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Oleru OO, Shamamian PE, Levy L, Gyasi A, Wang C, Seyidova N, Henderson PW. Underrepresented in Medicine Applicants are Less Likely to Successfully Match into Plastic Surgery. JOURNAL OF SURGICAL EDUCATION 2024; 81:1066-1074. [PMID: 38806307 DOI: 10.1016/j.jsurg.2024.05.007] [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: 01/17/2024] [Revised: 04/02/2024] [Accepted: 05/10/2024] [Indexed: 05/30/2024]
Abstract
IMPORTANCE The lack of underrepresented in medicine physicians in academic plastic surgery has been a topic of interest for many years, and accordingly outreach has been undertaken to address the pipeline from medical school to residency and beyond. OBJECTIVE This study aims to assess and identify the characteristics associated with plastic surgery match success for underrepresented in medicine applicants. DESIGN Residency application data for first time, US allopathic medical school seniors from the 2017-2018 to 2021-2022 applicant cycles were abstracted from Electronic Residency Application Service applications, and match results were determined using the National Residency Matching Program database and online public sources. Data included self-reported race, and multiple application characteristics. Multivariable logistic regression of application characteristics were used to assess the relationship between underrepresented in medicine status and successfully matching. Binary logistic regression was used in subgroup analyses of each application characteristic, and interactions regression was used to evaluate the relative weight of each characteristic on successfully matching. RESULTS Underrepresented in medicine applicants were 57% less likely to match than non-underrepresented in medicine applicants (OR 0.43, p = 0.001), though they were 60% less likely to match (ORadj 0.4, p = 0.216) when adjusted. Subgroup analysis revealed that odds of matching as an underrepresented in medicine applicant were significantly increased if the applicant had a home program, took a research year, and had an increased number of published research and presentations (ORs 0.43-0.48, all p < 0.05). Odds of matching as an underrepresented in medicine applicant were significantly decreased if the applicant went to a medical school ranked in the highest or lowest third (ORs 0.41-0.42, all p < 0.01); however, on interaction regression the odds of matching from a highly ranked medical school was increased (OR 3.5, 95% CI 0.98-12.55, p = 0.05). CONCLUSIONS The likelihood of matching as an underrepresented in medicine applicant is lower than the rest of the applicant population, and there are no individual applicant characteristics that can increase these odds to equal that of the general applicant population.
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Affiliation(s)
- Olachi O Oleru
- Icahn School of Medicine at Mount Sinai, Division of Plastic and Reconstructive Surgery, Gustav Levy Place, New York, NY, USA 10029
| | - Peter E Shamamian
- Icahn School of Medicine at Mount Sinai, Division of Plastic and Reconstructive Surgery, Gustav Levy Place, New York, NY, USA 10029
| | - Lior Levy
- Icahn School of Medicine at Mount Sinai, Division of Plastic and Reconstructive Surgery, Gustav Levy Place, New York, NY, USA 10029; New York Medical College, 40 Sunshine Cottage Road, Valhalla, NY 10595
| | - Abena Gyasi
- Icahn School of Medicine at Mount Sinai, Division of Plastic and Reconstructive Surgery, Gustav Levy Place, New York, NY, USA 10029
| | - Carol Wang
- Icahn School of Medicine at Mount Sinai, Division of Plastic and Reconstructive Surgery, Gustav Levy Place, New York, NY, USA 10029
| | - Nargiz Seyidova
- Icahn School of Medicine at Mount Sinai, Division of Plastic and Reconstructive Surgery, Gustav Levy Place, New York, NY, USA 10029
| | - Peter W Henderson
- Icahn School of Medicine at Mount Sinai, Division of Plastic and Reconstructive Surgery, Gustav Levy Place, New York, NY, USA 10029.
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Hutchings H, Behinaein P, Okereke I. Well-being Through the Synergy of Community Engagement, Health Equity, and Advocacy. Thorac Surg Clin 2024; 34:281-290. [PMID: 38944455 DOI: 10.1016/j.thorsurg.2024.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/01/2024]
Abstract
Facets of well-being for cardiothoracic surgeons include interconnectivity, or a sense of belonging within a community, and social relatedness. Striving for health equity achieves a sense of belonging and meaning to one's work. In "Elevating Health Equity: The Synergy of Community Engagement and Advocacy," the imperative for mentorship and diversification within health care is expounded, establishing a multitiered blueprint for equity. Integral to this framework is the nurturing of a heterogeneous health care workforce, ameliorating racial and gender disparities in patient care. This article puts forth an intricate, empirically substantiated roadmap toward a more empathic and efficacious health care system.
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Affiliation(s)
- Hollis Hutchings
- Henry Ford Health, 2799 West Grand Boulevard, Detroit, MI 48202, USA
| | - Parnia Behinaein
- School of Medicine, Wayne State University, 540 Canfield Street, Detroit, MI 48201, USA
| | - Ikenna Okereke
- Department of Surgery, Thoracic Surgery, Henry Ford Health, 2799 West Grand Boulevard, Detroit, MI 48202, USA.
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Contreras N, Essig R, Magarinos J, Pereira S. Abuse, Bullying, Harassment, Discrimination, and Allyship in Cardiothoracic Surgery. Thorac Surg Clin 2024; 34:239-247. [PMID: 38944451 DOI: 10.1016/j.thorsurg.2024.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/01/2024]
Abstract
Abuse, bullying, harassment, and discrimination are prominent workplace occurrences within cardiothoracic (CT) surgery that cause burnout and threaten the well-being of surgeons. Under-represented and marginalized groups experience higher incidences of these negative events, and CT surgery is one of the least diverse specialties. The CT surgery workforce and institutional leadership must prioritize mentorship, sponsorship, and allyship to promote a diverse and healthy specialty for surgeon recruitment, growth, and job satisfaction.
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Affiliation(s)
- Nicolas Contreras
- Division of Cardiothoracic Surgery, University of Utah and Huntsman Cancer Institute, 1950 Circle of Hope Drive, Salt Lake City, UT 84112, USA
| | - Rachael Essig
- Department of Surgery, Georgetown University Hospital, 3800 Reservoir Road, PHC4, Washington, DC 20007, USA. https://twitter.com/RachaelEssig
| | - Jessica Magarinos
- Department of Surgery, Temple University, 3401 North Broad Street, Philadelphia, PA 19147, USA
| | - Sara Pereira
- Division of Cardiothoracic Surgery, Department of Surgery, University of Utah, 30 North Mario Capecchi Drive, 4N133, Salt Lake City, UT 84112, USA.
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Yaros J, de Mortier C, Oude Egbrink M, Evers S, Paulus A. Cost identification in health professions education: A scoping review. MEDICAL EDUCATION 2024; 58:920-929. [PMID: 38700082 DOI: 10.1111/medu.15393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 03/04/2024] [Accepted: 03/06/2024] [Indexed: 05/05/2024]
Abstract
BACKGROUND Resource scarcity in health professions education (HPE) demands rigorous consideration of costs. Yet, thus far, we have been unable to completely and consistently identify the costs of HPE. To address this knowledge gap and enable use of economic evidence in decision making, a detailed overview of all existing costs and approaches to cost identification in HPE is needed. OBJECTIVES This review summarises the diversity of costs, cost perspectives and cost identification methods used in economic research of HPE to answer the following questions: which educational topics, costs, cost perspectives and cost identification methods are being investigated in HPE literature? METHODS This investigation followed the Joanna Briggs Institute guidelines for scoping reviews. PubMed, ERIC, CINAHL and PsycINFO were iteratively searched for English language publications between 2012 and 2022 that reported costs of HPE. Data was extracted for study characteristics, educational context and economic methodology. RESULTS A total of 136 articles of original research on the costs of educating all major licence healthcare professionals were included. A diffuse interest in costs is reflected in publications from 93 distinct journals and by the diversity of educational topics and cost types explored. However, the majority of investigations failed to define the cost perspective (86, 63%) and cost identification methods (117, 86%) and did not demonstrate common reporting structure or cost terminology, all of which contribute to persistent inconsistencies in cost identification. CONCLUSION The source of disharmonious cost identification in HPE is fuelled by diverse interests and divergent concepts of costs and costing methodology. Left in its current state, disharmonious cost identification will continue to limit transparency, comparison and synthesis of evidence, hamper objectivity in implementation and policy decisions and impede the efficient and sustainable allocation of resources. A research agenda must be developed, prioritised, and validated by the broader community to develop a theoretical framework for HPE cost research, define stakeholders, elicit values and preferences and chart a path toward harmonised costing.
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Affiliation(s)
- Jennifer Yaros
- Faculty of Health Medicine and Life Sciences, School of Health Professions Education (SHE), Department of Health Services Research (HSR), Maastricht University, Maastricht, The Netherlands
| | - Chloé de Mortier
- Faculty of Health Medicine and Life Sciences, School of Health Professions Education (SHE), Care and Public Health Research Institute (CAPHRI), Department of Health Services Research, Maastricht University, Maastricht, The Netherlands
- Knowledge Institute of Medical Specialists, Utrecht, The Netherlands
| | - Mirjam Oude Egbrink
- Faculty of Health Medicine and Life Sciences, School of Health Professions Education (SHE), Department of Physiology, Maastricht University, Maastricht, The Netherlands
| | - Silvia Evers
- Faculty of Health Medicine and Life Sciences, Care and Public Health Research Institute (CAPHRI), Department of Health Services Research, Maastricht University, Maastricht, The Netherlands
- Center for Economic Evaluation and Machine Learning, Netherlands Institute of Mental Health and Addiction, Trimbos Institute, Utrecht, The Netherlands
| | - Aggie Paulus
- Faculty of Health Medicine and Life Sciences, School of Health Professions Education (SHE), Maastricht University, Maastricht, The Netherlands
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Maastricht, The Netherlands
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Dejenie R, Fannon EE, Persky J, Gaeta E, Soufi K, Howard B, Stadeli KM, Godoy LA. Dissecting Diversity: A Comprehensive Look at the Present Landscape and Future Challenges in Surgical Specialties. JOURNAL OF SURGICAL EDUCATION 2024; 81:1004-1011. [PMID: 38760190 DOI: 10.1016/j.jsurg.2024.04.003] [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: 11/01/2023] [Revised: 03/20/2024] [Accepted: 04/03/2024] [Indexed: 05/19/2024]
Abstract
BACKGROUND As the US demographic evolves, surgical fields must adapt to ensure equitable healthcare. Healthcare disparities notably affect minority populations, with communities of color often facing physician shortages and higher rates of diseases such as coronary disease, stroke, and cancer. Research shows that minority physicians significantly improve patient satisfaction and outcomes in underserved communities, highlighting the need for increased physician diversity to enhance cultural competency and patient centered care. Data from the Association of American Medical Colleges (AAMC) reveals minimal increases in underrepresented minorities (URM) in surgical residency and academic careers over the past thirty-six years, with little change URM applicants and matriculants in the nine surgical specialties recognized by the American College of Surgeons from 2010 to 2018. OBJECTIVE This review aims to critically evaluate the current landscape of racial and gender diversity in six out of the nine defined surgical specialties (general surgery, plastic surgery, neurosurgery, orthopedic surgery, cardiothoracic surgery, and vascular surgery) in the US. DESIGN We conducted a comprehensive literature review to assess of the state of diversity within surgical specialties in the United States. By analyzing the benefits of diversity in surgical fields, evaluating the effectiveness of various diversity programs and initiatives, examining the comparative diversity between surgical subspecialties, and assessing the impact of diversity on patient outcomes, our aim is to highlight the critical importance of enhancing diversity in surgical fields. RESULTS While nuances in representation and diversity vary across surgical specialties, all fields persistently exhibit underrepresentation of certain racial/ethnic groups and persistent gender disparities. These disparities manifest throughout various phases, including in residency, and in the recruitment and retention of URM individuals in surgery and surgical subspecialties. While interventions over the past decade have contributed to improving diversity in surgical fields, significant disparities persist. Limitations include the time required for recent interventions to show significant impacts and the inability of established interventions to eliminate disparities. CONCLUSIONS Despite the clear benefits, diversity within surgical specialties remains an uphill battle. Addressing the diversity gap in surgical fields is crucial for improving patient outcomes, healthcare access, and workplace environments, requiring strategies such as targeted recruitment, mentorship programs, and addressing systemic biases. This review highlights the undeniable imperative for change and serve a call to action.
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Affiliation(s)
- Rebeka Dejenie
- University of California, Davis Medical Center. Department of Surgery. 4301 X St, Sacramento, California 95817, USA
| | - Elise Eh Fannon
- University of California, Davis Medical Center. Department of Surgery. 4301 X St, Sacramento, California 95817, USA; David Grant Medical Center. Department of Surgery. 101 Bodin Cir, Fairfield, California 94533, USA.
| | - Julia Persky
- University of California, Davis Medical Center. Department of Surgery. 4301 X St, Sacramento, California 95817, USA
| | - Emmanuel Gaeta
- University of California, Davis Medical Center. Department of Surgery. 4301 X St, Sacramento, California 95817, USA
| | - Khadija Soufi
- University of California, Davis Medical Center. Department of Surgery. 4301 X St, Sacramento, California 95817, USA
| | - Brian Howard
- University of California, Davis Medical Center. Department of Surgery. 4301 X St, Sacramento, California 95817, USA
| | - Kathryn M Stadeli
- University of California, Davis Medical Center. Department of Surgery. 4301 X St, Sacramento, California 95817, USA
| | - Luis A Godoy
- University of California, Davis Medical Center. Department of Surgery. 4301 X St, Sacramento, California 95817, USA
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Gelhard S, O'Brien L, Vincenti S, Smego DR, Hobbs R, Varghese TK, Selzman CH, Pereira SJ. Disparities in Gender and Diversity Representation Among Surgical Subspecialties: Are we Losing Momentum? J Surg Res 2024; 293:413-419. [PMID: 37812874 DOI: 10.1016/j.jss.2023.08.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 07/30/2023] [Accepted: 08/31/2023] [Indexed: 10/11/2023]
Abstract
INTRODUCTION Recruitment efforts have demonstrated small increases in female and under-represented applicants in recent years; however, the majority of surgical programs remain predominantly Caucasian and male. With increased national emphasis on Diversity, Equity, and Inclusion initiatives and mentoring programs, applicants to surgical specialties have continued to increase. While strategies to improve gender and racial diversity are now openly discussed, it is unclear if we have seen significant improvement. We sought to analyze the gender and diversity trends between surgical specialties. METHODS Publicly available data from the Association of American Medical Colleges, National Board of Medical Examiners, and Accreditation Council for Graduate Medical Education were extracted to determine total number, gender, and diversity of surgery applicants and active residents from the years 2018 to 2021. Surgical specialties within the main match were compared through an analysis completed through Microsoft Excel. RESULTS Between the years from 2018 to 2021, there was a rise in diversity representation among all surgical residents except for orthopedics which remained less than 30%. Orthopedics, Neurosurgery, and Thoracic Integrated training programs have the lowest rates of female representation among current residents at 16.72%, 20.37%, and 30.05%, respectively. General surgery demonstrates the greatest increase of female residents with a positive 6% change over this recent four-year time period. CONCLUSIONS There has been minimal positive progress in gender and diversity representation in surgical subspecialties overall in recent years. Continued advocacy through mentorship and scholarship programs is recommended to achieve greater gender and diversity representation in general surgery and surgical subspecialties.
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Affiliation(s)
| | - Liam O'Brien
- School of Medicine, University of Utah, Salt Lake City, Utah
| | - Sydney Vincenti
- School of Medicine, University of Utah, Salt Lake City, Utah
| | - Douglas R Smego
- Division of Cardiothoracic Surgery, University of Utah Health, Salt Lake City, Utah
| | - Reilly Hobbs
- Division of Cardiothoracic Surgery, University of Utah Health, Salt Lake City, Utah; Department of Surgery, Division of Cardiothoracic Surgery, Section of Pediatric Cardiac Surgery, Primary Children's Hospital, Salt Lake, Utah
| | - Thomas K Varghese
- Division of Cardiothoracic Surgery, University of Utah Health, Salt Lake City, Utah; Huntsman Cancer Institute, The University of Utah, Salt Lake City, Utah
| | - Craig H Selzman
- Division of Cardiothoracic Surgery, University of Utah Health, Salt Lake City, Utah
| | - Sara J Pereira
- Division of Cardiothoracic Surgery, University of Utah Health, Salt Lake City, Utah.
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Lee HJ, Akulian JA, Argento AC, Batra H, Lamb C, Mullon J, Murgu S. Interventional Pulmonary Fellowship Training: End of the Beginning. ATS Sch 2023; 4:405-412. [PMID: 38196682 PMCID: PMC10773264 DOI: 10.34197/ats-scholar.2022-0107ps] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 06/23/2023] [Indexed: 01/11/2024] Open
Abstract
Interventional pulmonology (IP) fellowship training has undergone increased popularity and growth. The Accreditation Council of Graduate Medical Education recently recognized IP medicine as a new subspecialty, which leads to new challenges and opportunities for a young subspecialty. Although the specialty-specific requirements are in progress, IP fellowship programs must plan ahead for the known common program requirements and anticipated accreditation process. The educational leadership in IP must identify and execute solutions to sustain continued excellence. This includes transitioning to a new regulatory environment with issues of funding new fellowships, keeping up to date with training/assessment of new procedures, and shaping the future through recruitment of talent to lead the young subspecialty.
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Affiliation(s)
- Hans J. Lee
- Section of Interventional Pulmonology, Division of Pulmonary and Critical Care Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jason A. Akulian
- Division of Pulmonary and Critical Care Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - A. Christine Argento
- Section of Interventional Pulmonology, Division of Pulmonary and Critical Care Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Hitesh Batra
- University of Alabama at Birmingham, Birmingham, Alabama
| | - Carla Lamb
- Lahey Hospital and Medical Center, Burlington, Massachusetts
| | - John Mullon
- Division of Pulmonary, Critical Care, and Sleep Medicine, Mayo Clinic, Rochester, Minnesota; and
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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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Thornton SW, Leraas HJ, Tracy ET. Taking Steps to Promote Diversity, Equity, and Inclusion in the Surgical Workforce. JAMA Surg 2022; 157:755-756. [DOI: 10.1001/jamasurg.2022.1065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
| | - Harold J. Leraas
- Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Elisabeth T. Tracy
- Department of Surgery, Duke University Medical Center, Durham, North Carolina
- Division of Pediatric Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina
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