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Lee JKH, McGuire C, Raîche I, Domecq MC, Tudorache M, Gawad N. Underrepresented in medicine (URiM) residents: A scoping review on prevalence trends & improving recruitment. Am J Surg 2024; 237:115924. [PMID: 39208503 DOI: 10.1016/j.amjsurg.2024.115924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Revised: 07/31/2024] [Accepted: 08/21/2024] [Indexed: 09/04/2024]
Abstract
BACKGROUND Disparities exist in underrepresented in medicine (URiM) resident representation. This review examines recent trends in resident diversity, URiM recruitment strategies, and identifies research gaps in equity, diversity, and inclusion (EDI) for URiM residents. METHODS MEDLINE, EMBASE, Web of Science, and ERIC databases were searched for studies published from 2017 to 2022 on URiM resident prevalence and recruitment initiatives. RESULTS 3634 abstracts were reviewed, and 52 articles were included. 35 (67 %) studies reported on prevalence of URiM residents, demonstrating URiM resident composition is lower than residency applicant demographics, particularly in surgery. Seventeen (33 %) studies reported on URiM recruitment interventions, such as visiting clerkship programs, holistic review, and targeted outreach, and demonstrated success in increasing recruitment of URiM candidates to programs. CONCLUSIONS URiM residents remain disproportionately underrepresented, and markedly so among surgical residency programs. Further research should focus on implementing EDI interventions in surgery and assess URiM resident attrition post-matriculation.
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Affiliation(s)
- Jeremy K H Lee
- Division of General Surgery, Department of Surgery, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada; The Ottawa Hospital, Civic Campus, 737 Parkdale Ave, Ottawa, ON, Canada K1Y 4M9.
| | - Catherine McGuire
- Faculty of Medicine, University of Ottawa, Roger Guindon Hall, 451 Smyth Rd, Ottawa, ON, Canada, K1H 8M5.
| | - Isabelle Raîche
- Division of General Surgery, Department of Surgery, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada; The Ottawa Hospital, Civic Campus, 737 Parkdale Ave, Ottawa, ON, Canada K1Y 4M9.
| | - Marie-Cécile Domecq
- Health Sciences Library, University of Ottawa, 451 Smyth Road (1020F), Ottawa, ON, Canada, K1H 8M5.
| | - Mihaela Tudorache
- Faculty of Medicine, University of Ottawa, Roger Guindon Hall, 451 Smyth Rd, Ottawa, ON, Canada, K1H 8M5.
| | - Nada Gawad
- Division of General Surgery, Department of Surgery, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada; The Ottawa Hospital, Civic Campus, 737 Parkdale Ave, Ottawa, ON, Canada K1Y 4M9.
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Smink DS, Ortega G, Dacier BM, Petrusa ER, Chen YJ, Shaikh NQ, Allar BG, Chun MBJ, Green AR, Caldwell KE, Atkinson RB, Reidy E, Olufajo OA, Britt LD, Brittain MA, Zárate Rodriguez J, Swoboda SM, Cornwell EE, Lynch KA, Wise PE, Harrington DT, Kent TS, Mullen JT, Lipsett PA, Haider AH. A Randomized Crossover Trial Evaluating the Impact of Cultural Dexterity Training on Surgical Residents' Knowledge, Cross-Cultural Care, Skills, and Beliefs: The Provider Awareness and Cultural Dexterity Training for Surgeons (PACTS) Trial. Ann Surg 2024; 280:403-413. [PMID: 38921829 DOI: 10.1097/sla.0000000000006408] [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: 06/27/2024]
Abstract
OBJECTIVES This trial examines the impact of the Provider Awareness and Cultural dexterity Toolkit for Surgeons (PACTS) curriculum on surgical residents' knowledge, cross-cultural care, skills, and beliefs. BACKGROUND Cross-cultural training of providers may reduce health care outcome disparities, but its effectiveness in surgical trainees is unknown. METHODS PACTS focuses on developing skills needed for building trust, working with patients with limited English proficiency, optimizing informed consent, and managing pain. The PACTS trial was a randomized crossover trial of 8 academic general surgery programs in the United States: The Early group ("Early") received PACTS between periods 1 and 2, while the Delayed group ("Delayed") received PACTS between periods 2 and 3. Residents were assessed preintervention and postintervention on Knowledge, Cross-Cultural Care, Self-Assessed Skills, and Beliefs. χ 2 and Fisher exact tests were conducted to evaluate within-intervention and between-intervention group differences. RESULTS Of 406 residents enrolled, 315 were exposed to the complete PACTS curriculum. Early residents' Cross-Cultural Care (79.6%-88.2%, P <0.0001), Self-Assessed Skills (74.5%--85.0%, P <0.0001), and Beliefs (89.6%-92.4%, P =0.0028) improved after PACTS; knowledge scores (71.3%-74.3%, P =0.0661) were unchanged. Delayed resident scores pre-PACTS to post-PACTS showed minimal improvements in all domains. When comparing the 2 groups in period 2, Early residents had modest improvement in all 4 assessment areas, with a statistically significant increase in Beliefs (92.4% vs 89.9%, P =0.0199). CONCLUSIONS The PACTS curriculum is a comprehensive tool that improved surgical residents' knowledge, preparedness, skills, and beliefs, which will help with caring for diverse patient populations.
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Affiliation(s)
- Douglas S Smink
- Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
- Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Gezzer Ortega
- Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
- Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Brittany M Dacier
- Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
- Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | - Emil R Petrusa
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Yu-Jen Chen
- Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Namra Q Shaikh
- Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
- Department of Surgery, Aga Khan University, Karachi, Sindh, Pakistan
| | - Benjamin G Allar
- Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
- Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Maria B J Chun
- Department of Surgery, John A. Burns School of Medicine, University of Hawaii at Manoa, Honolulu, HI
| | | | | | - Rachel B Atkinson
- Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
- Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Emma Reidy
- Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Olubode A Olufajo
- Department of Surgery, Howard University College of Medicine, Washington, DC
| | - L D Britt
- Department of Surgery, Eastern Virginia University, Norfolk, VA
| | | | | | | | - Edward E Cornwell
- Department of Surgery, Howard University College of Medicine, Washington, DC
| | - Kenneth A Lynch
- Department of Surgery, Rhode Island Hospital, Warren Alpert Medical School of Brown University, Providence, RI
| | - Paul E Wise
- Department of Surgery, Washington University School of Medicine, St. Louis, MO
| | - David T Harrington
- Department of Surgery, Rhode Island Hospital, Warren Alpert Medical School of Brown University, Providence, RI
| | - Tara S Kent
- Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - John T Mullen
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Pamela A Lipsett
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Adil H Haider
- Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
- Aga Khan University Medical College, Karachi, Pakistan
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Acker RC, Sharpe J, Shea JA, Ginzberg SP, Bakillah E, Rosen CB, Finn CB, Roberts SE, Ajmera S, Kelz RR. Belonging in Surgery: A Validated Instrument and Single Institutional Pilot. Ann Surg 2024; 280:345-352. [PMID: 38348669 DOI: 10.1097/sla.0000000000006234] [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: 07/11/2024]
Abstract
OBJECTIVE The aim of this study was to develop and validate an instrument to measure Belonging in Surgery among surgical residents. BACKGROUND Belonging is the essential human need to maintain meaningful relationships and connections to one's community. Increased belongingness is associated with better well-being, job performance, and motivation to learn. However, no tools exist to measure belonging among surgical trainees. METHODS A panel of experts adapted a belonging instrument for use among United States surgery residents. After administration of the 28-item instrument to residents at a single institution, a Cronbach alpha was calculated to measure internal consistency, and exploratory principal component analyses were performed. Multiple iterations of analyses with successively smaller item samples suggested the instrument could be shortened. The expert panel was reconvened to shorten the instrument. Descriptive statistics measured demographic factors associated with Belonging in Surgery. RESULTS The overall response rate was 52% (114 responses). The Cronbach alpha among the 28 items was 0.94 (95% CI: 0.93-0.96). The exploratory principal component analyses and subsequent Promax rotation yielded 1 dominant component with an eigenvalue of 12.84 (70% of the variance). The expert panel narrowed the final instrument to 11 items with an overall Cronbach alpha of 0.90 (95% CI: 0.86, 0.92). Belonging in Surgery was significantly associated with race (Black and Asian residents scoring lower than White residents), graduating with one's original intern cohort (residents who graduated with their original class scoring higher than those that did not), and inversely correlated with resident stress level. CONCLUSIONS An instrument to measure Belonging in Surgery was validated among surgical residents. With this instrument, Belonging in Surgery becomes a construct that may be used to investigate surgeon performance and well-being.
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Affiliation(s)
- Rachael C Acker
- Department of Surgery, Center for Surgery and Health Economics, Department of Surgery, Philadelphia, PA
- Department of Surgery, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA
| | - James Sharpe
- Department of Surgery, Center for Surgery and Health Economics, Department of Surgery, Philadelphia, PA
- Department of Surgery, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA
| | - Judy A Shea
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
- Leonard Davis Institute of Healthcare Economics, Wharton School, University of Pennsylvania, PA
| | - Sara P Ginzberg
- Department of Surgery, Center for Surgery and Health Economics, Department of Surgery, Philadelphia, PA
- Department of Surgery, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA
| | - Emna Bakillah
- Department of Surgery, Center for Surgery and Health Economics, Department of Surgery, Philadelphia, PA
- Department of Surgery, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA
| | - Claire B Rosen
- Department of Surgery, Center for Surgery and Health Economics, Department of Surgery, Philadelphia, PA
- Department of Surgery, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA
| | - Caitlin B Finn
- Leonard Davis Institute of Healthcare Economics, Wharton School, University of Pennsylvania, PA
- Department of Surgery, New York-Presbyterian Hospital/Weill Cornell Medicine, New York, NY
| | - Sanford E Roberts
- Department of Surgery, Center for Surgery and Health Economics, Department of Surgery, Philadelphia, PA
- Department of Surgery, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA
| | - Sonia Ajmera
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Rachel R Kelz
- Department of Surgery, Center for Surgery and Health Economics, Department of Surgery, Philadelphia, PA
- Department of Surgery, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA
- Leonard Davis Institute of Healthcare Economics, Wharton School, University of Pennsylvania, PA
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Harris M, Lau-Bogaardt T, Shifaza F, Attrill S. The experiences of culturally and linguistically diverse health practitioners in dominant culture practice: a scoping review. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2024:10.1007/s10459-024-10359-7. [PMID: 39037662 DOI: 10.1007/s10459-024-10359-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 07/07/2024] [Indexed: 07/23/2024]
Abstract
Increasing the proportion of culturally and linguistically diverse (CALD) health practitioners is identified as one strategy to address healthcare disparities that individuals from minority or under-represented backgrounds experience. However, professional and institutional cultures and structures are known to contribute to the challenges for CALD practitioners who work in dominant culture practice contexts. This scoping review used the theory of Legitimate Peripheral Participation to describe and interpret literature about the experiences of CALD health practitioners in view of informing strategies to increase their representation. A systematised search was conducted across four allied health, medicine and nursing databases. Following abstract and full text screening, articles which fit the inclusion criteria (n = 124) proceeded to data extraction. Categories relating to the experiences of practitioners were extracted, and three themes were identified that were subsequently theoretically interpreted: Discrimination, Consequences and Hierarchy. Discrimination functioned as a barrier to CALD practitioners being legitimised and able to participate equally in healthcare practice, retaining their position at the periphery of the practice community; Consequences reinforced this peripheral position and further impeded legitimation and participation; and Hierarchy was maintained through structures that reinforced and reproduced these barriers. The findings summarise how these barriers are reinforced through the intersections of professional and racial hierarchies, and highlight a need for strategies to address discrimination and structures that marginalise CALD practitioners' identity, practices and participation in their health professional communities.
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Affiliation(s)
- Mikaela Harris
- College of Nursing and Health Sciences, Flinders University, Level 1, Room N103, Sturt North Sturt Rd, Bedford Park, SA, 5042, Australia
| | - Timothea Lau-Bogaardt
- School of Allied Health Science and Practice, The University of Adelaide, Level 4, Engineering Maths and Science Building North Terrace Campus, Adelaide, SA, 5005, Australia
| | - Fathimath Shifaza
- College of Nursing and Health Sciences, Flinders University, Level 1, Room N103, Sturt North Sturt Rd, Bedford Park, SA, 5042, Australia
| | - Stacie Attrill
- College of Nursing and Health Sciences, Flinders University, Level 1, Room N103, Sturt North Sturt Rd, Bedford Park, SA, 5042, Australia.
- School of Allied Health Science and Practice, The University of Adelaide, Level 4, Engineering Maths and Science Building North Terrace Campus, Adelaide, SA, 5005, Australia.
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Tiyyagura G, Weiss J, Goldman MP, Crawley DM, Langhan ML. Selection and Recruitment Strategies among Competitive Pediatric Training Programs and the Impact of Diversity. Acad Pediatr 2024; 24:338-346. [PMID: 37748536 PMCID: PMC11217005 DOI: 10.1016/j.acap.2023.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 08/22/2023] [Accepted: 09/16/2023] [Indexed: 09/27/2023]
Abstract
OBJECTIVE Aspects of the written application, interview and ranking may negatively impact recruitment of underrepresented in medicine (URiM) applicants. Our objectives were to explore knowledge, attitudes, and perceptions of pediatric faculty who assess potential trainees and how diversity impacts these assessments. METHODS We performed qualitative interviews of 20 geographically diverse faculty at large pediatric residencies and fellowships. We analyzed data using the constant comparative method to develop themes. RESULTS Four main themes emerged. CONCLUSIONS We describe ways in which bias infiltrates recruitment and strategies to promote diversity. Many strategies are variably implemented and the impact on workforce diversity in pediatric training programs remains unknown.
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Affiliation(s)
- Gunjan Tiyyagura
- Department of Pediatrics and Emergency Medicine (G Tiyyagura, MP Goldman, and ML Langhan), Section of Emergency Medicine, Yale University School of Medicine, New Haven, Conn
| | - Jasmine Weiss
- Department of Pediatrics (J Weiss), Division of General Pediatrics and Adolescent Medicine, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Michael P Goldman
- Department of Pediatrics and Emergency Medicine (G Tiyyagura, MP Goldman, and ML Langhan), Section of Emergency Medicine, Yale University School of Medicine, New Haven, Conn
| | - Destanee M Crawley
- Department of Pediatrics (DM Crawley), Yale School of Medicine, New Haven, Conn
| | - Melissa L Langhan
- Department of Pediatrics and Emergency Medicine (G Tiyyagura, MP Goldman, and ML Langhan), Section of Emergency Medicine, Yale University School of Medicine, New Haven, Conn.
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Diaz R, Balgord S, Klekowski N, Farthing AS, Escolero SG, DeCloux K, Burkhardt JC, Haggins AN, Hopson LR. Understanding clerkship experiences in emergency medicine and their potential influence on specialty selection: A qualitative study. AEM EDUCATION AND TRAINING 2024; 8:e10932. [PMID: 38343629 PMCID: PMC10858322 DOI: 10.1002/aet2.10932] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Revised: 10/30/2023] [Accepted: 11/06/2023] [Indexed: 02/16/2024]
Abstract
Objectives The specialty of emergency medicine (EM) is experiencing a significant decrease in student interest. In addition, women are historically underrepresented within the specialty at all levels of training and practice. We sought to understand how clinical experiences and perceptions of EM influence specialty selection by medical students, particularly women. Methods Using a constructivist grounded theory approach, we analyzed semistructured interviews with senior medical students who considered EM as a specialty. We used purposive sampling to recruit from diverse learning environments and represent a variety of experiences. Participants reflected on their specialty selection process and experiences in EM including their perceived acceptance in the work environment. Results Twenty-five medical students from 11 geographically diverse schools participated. A total of 68% (17/25) identified as women. The majority (21/25, 84%) planned on applying to EM residency. We identified four major themes: (1) distressing interpersonal interactions with patients and the ED care team negatively affect students; (2) EM culture includes behaviors that are perceived as exclusionary; (3) beliefs about the attributes of an ideal EM physician and the specialty itself have a gendered nature; and (4) ease of access to mentors, representation, and early exposure to EM environment increased interest in specialty. Conclusions Our participants express that EM causes challenges for students to accept the norms of behavior in the field, which is an essential element in joining a group and professional identity formation. In addition, we raise concern that gendered perceptions and language may send exclusionary environmental cues that may negatively impact recruitment of a diverse physician workforce.
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Affiliation(s)
- Rosemarie Diaz
- Department of Emergency MedicineUniversity of California Los AngelesLos AngelesCaliforniaUSA
| | - Sarah Balgord
- Department of Emergency MedicineMedical College of WisconsinMilwaukeeWisconsinUSA
| | - Nicole Klekowski
- Department of Emergency MedicineUniversity of Michigan Medical SchoolAnn ArborMichiganUSA
| | | | | | - Korynne DeCloux
- Department of Internal MedicineYale UniversityNew HavenConnecticutUSA
| | - John C. Burkhardt
- Departments of Emergency Medicine and Learning Health SciencesUniversity of Michigan Medical SchoolAnn ArborMichiganUSA
| | - Adrianne N. Haggins
- Department of Emergency MedicineUniversity of Michigan Medical SchoolAnn ArborMichiganUSA
| | - Laura R. Hopson
- Department of Emergency MedicineUniversity of Michigan Medical SchoolAnn ArborMichiganUSA
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Chen M, Strony JT, Kroneberger EA, Karns MR, Salata MJ, Voos JE, Gillespie RJ, Brown MC. Patient Preferences and Perceptions of Provider Diversity in Orthopaedic Surgery. J Bone Joint Surg Am 2023; 105:1703-1708. [PMID: 37801560 DOI: 10.2106/jbjs.23.00071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/08/2023]
Abstract
BACKGROUND Orthopaedic surgery in the U.S. historically has been among the least demographically diverse specialties in medicine. Currently, limited data exist on how patients perceive diversity within the field and what patients look for when choosing an orthopaedic surgeon. The purpose of this study was to identify specific patient preferences for surgeon demographics and understand patient perceptions of racial and gender diversity in orthopaedic surgery. METHODS Nonconsecutive patients from orthopaedic clinics affiliated with a U.S. academic health system voluntarily completed a 39-item questionnaire that surveyed basic demographic information, perception of diversity, racial and gender preferences during surgeon selection, and perception of health-care inequalities. Bivariate analyses were used to test the association between patient-surgeon demographic variables and ratings of diversity. Multiple regression models were used to identify independent predictors of overall perceived diversity ratings. RESULTS A total of 349 patients (80.6% White, 17.9% Black, and 1.5% other) were analyzed. Black patients were more likely to experience difficulty relating to their surgeon than White patients (11.48% versus 2.29%; odds ratio [OR], 5.62; 95% confidence interval [CI], 1.55 to 21.1; p = 0.004). Moreover, Black patients were more likely to perceive racial bias from their surgeon than White patients (5.17% versus 0.37%; OR, 14.44; 95% CI, 1.14 to 766.29; p = 0.02). While the level of racial diversity perceived by White patients (2.57 of 10) was significantly higher than that perceived by Black patients (2.10 of 10) (p = 0.001), the absolute difference between these 2 figures was small, suggesting that both groups perceived racial diversity in orthopaedics to be low. White and Black patients differed in their importance ranking of a surgeon's race (p < 0.0001): Black patients ranked a surgeon's race with higher importance (mean, 3.49 of 10) when selecting a surgeon compared with White patients (1.45 of 10). Both male and female patients gave relatively low importance rankings for a surgeon's gender (mean, 1.58 of 10 and 2.15 of 10, respectively, p = 0.02). CONCLUSIONS Patients in this study did not perceive orthopaedic surgery as a diverse field (overall diversity rating, <3 of 10). There were significant racial and gender differences in patients' preferences for specific physician characteristics when choosing an orthopaedic surgeon, which may help explain some instances of perceived racial bias and difficulty relating to their orthopaedic surgeon.
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Affiliation(s)
- Mingda Chen
- Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - John T Strony
- Department of Orthopaedic Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | | | - Michael R Karns
- Department of Orthopaedic Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Michael J Salata
- Case Western Reserve University School of Medicine, Cleveland, Ohio
- Department of Orthopaedic Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - James E Voos
- Case Western Reserve University School of Medicine, Cleveland, Ohio
- Department of Orthopaedic Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Robert J Gillespie
- Case Western Reserve University School of Medicine, Cleveland, Ohio
- Department of Orthopaedic Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Marsalis C Brown
- Department of Orthopaedic Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio
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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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Batool S, Burks CA, Bergmark RW. Healthcare Disparities in Otolaryngology. CURRENT OTORHINOLARYNGOLOGY REPORTS 2023; 11:1-14. [PMID: 37362031 PMCID: PMC10247342 DOI: 10.1007/s40136-023-00459-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/19/2023] [Indexed: 06/28/2023]
Abstract
Purpose of Review The purpose of this review is to summarize some of the recent research studies on healthcare disparities across various subspecialties within otolaryngology. This review also highlights the impact of COVID-19 pandemic on disparities and proposes potential interventions to mitigate disparities. Recent Findings Significant healthcare disparities in care and treatment outcomes have been reported across all areas of otolaryngology. Notable differences in survival, disease recurrence, and overall mortality have been noted based on race, ethnicity, socioeconomic status (SES), insurance status, etc. This is most well-researched in head and neck cancer (HNC) within otolaryngology. Summary Healthcare disparities have been identified by numerous research studies within otolaryngology for many vulnerable groups that include racial and ethnic minority groups, low-income populations, and individuals from rural areas among many others. These populations continue to experience suboptimal access to timely, quality otolaryngologic care that exacerbate disparities in health outcomes.
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Affiliation(s)
- Sana Batool
- Center for Surgery and Public Health, Brigham and Women’s Hospital, Boston, MA USA
- Harvard Medical School, Boston, MA USA
| | - Ciersten A. Burks
- Center for Surgery and Public Health, Brigham and Women’s Hospital, Boston, MA USA
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Boston, MA USA
- Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, USA
| | - Regan W. Bergmark
- Center for Surgery and Public Health, Brigham and Women’s Hospital, Boston, MA USA
- Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, USA
- Division of Otolaryngology-Head and Neck Surgery, Brigham and Women’s Hospital and Dana Farber Cancer Institute, 45 Francis Street, Boston, MA 02115 USA
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Burks CA, Hansen EE, Watson J, Bergmark RW. Presence of Diversity and Inclusion Information on United States Otolaryngology Residency Program Websites. Laryngoscope 2023; 133:1306-1307. [PMID: 36919630 DOI: 10.1002/lary.30663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 02/07/2023] [Accepted: 03/03/2023] [Indexed: 03/16/2023]
Affiliation(s)
- Ciersten A Burks
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Boston, Massachusetts, U.S.A.,Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts, U.S.A.,Center for Surgery and Public Health and Division of Otolaryngology-Head and Neck Surgery, Brigham and Women's Hospital/Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Elisabeth E Hansen
- Center for Surgery and Public Health and Division of Otolaryngology-Head and Neck Surgery, Brigham and Women's Hospital/Harvard Medical School, Boston, Massachusetts, U.S.A.,Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Jowan Watson
- Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Regan W Bergmark
- Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts, U.S.A.,Center for Surgery and Public Health and Division of Otolaryngology-Head and Neck Surgery, Brigham and Women's Hospital/Harvard Medical School, Boston, Massachusetts, U.S.A
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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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