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Shaikh NQ, Haider AH. Cultivating a culture of "belonging" - A necessary next step in the diversity equity and inclusion journey. Am J Surg 2024; 236:115824. [PMID: 38981837 DOI: 10.1016/j.amjsurg.2024.115824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2024] [Revised: 06/20/2024] [Accepted: 07/01/2024] [Indexed: 07/11/2024]
Affiliation(s)
- Namra Qadeer Shaikh
- Dean's Office, Medical College, Aga Khan University, Karachi, 74800, Pakistan; Department of Surgery, Medical College, Aga Khan University, Karachi, 74800, Pakistan; Centre for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School and Harvard T.H. Chan School of Public Health, Boston, MA, 02120, USA.
| | - Adil H Haider
- Dean's Office, Medical College, Aga Khan University, Karachi, 74800, Pakistan; Department of Surgery, Medical College, Aga Khan University, Karachi, 74800, Pakistan; Centre for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School and Harvard T.H. Chan School of Public Health, Boston, MA, 02120, USA
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Ginzberg SP, Gasior JA, Passman JE, Stein J, Keddem S, Soegaard Ballester JM, Finn CB, Myers JS, Kelz RR, Shea JA, Wachtel H. Surgeon and Surgical Trainee Experiences After Adverse Patient Events. JAMA Netw Open 2024; 7:e2414329. [PMID: 38829617 PMCID: PMC11148685 DOI: 10.1001/jamanetworkopen.2024.14329] [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: 11/06/2023] [Accepted: 04/01/2024] [Indexed: 06/05/2024] Open
Abstract
Importance Adverse patient events are inevitable in surgical practice. Objectives To characterize the impact of adverse patient events on surgeons and trainees, identify coping mechanisms, and assess whether current forms of support are sufficient. Design, Setting, and Participants In this mixed-methods study, a validated survey instrument was adapted and distributed to surgical trainees from 7 programs, and qualitative interviews were conducted with faculty from 4 surgical departments in an urban academic health system. Main Outcomes and Measures The personal impact of adverse patient events, current coping mechanisms, and desired forms of support. Results Of 216 invited trainees, 93 (43.1%) completed the survey (49 [52.7%] male; 60 [64.5%] in third postgraduate year or higher; 23 [24.7%] Asian or Pacific Islander, 6 [6.5%] Black, 51 [54.8%] White, and 8 [8.6%] other race; 13 [14.0%] Hispanic or Latinx ethnicity). Twenty-three of 29 (79.3%) invited faculty completed interviews (13 [56.5%] male; median [IQR] years in practice, 11.0 [7.5-20.0]). Of the trainees, 77 (82.8%) endorsed involvement in at least 1 recent adverse event. Most reported embarrassment (67 of 79 trainees [84.8%]), rumination (64 of 78 trainees [82.1%]), and fear of attempting future procedures (51 of 78 trainees [65.4%]); 28 of 78 trainees (35.9%) had considered quitting. Female trainees and trainees who identified as having a race and/or ethnicity other than non-Hispanic White consistently reported more negative consequences compared with male and White trainees. The most desired form of support was the opportunity to discuss the incident with an attending physician (76 of 78 respondents [97.4%]). Similarly, faculty described feelings of guilt and shame, loss of confidence, and distraction after adverse events. Most described the utility of confiding in peers and senior colleagues, although some expressed unwillingness to reach out. Several suggested designating a departmental point person for event debriefing. Conclusions and Relevance In this mixed-methods study of the personal impact of adverse events on surgeons and trainees, these events were nearly universally experienced and caused significant distress. Providing formal support mechanisms for both surgical trainees and faculty may decrease stigma and restore confidence, particularly for underrepresented groups.
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Affiliation(s)
- Sara P. Ginzberg
- Department of Surgery, University of Pennsylvania Health System, Philadelphia
- Center for Healthcare Improvement and Patient Safety, University of Pennsylvania, Philadelphia
- Leonard Davis Institute for Health Economics, University of Pennsylvania, Philadelphia
| | - Julia A. Gasior
- Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Jesse E. Passman
- Department of Surgery, University of Pennsylvania Health System, Philadelphia
- Leonard Davis Institute for Health Economics, University of Pennsylvania, Philadelphia
| | - Jacob Stein
- Sackler School of Medicine New York State/American Program, Tel Aviv University, Tel Aviv, Israel
| | - Shimrit Keddem
- Leonard Davis Institute for Health Economics, University of Pennsylvania, Philadelphia
- Department of Family Medicine and Community Health, University of Pennsylvania Health System, Philadelphia
| | | | - Caitlin B. Finn
- Department of Surgery, Weill Cornell Medicine, Philadelphia, Pennsylvania
| | - Jennifer S. Myers
- Center for Healthcare Improvement and Patient Safety, University of Pennsylvania, Philadelphia
- Leonard Davis Institute for Health Economics, University of Pennsylvania, Philadelphia
- Perelman School of Medicine, University of Pennsylvania, Philadelphia
- Department of Medicine, University of Pennsylvania Health System, Philadelphia
| | - Rachel R. Kelz
- Department of Surgery, University of Pennsylvania Health System, Philadelphia
- Leonard Davis Institute for Health Economics, University of Pennsylvania, Philadelphia
- Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Judy A. Shea
- Leonard Davis Institute for Health Economics, University of Pennsylvania, Philadelphia
- Perelman School of Medicine, University of Pennsylvania, Philadelphia
- Department of Medicine, University of Pennsylvania Health System, Philadelphia
| | - Heather Wachtel
- Department of Surgery, University of Pennsylvania Health System, Philadelphia
- Perelman School of Medicine, University of Pennsylvania, Philadelphia
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Valji RH, Valji Y, Turner SR. Race and sex diversity in Canadian academic surgical societies. World J Surg 2024; 48:807-815. [PMID: 38415883 DOI: 10.1002/wjs.12114] [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: 10/10/2023] [Accepted: 02/09/2024] [Indexed: 02/29/2024]
Abstract
BACKGROUND It is vital for national professional surgical societies to embrace diversity, inclusion, and equity. This study examines race and sex diversity in two Canadian surgical societies. METHODS Websites of the Canadian Society of Cardiac Surgeons (CSCS) and the Canadian Association of General Surgeons (CAGS) and previous programs of their annual meetings were reviewed. Leadership positions, conference speakers, and award winners were categorized by race and sex. RESULTS White males made up the largest category of Cardiac Surgery meeting speakers (73/142 [51%]), CAGS committee members (89/198 [45%]), CAGS past presidents (38/43 [88%]), and General Surgery meeting speakers (841/1472 [57%]). Of the 17 members that made up the CSCS board of directors and officers, 8 were White males (47%), 5 were BIPOC males (29%), 3 were White females (18%), and 1 was a BIPOC female (6%). Of the 42 members of the CAGS board of directors and advisory committee, 16 were White males (38%), 5 were BIPOC males (12%), 17 were White females (40%), and 4 were BIPOC females (10%). CONCLUSIONS BIPOC individuals and females are underrepresented in both societies compared to White males. However, in CAGS, improvements in representation can be seen in recent years. It is important that both of these organizations continue to embrace diversity.
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Affiliation(s)
- Rahim H Valji
- Division of Thoracic Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Yasmin Valji
- Division of Thoracic Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Simon R Turner
- Division of Thoracic Surgery, University of Alberta, Edmonton, Alberta, Canada
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Ibáñez B, Jones AT, Jeyarajah DR, Dent DL, Prendergast C, Barry CL. A Look at Demographics and Transition to Virtual Assessments: An Analysis of Bias in the American Board of Surgery General Surgery Certifying Exams. JOURNAL OF SURGICAL EDUCATION 2024; 81:578-588. [PMID: 38402095 DOI: 10.1016/j.jsurg.2024.01.001] [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: 05/26/2023] [Revised: 11/16/2023] [Accepted: 01/04/2024] [Indexed: 02/26/2024]
Abstract
OBJECTIVE The goals of this study were (1) to assess if examiner ratings in the American Board of Surgery (ABS) General Surgery Cetifying Exam (CE) are biased based on the gender, race, and ethnicity of the candidate or the examiners, and (2) if the format of delivering of the exams, in-person or virtual, affects how examiners rate candidates. DESIGN We included every candidate-examiner combination for first time takers of the general surgery oral exam. Total scores and pass/fail outcomes based on the 4 scores given by examiners to candidates were analyzed using multilevel models, with candidates as random effects. Explanatory variables included the gender, race, and ethnicity of candidates and examiners, and the format of the exam (in-person or virtual). Candidates' first attempt scores on the ABS General Surgery Qualifying Exam (QE) were also included in the models to control for the baseline knowledge of the candidate. Three sets of models were evaluated for each demographic variable (gender, race, ethnicity) due to missingness in data. p-values and coefficients of determination R2 were used to quantify the statistical and practical significance of the model coefficients (an existent relationship between the explored variables on CE scores was considered statistically and practically significant if the p-value was lower than 0.01 and R2 higher than 1%). PARTICIPANTS All first-time takers of the American Board of Surgery General Surgery Certifying Exam from 2016 to 2022 that had demographic data, and the examiners that participated in those exams. RESULTS The number of candidates/examiners for the 3 sets of models was 8665/514 (gender), 5906/465 (race), and 4678/295 (ethnicity). The demographic variables, format of the exam, or their interactions were not found to significantly relate to examiner-candidate ratings or pass/fail outcomes. The only variable that was significantly related to CE scores was candidates' QE scores, which was added to the models as a measure of candidates' initial knowledge; this held for all models for total scores (F[1,8659] = 1069.89, p-value < 0.01, R2 = 5% [gender models], F(1,5696.3) = 589.13, p-value < 0.01, R2 = 5% [race models], F(1,4459.5) = 278.33, p-value < 0.01, R2 = 5% [ethnicity models]), and pass/fail outcomes (CI = 1.61-1.73, p-value < 0.01, R2 = 3% [gender models], CI = 1.67-1.85, p-value < 0.01, R2 = 3% [race models], CI = 2.17-2.90, p-value < 0.01, R2 = 3% [ethnicity models]). CONCLUSIONS This study shows that there is not a relationship between candidate and examiner gender, race, or ethnicity, and exam outcomes based on statistical models looking at examiner-candidate ratings and pass/fail outcomes. In addition, the delivery of the certifying exam in a virtual format appears to have no statistical impact on outcomes compared to in-person delivery. This suggests that the ABS is performing well in both demographic bias and virtual space.
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Affiliation(s)
| | | | | | | | | | - Carol L Barry
- American Board of Surgery, Philadelphia, Pennsylvania
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Russel SM, Farzal Z, Ebert C, Buckmire R, DeMason C, Shah R, Frank-Ito DO. Finding the Potholes in Academic Career Pathways for Underrepresented Groups in Otolaryngology. Otolaryngol Head Neck Surg 2024; 170:396-404. [PMID: 37668176 PMCID: PMC11073850 DOI: 10.1002/ohn.513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 07/26/2023] [Accepted: 08/12/2023] [Indexed: 09/06/2023]
Abstract
OBJECTIVE To assess inequities in representation among ranks and odds of promotion by race in academic otolaryngology. STUDY DESIGN Cross-sectional study. SETTING US academic medical centers. METHODS Demographic data was collected for medical students, residents, and faculty in the Association of American Medical Colleges and Accreditation Council for Graduate Medical Education databases for the academic year 2020 to 2021. The rank equity index (REI) was used to make pairwise comparisons between ranks to determine groups' representation between levels. Odds ratios (ORs) and 95% confidence intervals (CIs) demonstrating the likelihood that an individual of a particular rank/race would advance in their academic career were determined. RESULTS Representation comparing medical students with full professors for black, Latine, and Asian otolaryngologists was below parity (REI: 0.27, 0.85, 0.85, respectively). Black (OR: 0.20, CI: 0.15, 0.26), Latine (OR: 0.61, CI: 0.50, 0.75), and Asian (OR: 0.62, CI: 0.55, 0.71) medical students all faced lower odds of becoming otolaryngology residents compared to their white counterparts. Similar findings occurred when comparing resident and assistant professor representation. American Indian/Alaskan Native (AIAN) and Native Hawaiian/Pacific Islander (NHPI) REIs and ORs could not be assessed as only 1 self-reported AIAN and no NHPI faculty are present in the studied data. CONCLUSION Underrepresented in Medicine and Asian physicians faced worsening representation at each rung of the academic otolaryngology ladder. The greatest losses occurred when medical students transitioned to residents and residents transitioned to assistant professors. AIAN and NH faculty were absent in otolaryngology, indicating vital targets for recruitment efforts.
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Affiliation(s)
- Sarah M. Russel
- Department of Otolaryngology/Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Department of Head and Neck Surgery and Communication Sciences, Duke University, Durham, North Carolina, USA
| | - Zainab Farzal
- Department of Otolaryngology/Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Charles Ebert
- Department of Otolaryngology/Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Robert Buckmire
- Department of Otolaryngology/Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Christine DeMason
- Department of Otolaryngology/Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Rupali Shah
- Department of Otolaryngology/Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Dennis O. Frank-Ito
- Department of Head and Neck Surgery and Communication Sciences, Duke University, Durham, North Carolina, USA
- Department of Mechanical Engineering and Materials Science, Duke University, Durham, North Carolina, USA
- Computational Biology and Bioinformatics PhD Program, Duke University, Durham, North Carolina, USA
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Drezdzon MK, Cowley NJ, Sweeney DP, Peterson CY, Ridolfi TJ, Ludwig KA, Evans DB, Calata JF. Going for Broke: The Impact of Cost of Living on Surgery Resident Stipend Value. Ann Surg 2023; 278:1053-1059. [PMID: 37226808 DOI: 10.1097/sla.0000000000005923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
OBJECTIVE The objective of this study was to provide a direct comparison of first-year general surgery resident stipends across states and major cities, using the Cost-of-Living Index (COLI) to determine stipend value. BACKGROUND Financial challenges are among residents' top sources of stress, and this may be exacerbated in areas with high costs of living. A 2021 survey found that the mean first-year medical resident stipend increased by 0.6%, or $358, from 2020 to 2021, and only 33% of institutions used cost-of-living to determine annual resident stipend adjustments. METHODS An American Medical Association database was used to identify accredited general surgery residency programs. The 2021-2022 stipend data for first-year general surgery positions were obtained, then data were grouped by state and major city and averaged. Major cities were defined as cities with >4 programs.A direct comparison of stipends was performed using the COLI. RESULTS Stipend data were available for 337 of 346 general surgery programs. The national average first-year residency stipend was $60,064±$4233. The average COLI-adjusted stipend was $57,090±$5742, with a value loss of -$3493, or 5%.For major cities, the average stipend was $63,383±$4524, and the average COLI-adjusted stipend was $46,929±$8383, with an average value loss of -$16,454, or 26%. CONCLUSIONS The financial burdens that residents face cannot be overlooked, and the cost of living has a meaningful impact on resident stipend value. The current Graduate Medical Education compensation structure limits federal and institutional capacity to adjust for the cost of living and creates an insulated market in which residents are under-compensated.
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Affiliation(s)
| | | | | | - Carrie Y Peterson
- Division of Colorectal Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI
| | - Timothy J Ridolfi
- Division of Colorectal Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI
- Department of Surgery, Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, WI
| | - Kirk A Ludwig
- Division of Colorectal Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI
| | - Douglas B Evans
- Department of Surgery, Medical College of Wisconsin, Milwaukee, WI
| | - Jed F Calata
- Division of Colorectal Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI
- Department of Surgery, Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, WI
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McLennan S, Purich K, Verhoeff K, Mador B. Attitudes of Canadian medical students towards surgical training and perceived barriers to surgical careers: a multicentre survey. CANADIAN MEDICAL EDUCATION JOURNAL 2023; 14:71-76. [PMID: 38045085 PMCID: PMC10690001 DOI: 10.36834/cmej.74694] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/05/2023]
Abstract
Background Medical student interest in surgical specialties continues to decline. This study aims to characterize attitudes of Canadian medical students towards surgical training and perceived barriers to surgical careers. Methods An anonymous survey was custom designed and distributed to medical students at the University of Alberta and University of Calgary. Survey questions characterized student interest in surgical specialties, barriers to pursuing surgery, and influence of surgical education opportunities on career interest. Results Survey engagement was 26.7% in 2015 and 24.2% in 2021. General surgery had the highest rate of interest in both survey years (2015: 38.3%, 2021: 39.2%). The most frequently reported barrier was worry about the stress that surgical careers can put on personal relationships (2015: 70.9%, 2021: 73.8%, p= 0.50). Female respondents were significantly more likely to cite gender discrimination as a deterrent to surgical careers (F: 52.0%, M: 5.8%, p < 0.001). Conclusions Despite substantial interest, perception of work-life imbalance was the primary reported barrier to surgical careers. Further, female medical students' awareness of gender discrimination in surgery highlights the need for continued efforts to promote gender inclusivity within surgical disciplines to support early career women interested in surgery.
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Affiliation(s)
| | - Kieran Purich
- Department of Surgery, University of Alberta, Alberta, Canada
| | - Kevin Verhoeff
- Department of Surgery, University of Alberta, Alberta, Canada
| | - Brett Mador
- Department of Surgery, University of Alberta, Alberta, Canada
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Didier AJ, Sutton JM. ASO Author Reflections: Advancing Racial Diversity and Gender Equity in Surgical Oncology Training: Addressing Imbalances and Building Inclusion. Ann Surg Oncol 2023; 30:6835-6836. [PMID: 37378846 DOI: 10.1245/s10434-023-13838-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 06/19/2023] [Indexed: 06/29/2023]
Affiliation(s)
- Alexander J Didier
- University of Toledo College of Medicine and Life Sciences, Toledo, OH, USA.
| | - Jeffrey M Sutton
- Division of Oncologic and Endocrine Surgery, Department of Surgery, Medical University of South Carolina, Charleston, SC, USA
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Didier AJ, Creeden JF, Pannell SM, Sutton JM. Trends in Racial and Gender Diversity Among Complex General Surgical Oncology Fellowship Trainees. Ann Surg Oncol 2023; 30:6824-6834. [PMID: 37351734 DOI: 10.1245/s10434-023-13743-6] [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: 12/16/2022] [Accepted: 06/01/2023] [Indexed: 06/24/2023]
Abstract
BACKGROUND This study examines trends in racial and gender diversity of trainees within Complex General Surgical Oncology Fellowships, and compares the racial and gender proportions of trainees across different fields to assess potential barriers to increasing diversity within surgical oncology training programs. METHODS Accredited Council for Graduate Medical Education (ACGME) data were queried to identify surgical trainees between 2013 and 2021. Trainees were identified based on self-reported race and gender and were stratified based on residency type and fellowship program type if applicable. Chi-square tests were used to assess differences between groups and trends. RESULTS A significantly lower proportion of individuals who are underrepresented in medicine (URMs) trained in surgical oncology fellowships (8.9%) compared with both the overall trainee pool (12.8%) and general surgery residency programs (13.1%) [p < 0.05]. There was no significant increase in URM representation in surgical oncology fellowships across the study period. Furthermore, there was a significantly lower proportion of females training in surgical oncology fellowships (38.6%) compared with the overall trainee pool (45.6%) [p < 0.05]. Despite a significant increase in female representation in general surgery residency and other surgical fellowships, there was no significant increase in female representation in surgical oncology fellowships across the study period. CONCLUSIONS This study identifies disparities in gender and racial minority representation within ACGME-accredited Complex General Surgical Oncology Fellowship training programs. While steps have been taken to expand diversity, more needs to be done to combat the systemic barriers that both racial minorities and women face during their training.
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Affiliation(s)
- Alexander J Didier
- University of Toledo College of Medicine and Life Sciences, Toledo, OH, USA.
| | - Justin F Creeden
- University of Toledo College of Medicine and Life Sciences, Toledo, OH, USA
| | - Stephanie M Pannell
- University of Toledo College of Medicine and Life Sciences, Toledo, OH, USA
- Division of Colon and Rectal Surgery, Department of Surgery, University of Toledo College of Medicine and Life Sciences, Toledo, OH, USA
| | - Jeffrey M Sutton
- Division of Oncologic and Endocrine Surgery, Department of Surgery, Medical University of South Carolina, Charleston, SC, USA
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Suraju MO, McElroy L, Moten A, Obeng-Gyasi S, Alimi Y, Carter D, Foretia DA, Stapleton S, Yilma M, Reid VJ, Tetteh HA, Khabele D, Rodriguez LM, Campbell A, Newman EA. A framework to improve retention of Black surgical trainees: A Society of Black Academic Surgeons white paper. Am J Surg 2023; 226:438-446. [PMID: 37495467 DOI: 10.1016/j.amjsurg.2023.07.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 06/19/2023] [Accepted: 07/11/2023] [Indexed: 07/28/2023]
Abstract
Attrition is high among surgical trainees, and six of ten trainees consider leaving their programs, with two ultimately leaving before completion of training. Given known historically and systemically rooted biases, Black surgical trainees are at high risk of attrition during residency training. With only 4.5% of all surgical trainees identifying as Black, underrepresentation among their peers can lend to misclassification of failure to assimilate as clinical incompetence. Furthermore, the disproportionate impact of ongoing socioeconomic crisis (e.g., COVID-19 pandemic, police brutality etc.) on Black trainees and their families confers additional challenges that may exacerbate attrition rates. Thus, attrition is a significant threat to medical workforce diversity and health equity. There is urgent need for surgical programs to develop proactive approaches to address attrition and the threat to the surgical workforce. In this Society of Black Academic Surgeons (SBAS) white paper, we provide a framework that promotes an open and inclusive environment conducive to the retention of Black surgical trainees, and continued progress towards attainment of health equity for racial and ethnic minorities in the United States.
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Affiliation(s)
- Mohammed O Suraju
- Department of Surgery, University of Iowa Hospitals and Clinics, Iowa City, IA, United States
| | - Lisa McElroy
- Department of Surgery, Duke University Hospital, Durham, NC, United States
| | - Ambria Moten
- Department of Surgery, The University of Tennessee Health Science Center, Memphis, TN, United States
| | - Samilia Obeng-Gyasi
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Yewande Alimi
- Department of Surgery, Georgetown University School of Medicine, Washington, DC, United States
| | - Damien Carter
- Department of Surgery, Maine Medical Center, Portland, ME, United States
| | - Denis A Foretia
- Department of Surgery, The University of Tennessee Health Science Center, Memphis, TN, United States
| | - Sahael Stapleton
- Department of Surgery, Kaiser Permanente Vacaville Medical Center, Vacaville, CA, United States
| | - Mignote Yilma
- Department of Surgery, University of California San Francisco, San Francisco, CA, United States
| | - Vincent J Reid
- Department of Surgery, University of Iowa Hospitals and Clinics, Iowa City, IA, United States; Department of Surgery, Mercy Medical Center Cedar Rapids, Cedar Rapids, IA, United States
| | - Hassan A Tetteh
- Department of Surgery, Uniformed Services University, Bethesda, MD, United States
| | - Dineo Khabele
- Division of Gynecologic Oncology, Washington University School of Medicine, And Alvin J. Siteman Cancer Center, St Louis, MO, United States
| | - Luz M Rodriguez
- Gastrointestinal and Other Cancers Research Group, Division of Cancer Prevention, NCI, NIH, Bethesda, MD, United States; Department of Surgery, Walter Reed National Military Medical Center (WRNMM) Uniformed Services University (USU), Bethesda, MD, United States
| | - Andre Campbell
- Department of Surgery, University of California San Francisco, San Francisco, CA, United States
| | - Erika A Newman
- Section of Pediatric Surgery, Department of Surgery, CS Mott Children's Hospital, The University of Michigan Medical School, United States.
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Lowry AC. Numbers Do Not Tell the Whole Story. Dis Colon Rectum 2023; 66:1146-1148. [PMID: 37341518 DOI: 10.1097/dcr.0000000000002980] [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: 06/22/2023]
Affiliation(s)
- Ann C Lowry
- Division of Colon and Rectal Surgery, University of Minnesota Wilson Library, University of Minnesota Twin Cities, Minneapolis, Minnesota
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12
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Russel SM, Carter TM, Wright ST, Hirshfield LE. How Do Academic Medicine Pathways Differ for Underrepresented Trainees and Physicians? A Critical Scoping Review. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2023; 98:00001888-990000000-00537. [PMID: 37556817 PMCID: PMC10834859 DOI: 10.1097/acm.0000000000005364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/11/2023]
Abstract
PURPOSE Academic medicine faces difficulty recruiting and retaining a diverse workforce. The proportion of medical students who are underrepresented in medicine (URiM) is smaller than the proportion of URiM's in the general population, and these numbers worsen with each step up the academic medicine ladder. Previously known as the "leaky pipeline," this phenomenon may be better understood as disparate "pathways with potholes," which acknowledges the different structural barriers that URiM trainees and faculty face in academic medicine. This critical scoping review analyzed current literature to determine what variables contribute to the inequitable "pathways and potholes" URiM physicians experience in academic medicine. METHOD The authors combined scoping review methodology with a critical lens. The comprehensive search strategy used terms about academic medicine, underrepresented groups, and leaving academic medical careers. One reviewer conducted screening, full text review, and data extraction while in consultation with members of the research team. Data extraction focused on themes related to pathways and potholes, such as attrition, recruitment, and retention in academic medicine. Themes were iteratively merged, and quality of contribution to the field and literature gaps were noted. RESULTS Included papers clustered into attrition, recruitment, and retention. Those pertaining to attrition noted that URiM faculty are less likely to get promoted even when controlling for scholarly output, and a hostile work environment may exacerbate attrition. Recruitment and retention strategies were most effective when multi-pronged approaches changed every step of the recruitment and promotion processes. CONCLUSIONS These studies provide examples of various "potholes" that can affect representation in academic medicine of URiM trainees and faculty. However, only a few studies examined the link between isolating and hostile work environments, the so-called "chilly climate," and attrition from academic medicine. Understanding these concepts is key to producing the most effective interventions to improve diversity in medicine.
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Affiliation(s)
- Sarah M Russel
- S.M. Russel is a third-year resident physician, Department of Otolaryngology/Head & Neck Surgery, University of North Carolina, Chapel Hill, North Carolina; ORCID: https://orcid.org/0000-0001-9299-8047
| | - Taylor M Carter
- T.M. Carter is a fourth-year resident physician, Department of Surgery, University of North Carolina, Chapel Hill, North Carolina, and a surgical education fellow, University of Utah, Salt Lake City, Utah
| | - Sarah T Wright
- S.T. Wright is a librarian, Health Sciences Library, University of North Carolina, Chapel Hill, North Carolina
| | - Laura E Hirshfield
- L.E. Hirshfield is The Dr. Georges Bordage Medical Education Faculty Scholar and associate professor of medical education and sociology, Department of Medical Education, University of Illinois College of Medicine, Chicago, Illinois; ORCID: https://orcid.org/0000-0003-0894-2994
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13
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Fenton D, Hamzat I, Dimitroyannis R, Nordgren R, Saunders MR, Baroody FM, Baird B, Shogan A. Assessment of Demographic Changes of Workforce Diversity in Otolaryngology, 2013 to 2022. JAMA Otolaryngol Head Neck Surg 2023; 149:628-635. [PMID: 37261840 PMCID: PMC10236323 DOI: 10.1001/jamaoto.2023.1130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Accepted: 04/14/2023] [Indexed: 06/02/2023]
Abstract
Importance Given the growth of minoritized groups in the US and the widening racial and ethnic health disparities, improving diversity remains a proposed solution in the field of otolaryngology. Evaluating current trends in workforce diversity may highlight potential areas for improvement. Objective To understand the changes in gender, racial, and ethnic diversity in the otolaryngology workforce in comparison with changes in the general surgery and neurosurgery workforces from 2013 to 2022. Design, Setting, and Participants This cross-sectional study used publicly available data from the Accreditation Council for Graduate Medical Education and the Association of American Medical Colleges for 2013 to 2022, and included medical students and trainees in all US medical residency programs and allopathic medical schools. Main Outcomes and Measures Average percentages of women, Black, and Latino trainees during 2 intervals of 5 years (2013-2017 and 2018-2022). Pearson χ2 tests compared demographic information. Normalized ratios were calculated for each demographic group in medical school and residency. Piecewise linear regression assessed linear fit for representation across time periods and compared rates of change. Results The study population comprised 59 865 medical residents (43 931 [73.4%] women; 6203 [10.4%] Black and 9731 [16.2%] Latino individuals; age was not reported). The comparison between the 2 study intervals showed that the proportions of women, Black, and Latino trainees increased in otolaryngology (2.9%, 0.7%, and 1.6%, respectively), and decreased for Black trainees in both general surgery and neurosurgery (-0.4% and -1.0%, respectively). In comparison with their proportions in medical school, Latino trainees were well represented in general surgery, neurosurgery, and otolaryngology (normalized ratios [NRs]: 1.25, 1.06, and 0.96, respectively); however, women and Black trainees remained underrepresented in general surgery, neurosurgery, and otolaryngology (women NRs, 0.76, 0.33, and 0.68; Black NRs, 0.63, 0.61, and 0.29, respectively). The percentage of women, Black, and Latino trainees in otolaryngology all increased from 2020 to 2022 (2.5%, 1.1%, and 1.1%, respectively). Piecewise regression showed positive trends across all 3 specialties. Conclusions and Relevance The findings of this cross-sectional study indicate a positive direction but only a modest increase of diversity in otolaryngology, particularly in the context of national demographic data. Novel strategies should be pursued to supplement existing efforts to increase diversity in otolaryngology.
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Affiliation(s)
- David Fenton
- Pritzker School of Medicine, University of Chicago, Chicago, Illinois
| | - Ibraheem Hamzat
- Pritzker School of Medicine, University of Chicago, Chicago, Illinois
| | | | - Rachel Nordgren
- Department of Public Health Sciences, University of Chicago, Chicago, Illinois
| | - Milda R. Saunders
- Department of Medicine, University of Chicago Medicine, Chicago, Illinois
| | - Fuad M. Baroody
- Department of Surgery, Section of Otolaryngology–Head and Neck Surgery, University of Chicago Medicine, Chicago, Illinois
| | - Brandon Baird
- Department of Surgery, Section of Otolaryngology–Head and Neck Surgery, University of Chicago Medicine, Chicago, Illinois
| | - Andrea Shogan
- Department of Surgery, Section of Otolaryngology–Head and Neck Surgery, University of Chicago Medicine, Chicago, Illinois
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14
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Gurayah AA, Mohamed AI, Rahman F, Bernstein AP, Asafu-Adjei D, Ezeh UC, Willey BC, Balumuka D, Yarholar LM, Gosman A, Ramasamy R. The Revolving Door of Residency: Predictors of Residency Attrition for Urology Matriculants Between 2001 and 2016. Urology 2023; 177:21-28. [PMID: 37076020 DOI: 10.1016/j.urology.2023.02.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 01/13/2023] [Accepted: 02/06/2023] [Indexed: 04/21/2023]
Abstract
OBJECTIVE To add to the literature which has reported higher attrition rates amongst General Surgery residents who identify as female or underrepresented in medicine (URM), we aimed to determine how these factors contribute to attrition within Urology. We hypothesized that women and URM Urology residents will similarly have higher attrition rates. METHODS The Association of American Medical Colleges surveyed residents to obtain matriculation and attrition status from 2001 to 2016. Data included demographics, medical school type, and specialty. A multivariable logistic regression model was performed to identify predictors of attrition amongst Urology residents. RESULTS In our sample of 4321 Urology residents, 22.5% were female, 9.9% were URM, 25.8% were older than 30 years, 2.5% were Doctor of Osteopathic Medicine graduates and 4.7% were International Medical Graduates. On multivariable analysis, being female (Odds ratio [OR] = 2.3, P < .001) was associated with increased residency attrition when compared to male residents. Additionally, residents who matriculated between 30 and 39 years old (OR = 1.9, P < .001) or ≥40 years old (OR = 10.7, P < .001) had an increased risk of residency attrition when compared to residents who matriculated between 26 and 29 years old. Attrition rates for URM trainees have recently increased. CONCLUSION Women, older, and URM Urology residents experience higher rates of attrition compared to their peers. It is essential to identify trainees with a higher likelihood of attrition to determine system-level changes to combat departures from training programs. Our study highlights the need to foster more inclusive training environments and change institutional cultures to diversify the surgical workforce.
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Affiliation(s)
| | | | - Farah Rahman
- Miller School of Medicine, Desai Sethi Urology Institute, University of Miami, Miami, FL.
| | - Ari P Bernstein
- Department of Urology, New York University Langone Health, New York, NY.
| | - Denise Asafu-Adjei
- Department of Urology, Stritch School of Medicine, Loyola University Chicago, Chicago, IL.
| | - Uche C Ezeh
- Miller School of Medicine, University of Miami, Miami, FL.
| | | | - Darius Balumuka
- Division of Plastic Surgery, Oregon Health Science University, Portland, OR.
| | - Lauren M Yarholar
- Division of Plastic Surgery, Miller School of Medicine, University of Miami, Miami, FL.
| | - Amanda Gosman
- Department of Plastic Surgery, University of California San Diego, San Diego, CA.
| | - Ranjith Ramasamy
- Miller School of Medicine, Desai Sethi Urology Institute, University of Miami, Miami, FL.
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15
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Escobar N, Keshinro A, Hambrecht A, Frangos S, Berman RS, DiMaggio C, Joseph KA, Bukur M, Klein MJ, Ude-Welcome A, Berry C. A Call to Action to Train Underrepresented Minorities in Surgical Subspecialties and Fellowships. J Am Coll Surg 2023; 237:109-116. [PMID: 36946471 DOI: 10.1097/xcs.0000000000000692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
BACKGROUND With each succession along the surgical career pathway, from medical school to faculty, the percentage of those who identify as underrepresented in medicine (URiM) decreases. We sought to evaluate the demographic trend of surgical fellowship applicants, matriculants, and graduates over time. STUDY DESIGN The Electronic Residency Application Service and the Graduate Medical Education Survey for general surgery fellowships in colorectal surgery, surgical oncology, pediatric surgery, thoracic surgery, and vascular surgery were retrospectively analyzed (2005 to 2020). The data were stratified by race and gender, descriptive statistics were performed, and time series were evaluated. Race/ethnicity groups included White, Asian, other, and URiM, which is defined as Black/African American, Hispanic/Latino(a), Alaskan or Hawaiian Native, and Native American. RESULTS From 2005 to 2020, there were 5,357 Electronic Residency Application Service applicants, 4,559 matriculants, and 4,178 graduates to surgery fellowships. Whites, followed by Asians, represented the highest percentage of applicants (62.7% and 22.3%, respectively), matriculants (65.4% and 23.8% respectively), and graduates (65.4% and 24.0%, respectively). For URiMs, the applicants (13.4%), matriculants (9.1%), and graduates (9.1%) remained significantly low (p < 0.001). When stratified by both race and gender, only 4.6% of the applicants, 2.7% of matriculants, and 2.4% of graduates identified as both URiM and female compared to White female applicants (20.0%), matriculants (17.9%), and graduates (16.5%, p < 0.001). CONCLUSIONS Significant disparities exist for URiMs in general surgery subspecialty fellowships. These results serve as a call to action to re-examine and improve the existing processes to increase the number of URiMs in the surgery subspecialty fellowship training pathway.
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Affiliation(s)
- Natalie Escobar
- From the Department of Surgery, New York University Grossman School of Medicine, New York, NY (Escobar, Keshinro, Hambrecht, Frangos, Berman, DiMaggio, Joseph, Bukur, Klein, Ude-Welcome, Berry)
| | - Ajaratu Keshinro
- From the Department of Surgery, New York University Grossman School of Medicine, New York, NY (Escobar, Keshinro, Hambrecht, Frangos, Berman, DiMaggio, Joseph, Bukur, Klein, Ude-Welcome, Berry)
| | - Amanda Hambrecht
- From the Department of Surgery, New York University Grossman School of Medicine, New York, NY (Escobar, Keshinro, Hambrecht, Frangos, Berman, DiMaggio, Joseph, Bukur, Klein, Ude-Welcome, Berry)
| | - Spiros Frangos
- From the Department of Surgery, New York University Grossman School of Medicine, New York, NY (Escobar, Keshinro, Hambrecht, Frangos, Berman, DiMaggio, Joseph, Bukur, Klein, Ude-Welcome, Berry)
| | - Russell S Berman
- From the Department of Surgery, New York University Grossman School of Medicine, New York, NY (Escobar, Keshinro, Hambrecht, Frangos, Berman, DiMaggio, Joseph, Bukur, Klein, Ude-Welcome, Berry)
| | - Charles DiMaggio
- From the Department of Surgery, New York University Grossman School of Medicine, New York, NY (Escobar, Keshinro, Hambrecht, Frangos, Berman, DiMaggio, Joseph, Bukur, Klein, Ude-Welcome, Berry)
| | - Kathie-Ann Joseph
- From the Department of Surgery, New York University Grossman School of Medicine, New York, NY (Escobar, Keshinro, Hambrecht, Frangos, Berman, DiMaggio, Joseph, Bukur, Klein, Ude-Welcome, Berry)
- the New York University Langone Health Institute for Excellence in Health Equity, New York, NY (Joseph)
| | - Marko Bukur
- From the Department of Surgery, New York University Grossman School of Medicine, New York, NY (Escobar, Keshinro, Hambrecht, Frangos, Berman, DiMaggio, Joseph, Bukur, Klein, Ude-Welcome, Berry)
| | - Michael J Klein
- From the Department of Surgery, New York University Grossman School of Medicine, New York, NY (Escobar, Keshinro, Hambrecht, Frangos, Berman, DiMaggio, Joseph, Bukur, Klein, Ude-Welcome, Berry)
| | - Akuezunkpa Ude-Welcome
- From the Department of Surgery, New York University Grossman School of Medicine, New York, NY (Escobar, Keshinro, Hambrecht, Frangos, Berman, DiMaggio, Joseph, Bukur, Klein, Ude-Welcome, Berry)
| | - Cherisse Berry
- From the Department of Surgery, New York University Grossman School of Medicine, New York, NY (Escobar, Keshinro, Hambrecht, Frangos, Berman, DiMaggio, Joseph, Bukur, Klein, Ude-Welcome, Berry)
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16
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Jung S, Rosser AA, Alagoz E. Cultural Change, Community, and Belonging: Supporting the Next Generation of Surgeons From Groups Historically Excluded From Medicine. ANNALS OF SURGERY OPEN 2023; 4:e291. [PMID: 37601472 PMCID: PMC10431357 DOI: 10.1097/as9.0000000000000291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 04/24/2023] [Indexed: 08/22/2023] Open
Affiliation(s)
- Sarah Jung
- From the Department of Surgery, University of Wisconsin-Madison, Madison, WI
| | | | - Esra Alagoz
- From the Department of Surgery, University of Wisconsin-Madison, Madison, WI
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17
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O'Sullivan L, Kagabo W, Prasad N, Laporte D, Aiyer A. Racial and Ethnic Bias in Medical School Clinical Grading: A Review. JOURNAL OF SURGICAL EDUCATION 2023; 80:806-816. [PMID: 37019709 DOI: 10.1016/j.jsurg.2023.03.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 02/26/2023] [Accepted: 03/17/2023] [Indexed: 05/23/2023]
Abstract
OBJECTIVE Improving diversity in healthcare is a widely recognized national goal. The diversity of medical student matriculants has increased, yet this trend is not seen in the composition of competitive residency programs. In this review, we examine racial and ethnic disparities in medical student grading during clinical years and explore the consequences of how this may exclude minority students from accessing competitive residency positions. DESIGN Following PRISMA guidelines, we searched PubMed, Embase, Scopus, and ERIC databases using variations of the terms "race," "ethnicity," "clerkship," "rotation," "grade," "evaluation", or "shelf exam." Of 391 references found using the criteria, 29 were related to clinical grading and race/ethnicity and included in the review. The GRADE criteria were used to determine the quality of evidence. SETTING Johns Hopkins School of Medicine, Baltimore MD. RESULTS Five studies examining a total of 107,687 students from up to 113 different schools found racial minority students receive significantly fewer Honors grades in core clerkships compared to White students. Three studies examining 94,814 medical student evaluations from up to 130 different schools found significant disparities in the wording of written clerkship evaluations based on race and/or ethnicity. CONCLUSIONS A large body of evidence suggests the presence of racial bias in subjective clinical grading and written clerkship evaluations of medical students. Grading disparities can disadvantage minority students when applying to competitive residency programs and may contribute to a lack of diversity in these fields. As low minority representation has a negative impact on patient care and research advancement, strategies to resolve this issue must be further explored.
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Affiliation(s)
- Lucy O'Sullivan
- Johns Hopkins Orthopedics, Johns Hopkins University School of Medicine, Baltimore, Maryland.
| | - Whitney Kagabo
- Department of Orthopedics, Johns Hopkins Orthopedics, Johns Hopkins Medicine, Baltimore, Maryland
| | - Niyathi Prasad
- Department of Orthopedics, Johns Hopkins Orthopedics, Johns Hopkins Medicine, Baltimore, Maryland
| | - Dawn Laporte
- Department of Orthopedics, Johns Hopkins Orthopedics, Johns Hopkins Medicine, Baltimore, Maryland
| | - Amiethab Aiyer
- Department of Orthopedics, Johns Hopkins Orthopedics, Johns Hopkins Medicine, Baltimore, Maryland
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18
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Haruno LS, Chen X, Metzger M, Lin CA, Little MT, Kanim LE, Poon SC. Racial and Sex Disparities in Resident Attrition in Orthopaedic Surgery. JB JS Open Access 2023; 8:e22.00148. [PMID: 37351087 PMCID: PMC10284323 DOI: 10.2106/jbjs.oa.22.00148] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/24/2023] Open
Abstract
Studies have suggested that female individuals and individuals from backgrounds under-represented in medicine (URiM) are at increased risk of attrition during residency. This likely exacerbates the lack of diversity in our field. The aims of this study were to (1) characterize demographic composition in orthopaedic residency from 2001 to 2018 and (2) determine the race/ethnicity and identify any disparities. Methods Demographic and attrition data from 2001 to 2018 were obtained from the Association of American Medical Colleges. Attrition data comprised the following categories: withdrawals, dismissals, and transfers to another specialty. Analysis compared demographic composition and determined attrition rates with subgroup analysis by race/ethnicity and sex. Results From 2001 to 2018, female orthopaedic residents increased from 8.77% to 15.54% and URiM residents from 9.49% to 11.32%. The overall and unintended attrition rates in orthopaedic surgery were 3.20% and 1.15%, respectively. Among female residents, the overall and unintended attrition rates were 5.96% and 2.09% compared with 2.79% and 1.01%, respectively, in male residents. URiM residents had overall and unintended attrition rates of 6.16% and 3.11% compared with 2.71% and 0.83%, respectively, for their White counterparts. Black/African American residents had an attrition rate of nearly 10%. Female residents averaged 12.9% of all residents but 24% of those leaving orthopaedics. URiM residents were 10.14% of all residents but 19.51% of those experiencing attrition. In logistic regression models, female residents had a relative risk (RR) of 2.20 (p < 0.001) for experiencing all-cause attrition and 2.09 (p < 0.001) for unintended attrition compared with male residents. Compared with their White male counterparts, URiM residents had a RR for overall and unintended attrition of 2.36 and 3.84 (p < 0.001), respectively; Black/African American residents had a RR for the same of 3.80 and 7.20 (p < 0.001), respectively. Conclusion Although female resident percentage has increased, orthopaedics continues to train fewer female surgeons than all other fields. Female and URiM residents in orthopaedic surgery are disproportionately affected by attrition. While recruitment has been the primary focus of diversity, equity, and inclusion efforts, this study suggests that resident retention through appropriately supporting residents during training is equally critical.
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Affiliation(s)
- Lee S. Haruno
- Department of Orthopaedic Surgery, Cedars Sinai Medical Center, Los Angeles, California
| | - Xi Chen
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Melodie Metzger
- Department of Orthopaedic Surgery, Cedars Sinai Medical Center, Los Angeles, California
| | - Carol A. Lin
- Department of Orthopaedic Surgery, Cedars Sinai Medical Center, Los Angeles, California
| | - Milton T.M. Little
- Department of Orthopaedic Surgery, Cedars Sinai Medical Center, Los Angeles, California
| | - Linda E.A. Kanim
- Department of Orthopaedic Surgery, Cedars Sinai Medical Center, Los Angeles, California
- Cedars Sinai Medical Center Spine Center, Los Angeles, California
| | - Selina C. Poon
- Shriners Children's Southern California, Pasadena, California
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19
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Tseng ES, Weaver JL, Sangosanya AT, Gelbard RB, Martin MJ, Tung L, Santos AP, McCunn M, Bonne S, Joseph B, Zakrison TL. And Miles to Go Before We Sleep: EAST Diversity and Inclusivity Progress and Remaining Challenges. Ann Surg 2023; 277:e914-e918. [PMID: 35129486 DOI: 10.1097/sla.0000000000005290] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of this study was to examine the diversity, equity, and inclusion landscape in academic trauma surgery and the EAST organization. SUMMARY BACKGROUND DATA In 2019, the Eastern Association for the Surgery of Trauma (EAST) surveyed its members on equity and inclusion in the #EAST4ALL survey and assessed leadership representation. We hypothesized that women and surgeons of color (SOC) are underrepresented as EAST members and leaders. METHODS Survey responses were analyzed post-hoc for representation of females and SOC in academic appointments and leadership, EAST committees, and the EAST board, and compared to the overall respondent cohort. EAST membership and board demographics were compared to demographic data from the Association of American Medical Colleges. RESULTS Of 306 respondents, 37.4% identified as female and 23.5% as SOC. There were no significant differences in female and SOC representation in academic appointments and EAST committees compared to their male and white counterparts. In academic leadership, females were underrepresented ( P < 0.0001), whereas SOC were not ( P = 0.08). Both females and SOC were underrepresented in EAST board membership ( P = 0.002 and P = 0.043, respectively). Of EAST's 33 presidents, 3 have been white women (9%), 2 have been Black, non-African American men (6%), and 28 (85%) have been white men. When compared to 2017 AAMC data, women are well-represented in EAST's 2020 membership ( P < 0.0001) and proportionally represented on EAST's 2019-2020 board ( P > 0.05). CONCLUSIONS The #EAST4ALL survey suggests that women and SOC may be underrepresented as leaders in academic trauma surgery. However, lack of high-quality demographic data makes evaluating representation of structurally marginalized groups challenging. National trauma organizations should elicit data from their members to re-assess and promote the diversity landscape in trauma surgery.
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Affiliation(s)
- Esther S Tseng
- Department of Surgery, MetroHealth Medical Center, Cleveland, OH
| | - Jessica L Weaver
- Department of Surgery, Division of Trauma, Surgical Critical Care, Burns, and Acute Care Surgery, University of California San Diego School of Medicine, San Diego, CA
| | - Ayodele T Sangosanya
- Division of Acute Care Surgery, University of RochesterMedical Center, Rochester, NY
| | - Rondi B Gelbard
- Department ofSurgery, University of Alabama at Birmingham, Birmingham, AL
| | | | - Lily Tung
- Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Ariel P Santos
- Texas Tech University Health Sciences Center and Covenant Medical Center, Lubbock, TX
| | | | - Stephanie Bonne
- Department of Surgery, Division of Trauma and Surgical Critical Care, Rutgers-New Jersey Medical School, Newark, NJ
| | - Bellal Joseph
- Division of Trauma, Critical Care, Burn and Emergency Surgery, Department of Surgery, University of Arizona, Tucson, AZ
| | - Tanya L Zakrison
- Department of Trauma and Acute Care Surgery, The University of Chicago Medicine & Biological Sciences, Chicago, IL
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20
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Haruno LS, Chen X, Metzger M, Lin CA, Little MTM, Kanim LEA, Poon SC. Racial and Sex Disparities in Resident Attrition Among Surgical Subspecialties. JAMA Surg 2023; 158:368-376. [PMID: 36753189 PMCID: PMC9909577 DOI: 10.1001/jamasurg.2022.7640] [Citation(s) in RCA: 36] [Impact Index Per Article: 36.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 10/17/2022] [Indexed: 02/09/2023]
Abstract
Importance Racial and sex disparities are prevalent in surgical trainees. Although retrospective studies on resident attrition have been conducted for individual specialties, this study analyzes racial and sex differences in resident attrition among all surgical subspecialties over an 18-year period. Objective To evaluate the racial and sex differences in resident attrition among surgical specialties over an 18-year period. Design, Setting, and Participants This was a large, cross-sectional, database study that analyzed program-reported resident censuses (program information, resident demographics, and attrition status) obtained by the Association of American Medical Colleges from 2001 to 2018 for trainees in surgical residency programs. Data were analyzed from March 20, 2021, to June 8, 2022. Main Outcomes and Measures Demographic trends (including race and ethnicity and sex) for all surgical subspecialty training programs over an 18-year period. Resident attrition includes all-cause withdrawals, dismissals, and transfers to another specialty. Unintended attrition encompasses all withdrawals, dismissals, and transfers except for changing career plans. Results This study included 407 461 program-reported resident years collected from 112 205 individual surgical residents (67 351 male individuals [60.0%]). The mean percentage of female trainees was 40.0% (44 835) and increased over the study period. Sex disparity remained greatest in orthopedic surgery. Residents who were underrepresented in medicine (URiM) comprised 14.9% (16 695) of all surgical trainees but demonstrated a 2.1% decrease over the study period. Overall attrition rate among all specialties was 6.9% (7759), with an unintended attrition rate of 2.3% (2556). Female residents had a significantly higher relative risk (RR) of attrition (RR, 1.16; 95% CI, 1.11-1.22; P < .001) and unintended attrition (RR, 1.17; 95% CI, 1.08-1.26; P < .001) compared with their male counterparts. URiM residents were at significantly higher RR for attrition (RR, 1.40; 95% CI, 1.32-1.48; P < .001) and unintended attrition (RR, 1.92; 95% CI, 1.75-2.11; P < .001) compared with non-URiM residents. The highest attrition (10.6% [746 of 7043]) and unintended attrition (5.2% [367 of 7043]) rates were in Black/African American residents. The lowest attrition and unintended attrition rates were seen in White residents at 6.2% (4300 of 69 323) and 1.8% (1234 of 69 323), respectively. Black/African American residents were at disproportionate risk for attrition (RR, 1.66; 95% CI, 1.53-1.80; P < .001) and unintended attrition (RR, 2.59; 95% CI, 2.31-2.90; P < .001) compared with all other residents. Orthopedic surgery had the highest attrition (RR, 3.80; 95% CI, 2.84-5.09; P < .001) and unintended attrition (RR, 7.20; 95% CI, 4.84-10.71; P < .001) for Black/African American residents. Conclusions and Relevance Results of this cross-sectional study suggest that the percentage of female residents in surgical specialties has improved over the last 18 years, and the percentage of URiM residents has remained relatively unchanged. Risk for attrition and unintended attrition was significantly elevated for female and URiM residents, specifically Black/African Americans. These results highlight current racial and sex disparities in resident attrition and demonstrate the importance of developing strategies to recruit, retain, and support residents.
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Affiliation(s)
- Lee S. Haruno
- Department of Orthopedic Surgery, Cedars Sinai Medical Center, Los Angeles, California
| | - Xi Chen
- Department of Orthopedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Melodie Metzger
- Department of Orthopedic Surgery, Cedars Sinai Medical Center, Los Angeles, California
| | - Carol A. Lin
- Department of Orthopedic Surgery, Cedars Sinai Medical Center, Los Angeles, California
| | - Milton T. M. Little
- Department of Orthopedic Surgery, Cedars Sinai Medical Center, Los Angeles, California
| | | | - Selina C. Poon
- Shriners Children’s Southern California, Pasadena, California
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21
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O'Conor KJ, Young L, Tomobi O, Golden SH, Samen CDK, Banks MC. Implementing pathways to anesthesiology: Promoting diversity, equity, inclusion, and success. Int Anesthesiol Clin 2023; 61:34-41. [PMID: 36480648 DOI: 10.1097/aia.0000000000000386] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Katie J O'Conor
- Faculty, Chief Diversity & Equity Officer, Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine
| | - Lisa Young
- Johns Hopkins University School of Medicine
| | - Oluwakemi Tomobi
- Global Alliance of Perioperative Professionals, Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine
| | - Sherita Hill Golden
- Hugh P. McCormick Family Professor of Endocrinology and Metabolism, Vice President, Chief Diversity Officer, Office of Diversity, Inclusion, and Health Equity, Johns Hopkins Medicine
| | - Christelle D K Samen
- Clinical Fellow, Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine
| | - Michael C Banks
- Assistant Professor, Vice Chair for Diversity, Equity, and Inclusion, Assistant Residency Director, Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine; Adjunct Faculty, Johns Hopkins School of Education
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22
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Mueller L, Morenas R, Loe M, Toraih E, Turner J. Gender and Race Demographics of Fellowships After General Surgery Training in the United States: A Five-Year Analysis in Applicant and Resident Trends. Am Surg 2022:31348221146945. [PMID: 36565153 DOI: 10.1177/00031348221146945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
INTRODUCTION The gender and minority gap in general surgery residency is narrowing; however, literature lacks comprehensive data regarding the demographics of fellowship programs following general surgery training. METHODS Data from 2017 to 2021 for gender, ethnicity, and surgical subspecialty are publicly available from the ERAS database and ACGME yearly data reports. Cochran-Armitage trend tests were used to determine statistical significance in trends for female and minority applicants and trainees. RESULTS The overall trend of female applicants to surgical specialties remained stagnant. However, female applicants to vascular surgery increased significantly from 25% to 35% (P = .045). There was no significant increase in female trainees in any surgical specialties evaluated. Furthermore, the overall trend of minority applicants to surgical specialties also remained stagnant, except for pediatric surgery, which showed significantly fewer minority applicants. Despite pediatric surgery having fewer applicants, minority trainees in this specialty increased significantly from 8% to 19% (P = .008). CONCLUSION Several current initiatives, such as intentional mentorship, are being reported to promote diverse and equal representation among female and minority applicants and trainees. However, the current overall margin of increase in diversity among surgical specialty applicants and trainees is minimal, indicating that continued efforts are needed to diversify surgical specialty training programs.
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Affiliation(s)
- Lauren Mueller
- School of Medicine, 12255Tulane University, New Orleans, LA, USA
| | - Rohan Morenas
- School of Medicine, 12255Tulane University, New Orleans, LA, USA
| | - Mallory Loe
- School of Medicine, 12255Tulane University, New Orleans, LA, USA
| | - Eman Toraih
- Division of Endocrine and Oncologic Surgery, Department of Surgery, School of Medicine, 12255Tulane University, New Orleans, LA, USA.,Genetics Unit, Department of Histology and Cell Biology, 12255Suez Canal University, Ismailia, Egypt
| | - Jacquelyn Turner
- Department of Surgery, Division of Colon and Rectal Surgery, 12255Tulane University School of Medicine, New Orleans, LA, USA
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Krecko LK, Jung S. Impacts of a Clinical Research Program for High School Students from Groups Historically Excluded from Science and Medicine. Health Equity 2022; 6:873-880. [PMID: 36479185 PMCID: PMC9712034 DOI: 10.1089/heq.2022.0050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/27/2022] [Indexed: 12/02/2022] Open
Abstract
Introduction Pathway programs engage students who identify with groups historically excluded from, and therefore underrepresented in, science, technology, engineering, math, and medicine (STEMM). We explored alumni-reported impacts of eight U.S. high school-to-college pathway programs funded by the Doris Duke Charitable Foundation (DDCF). Methods A survey was sent to 499 alumni to evaluate their perceptions of the DDCF programs, which offer mentored experiences in clinical research. A multivariate analysis was used to compare Likert-style questions related to the programs' impact on education and career plans. Open-ended responses were analyzed using inductive analysis. Results Two hundred sixty-nine alumni responded to the survey, the majority of whom identified as Hispanic/Latinx or Black/African American. One hundred nineteen alumni (∼75%) currently in college reported majoring in STEMM fields. Of college graduates, 30 (∼65%) obtained a degree in an STEMM field. Participants identifying as Hispanic/Latinx had a significantly higher reported level of impact of the programs on their plans to attend college. Most alumni felt that the programs impacted their chosen majors and future professions and made them more confident to pursue careers in STEMM. Discussion Surveyed alumni perceive DDCF programs to have positively impacted their interest, confidence, and skills in STEMM-related areas. Our results support the benefit of DDCF programs and substantiate their funding, integration into higher education systems, and iterative redesign to ensure positive impacts on students with diverse backgrounds. Health Equity Implications Assessment and improvement of pathway programs may support underrepresented students in their STEMM aspirations and increase the diversity of the medical and scientific workforce.
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Affiliation(s)
- Laura K. Krecko
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Sarah Jung
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
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Thompson BN, Colbert K, Nussbaum MS, Paget CJ. Practical Strategies for Underrepresented Minority Recruitment in General Surgery Residency. JOURNAL OF SURGICAL EDUCATION 2022; 79:e130-e136. [PMID: 36266229 DOI: 10.1016/j.jsurg.2022.09.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 08/19/2022] [Accepted: 09/10/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVE To analyze the effects of diversification efforts on underrepresented minority in medicine (URiM) resident recruitment in general surgery residency at a single large southeastern United States academic institution with five categorical positions. METHODS A retrospective review of applications from the 2016 to 2022 ACGME match cycles was conducted. In an effort to diversify resident recruitment, multiple new strategies were enacted in 2021. URiM candidates were identified via a more laborious review of individual applications to the program. In addition, a holistic review process was conducted, URiM faculty and residents were prominently featured, previous underperformance in diversity was openly addressed, and URiM applicants were contacted with follow up emails. Cohorts pre- and post-implementation of these strategies were analyzed. The proportion of URiM applicants invited, interviewed, ranked, and matched were compared. RESULTS Pre-intervention during the 2016to 20 match cycles, URiM candidates represented 4% of total applicants invited. Post-intervention during the 2021to 22 match cycles, URiM candidates represented 27% of total applicants invited. Over the past 5 years under the present program director, 1 URiM resident of 24 (4%) matched into the categorical program. Over the past 15 years under the direction of 3 program directors, a total of 6 out of 69 matched residents (9%) identified as URiM. Post intervention, the program matched on average 30% of its incoming categorical class from URiM candidates. CONCLUSION Recruitment and selection of diverse medical school applicants is an ongoing concern of general surgery residency program directors. Historically, URiM candidates are underrepresented in applicants selected for interview. Interventions aimed at increasing the matriculation of URiM include concentrated efforts to identify more URiM candidates for interview. However, importantly, transparency of ongoing diversity efforts and diversifying both faculty and trainees involved in the selection process may also improve general surgery URiM recruitment.
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Affiliation(s)
- Britany N Thompson
- Virginia Tech Carilion School of Medicine, Carilion Clinic, Department of Surgery, Roanoke, Virginia
| | - Kendra Colbert
- Virginia Tech Carilion School of Medicine, Carilion Clinic, Department of Surgery, Roanoke, Virginia
| | - Michael S Nussbaum
- Virginia Tech Carilion School of Medicine, Carilion Clinic, Department of Surgery, Roanoke, Virginia
| | - Charles J Paget
- Virginia Tech Carilion School of Medicine, Carilion Clinic, Department of Surgery, Roanoke, Virginia.
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Staples H, Frank S, Mullen M, Ogburn T, Hammoud MM, Morgan HK. Improving the Medical School to Residency Transition: Narrative Experiences From First-Year Residents. JOURNAL OF SURGICAL EDUCATION 2022; 79:1394-1401. [PMID: 35732576 DOI: 10.1016/j.jsurg.2022.06.001] [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: 03/24/2022] [Revised: 05/19/2022] [Accepted: 06/03/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVES We sought to identify first-year obstetrics and gynecology residents' perceptions of both support needed at the medical school to residency transition and readiness to address structural racism and bias at the start of residency training. STUDY DESIGN Residents were recruited by email and social media for 1:1 interviews from March to June 2021. All interviews were completed by a first-year resident or fourth-year medical student using an interview guide created by the authorship team. Recorded interviews were anonymously transcribed and independently reviewed for themes by two authors. SETTING Virtual interviews on the Zoom platform. PARTICIPANTS First-year obstetrics and gynecology residents. RESULTS Interviews were performed with 26 residents, and six themes for support emerged from their narratives: 1) Establishing a residency program community; 2) Relocation resources; 3) Residency preparation content in medical school and residency; 4) Preparedness to address racism and bias; 5) Connecting with peers with similar lived experiences across institutions; and 6) More proactive intentional touchpoints from program leadership early in residency. CONCLUSIONS Resident narratives described multiple crucial opportunities to improve learners' transition to residency. These findings can help define a roadmap of resources and support that residency programs can provide for learners from Match Day through the first few months of residency.
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Affiliation(s)
- Halley Staples
- Washington University School of Medicine in St. Louis, St. Louis, Missouri
| | | | - Mark Mullen
- Creighton University School of Medicine, Omaha, Nebraska
| | - Tony Ogburn
- University of Texas Rio Grande Valley, Edinburg, Texas
| | - Maya M Hammoud
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan; Department of Learning Health Sciences, University of Michigan, Ann Arbor, Michigan
| | - Helen K Morgan
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan; Department of Learning Health Sciences, University of Michigan, Ann Arbor, Michigan.
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Barrios P, Chen L, Bribriesco AC, Karamlou T. Comment on: State of Diversity in Surgery: How We Move Forward. Ann Surg 2022; 276:e639-e640. [PMID: 35129498 DOI: 10.1097/sla.0000000000005285] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Paola Barrios
- Cleveland Clinic Lerner College of Medicine Cleveland, OH
- Case Western Reserve University School of Medicine Cleveland, OH
| | - Lin Chen
- Case Western Reserve University School of Medicine Cleveland, OH
| | - Alejandro C Bribriesco
- Division of Thoracic Surgery Department of Thoracic and Cardiovascular Surgery, Heart Vascular and Thoracic Institute, Cleveland Clinic Cleveland, OH
| | - Tara Karamlou
- Division of Thoracic Surgery Department of Thoracic and Cardiovascular Surgery, Heart Vascular and Thoracic Institute, Cleveland Clinic Cleveland, OH
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Choubey AP, Bullock B, Hoste B, Ortiz A, Khan SA, Mishra A, Pearson T, Koizumi N, Ortiz J. Diversity in American Society of Transplant Surgeons Governance: Equitable but Unequal. EXP CLIN TRANSPLANT 2022; 20:973-979. [PMID: 34498553 DOI: 10.6002/ect.2021.0111] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVES The diversity in the governance of the American Society of Transplant Surgeons has not been described. We aimed to quantify the present state of its leadership as a baseline to inform future research. MATERIALS AND METHODS Lists of leaders on the American Society of Transplant Surgeons Council, the COVID-19 Strike Force, and 20 different American Society of Transplant Surgeons committees were obtained from the Society's website. Demographic and training information for the members were compiled through internet searches and analyzed. RESULTS The American Society of Transplant Surgeons Council included 15 members, with 20% women. It was 93.3% non-Hispanic White. The COVID-19 Strike Force included 12 surgeons, 16.7% of whom were female, with 75% non-Hispanic White. Of the 198 committee members, 23.7% were women, 68.7% were nonHispanic White, 16.6% were Asian, 8.1% were Hispanic, and 6.6% were Black. Among female committee members, underrepresented minorities comprised 23.6%. Committee chairs included 23% women, 23% underrepresented minorities, and 2.3% minority women. International medical graduates were more likely men (P = .02). CONCLUSIONS Representation of women in the American Society of Transplant Surgeons leadership has kept pace with their membership in the transplant surgery workforce. There is a deficiency of female under - represented minorities in leadership positions at the Society. Further interventions are required to recruit underrepresented minorities to transplant surgery, catalog their footprint in the workforce, and champion their role as leaders within the American Society of Transplant Surgeons.
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Affiliation(s)
- Ankur P Choubey
- From the Department of Surgery, University of Toledo Medical Center, Toledo, Ohio, USA
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28
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McElroy LM, Migaly J. Equity in surgical training: Pipeline or process? Am J Surg 2022; 224:248-249. [PMID: 35000754 PMCID: PMC10105602 DOI: 10.1016/j.amjsurg.2021.12.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 12/24/2021] [Accepted: 12/26/2021] [Indexed: 11/26/2022]
Affiliation(s)
- Lisa M McElroy
- Department of Surgery, Duke University School of Medicine, Durham, NC, United States.
| | - John Migaly
- Department of Surgery, Duke University School of Medicine, Durham, NC, United States.
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Koea J. The drawbacks of advantages. MEDICAL EDUCATION 2022; 56:596-598. [PMID: 35257396 PMCID: PMC9314907 DOI: 10.1111/medu.14795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Accepted: 03/01/2022] [Indexed: 06/14/2023]
Abstract
This commentary offers reflection on what is lost when selection interviews move into a virtual space, using Rodriguez et al. to argue that inviting applicants to visit, spend time and “be there” still looks like the best way to consider “fit.”
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Affiliation(s)
- Jonathan Koea
- Department of SurgeryNorth Shore HospitalAucklandNew Zealand
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30
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Keshinro A, Butler P, Fayanju O, Khabele D, Newman E, Greene W, Ude Welcome A, Joseph KA, Stallion A, Backhus L, Frangos S, DiMaggio C, Berman R, Hasson R, Rodriguez LM, Stain S, Bukur M, Klein MJ, Henry-Tillman R, Barry L, Oseni T, Martin C, Johnson-Mann C, Smith R, Karpeh M, White C, Turner P, Pugh C, Hayes-Jordan A, Berry C. Examination of Intersectionality and the Pipeline for Black Academic Surgeons. JAMA Surg 2022; 157:327-334. [PMID: 35138327 PMCID: PMC8829744 DOI: 10.1001/jamasurg.2021.7430] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE The lack of underrepresented in medicine physicians within US academic surgery continues, with Black surgeons representing a disproportionately low number. OBJECTIVE To evaluate the trend of general surgery residency application, matriculation, and graduation rates for Black trainees compared with their racial and ethnic counterparts over time. DESIGN, SETTING, AND PARTICIPANTS In this nationwide multicenter study, data from the Electronic Residency Application Service (ERAS) for the general surgery residency match and Graduate Medical Education (GME) surveys of graduating general surgery residents were retrospectively reviewed and stratified by race, ethnicity, and sex. Analyses consisted of descriptive statistics, time series plots, and simple linear regression for the rate of change over time. Medical students and general surgery residency trainees of Asian, Black, Hispanic or Latino of Spanish origin, White, and other races were included. Data for non-US citizens or nonpermanent residents were excluded. Data were collected from 2005 to 2018, and data were analyzed in March 2021. MAIN OUTCOMES AND MEASURES Primary outcomes included the rates of application, matriculation, and graduation from general surgery residency programs. RESULTS Over the study period, there were 71 687 applicants, 26 237 first-year matriculants, and 24 893 graduates. Of 71 687 applicants, 24 618 (34.3%) were women, 16 602 (23.2%) were Asian, 5968 (8.3%) were Black, 2455 (3.4%) were Latino, and 31 197 (43.5%) were White. Women applicants and graduates increased from 29.4% (1178 of 4003) to 37.1% (2293 of 6181) and 23.5% (463 of 1967) to 33.5% (719 of 2147), respectively. When stratified by race and ethnicity, applications from Black women increased from 2.2% (87 of 4003) to 3.5% (215 of 6181) (P < .001) while applications from Black men remained unchanged (3.7% [150 of 4003] to 4.6% [284 of 6181]). While the matriculation rate for Black women remained unchanged (2.4% [46 of 1919] to 2.3% [52 of 2264]), the matriculation rate for Black men significantly decreased (3.0% [57 of 1919] to 2.4% [54 of 2264]; P = .04). Among Black graduates, there was a significant decline in graduation for men (4.3% [85 of 1967] to 2.7% [57 of 2147]; P = .03) with the rate among women remaining unchanged (1.7% [33 of 1967] to 2.2% [47 of 2147]). CONCLUSIONS AND RELEVANCE Findings of this study show that the underrepresentation of Black physicians at every stage in surgical training pipeline persists. Black men are especially affected. Identifying factors that address intersectionality and contribute to the successful recruitment and retention of Black trainees in general surgery residency is critical for achieving racial and ethnic as well as gender equity.
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Affiliation(s)
- Ajaratu Keshinro
- Department of Surgery, New York University Grossman School of Medicine, New York
| | - Paris Butler
- Division of Plastic Surgery, University of Pennsylvania Health System, Philadelphia
| | | | - Dineo Khabele
- Department of Obstetrics and Gynecology, Washington University School of Medicine, St Louis, Missouri
| | - Erika Newman
- Department of Surgery, University of Michigan School of Medicine, Ann Arbor
| | - Wendy Greene
- Department of Surgery, Emory University School of Medicine, Atlanta, Georgia
| | - Akuezunkpa Ude Welcome
- Department of Surgery, New York University Grossman School of Medicine, New York,Department of Surgery, NYC Health+ Hospitals/Bellevue, New York, New York
| | - Kathie-Ann Joseph
- Department of Surgery, New York University Grossman School of Medicine, New York,Department of Surgery, NYC Health+ Hospitals/Bellevue, New York, New York
| | - Anthony Stallion
- Department of Surgery, Oakland University William Beaumont School of Medicine, Royal Oak, Michigan
| | - Leah Backhus
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, California
| | - Spiros Frangos
- Department of Surgery, New York University Grossman School of Medicine, New York,Department of Surgery, NYC Health+ Hospitals/Bellevue, New York, New York
| | - Charles DiMaggio
- Department of Surgery, New York University Grossman School of Medicine, New York,Department of Surgery, NYC Health+ Hospitals/Bellevue, New York, New York
| | - Russell Berman
- Department of Surgery, New York University Grossman School of Medicine, New York,Department of Surgery, NYC Health+ Hospitals/Bellevue, New York, New York
| | - Rian Hasson
- Department of Surgery, Geisel School of Medicine of Dartmouth College, Hanover, New Hampshire
| | - Luz Maria Rodriguez
- Gastrointestinal and Other Cancers Research Group, National Cancer Institute, Rockville, Maryland,Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Steven Stain
- Department of Surgery, Lahey Hospital and Medical Center, Burlington, Massachusetts
| | - Marko Bukur
- Department of Surgery, New York University Grossman School of Medicine, New York,Department of Surgery, NYC Health+ Hospitals/Bellevue, New York, New York
| | - Michael J. Klein
- Department of Surgery, New York University Grossman School of Medicine, New York,Department of Surgery, NYC Health+ Hospitals/Bellevue, New York, New York
| | - Ronda Henry-Tillman
- Department of Surgery, University of Arkansas for Medical Sciences, Little Rock
| | - Linda Barry
- Department of Surgery, University of Connecticut Health, Farmington
| | - Tawakalitu Oseni
- MGH Department of Surgery, Harvard Medical School, Boston, Massachusetts
| | - Colin Martin
- Department of Surgery, University of Alabama at Birmingham
| | | | - Randi Smith
- Department of Surgery, Emory University School of Medicine, Atlanta, Georgia
| | - Martin Karpeh
- Department of Surgery, Northwell Health, Huntington, New York
| | | | | | - Carla Pugh
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, California
| | - Andrea Hayes-Jordan
- Department of Surgery, University of North Carolina School of Medicine in Chapel Hill
| | - Cherisse Berry
- Department of Surgery, New York University Grossman School of Medicine, New York,Department of Surgery, NYC Health+ Hospitals/Bellevue, New York, New York
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A disturbing trend: An analysis of the decline in surgical critical care (SCC) fellowship training of Black and Hispanic surgeons. J Trauma Acute Care Surg 2022; 93:84-90. [PMID: 35343928 DOI: 10.1097/ta.0000000000003621] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Underrepresented minorities in medicine (URiM) are disproportionally represented in surgery training programs. Rates of URiM applying to and completing General Surgery residency remain low. We hypothesized that the patterns of URiM disparities would persist into Surgical Critical Care (SCC) fellowship applicants, matriculants and graduates. METHODS We performed a retrospective analysis of SCC applicants, matriculants and graduates from 2005-2020 using the Graduate Medical Education (GME) resident survey and analyzed applicant characteristics using the Surgical critical care and Acute care surgery Fellowship Application Service (SAFAS) from 2018-2020. The data were stratified by race/ethnicity and gender. Indicator variables were created for Asian, Hispanic, White and Black trainees. Yearly proportions for each race/ethnicity and gender categories completing or enrolling in a program were calculated and plotted over time with Loess smoothing lines and overlying 95% confidence bands. The yearly rate and statistical significance of change over time were tested with linear regression models with race/ethnicity and gender proportion as the dependent variables and year as the explanatory variable. RESULTS From 2005-2020, there were a total of 2,481 graduates. Black men accounted for 4.7% of male graduates with a significant decline of 0.3% per year for the study period of those completing the fellowship (p = 0.02). Black women comprised 6.4% of female graduates and had a 0.6% decline each year (p < 0.01). A similar trend was seen with Hispanic men, who comprised 3.2% of male graduates and had a 0.3% annual decline (p = 0.02). White men had a significant increase in both matriculation to and graduation from SCC fellowships during the same interval. Similarly, Black and Hispanic applicants declined from 2019 to 2020, while the percentage of White applicants increased. CONCLUSIONS Disparities in URiM representation remain omnipresent in surgery and extend from residency training to SCC fellowship. Efforts to enhance the recruitment and retention of URiM in SCC training are warranted. LEVEL OF EVIDENCE Level IV - Therapeutic/Care Management.
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Kearse LE, Jensen RM, Schmiederer IS, Zeineddin A, Anderson TN, Dent DL, Payne DH, Korndorffer JR. Diversity, Equity, and Inclusion: A Current Analysis of General Surgery Residency Programs. Am Surg 2022; 88:414-418. [PMID: 34730421 DOI: 10.1177/00031348211048824] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Local, regional, and national diversity, equity, and inclusion (DEI) initiatives have been established to combat barriers to entry and promote retention in surgery residency programs. Our study evaluates changes in diversity in general surgery residency programs. We hypothesize that diversity trends have remained stable nationally and regionally. MATERIALS AND METHODS General surgery residents in all postgraduate years were queried regarding their self-reported sex, race, and ethnicity following the 2020 ABSITE. Residents were then grouped into geographic regions. Data were analyzed utilizing descriptive statistics, Kruskal-Wallis test, and chi-square analyses. RESULTS A total of 9276 residents responded. Nationally, increases in female residents were noted from 38.0 to 46.0% (P < .001) and in Hispanic or Latinx residents from 7.3 to 8.3% (P = .031). Across geographic regions, a significant increase in female residents was noted in the Northwest (51.9 to 58.3%, P = .039), Midwest (36.9 to 43.3%, P = .006), and Southwest (35.8 to 47.5%, P = .027). A significant increase in black residents was only noted in the Northwest (0 to 15.8%, P = .031). The proportion of white residents decreased nationally by 8.9% and in the Mid-Atlantic, Southeast, and Southwest between 5.5 and 15.9% (P < .05). DISCUSSION In an increasingly diverse society, expanding the numbers of underrepresented surgeons in training, and ultimately in practice, is a necessity. This study shows that there are region-specific increases in diversity, despite minimal change on a national level. This finding may suggest the need for region-specific DEI strategies and initiatives. Future studies will seek to evaluate individual programs with DEI plans and determine if there is a correlation to changing demographics.
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Affiliation(s)
- LaDonna E Kearse
- Department of Surgery, 10624Stanford University, Stanford, CA, USA
| | - Rachel M Jensen
- Department of Surgery, 10624Stanford University, Stanford, CA, USA
| | | | - Ahmad Zeineddin
- Department of Surgery, 20814Howard University, Washington, DC, USA
| | - Tiffany N Anderson
- Department of Surgery, 440202University of Florida, Gainesville, FL, USA
| | - Daniel L Dent
- Department of Surgery, 14742University of Texas Health at San Antonio, San Antonio, TX, USA
| | - Davis H Payne
- Department of Surgery, 14742University of Texas Health at San Antonio, San Antonio, TX, USA
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Blalock AE, Smith MC, Patterson BR, Greenberg A, Smith BRG, Choi C. "I might not fit that doctor image": Ideal worker norms and women medical students. MEDICAL EDUCATION 2022; 56:339-348. [PMID: 34862660 DOI: 10.1111/medu.14709] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 11/16/2021] [Accepted: 11/22/2021] [Indexed: 06/13/2023]
Abstract
Despite the increasing numbers of women students in medical schools, focused attention on their perceptions about medical school and the medical profession remain underexamined. These perceptions are important to understand, particularly since women students are likely burdened with a host of gender norms related to work, family, and their future roles as physicians. Early experiences in medical school offer important insights into the larger student experience and are tied to academic outcomes and feelings of belonging. To examine early experiences of women medical students, this qualitative study used sensemaking theory to describe the current context and "story" of ideal worker norms. Critical qualitative interviews of 38 women students were performed during their first 2 months of medical school and explored both how the students perceived and experienced ideal worker norms, and how they made sense of the "story" of ideal worker norms. The participants described ways they encountered gendering and ideal worker norms through displays of nurturing behaviour, expectations to balance a future family, and whether they looked or acted the part of a doctor. This article highlights the challenges women medical students are already aware they will face, the opportunities they look forward to, and the strengths they anticipate leaning on to navigate their profession. Results from this study have implications for women medical students' learning experiences and transitions into medical school and for faculty, staff, and scholars concerned with challenging gendering norms that shape medical education.
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Affiliation(s)
- A Emiko Blalock
- Office of Medical Education Research and Development, College of Human Medicine, Michigan State University, East Lansing, Michigan, USA
| | | | - B R Patterson
- Premed, University of North Carolina System, Chapel Hill, North Carolina, USA
| | - Amy Greenberg
- Office of Medical Education Research and Development, Office of Academic Affairs, College of Human Medicine, Michigan State University, East Lansing, Michigan, USA
| | - Brandon R G Smith
- Higher Adult and Lifelong Education, Michigan State University, East Lansing, Michigan, USA
| | - Christine Choi
- Student Affairs, Michigan State University, East Lansing, Michigan, USA
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Choubey AP, Bullock B, Choubey AS, Ortiz J. Diversity among transplant surgery fellowship program directors: a call to action. HPB (Oxford) 2022; 24:386-390. [PMID: 34400052 DOI: 10.1016/j.hpb.2021.07.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 07/04/2021] [Accepted: 07/16/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND The diversity among general surgery residency, HPB and other fellowship program directors has been previously analyzed. However, the diversity in abdominal transplant surgery fellowship program directors remains unknown. METHODS Abdominal transplant fellowship programs and the corresponding program directors were identified from the American Society of Transplant Surgeons website. Demographic and training information for the members was compiled through internet searches and analyzed. RESULTS 72 program directors were included. 83.33% were male. 63.9% were non-Hispanic White, 25% were Asian, along with 5.56% Hispanic and Black each. Male program directors were more likely to be Associate Professor (p = 0.041), while females were more likely to be Assistant Professor (p = 0.021). 66% of female program directors were non-Hispanic White. CONCLUSION Transplant surgery fellowship programs are primarily led by male and non-Hispanic White surgeons. Female representation as leaders is on par with their membership in the transplant surgery workforce. There is a deficiency of both male and female underrepresented minorities in program director positions.
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Affiliation(s)
- Ankur P Choubey
- Department of Surgery, Rutgers Robert Wood Johnson University Hospital, New Brunswick NJ, USA.
| | - Brenna Bullock
- Department of Surgery, University of Toledo Medical Center, OH, USA
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Hernandez S, Nnamani Silva ON, Conroy P, Weiser L, Thompson A, Mohamedaly S, Coe TM, Alseidi A, Campbell AR, Sosa JA, Gosnell J, Lin MYC, Roman SA. Bursting the Hidden Curriculum Bubble: A Surgical Near-Peer Mentorship Pilot Program for URM Medical Students. JOURNAL OF SURGICAL EDUCATION 2022; 79:11-16. [PMID: 34315681 PMCID: PMC9308488 DOI: 10.1016/j.jsurg.2021.07.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 06/11/2021] [Accepted: 07/06/2021] [Indexed: 06/13/2023]
Abstract
The hidden curriculum of unspoken professional expectations negatively impacts medical student interest in surgery. Medical student mentorship and early surgical exposure have been shown to demystify the hidden curriculum. Although residents and faculty play a vital role, near-peer mentorship may aid in uncovering the hidden curriculum and promoting medical student interest in surgery, especially for those learners who are underrepresented in medicine. We developed and implemented a formalized near-peer mentorship program composed of quarterly small group Surgical Peer Teacher led lessons and one-on-one Surgical Support Team mentorship meetings covering surgical curriculum topics for medical students at an academic medical school. This structured near-peer mentorship model provides a mechanism to demystify surgical culture, increase early access to surgical mentorship, and develop mentorship skills amongst students. This program aims to uncover the surgical hidden curriculum to improve surgical career support and interest among medical students with less exposure and access to physician role models. This longitudinal mentorship model is student-run and can be easily adapted to enhance existing support models at medical schools. Future studies will evaluate utilization, impact on surgical specialty interest, and efficacy in demystifying the surgical hidden curriculum.
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Affiliation(s)
- Sophia Hernandez
- University of California, San Francisco Department of Surgery, San Francisco, California
| | - Ogonna N Nnamani Silva
- Department of Surgery, Division of Plastic Surgery, Harvard Medical School, Boston, Massachusetts
| | - Patricia Conroy
- University of California, San Francisco Department of Surgery, San Francisco, California
| | - Lucas Weiser
- University of California, San Francisco School of Medicine, San Francisco, California
| | - Avery Thompson
- University of California, San Francisco School of Medicine, San Francisco, California
| | - Sarah Mohamedaly
- University of California, San Francisco Department of Surgery, San Francisco, California
| | - Taylor M Coe
- Massachusetts General Hospital, Department of Surgery, Boston, Massachusetts
| | - Adnan Alseidi
- University of California, San Francisco Department of Surgery, San Francisco, California
| | - Andre R Campbell
- University of California, San Francisco Department of Surgery, San Francisco, California
| | - Julie Ann Sosa
- University of California, San Francisco Department of Surgery, San Francisco, California
| | - Jessica Gosnell
- University of California, San Francisco Department of Surgery, San Francisco, California
| | - Matthew Y C Lin
- University of California, San Francisco Department of Surgery, San Francisco, California
| | - Sanziana A Roman
- University of California, San Francisco Department of Surgery, San Francisco, California.
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Ramnath RE, Sorensen MJ. Students, stereotypes, and surgery: Invited commentary for "Eye of the Beholders: First year medical students perceptions of surgeons and the field of surgery. Am J Surg 2021; 223:1024-1025. [PMID: 34895895 DOI: 10.1016/j.amjsurg.2021.12.007] [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: 12/06/2021] [Accepted: 12/06/2021] [Indexed: 11/29/2022]
Affiliation(s)
| | - Meredith J Sorensen
- Dartmouth Hitchcock Medical Center, Lebanon, NH, United States; Geisel Medical School at Dartmouth, Hanover, NH, United States.
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Brasel K, Berry C, Williams BH, Henry SM, Upperman J, West MA. Lofty goals and strategic plans are not enough to achieve and maintain a diverse workforce: an American Association for the Surgery of Trauma Diversity, Equity, and Inclusion Committee conversation. Trauma Surg Acute Care Open 2021; 6:e000813. [PMID: 34805547 PMCID: PMC8576479 DOI: 10.1136/tsaco-2021-000813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 10/18/2021] [Indexed: 11/04/2022] Open
Abstract
The American Association for the Surgery of Trauma Diversity, Equity, and Inclusion (DEI) Ad Hoc Committee organized a luncheon symposium with a distinguished panel of experts to discuss how to ensure a diverse surgical workforce. The panelists discussed the current state of DEI efforts within surgical departments and societal demographic changes that inform and necessitate surgical workforce adaptations. Concrete recommendations included the following: obtain internal data, establish DEI committee, include bias training, review hiring and compensation practices, support the department members doing the DEI work, commit adequate funding, be intentional with DEI efforts, and develop and support alternate pathways for promotion and tenure.
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Affiliation(s)
- Karen Brasel
- Department of Surgery, Oregon Health & Science University, Portland, Oregon, USA
| | - Cherisse Berry
- Department of Surgery, New York University Grossman School of Medicine, New York, New York, USA
| | - Brian H Williams
- Department of Surgery, University of Chicago Pritzker School of Medicine, Chicago, Illinois, USA
| | - Sharon M Henry
- Department of Surgery, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Jeffrey Upperman
- Pediatric Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Michaela A West
- Department Trauma and Acute Care Surgery, North Memorial Health, Minneapolis, Minnesota, USA
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Bradford PS, Akyeampong D, Fleming MA, Dacus AR, Chhabra AB, DeGeorge BR. Racial and Gender Discrimination in Hand Surgery Letters of Recommendation. J Hand Surg Am 2021; 46:998-1005.e2. [PMID: 34420838 DOI: 10.1016/j.jhsa.2021.07.009] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Revised: 06/29/2021] [Accepted: 07/09/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE We sought to evaluate hand surgery applicants' letters of recommendations to understand whether applicant and letter writer demographics contribute to racial and gender bias. METHODS All applications submitted through the American Society for Surgery of the Hand match to a single institution fellowship program for the 2017 to 2019 application cycles were analyzed using validated text analysis software. Race/ethnicity information was derived from an analysis of applicant photos using the Face Secret Pro software. Primary outcome measures were differences in communal and agentic language used in letters of recommendation, stratified by both race/ethnicity and gender. RESULTS A total of 912 letters of recommendation were analyzed for 233 applicants (51 female and 172 male). Of these, 88 were written by female letter writers and 824 were written by male letter writers. There were 8 Black, 12 Hispanic, 36 Asian, and 167 White applicants. Letter writers used more agentic language with Asian applicants and non-White applicants overall. Female letter writers used more communal terms and were not associated with applicant race or gender. CONCLUSIONS Letters of recommendation in hand surgery demonstrate disparities in language based on race and gender. CLINICAL RELEVANCE Alerting letter writers to the role of implicit bias will hopefully spur a discussion on tools to mitigate the use of biased language and provide a foundation for an equitable selection process. Efforts to improve policies and procedures pertaining to diversity and inclusion are paramount to ensuring that fellows more completely represent the population hand surgeons wish to serve.
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Affiliation(s)
- Perry S Bradford
- Department of Plastic Surgery, University of Virginia Health System, Charlottesville, VA
| | | | - Mark A Fleming
- Department of General Surgery, University of Virginia Health System, Charlottesville, VA
| | - A Rashard Dacus
- Department of Orthopedic Surgery, University of Virginia Health System, Charlottesville, VA
| | - A Bobby Chhabra
- Department of Orthopedic Surgery, University of Virginia Health System, Charlottesville, VA
| | - Brent R DeGeorge
- Department of Plastic Surgery, University of Virginia Health System, Charlottesville, VA; Department of Orthopedic Surgery, University of Virginia Health System, Charlottesville, VA.
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West MA. Discrimination, Harassment, and Bullying Is Reported to be High by LGBTQ+ Surgical Residents. JAMA Surg 2021; 157:32-33. [PMID: 34668960 DOI: 10.1001/jamasurg.2021.5272] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Hemal K, Reghunathan M, Newsom M, Davis G, Gosman A. Diversity and Inclusion: A Review of Effective Initiatives in Surgery. JOURNAL OF SURGICAL EDUCATION 2021; 78:1500-1515. [PMID: 33879396 DOI: 10.1016/j.jsurg.2021.03.010] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 03/07/2021] [Accepted: 03/21/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE Surgery lacks women and racial minorities that are underrepresented in medicine (UIM). This systematic review evaluates interventions used to promote diversity in surgery. DESIGN The PubMed (MEDLINE), EMBASE, and Cochrane databases were searched for studies (1) describing interventions for increasing UIM and gender diversity, (2) within surgery, and (3) targeting any learner prior to residency. SETTING Nine surgical specialties were searched: general, neurosurgery, plastics, orthopedics, otolaryngology, urology, cardiothoracic, vascular, and ophthalmology. RESULTS Of the 982 studies identified, 16 were included. Awards, clerkships, and workshops were each described by three studies; awards funded research or travel to national meetings, clerkships referred to a third- or fourth-year rotation that provided exposure to surgery, and workshops were hands-on skills sessions for learners. Two studies proposed a holistic review of residency applications, which involves emphasizing an individual's attributes and life experiences rather than strictly academics. Two studies detailed a longitudinal mentoring program comprised of mentorship throughout medical school plus opportunities for research, lectures, and workshops. One study described a combination of interventions and the remaining 2 presented interventions that were characterized as "other." Longitudinal mentoring programs significantly increased the likelihood of women and UIM applying to surgical residency, while holistic review significantly increased the numbers of women and UIM being interviewed and ranked by residency programs. One award increased the number of female residents matriculating into surgical residency. Clerkships significantly increased the number of women applying to surgical residency. The mere mention of diversity initiatives on a program's website was associated with more female surgical residents, but not UIM residents. Workshops led to a higher, but not statistically significant, proportion of women applying to surgery. CONCLUSION Holistic review and longitudinal mentoring programs are the most effective interventions for increasing UIM and female representation among surgical trainees.
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Affiliation(s)
- Kshipra Hemal
- Department of Plastic and Reconstructive Surgery, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Meera Reghunathan
- Division of Plastic and Reconstructive Surgery, University of San Diego, San Diego, California
| | - Megan Newsom
- Department of Plastic and Reconstructive Surgery, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Greta Davis
- Division of Plastic and Reconstructive Surgery, University of San Diego, San Diego, California
| | - Amanda Gosman
- Division of Plastic and Reconstructive Surgery, University of San Diego, San Diego, California.
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Santos-Parker JR, Santos-Parker KS, Caceres J, Vargas GM, Kwakye G, Englesbe MJ, Valbuena VSM. Building an Equitable Surgical Training Pipeline: Leadership Exposure for the Advancement of Gender and Underrepresented Minority Equity in Surgery (LEAGUES). JOURNAL OF SURGICAL EDUCATION 2021; 78:1413-1418. [PMID: 33664009 DOI: 10.1016/j.jsurg.2021.01.017] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 01/12/2021] [Accepted: 01/23/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE Underrepresented minority (URM) medical students face many educational challenges. Barriers include lack of equitable representation, scarce mentorship, and the effects of systemic racism. For students interested in diversity and health equity, perceptions of surgical culture may discourage pursuing surgical specialties. We describe a national pilot for a novel surgical pipeline program, Leadership Exposure for the Advancement of Gender and Underrepresented Minority Equity in Surgery (LEAGUES), which utilizes early exposure, mentorship, and community building to empower URM students in pursuit of academic surgical careers. DESIGN A 4-week virtual program included pairing students with faculty research mentors, virtual skills sessions, and seminars on leadership, advocacy, and career development. Participants underwent semi-structured interviews before and after participation, assessing experiences with mentorship and research, interest in surgery, career aspirations, and perceived barriers to career goals. SETTING Department of Surgery, Michigan Medicine, Ann Arbor, Michigan. PARTICIPANTS Rising second-year medical students. RESULTS All 3 participants were Latinx; 2 were first-generation college students. Participants had no surgical mentorship and limited research exposure, citing a desire to learn research methodology, connect with mentors, and build towards a career working with underserved communities as motivating factors for participation. Perceived barriers to a surgical career included surgical culture, burnout, and lack of research expertise or academic network necessary for success. At completion of the program, participants described several themes: (1) new positive perspective on academic surgical culture, (2) interest and confidence in research, (3) hope for improving health disparities, (4) networking and longitudinal mentorship connections contributing to a sense of surgical community, and (5) eagerness to share resources with colleagues at their home institutions. CONCLUSIONS LEAGUES program participants acquired tools and motivation to pursue careers in surgery, and established valuable longitudinal network and mentor relationships. LEAGUES is a novel model for national surgical pipeline programs.
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Affiliation(s)
| | | | - Juan Caceres
- University of Michigan Medical School, Ann Arbor, Michigan
| | | | - Gifty Kwakye
- Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | | | - Valeria S M Valbuena
- Department of Surgery, University of Michigan, Ann Arbor, Michigan; National Clinician Scholars Program, Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan; Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, Michigan.
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Olive JK, Mansoor S, Simpson K, Cornwell LD, Jimenez E, Ghanta RK, Groth SS, Burt BM, Rosengart TK, Coselli JS, Preventza O. Demographic Landscape of Cardiothoracic Surgeons and Residents at United States Training Programs. Ann Thorac Surg 2021; 114:108-114. [PMID: 34454903 DOI: 10.1016/j.athoracsur.2021.07.076] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 06/29/2021] [Accepted: 07/20/2021] [Indexed: 11/01/2022]
Abstract
BACKGROUND Recruiting and promoting women and racial/ethnic minorities could help enhance diversity and inclusion in the academic cardiothoracic (CT) surgery workforce. However, the demographics of trainees and faculty at US training programs have not yet been studied. METHODS Traditional, integrated (I-6), and fast-track (4+3) programs listed in the Accreditation Council for Graduate Medical Education (ACGME) public database were analyzed. Demographics of trainees and surgeons, including gender, race/ethnicity, subspecialty, and academic appointment (if applicable), were obtained from ACGME Data Resource Books, institutional websites, and public profiles. Chi-square and Cochran-Armitage trend tests were performed. RESULTS In July 2020, 78 institutions had at least one CT surgery training program; 40 (51%) had only a traditional program, 20 (26%) traditional and I-6, 6 (8%) all three types of program, and 4 (5%) only I-6. The proportion of female trainees increased significantly from 2011 to 2019 (19% vs 24%, p<0.001), with female I-6 trainees outnumbering female traditional trainees since 2018. Significant increases by race/ethnicity were observed overall and by program type, notably for Asians and Hispanics in I-6 programs and Blacks in traditional programs. Finally, of the 1,175 CT surgeons identified, 633 (54%) were adult cardiac surgeons, 360 (37%) assistant professors, 116 (10%) women, and 33 (3%) Black. CONCLUSIONS The demographic landscape of CT surgery trainees and faculty across multiple training pathways reflects increasing representation by gender and race/ethnicity. However, we must continue to work toward equitable representation in the workforce to benefit the diverse patients we treat.
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Affiliation(s)
| | | | - Katherine Simpson
- Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Lorraine D Cornwell
- Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Ernesto Jimenez
- Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Ravi K Ghanta
- Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Shawn S Groth
- Division of General Thoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Bryan M Burt
- Division of General Thoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Todd K Rosengart
- Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Joseph S Coselli
- Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas; Department of Cardiovascular Surgery, Texas Heart Institute, Houston, Texas
| | - Ourania Preventza
- Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas; Department of Cardiovascular Surgery, Texas Heart Institute, Houston, Texas.
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Dekhou A, Jahshan A, Aoun M, Folbe A. The Representation of Women and Ethnic Minorities among Integrated Plastic Surgery Trainees: A Persistent Need for Diversification. J Natl Med Assoc 2021; 113:576-579. [PMID: 34112525 DOI: 10.1016/j.jnma.2021.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 04/26/2021] [Accepted: 05/11/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Diversity in the workplace is crucial. As the United States population continues to diversify, the composition of graduate medical trainees (GMTs) among various medical specialties is not diversifying at nearly the same rate. This study aims to identify gender and ethnic minority disparities present in medicine, specifically among GMTs in the field of plastic surgery. PURPOSE The field of plastic surgery is vast, with the patient population ranging from newborns to elders of all different races, religions, and ethnicities. However, the representation of women and minorities among the current plastic surgery trainees is not equivalent to the population they serve. METHODS Data from the Graduate Medical Education (GME) census published in the Journal of the American Medical Association (JAMA) was analyzed to compare trends of female and underrepresented ethnic minorities over the academic period from 2015 through 2019. Data regarding all GMTs and specifically those in the integrated plastic surgery (IPS) program was collected. RESULTS Over the five-year study period, females were consistently underrepresented in plastic surgery when compared to the total number of female medical trainees. Currently, females represent 42.7% of GMTs in IPS, a small increase from 40.9% in 2015. Furthermore, Whites and Asians encompassed 87.7% (65.6% and 22.1%, respectively) of plastic surgery GMTs in 2019-2020. In the same academic year, Blacks and Hispanics together made up only 9.1% (2.5% and 6.6%, respectively) of GMTs in plastic surgery. CONCLUSION This study portrays the importance of highlighting gender and ethnic minority disparities in the field of plastic surgery, thereby promoting initiatives for change in the coming future.
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Affiliation(s)
- Antonio Dekhou
- Oakland University William Beaumont School of Medicine, Rochester, MI, USA.
| | - Anna Jahshan
- Oakland University William Beaumont School of Medicine, Rochester, MI, USA
| | - Mariam Aoun
- Oakland University William Beaumont School of Medicine, Rochester, MI, USA
| | - Adam Folbe
- William Beaumont Hospital - Royal Oak, Department of Otolaryngology, Royal Oak, MI, USA
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María FM, Lorena MR, María Luz FV, Cristina RV, Dolores PD, Fernando TF. Overall management of emergency general surgery patients during the surge of the COVID-19 pandemic: an analysis of procedures and outcomes from a teaching hospital at the worst hit area in Spain. Eur J Trauma Emerg Surg 2021; 47:693-702. [PMID: 33399877 PMCID: PMC7782559 DOI: 10.1007/s00068-020-01558-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Accepted: 11/16/2020] [Indexed: 01/19/2023]
Abstract
Objective To assess how the COVID-19 outbreak has affected emergency general surgery (EGS) care during the pandemic, indications for surgery, types of procedures, perioperative course, and final outcomes. Methods This is a retrospective study of EGS patients during the pandemic period. The main outcome was 30-day morbidity and mortality according to severity and COVID-19 infection status. Secondary outcomes were changes in overall management. A logistic regression analysis was done to assess factors predictive of mortality. Results One hundred and fifty-three patients were included. Half of the patients with an abdominal ultrasound and/or CT scan had signs of severity at diagnosis, four times higher than the previous year. Non-COVID patients underwent surgery more often than the COVID group. Over 1/3 of 100 operated patients had postoperative morbidity, versus only 15% the previous year. The most common complications were septic shock, pneumonia, and ARDS. ICU care was required in 17% of patients, and was most often required in the SARS-CoV-2-infected group, which also had a higher morbidity and mortality. The 30-day mortality in the surgical series was of 7%, with no differences with the previous year. The strongest independent predictors of overall mortality were age > 70 years, ASA III–IV, ESS > 9, and SARS-CoV-2 infection. Conclusions Non-operative management (NOM) was undertaken in a third of patients, and only 14% of operated patients had a perioperative confirmation of -CoV-2 infection. The severity and morbidity of COVID-19-infected patients was much higher. Late presentations for medical care may have added to the high morbidity of the series.
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Affiliation(s)
- Fernández-Martínez María
- Emergency General Surgery Unit (General and Gastrointestinal Surgery Service), University General Hospital Gregorio Marañón, Doctor Esquerdo 46, 28007, Madrid, Spain.
| | - Martín-Román Lorena
- Emergency General Surgery Unit (General and Gastrointestinal Surgery Service), University General Hospital Gregorio Marañón, Doctor Esquerdo 46, 28007, Madrid, Spain
| | - Fernández-Vázquez María Luz
- Emergency General Surgery Unit (General and Gastrointestinal Surgery Service), University General Hospital Gregorio Marañón, Doctor Esquerdo 46, 28007, Madrid, Spain
| | - Rey-Valcarcel Cristina
- Emergency General Surgery Unit (General and Gastrointestinal Surgery Service), University General Hospital Gregorio Marañón, Doctor Esquerdo 46, 28007, Madrid, Spain
| | - Pérez-Díaz Dolores
- Emergency General Surgery Unit (General and Gastrointestinal Surgery Service), University General Hospital Gregorio Marañón, Doctor Esquerdo 46, 28007, Madrid, Spain
| | - Turégano-Fuentes Fernando
- Emergency General Surgery Unit (General and Gastrointestinal Surgery Service), University General Hospital Gregorio Marañón, Doctor Esquerdo 46, 28007, Madrid, Spain
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