of Orthopedic Surgery, Stanford University, Stanford, CA, USA
| | - Timothy A McAdams
- Department of Orthopedic Surgery, Stanford University, Stanford, CA, USA
| | - Amy Ladd
- Department of Orthopedic Surgery, Stanford University, Stanford, CA, USA
| | - Kevin Shea
- Department of Orthopedic Surgery, Stanford University, Stanford, CA, USA
| | - Steven Frick
- Department of Orthopedic Surgery, Stanford University, Stanford, CA, USA
| | - William J Maloney
- Department of Orthopedic Surgery, Stanford University, Stanford, CA, USA
| | - Constance R Chu
- Department of Orthopedic Surgery, Stanford University, Stanford, CA, USA.
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Yudien MA, Brooks AD, Aarons CB. Medical Student Perceptions of Academic Surgery: Rose-Colored Glasses or Jaded Prism? JOURNAL OF SURGICAL EDUCATION 2024; 81:373-381. [PMID: 38177035 DOI: 10.1016/j.jsurg.2023.11.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 10/25/2023] [Accepted: 11/26/2023] [Indexed: 01/06/2024]
Abstract
OBJECTIVE Stereotypes of surgeons are pervasive and play a role in medical students' decisions about pursuing a surgical career. This study aimed to determine: (1) how medical students' perceptions of surgery and surgeons changed following exposure to surgery during clerkship rotations; and (2) if gender and racial/ethnic identification played a role in this process. DESIGN, SETTING, AND PARTICIPANTS In this mixed-method study, clerkship students at one U.S. medical school were asked to anonymously contribute words and phrases that they associated with surgery to an online "word cloud" at the beginning and end of their 12-week surgery clerkship. In addition, an end-of-year, anonymous survey of their perceptions was administered and analyzed using a Grounded Theory approach. RESULTS Of 154 students invited to complete the online survey, analysis of 24 completed surveys suggested that students believe surgical culture to be toxic, with unfriendly attitudes, strict hierarchy, and lack of work-life balance. Analysis of 678 Word Cloud responses, however, indicated that the frequency of complimentary responses increased following surgery clerkships (25% vs 36%; z = -3.26; p = 0.001), while the proportion of responses describing surgery/surgeons as male-dominated, egotistical, and scary decreased (5% vs 1%, z = 2.86, p = 0.004; 9% vs 4%, z = 2.78, p = 0.005; 3% vs 0.3%, z = 2.56, p = 0.011, respectively). The association between surgeons and being White disappeared entirely. Female students were more likely than male students to state that their perceptions did not change following exposure (40% vs 0%; z = 2.19; p = 0.029). CONCLUSIONS With exposure to surgery, students' preconceived notions may be positively influenced. However, students continue to hold negative perceptions, and this effect may be stratified by gender identification. Institutions should work to address these perceptions in pre-clerkship years to attract a more diverse pool of future surgeons.
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Affiliation(s)
- Mikhal A Yudien
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.
| | - Ari D Brooks
- Department of Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Cary B Aarons
- Department of Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
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Kumaran Y, Bellamy J, Maciejewski R, Tulchin-Francis K, Samora JB. How Much Bullying and Discrimination Are Reported by Sexual and Gender Minorities in Orthopaedics? Clin Orthop Relat Res 2024:00003086-990000000-01509. [PMID: 38415710 DOI: 10.1097/corr.0000000000003009] [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: 09/28/2023] [Accepted: 01/23/2024] [Indexed: 02/29/2024]
Abstract
BACKGROUND Discriminatory practices against minority populations are prominent, especially in the workplace. In particular, lesbian, gay, bisexual, transgender, and queer or questioning (LGBTQ+) individuals experience several barriers and stressors more often than individuals who do not identify as LGBTQ+. Mistreatment is common among these individuals in their personal and professional lives. However, representation and perceptions of discrimination and bullying among attendings, residents, medical students, and other professionals who identify as LGBTQ+ and are "out" (openly acknowledging and expressing one's sexual orientation or gender identity) is seldom studied in orthopaedic surgery. QUESTIONS/PURPOSES (1) How often are orthopaedic trainees and professionals who identify as LGBTQ+ out in their workplaces? (2) What proportion of these individuals report experiencing discrimination, bullying, or differential treatment? (3) Is there regional variation in these reported experiences of bullying and discriminatory behaviors by orthopaedic trainees and professionals in the LGBTQ+ community? METHODS Individuals registering for Pride Ortho, a community of LGBTQ+ individuals and their allies established in 2021 to provide mentorship, networking, and a sense of community among its members, completed an internet-based survey developed by organization leadership. A total of 156 individuals registering for the Pride Ortho community were eligible to participate in the internet-based survey. In all, 92% (144 of 156) fully completed the survey, 6% (10 of 156) partially completed it, and 1% (2 of 156) did not complete any part of the survey. Most respondents (64% [100 of 156]) identified as being LGBTQ+, with 77 members at the attending level of their careers. More than half of LGBTQ+ members (56% [56 of 100]) identified as cisgender women (individuals who identify as women and who were born female). Demographic information was privately collected and deidentified, and included sex assigned at birth, gender expression or identity (the social constructed role that an individual chooses to inhabit, regardless of that individual's assigned sex at birth), sexual orientation, self-identified race, location, level of training, and orthopaedic subspecialty. RESULTS Ninety-four percent (94 of 100) of LGBTQ+ respondents reported being out at their workplace, with nearly one-third of respondents indicating they were only partially out. Most (74% [74 of 100]) respondents reported either "yes" or "maybe" to perceived experiences of bullying, discrimination, or being treated differently. All individuals who partially completed the survey were straight or heterosexual and did not answer or answered "not applicable" to being out in their workplace. These individuals also all answered "no" to experiencing bullying, discrimination, or being treated differently. There was no geographic variation in reported experiences of bullying and discriminatory behaviors by orthopaedic trainees and professionals. CONCLUSION Most LGBTQ+ orthopaedic trainees and professionals are out in their workplaces, although they report experiencing discrimination and bullying more than do non-LGBTQ+ individuals. Bullying and discrimination can deter individuals from beginning and completing their training in orthopaedic surgery. We recommend that orthopaedic institutions not only enforce existing antidiscrimination legal mandates but also increase the visibility of LGBTQ+ faculty and residents. This effort should include the implementation of diversity and sensitivity training programs, strengthened by a structured process of monitoring, reporting, and integrating feedback from all members in the workplace to continuously refine policy adherence and identify the root cause of the reported perceptions of bullying and discrimination. CLINICAL RELEVANCE To deepen our understanding of the experiences faced by sexual and gender minorities in orthopaedic surgery settings, it is crucial to quantify reports of perceived bullying and discrimination. Addressing these issues is key to creating a more diverse and empathetic workforce within orthopaedic institutions, which in turn can lead to improved patient care and a better work environment. Recognizing and understanding the specific contexts of these experiences is an essential starting point for developing a truly inclusive environment for both trainees and attending physicians.
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Affiliation(s)
- Yogesh Kumaran
- University of Toledo Colleges of Medicine and Engineering, Toledo, OH, USA
| | | | | | | | - Julie Balch Samora
- Nationwide Children's Hospital, Department of Orthopedic Surgery, Columbus, OH, USA
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Koschmeder KT, Hurley-Novatny AC, Marti AA, Sharp KM, Linderman SE, Coffman AR, Olinger CR. A Cross-Sectional Study of Gender-Specific Influences of Orthopedic Subspecialty Selection. THE IOWA ORTHOPAEDIC JOURNAL 2024; 44:1-10. [PMID: 38919343 PMCID: PMC11195877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/27/2024]
Abstract
Background Per the American Academy of Orthopaedic Surgeons, 6.5% of practicing orthopedic surgeons are female and a majority subspecialize in pediatrics, hand, and foot and ankle surgery. The study purpose is to evaluate influences of orthopedic subspecialty selection, specifically factors such as perceived strength, lifestyle, and mentorship influence on subspecialty decisions and to identify if gender plays a role in these perceptions. Methods An IRB approved cross-sectional study was conducted via email distribution of a REDCapTM survey to U.S. licensed orthopedic surgeons. Data regarding demographics, professional degree, training and current practice location, and perceptions regarding orthopedic surgery was obtained using Likert rating scales. Data was analyzed using descriptive statistics with two-tailed student's t-tests (α=0.05). Results The survey yielded 282 responses (182 females and 100 males). Overall, the distribution of residents (28%), fellows (6%), and attendings (66%) correlates well with the prevalence of each respective physician category in the field of orthopedic surgery. The study demonstrated no difference in subspecialty choice based on mentorship, work-life-balance, career advancement, subspecialty culture, salary potential, family planning, or schedule. However, a statistically significant difference exists regarding stereotypes, perceived strength required, and perception of discrimination from pursuing a specific orthopedic subspecialty. 27% of females and 10% of males reported discouragement from any subspecialty (p<0.05). Adult reconstructive and oncology were most frequently discouraged. Women reported not choosing a subspecialty because of perceived physical demands more often than men (p<0.001). Women reported an increased use of adaptive strategies in the operating room (p<0.001). Women were also more likely to report feeling discouraged from pursuing a subspecialty due to their gender (p<0.001). Both men and women reported mentorship as the most influential factor in subspecialty selection. Conclusion Women and men reported different factors were important in their decision of subspecialty. Women were more likely to be discouraged from a subspecialty and experience discrimination based on their perceived strength compared to male peers. Residents, fellows, and attending surgeons valued mentorship as the most influential in their subspeciality choice. This study suggests intrinsic and extrinsic influences that may differentially affect male and female orthopedic surgeons when they choose a subspecialty. Level of Evidence: III.
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Affiliation(s)
- Katelyn T. Koschmeder
- Carver College of Medicine, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Amelia C. Hurley-Novatny
- Carver College of Medicine, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
- Carver College of Medicine Medical Scientist Training Program, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
- Department of Anatomy and Cell Biology, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Alex A. Marti
- Carver College of Medicine, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Kathryn M. Sharp
- Carver College of Medicine, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Shannon E. Linderman
- Carver College of Medicine, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Alex R. Coffman
- Department of Orthopedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Catherine R. Olinger
- Department of Orthopedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
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Sorgini A, Istl AC, Downie ML, Kirpalani A. Pride & prejudice: A scoping review of LGBTQ + medical trainee experiences. MEDICAL TEACHER 2024; 46:73-81. [PMID: 37418565 DOI: 10.1080/0142159x.2023.2229503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/09/2023]
Abstract
PURPOSE LGBTQ + medical trainees experience significant discrimination. These individuals are stigmatized within a hetero- and cis-normative system, resulting in poorer outcomes in mental health and increased stress regarding career trajectory compared with their hetero- and cis-identifying counterparts. However, literature on the barriers experienced during medical training in this marginalized group is limited to small heterogeneous studies. This scoping review collates and explores prominent themes in existing literature on the personal and professional outcomes of LGBTQ + medical trainees. METHODS We searched five library databases (SCOPUS, Ovid-Medline, ERIC, PsycINFO and EMBASE) for studies that investigated LGBTQ + medical trainees' academic, personal, or professional outcomes. Screening and full text review were performed in duplicate, and all authors participated in thematic analysis to determine emerging themes, which were iteratively reviewed to consensus. RESULTS From 1809 records, 45 met inclusion criteria (κ = 0.57). Major themes that emerged in the literature included the prevalence of discrimination and mistreatment faced by LGBTQ + medical trainees from colleagues and superiors, concerns regarding disclosure of sexual and/or gender minority identity, and overall negative impacts on mental health including higher rates of depression, substance use, and suicidal ideation. There was a noted lack of inclusivity in medical education and having an LGBTQ + identity had a large impact on career trajectory. Community with peers and mentors was an important determinant of success and belonging. There was a noteworthy lack of research on intersectionality or positive interventions that improved outcomes for this population. CONCLUSION This scoping review highlighted important barriers facing LGBTQ + medical trainees, identifying substantial gaps in the existing literature. Research on supportive interventions and predictors of training success is lacking and will be important to foster an inclusive education system. These findings provide critical insights for education leaders and researchers to help create and evaluate inclusive and empowering environments for trainees.
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Affiliation(s)
- Alana Sorgini
- Department of Paediatrics, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Alexandra C Istl
- Department of Surgery, Division of Surgical Oncology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Mallory L Downie
- Department of Renal Medicine, University College London, London, UK
- Department of Nephrology, Great Ormond Street Hospital NHS Trust, London, UK
| | - Amrit Kirpalani
- Department of Paediatrics, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
- Division of Nephrology, Children's Hospital, London Health Sciences Centre, London, ON, Canada
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Rama E, Ekhtiari S, Thevendran G, Green J, Weber K, Khanduja V. Overcoming the Barriers to Diversity in Orthopaedic Surgery: A Global Perspective. J Bone Joint Surg Am 2023; 105:1910-1919. [PMID: 37639495 DOI: 10.2106/jbjs.23.00238] [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] [Indexed: 08/31/2023]
Abstract
BACKGROUND Diversity in orthopaedics continues to lag behind that in other surgical specialties. This pattern exists globally and is not unique to gender or race. This review offers a global perspective on overcoming the barriers to diversity in orthopaedics. METHODS A literature search of MEDLINE and Embase was conducted and a narrative review was undertaken. Publications that discussed any aspect of diversity or solutions to diversity within orthopaedics or academic orthopaedics were identified. RESULTS A total of 62 studies were included. Studies showed that diversity in orthopaedic training is limited by structural barriers such as long hours, requirements to relocate during training, training inflexibility, and a lack of exposure to orthopaedics. Implicit bias during the selection process for training, discrimination, and a lack of role models are additional barriers that are experienced by both minority and female surgeons. The global lack of diversity suggests that there are also inherent "cultural barriers" that are unique to orthopaedics; however, these barriers are not uniformly experienced. Perceptions of orthopaedics as promoting an unhealthy work-life balance and the existence of a "boys' club" must be addressed. Strong, committed leaders can embed cultural norms, support trainees, and act as visible role models. Targeted efforts to increase diverse recruitment and to reduce bias in selection processes for medical school and specialty training will increase diversity in the "training pipeline." CONCLUSIONS Diversity in orthopaedics continues to lag behind that in other specialties. Increasing diversity is important for providing a more inclusive training environment, improving patient care, and reducing health disparities. Structural and cultural barriers need to be addressed to improve diversity in orthopaedics. Promoting a culture supportive of all surgeons is essential to reframing perceptions that may prevent individuals from even considering a career as an orthopaedic surgeon. Changing attitudes require focused efforts from committed leadership in a "top-down" approach that prioritizes diversity. The efforts from national bodies seeking to tackle the lack of diversity, as well as the establishment of organizations committed to diversity, such as the International Orthopaedic Diversity Alliance, provide reasons to be optimistic for the future.
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Affiliation(s)
- Essam Rama
- University of Cambridge, Cambridge, United Kingdom
| | - Seper Ekhtiari
- Addenbrooke's-Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | | | | | - Kristy Weber
- Penn Orthopaedics Perelman, Penn Medicine, Philadelphia, Pennsylvania
| | - Vikas Khanduja
- University of Cambridge, Cambridge, United Kingdom
- Addenbrooke's-Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
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Mirza K, Acharya PU, Crasta N, Austine J. The Ideal Orthopaedic Surgeon: Comparing Patient Preferences of Surgeon Attributes to Notions Held by Orthopaedic Postgraduates. Indian J Orthop 2023; 57:1748-1756. [PMID: 37881289 PMCID: PMC10593707 DOI: 10.1007/s43465-023-00988-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 08/25/2023] [Indexed: 10/27/2023]
Abstract
Introduction Stereotypes have been a barrier to providing patients a diverse orthopaedic workforce. Our goal was to identify stereotypes and disparities among doctors and their patients regarding the attributes that should determine a competent orthopaedic surgeon. Materials and Methods A cross-sectional descriptive multicenter study was conducted in India. Tailored questionnaires were administered to patients and orthopaedic postgraduates to determine the attributes they believe patients prefer in their orthopaedic surgeon. Likert data and data on preferred sex of the surgeon were analyzed as categorical data sets using frequency statistics. Participants were asked to rank surgeon attributes and analysis was based on frequency of an item among top 5 surgeon attributes. Results 304 patients and 91 orthopaedic postgraduates participated in the study. 70.4% and 73% of patients and 27.5% and 29.6% of postgraduates preferred an orthopaedic surgeon with greater physical strength as an outpatient consultant or operating surgeon respectively. 81% of patients had no preference of the sex of their doctor. 56% of postgraduates felt patients would prefer a male operating surgeon, none felt their patient would prefer female orthopaedic surgeon. 92.3% of the female postgraduates felt patients would prefer a male orthopaedic surgeon. Patients most often ranked years of experience, surgical outcomes, time spent with patients, reputation, and physical strength in their top 5 surgeon attributes and sex, religion, and community were given least importance. Conclusion Diversity among the orthopaedic workforce is necessary to optimize patient care. It is our collective responsibility to educate our patients and trainees and redress the misconceptions and stereotypes that plague our profession. Supplementary Information The online version contains supplementary material available at 10.1007/s43465-023-00988-2.
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Affiliation(s)
- Kiyana Mirza
- Government Hospital Hoskote, Hoskote Taluk, Bangalore, Karnataka 562114 India
| | - Prashant Upendra Acharya
- Department of Orthopaedic Surgery, Father Muller Medical College, Father Muller Road, Kankanady, Mangalore, Karnataka 575002 India
| | - Nikitha Crasta
- Department of Sports Medicine, Massachusetts General Hospital, Boston, MA 02114 USA
| | - Jose Austine
- Trauma and Orthopaedics, Portsmouth Hospitals University NHS Trust, Portsmouth, PO6 3LY UK
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11
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Brennan JN, Hall AJ, Baird EJ. Online case-based educational meetings can increase knowledge, skills, and widen access to surgical training:The nationwideVirtualTrauma & Orthopaedic Meetingseries. Surgeon 2023; 21:e263-e270. [PMID: 36914519 DOI: 10.1016/j.surge.2023.02.005] [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: 12/04/2022] [Revised: 02/17/2023] [Accepted: 02/22/2023] [Indexed: 03/13/2023]
Abstract
BACKGROUND Access to surgical training is challenging for undergraduate and early postgraduate trainees due to a greater focus on developing generic knowledge and skills, and a drive to recruit greater numbers into internal medicine and primary care. COVID-19 accelerated the declining access to surgical training environments. Our aims were to: 1) establish the feasibility of an online, specialty-specific, case-based surgical training series, and 2) evaluate its suitability for meeting the needs of trainees. METHODS A nationwide audience of undergraduate and early postgraduate trainees were invited to a series of bespoke online case-based educational meetings in Trauma & Orthopaedics (T&O) over a six month period. The six sessions, which simulated real-world clinical meetings, were constructed by Consultant sub-specialists and involved the presentation of cases by registrars, followed by structured discussion of basic principles, radiological interpretation, and management strategies. Mixed qualitative and quantitative analyses were conducted. RESULTS There were 131 participants (59.5% male), consisting mostly of doctors in training (58%) and medical students (37.4%). The mean quality rating was 9.0/10 (SD 1.06), further supported by qualitative analysis. 98% enjoyed the sessions, 97% reported improved knowledge of T&O, and 94% reported a direct benefit to clinical practice. There was a significant improvement in knowledge of T&O conditions, management plans, and radiological interpretation (p = <0.05). CONCLUSION Structured virtual meetings, underpinned by bespoke clinical cases, may widen access to T&O training, increase flexibility and robustness of learning opportunities, and mitigate the effects of reduced exposure on preparation for surgical careers and recruitment.
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Affiliation(s)
- Joseph N Brennan
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Andrew J Hall
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK; Department of Orthopaedics, Golden Jubilee University National Hospital, Clydebank, UK; University of Edinburgh, Edinburgh, UK.
| | - Emily J Baird
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK; Royal Hospital for Children & Young People, Edinburgh, UK
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12
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Pechlivanidou E, Antonopoulos I, Margariti RE. Gender equality challenges in orthopaedic surgery: a systematic review. INTERNATIONAL ORTHOPAEDICS 2023; 47:2143-2171. [PMID: 37433883 DOI: 10.1007/s00264-023-05876-w] [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: 05/03/2023] [Accepted: 06/20/2023] [Indexed: 07/13/2023]
Abstract
PURPOSE Several studies have examined gender-equality challenges and ways to improve women's representation and management. Orthopaedic surgeons and patients are less gender equitable than them of other surgical disciplines. This systematic review summarizes these findings and highlights orthopaedic surgery gender inequality. METHODS Search of the PubMed, Embase, and Cochrane databases was carried out to extract human studies investigating the gender gap in orthopaedics, trying to highlight the equality challenges orthopaedic surgery faces. Studies incorporating patients with comorbidities in which gender is a proven risk factor, and pregnant women were excluded. RESULTS This systematic review included 59 studies involving 692,435 people (mean females/males ratio: 4.44), spanning the years 1987-2023. Regarding the targeted population, 35 (59.32%) studies focused on patients, while 24 (40.68%) on physicians. Orthopaedic surgery is described as an unfriendly career field for women as surgeons or sports leading physicians while women are generally under represented in the academic field of orthopaedics. Regarding patients, female gender consists both a risk and prognostic factor influencing the prevalence of degenerative disease and the outcome of the operative treatment in reconstructive orthopaedics. Female gender is a risk factor for multiple sports injuries and influences the pathogenetic mechanisms resulting in ACL reconstruction. Regarding spine surgery, women are less likely to have surgery suggested, and such suggestion underlines severe disease's progression. CONCLUSIONS Gender differences affect orthopaedic patient-physician-healthcare system interactions. Recognizing biases and their patterns is useful to improve the actual situation. By preventing those an unbiased, tolerant, and egalitarian workplace for physicians and a healthcare system that provides the best treatment to patients could be created.
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Affiliation(s)
- Evmorfia Pechlivanidou
- 1st Department of Orthopaedics, P. & A. Kyriakou Children's Hospital, Athens, Greece.
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece.
| | - Ioannis Antonopoulos
- Department of Anatomy, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Rodanthi E Margariti
- 1st Department of Orthopaedics, P. & A. Kyriakou Children's Hospital, Athens, Greece
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13
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Ghattas YS, Kyin C, Grise A, Glasser J, Johnson T, Druskovich K, Cannada LK, Service BC. Trends in Female Authorship in Orthopaedic Literature from 2002 to 2021: An Analysis of 168,451 Authors. J Bone Joint Surg Am 2023; 105:1285-1294. [PMID: 37155604 DOI: 10.2106/jbjs.22.01290] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
BACKGROUND Significant gender disparity exists in orthopaedic surgery. While women have increasingly entered the field, we are short of the critical mass needed to drive change, including in authorship. This study aimed to characterize trends in authorship in peer-reviewed orthopaedic journals in the context of gender. METHODS This is a cross-sectional bibliometric study of orthopaedic journals in the United States. Articles that were indexed in the orthopaedic category of the Clarivate Journal Citation Report (JCR) and the Science Citation Index Expanded (SCIE) were analyzed (n = 82). Journals not originating from the U.S. (n = 43) or not considered primarily orthopaedic journals (n = 13) were excluded. The 2020 impact factors (IFs) of the remaining 26 journals were recorded. The articles underwent automated data collection from PubMed for January 2002 to December 2021 using R software to collect the title, the journal, the publication year, the first and senior author names, and the country of origin. Gender was determined by Gender API ( https://gender-api.com ). Names with <90% accuracy were excluded. RESULTS Overall, 168,451 names were studied, with 85,845 and 82,606 first and senior authors, respectively. Of the first and senior authors, 13.6% and 9.9%, respectively, were female. The proportion of female first authors was significantly greater than the proportion of female senior authors. The average IF was significantly higher for male authors compared with female authors (p < 0.005). Articles with female first authors were significantly more likely to have a female senior author. Orthopaedic subspecialty journals had a smaller proportion of manuscripts authored by female first and senior authors than general journals (p < 0.0001). There were 4,451 articles written by a single author, of which 92% (4,093) were written by a man and 8% (358) were written by a woman. Over the 20-year study period, the proportion of female first authorship exhibited a significant positive trend; however, there was a non-significant increase in female senior authorship. CONCLUSIONS Female representation in orthopaedics has been growing over the past decade. Increasing publication rates of female authors reveal steps toward positive gender equity in the field and present an opportunity for female leadership visibility, illustrating the capabilities of women in orthopaedics and encouraging more women to join the field.
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Affiliation(s)
| | - Cynthia Kyin
- University of Central Florida College of Medicine, Orlando, Florida
| | - Alison Grise
- University of Central Florida College of Medicine, Orlando, Florida
| | - Jillian Glasser
- University of Central Florida College of Medicine, Orlando, Florida
| | - Taylor Johnson
- Orlando Health Jewett Orthopedic Institute, Orlando, Florida
| | | | - Lisa K Cannada
- University of Central Florida College of Medicine, Orlando, Florida
- Novant Health Orthopedics, Charlotte, North Carolina
| | - Benjamin C Service
- University of Central Florida College of Medicine, Orlando, Florida
- Orlando Health Jewett Orthopedic Institute, Orlando, Florida
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14
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Lavorgna TR, Gupta S, Maginnis C, Saraf SM, Stamm MA, Wong SE, Mulcahey MK. Persistent Lack of Female Orthopaedic Sports Medicine Fellows. Arthrosc Sports Med Rehabil 2023; 5:100725. [PMID: 37645400 PMCID: PMC10461135 DOI: 10.1016/j.asmr.2023.02.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Accepted: 02/27/2023] [Indexed: 08/31/2023] Open
Abstract
Purpose To evaluate the gender composition of fellows, faculty, and leaders within orthopaedic sports medicine fellowship programs to provide a more complete description of gender diversity within this subspecialty. Methods Official program websites of orthopaedic sports medicine fellowships listed on the Arthroscopy Association of North America fellowship directory were examined. Data collected for analysis included the gender of program directors, fellowship faculty, orthopaedic surgery department faculty, current sports medicine fellows, and fellows who graduated within the last 5 years. Results Of the 132 orthopaedic sports medicine fellows in training in the United States in the 2021 to 2022 academic year, 113 (85.6%) were men and 19 (14.4%) were women (P < .001). Within the past 5 years, 419 fellows were listed as completing a sports medicine fellowship, with 375 (89.5%) being men, and 44 (10.5%) being women (P < .001). There was no significant difference in the gender composition of current fellows compared with the composition of fellows within the last 5 years (P = .74). When we examined gender trends in sports medicine faculty, 639 (86.6%) were men and 99 (13.4%) were women (P < .001). There were 14 women (14.4%) orthopaedic sports medicine faculty in leadership positions (i.e., program director or assistant program director) compared with 83 men in such positions (85.6%) (P < .001). Conclusions Orthopaedic sports medicine fellowships remain heavily male-dominated on all levels, including fellows, faculty, and leadership. There were no differences in the gender composition of current fellows when compared with those who graduated in the last 5 years, suggesting persistent gender disparity and the need for novel initiatives to enhance gender diversity in sports medicine. Level of Evidence IV, descriptive study.
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Affiliation(s)
- Tessa R. Lavorgna
- Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, Louisiana, U.S.A
| | - Sanchita Gupta
- Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, Louisiana, U.S.A
| | - Connor Maginnis
- Louisiana State University School of Medicine, New Orleans, Louisiana, U.S.A
| | - Shreya M. Saraf
- Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, Louisiana, U.S.A
| | - Michaela A. Stamm
- Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, Louisiana, U.S.A
| | - Stephanie E. Wong
- University of California San Francisco School of Medicine, Dept of Orthopaedic Surgery, San Francisco, California, U.S.A
| | - Mary K. Mulcahey
- Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, Louisiana, U.S.A
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15
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Jackson EM, Sellke N, Rhodes S, Jella TK, Cwalina TB, Schmidt JE, Callegari M, Jesse E, Prunty M, Woo LL, Hannick JH. How Female Is the Future of Urology? Projecting Various Trajectories of the United States Urology Workforce. Urology 2023; 178:180-186. [PMID: 37244431 DOI: 10.1016/j.urology.2023.04.028] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 04/09/2023] [Accepted: 04/18/2023] [Indexed: 05/29/2023]
Abstract
OBJECTIVE To project the number and proportion of women in the urology workforce using recent demographic trends and develop an app to explore updated projections using future data. METHODS Demographic data were obtained from AUA Censuses and ACGME Data Resource Books. The proportion of female graduating urology residents was characterized with a logistic growth model. "Stock and Flow" models were used to project future population numbers and proportions of female practicing urologists, accounting for trainee demographics, retirement trends, and growth in the field. RESULTS Assuming growth in urology graduate numbers and continued logistic growth in the proportion of women, 10,957 practicing urologists (38%) will be female by 2062. If the rate of women entering urology residency stagnates, 7038 urologists (24%) will be female. If the retirement rates for women in urology change to mirror those of men and the proportion of female residents continues to experience logistic growth, 11,178 urologists (38%) will be female. An interactive app was designed to allow for a range of assumptions and future data: https://stephenrho.shinyapps.io/uro-workforce/. CONCLUSION Workforce projections should incorporate recent growth in numbers of female residents. If current growth continues, 38% of urologists will be female by 2062. The app allows for exploration of different scenarios and can be updated with new data. The projections demonstrate the need for targeted efforts to recruit women into urology, address disparities within the field, and work toward retaining female urologists. We must continue working toward an equitable future workforce that can address the impending shortage of urologists.
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Affiliation(s)
| | - Nicholas Sellke
- Department of Urology, University Hospitals Cleveland Medical Center, Cleveland, OH
| | - Stephen Rhodes
- Department of Urology, University Hospitals Cleveland Medical Center, Cleveland, OH
| | - Tarun K Jella
- Case Western Reserve University School of Medicine, Cleveland, OH
| | - Thomas B Cwalina
- Case Western Reserve University School of Medicine, Cleveland, OH
| | | | - Michael Callegari
- Department of Urology, University Hospitals Cleveland Medical Center, Cleveland, OH
| | - Erin Jesse
- Department of Urology, University Hospitals Cleveland Medical Center, Cleveland, OH
| | - Megan Prunty
- Department of Urology, University Hospitals Cleveland Medical Center, Cleveland, OH
| | - Lynn L Woo
- Department of Urology, University Hospitals Cleveland Medical Center, Cleveland, OH; Division of Pediatric Urology, Department of Surgery, UH Rainbow Babies & Children's Hospital, Cleveland, OH
| | - Jessica H Hannick
- Department of Urology, University Hospitals Cleveland Medical Center, Cleveland, OH; Division of Pediatric Urology, Department of Surgery, UH Rainbow Babies & Children's Hospital, Cleveland, OH
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16
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Qin LA, Menhaji K, Sifri Y, Hardart A, Ascher-Walsh CJ. Gender Equity in Academic Female Pelvic Medicine and Reconstructive Surgery Departments: A Cross-Sectional Observational Study. UROGYNECOLOGY (PHILADELPHIA, PA.) 2023:02273501-990000000-00094. [PMID: 37093574 DOI: 10.1097/spv.0000000000001357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 04/25/2023]
Abstract
IMPORTANCE Gender equity in obstetrics and gynecology remains a barrier to career mobility and workplace satisfaction. OBJECTIVE This study aimed to evaluate gender equity for academic positions in female pelvic medicine and reconstructive surgery (FPMRS) divisions with an Accreditation Council for Graduate Medical Education-accredited fellowship in the United States. STUDY DESIGN This was a cross-sectional observational study of all FPMRS divisions with an Accreditation Council for Graduate Medical Education-accredited fellowship program in the United States in July 2020 using publicly available demographic and academic data collected from online search engines. Gender equity in academic FPMRS was assessed by gender representation, academic appointment, and research productivity of each attending physician within the division. Research productivity was assessed using both the H-index with career length controlled for with the M-quotient. RESULTS There were 348 attending physicians from 72 FPMRS divisions (198 female [56.9%], 150 male [43.1%]). A large percentage of female attending physicians were at the assistant professor level (75.8% [94 of 124]) when compared with their male counterparts (24.4% [30 of 124]; P < 0.001). Conversely, there were a larger percentage of male attending physicians (62.2% [56 of 90]) at the professor level when compared with their female counterparts (37.8% [34 of 90]; P < 0.001). There was no difference in research productivity between male and female attending physicians after controlling for career length with the M-quotient (P = 0.65). Only age (odds ratio, 1.14; 95% confidence interval, 1.05-1.24) and the M-quotient (odds ratio, 36.17, 95% confidence interval, 8.57-152.73) were significantly associated with professorship. CONCLUSIONS Our study found that there are more female attending physicians in FPMRS and that most are assistant professors. Male and female FPMRS attending physicians had similar research productivity with respect to their career lengths. Gender was not a determinant for achieving a "professor" appointment.
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Affiliation(s)
- Lei Alexander Qin
- From the Department of Obstetrics, Gynecology, and Reproductive Sciences, and
| | | | - Yara Sifri
- From the Department of Obstetrics, Gynecology, and Reproductive Sciences, and
| | - Anne Hardart
- Division of Female Pelvic Medicine and Reconstructive Surgery, Icahn School of Medicine at Mount Sinai, New York, New York; and
| | - Charles J Ascher-Walsh
- Division of Female Pelvic Medicine and Reconstructive Surgery, Icahn School of Medicine at Mount Sinai, New York, New York; and
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17
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Lavorgna TR, Gupta S, Maginnis C, Saraf SM, Stamm MA, Wong SE, Mulcahey MK. Persistent Lack of Female Orthopaedic Sports Medicine Fellows. Arthroscopy 2023:S0749-8063(23)00294-3. [PMID: 37062433 DOI: 10.1016/j.arthro.2023.02.026] [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: 09/11/2022] [Revised: 01/23/2023] [Accepted: 02/27/2023] [Indexed: 04/18/2023]
Abstract
PURPOSE The purpose of this study was to evaluate the gender composition of fellows, faculty, and leaders within orthopaedic sports medicine fellowship programs to provide a more complete analysis of gender diversity within this subspecialty. METHODS Official program websites of orthopaedic sports medicine fellowships listed on the Arthroscopy Association of North America (AANA) fellowship directory were examined. Data collected for analysis included the gender of program directors, fellowship faculty, orthopaedic surgery department faculty, current sports medicine fellows, and fellows who graduated within the last five years. RESULTS Of the 132 orthopaedic sports medicine fellows in training in the United States in the 2021-2022 academic year, 113 (85.6%) were men and 19 (14.4%) were women (p<0.001). Within the past five years, 419 fellows were listed as completing a sports medicine fellowship, with 375 (89.5%) being men, and 44 (10.5%) being women (p<0.001). There was no significant difference in the gender composition of current fellows compared to the composition of fellows within the last 5 years (p=0.74). When examining gender trends in sports medicine faculty, 639 (86.6%) were men and 99 (13.4%) were women (p<0.001). There were 14 women (14.4%) orthopaedic sports medicine faculty in leadership positions (i.e., program director or assistant program director) compared to 83 men in such positions (85.6%) (p<0.001) CONCLUSIONS: Orthopaedic sports medicine fellowships remain heavily male-dominated on all levels, including fellows, faculty, and leadership. There were no differences in the gender composition of current fellows when compared to those who graduated in the last five years, suggesting persistent gender disparity and the need for novel initiatives to enhance gender diversity in sports medicine.
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Affiliation(s)
- Tessa R Lavorgna
- Tulane University School of Medicine, Dept of Orthopaedic Surgery, New Orleans, LA
| | - Sanchita Gupta
- Tulane University School of Medicine, Dept of Orthopaedic Surgery, New Orleans, LA
| | - Connor Maginnis
- Louisiana State University School of Medicine, New Orleans, LA
| | - Shreya M Saraf
- Tulane University School of Medicine, Dept of Orthopaedic Surgery, New Orleans, LA
| | - Michaela A Stamm
- Tulane University School of Medicine, Dept of Orthopaedic Surgery, New Orleans, LA
| | - Stephanie E Wong
- University of California San Francisco School of Medicine, Dept of Orthopaedic Surgery, San Francisco, CA
| | - Mary K Mulcahey
- Tulane University School of Medicine, Dept of Orthopaedic Surgery, New Orleans, LA.
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Examining behavioural intention of using smart health care technology among females: dynamics of social influence and perceived usefulness. BENCHMARKING-AN INTERNATIONAL JOURNAL 2023. [DOI: 10.1108/bij-09-2022-0585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/27/2023]
Abstract
PurposeThe aim of this study is to comprehend the behavioural intention of females' perception toward smart healthcare technology. The study also examines the moderation effect of social influences between perceived smart healthcare technology and perceived usefulness among female users.Design/methodology/approachTo test the model, this study collected data from female respondents (n = 913) responses. The data were analyzed by structural equation modeling (SEM) using Smart-PLS 3.2. To complement the findings from structural equation modeling, the study also conducted a post-hoc test via experimental research design. The authors also applied a t-test and PROCESS macro analysis to re-confirm the relationship mentioned above.FindingsThe findings revealed that perceived ease of use significantly mediates the relationship between females' perceived smart healthcare technology and intention to use. The findings also show that social influence moderates between smart healthcare technology and the perceived usefulness relationship.Research limitations/implicationsSocial influence is one of the major issues while adopting smart healthcare technology because the respondents perceived that they are accustomed to the technologies related to smart health once their surroundings and social environment influence them.Originality/valueThe current study is a pioneer in the context of a developing country and unique in that it makes two contributions: it extends previous research on smart health technology adoption in the healthcare business by considering females, and it gives a broad knowledge of the female healthcare consumers from emerging nations which can be useful for developing technology-driven healthcare services strategies.
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Shah K, Zhuang T, Scott B, Sobel A, Akelman E. What Program Characteristics Are Associated with Resident Racial Diversity in Orthopaedic Surgery? An Analysis of Association of American Medical Colleges Data. JB JS Open Access 2023; 8:JBJSOA-D-22-00056. [PMID: 36816139 PMCID: PMC9931034 DOI: 10.2106/jbjs.oa.22.00056] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/17/2023] Open
Abstract
In orthopaedic surgery, there are fewer Black or African American (4%) and Hispanic or Latino (4%) residents compared with general surgery, internal medicine, family medicine, and pediatrics (5%-7% Black residents and 7%-9% Hispanic/Latino residents, respectively). There are also fewer underrepresented in medicine minority (URiM) faculty in orthopaedic surgery (6.1%) compared with general surgery (8.9%), otolaryngology (7.8%), internal medicine (9.7%), and obstetrics and gynecology (15.6%). Identifying program characteristics that are associated with the percentage of URiM residents could reveal strategies for improving diversity. Methods Using Association of American Medical Colleges orthopaedic resident and faculty race/ethnicity data from 2007 to 2016, we analyzed the racial diversity of 166 of 207 residency programs. The primary outcome was program racial diversity, measured as the percentage of URiM residents per program. The top quartile of programs was compared with the other quartiles. Characteristics analyzed included percentage of URiM faculty, affiliation with a university/top 40 medical school/top 40 orthopaedic hospital, geographic region, city type, and city size. We used a multivariable linear regression model to evaluate program characteristics associated with diversity and a linear mixed-effects model with program-specific random effects to evaluate time trends. Results The mean percentage of URiM residents per program was 9.3% (SD = 10.5%). In the top quartile of programs, URiM residents composed 20.7% ± 2.5% of the program compared with 5.8% ± 0.3% in other quartiles (p < 0.001). After adjusting for program and faculty size, the only factor associated with the number of URiM residents per program was the number of URiM faculty. For every 5 additional URiM faculty members, there was an associated increase in the number of URiM residents per program by 3.6 (95% confidence interval [CI]: 2.3-5.0). There was a small but statistically significant annual increase in the percentage of URiM residents per program of 0.207 (95% CI: 0.112-0.302) percentage points during the study period. Conclusion URiM representation remains low among orthopaedic residents. Efforts to increase the URiM faculty base represent a potential strategy for programs to increase URiM representation among residents by attracting more diverse applicants.
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Affiliation(s)
- Kalpit Shah
- Department of Orthopaedic Surgery, Scripps Clinic, San Diego, California,E-mail address for K. Shah:
| | - Thompson Zhuang
- Department of Orthopaedic Surgery, Stanford University, Stanford, California
| | - Brandon Scott
- Department of Orthopaedic Surgery, Brown University, Providence, Rhode Island
| | - Andrew Sobel
- Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Edward Akelman
- Department of Orthopaedic Surgery, Brown University, Providence, Rhode Island
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20
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Blasier RD. CORR Insights®: How Does Orthopaedic Surgeon Gender Representation Vary by Career Stage, Regional Distribution, and Practice Size? A Large-database Medicare Study. Clin Orthop Relat Res 2023; 481:367-368. [PMID: 35446270 PMCID: PMC9831150 DOI: 10.1097/corr.0000000000002220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 04/01/2022] [Indexed: 02/04/2023]
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21
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Krueger CA. CORR Insights®: Which Application Factors Are Associated With Outstanding Performance in Orthopaedic Surgery Residency? Clin Orthop Relat Res 2023; 481:397-399. [PMID: 36668702 PMCID: PMC9831199 DOI: 10.1097/corr.0000000000002458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 09/22/2022] [Indexed: 01/22/2023]
Affiliation(s)
- Chad A Krueger
- Assistant Professor, Sidney Kimmel Medical College, Philadelphia, PA, USA
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22
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Patient Disparities and Provider Diversity in Orthopaedic Surgery: A Complex Relationship. J Am Acad Orthop Surg 2023; 31:132-139. [PMID: 36563332 DOI: 10.5435/jaaos-d-22-00410] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 11/15/2022] [Indexed: 12/24/2022] Open
Abstract
Disparities in the access to, utilization of, and outcomes after orthopaedic surgery are a notable problem in the field that limits patients' ability to access the highest level of care and achieve optimal outcomes. Disparities exist based on numerous sociodemographic factors, with sex and race/ethnicity being two of the most well-studied factors linked to disparities in orthopaedic care. These disparities cross all subspecialties and tend to negatively affect women and racial/ethnic minorities. The increased recognition of the disparities in orthopaedic care has been paralleled by an increased recognition of the lack of diversity among orthopaedic surgeons. Although efforts are being made to improve the representation of women and underrepresented minorities among orthopaedic surgeons, the numbers, particularly of racial and ethnic minorities, show little improvement. The lack of gender and racial diversity among orthopaedic surgeons may be one of many factors related to the gender and racial disparities seen in orthopaedic care. Patients may prefer a provider that they can better identify with and that may affect care. Orthopaedic surgery as a specialty must continue to work to foster an inclusive environment and make concerted efforts to improve diversity through the recruitment of women and underrepresented minorities, among others, for the benefit of patients, surgeons, and the continued growth of the field as a whole.
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Hoyt BW, Anderson AB, Dingle ME, Dickens JF, Eckel TT, Sterbis JR, Potter BK, Kilcoyne KG. Racial and Gender Diversity of Physicians Accepted to American Military Orthopaedic and Surgical Residencies: An 18-Year Analysis. JB JS Open Access 2023; 8:JBJSOA-D-22-00091. [PMID: 36698988 PMCID: PMC9831158 DOI: 10.2106/jbjs.oa.22.00091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Orthopaedic surgery ranks among the least racially and gender diverse medical/surgical specialties. United States military surgeons train in military or military-funded residency positions to care for a markedly diverse population; however, the composition and diversity of these training programs have not been previously assessed. The purpose of this study was to analyze the trends of physician diversity in military orthopaedics in comparison with other surgical specialties over time. Methods We performed a retrospective cohort study evaluating matriculation into first year of residency training in US military surgical training programs between 2002 and 2020. In total, 9,124 applicants were reviewed. We collected matriculant self-reported race/ethnicity and sex and the medical/specialty program. We considered under-represented minorities as those who reported their race as African American, Indian/Alaskan Native, and Native, other, or who reported ethnicity as Hispanic. We calculated changes in persons accepted to training positions over time and used linear regression to model trends in diversity among orthopaedic matriculating residents when compared with other surgical subspecialities over time. Results Across all surgical subspecialities, the average change in percent women was 0.94% per year for the study period (p < 0.01). The average annual percent women entering orthopaedic surgery residency programs was 14% for the 18-year study period. Across all surgical subspecialties, the average change for accepted applicants from groups underrepresented in medicine (URiM) was 1.01% per year for the study period (p < 0.01). The average annual percent URiM entering orthopaedic surgery residency programs was 17% for the 18-year study period. The annual change of women and URiM entering military orthopaedic residencies was 0.10% and 1.52%, respectively. Conclusions Despite statistically significant improvements, recruitment efforts as used to date fall far short of reversing sexual, racial, and ethnic disparities in military orthopaedic residencies. Orthopaedics has a lower representation of both women and physicians with minority backgrounds when compared with many surgical subspecialties. Additional interventions are still necessary to increase diversity for military orthopaedic surgeons.
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Affiliation(s)
- Benjamin W. Hoyt
- Uniformed Services University Department of Surgery, Bethesda, Maryland,James A Lovell Federal Health Care Center Department of Orthopaedics, North Chicago, Illinois
| | - Ashley B. Anderson
- Uniformed Services University Department of Surgery, Bethesda, Maryland,Fort Belvoir Community Hospital Department of Orthopaedics, Fort Belvoir, Virginia
| | - Marvin E. Dingle
- Uniformed Services University Department of Surgery, Bethesda, Maryland,Carolinas Medical Center Department of Hand & Upper Extremity Surgery, Charlotte, North Carolina
| | - Jon F. Dickens
- Uniformed Services University Department of Surgery, Bethesda, Maryland,Duke University, Department of Orthopaedic Surgery, Durham, North Carolina
| | - Tobin T. Eckel
- Uniformed Services University Department of Surgery, Bethesda, Maryland,Walter Reed National Military Medical Center Department of Orthopaedics, Bethesda, Maryland
| | - Joseph R. Sterbis
- Division of Urology, Department of Surgery, Tripler Army Medical Center, Honolulu, Hawaii
| | - Benjamin K. Potter
- Uniformed Services University Department of Surgery, Bethesda, Maryland,Walter Reed National Military Medical Center Department of Orthopaedics, Bethesda, Maryland,E-mail address for B.K. Potter:
| | - Kelly G. Kilcoyne
- Uniformed Services University Department of Surgery, Bethesda, Maryland,Walter Reed National Military Medical Center Department of Orthopaedics, Bethesda, Maryland
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Alomar AZ, Almonaie S, Nagshabandi KN, AlGhufaili D, Alomar M. Representation of women in orthopaedic surgery: perception of barriers among undergraduate medical students in Saudi Arabia. J Orthop Surg Res 2023; 18:19. [PMID: 36611180 PMCID: PMC9825039 DOI: 10.1186/s13018-022-03487-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 12/30/2022] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND While female participation has improved in several surgical specialties over time globally, no such increase has been observed in orthopaedic surgery over the past decades. The potential barriers to female participation are likely present from the beginning of medical education. Therefore, this study assessed the apparent lag in equal representation among men and women in orthopaedic surgery in the Kingdom of Saudi Arabia. METHODS This cross-sectional study used a questionnaire survey to investigate medical students' and interns' perceptions of women participating in orthopaedic surgery, their subspeciality preferences, and barriers preventing them from pursuing an orthopaedic career. The responses were analysed to understand general perceptions, gender-based differences, impact of clinical experiential learning, and exposure to orthopaedic surgery. RESULTS Approximately 565 medical students (49% females, 51% males) participated in the survey. Only 17% of students (11% females, 23% males) considered orthopaedic surgery as their future career option. While 31% of female and 17% of male students disagreed with the concept of female-appropriate orthopaedic subspecialties, most of the remaining male and female students perceived paediatric orthopaedics as a female-appropriate subspecialty. Concerning equal representation of women, gender bias and lack of a strong physique were the most frequently selected barriers by female and male students, respectively. Patient preference for male orthopaedicians, gender discrimination, social and family commitments, and need for physical strength were all perceived as barriers for women in orthopaedics. Overall, clinical experience and orthopaedic exposure did not significantly improve the likelihood of female students in choosing orthopaedic surgery as a career. CONCLUSIONS The bias against women in orthopaedic careers is prevalent among medical students early in their academic years. Clinical experience and exposure to orthopaedic surgery should be improved to make a significant impact on female participation in orthopaedic careers. Career building efforts in terms of improved career opportunities, career counselling, flexible working hours, social and family related adjustments and implementation of mentorship/research/fellowship programmes for females are needed to reduce gender discrimination and improve female orthopaedic participation. Furthermore, process improvements may yield greater flexibility for women pursuing the challenging field while accommodating other barriers faced by women in orthopaedic surgery.
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Affiliation(s)
- Abdulaziz Z. Alomar
- grid.56302.320000 0004 1773 5396Head of Arthroscopy and Sports Medicine Division, Orthopaedic Department, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Shahd Almonaie
- grid.411335.10000 0004 1758 7207College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | | | - Deema AlGhufaili
- grid.412149.b0000 0004 0608 0662College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Manar Alomar
- grid.412149.b0000 0004 0608 0662College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
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Adkins S, Hughes D, Zimmerman M, Templeton K. Correlations Between Department and Training Program Online Presence and Women in Orthopedic Surgery Training. WOMEN'S HEALTH REPORTS (NEW ROCHELLE, N.Y.) 2023; 4:103-110. [PMID: 36874238 PMCID: PMC9983131 DOI: 10.1089/whr.2022.0081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 01/31/2023] [Indexed: 03/05/2023]
Abstract
Background Orthopedic residency programs increasingly use websites and social media to reach students. This accelerated during the COVID-19 pandemic, especially as away rotations became limited. Women remain a minority of orthopedic residents, and there are no data that indicate the correlation between department/program website content or social media presence on the gender diversity of residency classes. Methods Orthopedic department websites were assessed between June 2021 and January 2022 to identify program director's gender, as well as the gender composition of the faculty and residents. Instagram presence for the department and/or program was also identified. Results There was no correlation found between the residency program director's gender and the gender diversity of residents in a given program. The percentage of women faculty identified on a department website was significantly correlated with the percentage of women residents in the program, regardless of the program director's gender. While there was an increase in the percentage of women residents among programs with Instagram accounts for the class that started in 2021, this was negated when the percentage of women faculty was taken into account. Conclusion Efforts on multiple fronts will be needed to increase the number and percentage of women applying for and training in orthopedic surgery. Given the increasing use of digital media, we need a better understanding of what information, including faculty gender diversity, can be conveyed through this format that is useful for women medical students interested in orthopedic surgery to address their concerns about the field.
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Affiliation(s)
- Sarah Adkins
- University of Kansas School of Medicine, Kansas City, Kansas, USA
| | - Dorothy Hughes
- University of Kansas School of Medicine-Salina, Population Health and Surgery, Salina, Kansas, USA
| | - Mary Zimmerman
- Department of Population Health, University of Kansas School of Medicine, Kansas City, Kansas, USA.,Department of Sociology, University of Kansas-Lawrence, Lawrence, Kansas, USA
| | - Kimberly Templeton
- Department of Orthopaedic Surgery, University of Kansas Medical Center, Kansas City, Kansas, USA
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Shazadeh Safavi K, Okereke R, Rezvani A, Kocjan K, Jupiter DC, Janney CF. Gender and Geographic Trends Among Foot and Ankle Surgeons: Where Are We and Where Do We Need to Improve? Foot Ankle Spec 2022:19386400221123619. [PMID: 36168716 DOI: 10.1177/19386400221123619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Women have historically been underrepresented in orthopaedics. This study analyzes the geographic distribution of female orthopaedic foot and ankle (OFA) surgeons, as well as geographic patterns between their training locations and current practices. METHODS American Orthopaedic Foot and Ankle Society (AOFAS) data regarding fellowship completion from 1988 to 2021 were analyzed. Internet searches were then performed to identify medical school, residency, and current practice locations of individual surgeons. States were categorized into regions and divisions based on US Census Bureau guidelines. RESULTS Of the 1088 OFA surgeons analyzed, 166 (15.26%) were women and 922 (84.74%) were men. The South has a higher number of female OFA surgeons; however, this region and the Midwest have the lowest percentages of female representation. The West and Northeast had significantly higher percentages of female representation and higher retention rates for women. There was high variability in the number and percentage of female OFA surgeons in divisions both within and between regions. CONCLUSION Although the number of female OFA surgeons has increased, their representation remains low. Geographically, the East South Central division of the United States consistently had the least number of OFA surgeons, whereas the South Atlantic division had the highest.Level of Evidence: Not applicable.
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Affiliation(s)
| | - Robyn Okereke
- School of Medicine, The University of Texas Medical Branch, Galveston, Texas
| | - Aryan Rezvani
- College of Medicine, Texas A&M Health Science Center, Bryan, Texas
| | | | - Daniel C Jupiter
- The University of Texas Medical Branch, Department of Preventive Medicine and Population Health, Galveston, Texas
| | - Cory F Janney
- Naval Medical Center San Diego, San Diego, California
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Bellamy JL, Fralinger D, Schultzel M, Hammouri Q, Letzelter J, Bridges CM, Odum SM, Samora J. New Beginnings and Revealing Invisible Identities. J Bone Joint Surg Am 2022; 104:e79. [PMID: 35383663 DOI: 10.2106/jbjs.22.00144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
| | | | | | - Qusai Hammouri
- Cohen Children's Northwell Health, Staten Island, New York
| | | | | | - Susan M Odum
- Atrium Health Musculoskeletal Institute, Charlotte, North Carolina
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LGBTQ+ in Orthopaedics: Creating an Open and Inclusive Environment. J Am Acad Orthop Surg 2022; 30:599-606. [PMID: 35609262 DOI: 10.5435/jaaos-d-20-01268] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 04/06/2022] [Indexed: 02/01/2023] Open
Abstract
Lesbian, gay, bisexual, transgender, and queer or questioning (LGBTQ+) individuals may encounter added challenges in the healthcare setting. Both providers and patients may face discrimination based on their sexual orientation or gender identity, which may lead to avoidance or delay in seeking care. LGBTQ+ physicians often choose not to disclose their sexual orientation because of concerns about harassment, isolation, and depression. Orthopaedic surgery remains the least diverse medical specialty and there is inconsistent training about the needs and cultural issues that affect sexual and gender minority individuals. Furthermore, orthopaedic research specific to LGBTQ+ patients and physicians is exceedingly limited. By encouraging mentorship and improving awareness of the challenges that this community faces, the field of orthopaedic surgery can work to foster an open and inclusive environment that is conducive to the experience of all patients, trainees, and healthcare personnel.
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Hull B, Pestrin O, Brennan CM, Hackney R, Scott CE. Women in Surgery Events Alone do not Change Medical Student Perceptions of Gender Bias and Discrimination in Orthopaedic Surgery. Front Surg 2022; 9:905558. [PMID: 35693302 PMCID: PMC9174672 DOI: 10.3389/fsurg.2022.905558] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Accepted: 05/06/2022] [Indexed: 12/05/2022] Open
Abstract
Aims This study investigated the perceptions of medical students regarding the barriers to pursuing a career in trauma and orthopaedics (T&O); and whether these perceptions were altered by attending an event promoting women in T&O. Methods An event consisting of presentations and interactive sessions from two female T&O trainees was hosted online. Attendees completed pre and post-event questionnaires. Students were asked about their previous exposure to T&O, perceptions of gender imbalances in T&O and what barriers they perceived prevented women from entering T&O. Univariate analysis was performed to identify changes in perceptions following the event. Results Pre-event questionnaires were completed by 102 people; and post-event by 52. Although 64/102 respondents were considering a career in T&O, 26/102 were dissuaded by perceived gender disparities. Perceptions of gender disparities were significantly higher in UK based attendees compared to other nationalities (p = 0.047). Attendees were more likely to want to pursue a career in T&O if they had been directly exposed at medical school (p = 0.044), but exposure did not alter perceptions of women in T&O. The most common perceived barrier was the orthopaedic stereotype followed by male dominated workplace culture, and lack of female role models. Pre and post-event responses did not differ significantly for any areas examined. Conclusion There are significant concerns amongst medical students regarding gender based discrimination within T&O, and these perceptions were not altered by attending a one-off women in T&O event. Early exposure to T&O appears important to improve interest in orthopaedics, whereas negative stereotyping is a barrier.
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Affiliation(s)
- Bethany Hull
- Edinburgh Medical School, University of Edinburgh, Edinburgh, United Kingdom
- Correspondence: Bethany Hull
| | - Olivia Pestrin
- Edinburgh Medical School, University of Edinburgh, Edinburgh, United Kingdom
| | - Caitlin M. Brennan
- Edinburgh Orthopaedics, Department of Trauma and Orthopaedic Surgery, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
| | - Rosie Hackney
- Edinburgh Orthopaedics, Department of Trauma and Orthopaedic Surgery, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
| | - Chloe E.H. Scott
- Edinburgh Medical School, University of Edinburgh, Edinburgh, United Kingdom
- Edinburgh Orthopaedics, Department of Trauma and Orthopaedic Surgery, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
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Ramos TA, Silver J, Owusu-Ansah G, Mulcahey MK. Letter to the Editor: How Long Will It Take to Reach Gender Parity in Orthopaedic Surgery in the United States? An Analysis of the National Provider Identifier Registry. Clin Orthop Relat Res 2021; 479:2757-2758. [PMID: 34570744 PMCID: PMC8726553 DOI: 10.1097/corr.0000000000001998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Accepted: 09/08/2021] [Indexed: 01/31/2023]
Affiliation(s)
| | - Julia Silver
- Tulane University School of Medicine, New Orleans, LA, USA
| | | | - Mary K. Mulcahey
- Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, LA, USA
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Acuña AJ, Sato EH, Jella TK, Samuel LT, Jeong SH, Chen AF, Kamath AF. Reply to the Letter to the Editor: How Long Will It Take to Reach Gender Parity in Orthopaedic Surgery in the United States? An Analysis of the National Provider Identifier Registry. Clin Orthop Relat Res 2021; 479:2759-2760. [PMID: 34581698 PMCID: PMC8726535 DOI: 10.1097/corr.0000000000001999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 09/08/2021] [Indexed: 01/31/2023]
Affiliation(s)
- Alexander J. Acuña
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Eleanor H. Sato
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT, USA
| | - Tarun K. Jella
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Linsen T. Samuel
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Stacy H. Jeong
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Antonia F. Chen
- Orthopaedic and Arthritis Center, Brigham and Women’s Hospital, Boston, MA, USA
| | - Atul F. Kamath
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, OH, USA
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LeBrun DG. CORR Insights®: Does Medical Students' Sense of Belonging Affect Their Interest in Orthopaedic Surgery Careers? A Qualitative Investigation. Clin Orthop Relat Res 2021; 479:2253-2255. [PMID: 34398856 PMCID: PMC8445584 DOI: 10.1097/corr.0000000000001833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 04/29/2021] [Indexed: 01/31/2023]
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Wiggins AJ, Agha O, Diaz A, Jones KJ, Feeley BT, Pandya NK. Current Perceptions of Diversity Among Head Team Physicians and Head Athletic Trainers: Results Across US Professional Sports Leagues. Orthop J Sports Med 2021; 9:23259671211047271. [PMID: 34660831 PMCID: PMC8516385 DOI: 10.1177/23259671211047271] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 07/02/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Discrepancies in race, ethnicity, and sex among health care providers and their patients have been shown to affect the patient-provider relationship as well as the quality of care. Currently, minority and female representation among orthopaedic surgeons remains low. Given the large proportion of minority athletes and their degree of public visibility, professional sports serves as an important arena within which to analyze the diversity of health care providers. PURPOSE To describe and evaluate the current level of diversity of head team physicians (HTPs) and head athletic trainers (ATCs), primarily in terms of race and sex, within men's professional sports leagues in the United States. STUDY DESIGN Cross-sectional study. METHODS Five major US professional sports leagues were evaluated: National Basketball Association, National Football League, National Hockey League, Major League Soccer, and Major League Baseball. Publicly available data were collected to identify the HTPs and head ATCs for each team within these leagues. Two independent observers analyzed photographs and names of these individuals to determine his or her perceived race and sex, with disagreements being resolved by a third independent observer. Other physician data collected included graduate degree(s), specialty, and number of years in practice. Kappa coefficients (κ) were employed to evaluate interobserver reliability. Chi-square, Fisher exact, and t tests were used for statistical comparisons across leagues. RESULTS The κ values for perceived race were 0.85 for HTPs and 0.89 for head ATCs, representing near-perfect interobserver agreement. Minorities comprised 15.5% of HTPs and 20.7% of ATCs (P = .24). Women comprised 3.9% of HTPs and 1.3% of head ATCs (P = .017). The majority of HTPs were orthopaedic surgeons with medical doctorates. Female HTPs had significantly fewer years in practice compared with male HTPs (15.0 ± 4.9 vs 23.1 ± 9.6; P = .04). CONCLUSION The lead physicians and athletic training providers for men's professional sports teams demonstrated low rates of minority and female representation, denoting a highly visible area for discussing the role of increased diversity in health care.
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Affiliation(s)
- Anthony J. Wiggins
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Obiajulu Agha
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Agustin Diaz
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Kristofer J. Jones
- Department of Orthopaedic Surgery, University of California, Los Angeles, Los Angeles, California, USA
| | - Brian T. Feeley
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Nirav K. Pandya
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
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Arjani S, Tasnim S, Sumra H, Zope M, Riner AN, Reyna C, Henry M, Anand T. It begins with the search committee: Promoting faculty diversity at the source. Am J Surg 2021; 223:432-435. [PMID: 34482952 DOI: 10.1016/j.amjsurg.2021.08.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 08/20/2021] [Accepted: 08/21/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Simran Arjani
- Association of Women Surgeons, Publications Committee, USA; Rutgers New Jersey Medical School, 108 S Orange Ave, Newark, NJ, 07103, USA
| | - Sadia Tasnim
- Association of Women Surgeons, Publications Committee, USA; Cleveland Clinic Department of Surgery, 9500 Euclid Ave, Cleveland, OH, 44195, USA
| | - Hibba Sumra
- Association of Women Surgeons, Publications Committee, USA; University of Toledo College of Medicine, 3000 Arlington Ave, Toledo, OH, 43614, USA
| | - Madhushree Zope
- Association of Women Surgeons, Publications Committee, USA; The University of Alabama School of Medicine, Department of Surgery, 1720 2nd Ave. S, Birmingham, AL, 35294-3412, USA
| | - Andrea N Riner
- Association of Women Surgeons, Publications Committee, USA; University of Florida Department of Surgery, 1600 SW Archer Road, Gainesville, FL, 32610, USA
| | - Chantal Reyna
- Association of Women Surgeons, Publications Committee, USA; Crozer Health System, 2100 Keystone, Drexel Hill, PA, 19026, USA
| | - Marion Henry
- Association of Women Surgeons, Publications Committee, USA; University of Chicago Department of Surgery, 3841 S Maryland Ave, Chicago, IL, 60637, USA
| | - Tanya Anand
- Association of Women Surgeons, Publications Committee, USA; University of Arizona Department of Surgery, 1501 N. Campbell Ave, Rm 5411, Tucson, AZ, 85724, USA.
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McSweeney JE, Verma A, Kong J, Warrington D. Letter to the Editor: How Do Medical Students Perceive Diversity in Orthopaedic Surgery, and How Do Their Perceptions Change After an Orthopaedic Clinical Rotation? Clin Orthop Relat Res 2021; 479:1867-1868. [PMID: 34252918 PMCID: PMC8277274 DOI: 10.1097/corr.0000000000001841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 05/06/2021] [Indexed: 01/31/2023]
Affiliation(s)
- Jared E. McSweeney
- University of Manchester School of Medicine, Faculty of Biology, Medicine, and Health, University of Manchester, Manchester, United Kingdom
| | - Anish Verma
- University of Manchester School of Medicine, Faculty of Biology, Medicine, and Health, University of Manchester, Manchester, United Kingdom
| | - Jordon Kong
- University of Manchester School of Medicine, Faculty of Biology, Medicine, and Health, University of Manchester, Manchester, United Kingdom
| | - Daniel Warrington
- University of Manchester School of Medicine, Faculty of Biology, Medicine, and Health, University of Manchester, Manchester, United Kingdom
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Leopold SS. Editor's Spotlight/Take 5: How Long Will It Take to Reach Gender Parity in Orthopaedic Surgery in the United States? An Analysis of the National Provider Identifier Registry. Clin Orthop Relat Res 2021; 479:1175-1178. [PMID: 33961600 PMCID: PMC8133037 DOI: 10.1097/corr.0000000000001805] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 04/13/2021] [Indexed: 01/31/2023]
Affiliation(s)
- Seth S Leopold
- S. S. Leopold, Editor-in-Chief, Clinical Orthopaedics and Related Research® , Philadelphia, PA, USA
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