Association Between Racial and Ethnic Diversity in Medical Specialties and Residency Application Rates

Increasing African American representation in plastic surgery

Plastic surgery is a specialty crucial for addressing the needs of diverse patient, yet it faces significant underrepresentation of African Americans, especially in academic leadership. This imbalance persists throughout medical education, training, and professional advancement. Dr. Arthur L. Garnes, the first board-certified African American plastic surgeon, overcame profound challenges, inspiring subsequent generations. Notable figures like Dr. Camille Cash and Dr. Steven Williams further exemplify resilience in the face of barriers. Mentorship emerges as pivotal, fostering diversity and inclusion within plastic surgery. Initiatives promoting mentorship, financial support, and recruitment are essential to rectifying disparities, ensuring equitable representation, and improving access to care for minority patients.

Ethnic diversity and inclusiveness among medical residents in the Netherlands: results from a single-centered survey study

PURPOSE OF STUDY

Despite the recognized importance of an ethnically diverse healthcare workforce, the current population of medical specialists does not adequately reflect our society. To further unravel how and at which stages of the career path such diversity loss occurs, we studied ethnic diversity and perceptions of inclusiveness among medical residents.

MATERIALS AND METHODS

We conducted a cross-sectional study among all residents of Erasmus Medical Center in the highly multicultural city of Rotterdam, the Netherlands. An online survey was distributed, in which we inquired about (i) ethnic diversity and (ii) perceptions of inclusivity. The latter outcome includes sense of belonging to the team of supervisors, measured by perceived level of resemblance between residents and their supervisor(s), while focusing on ethnic, cultural, and socioeconomic levels. Residents from different specialties were divided into four groups, according to their medical specialty, i.e., surgical specialties, internal medicine specialties, overall diagnostic/supportive specialties, and family medicine & intellectual disability medicine. Descriptive statistics were applied.

RESULTS

From the total of 986 invited residents, 493 (50.0%) participated (median age 32 years [IQR 30-34]), consisting of 346 (70.2%) females. Results showed that the majority, 335 (68.2%) were of Dutch origin, 90 (18.3%) were children of migrants, and 66 (13.4%) were migrants. We observed notable differences across medical specialties, with the highest degree of ethnic diversity in surgical specialties. Except for residents from supportive specialties, residents from other specialties who are (children of) migrants reported significantly more often that they experienced differences on ethnic and/or cultural levels with their supervisors than residents of Dutch origin.

CONCLUSION

While (children of) migrants were underrepresented in this cohort, especially given the demographic distribution of the region of Rotterdam, a comparison of our results with previously published census data on medical students cohorts indicates no substantial loss of ethnic diversity in the transition from medical student to residency. Yet, these groups scored lower on questions related to sense of belonging.

CLINICAL TRIAL NUMBER

Not applicable.

Diversity Recruitment in Cardiovascular Specialties: Barriers and Opportunities in Postgraduate Training Programs

Background

Diversity in postgraduate training programs can be increased through program-based recruitment strategies. Prospective applicants often examine website content to determine if training programs are inclusive and offer a good fit. Poor overlap between program director recruitment goals and program website content as a barrier to recruiting a diverse physician workforce has not extensively been studied.

Objectives

The aim of this study was to characterize barriers to recruiting a diverse physician workforce in cardiovascular specialties in the United States.

Methods

Cross-sectional survey of program directors and evaluation of website content for training programs in adult general cardiology, cardiothoracic surgery, vascular surgery, and adult cardiothoracic anesthesiology.

Results

A total of 68 surveys were completed (response rates of 10% to 13% across specialties), and 626 websites in cardiovascular specialties were analyzed. A majority (63%) of program directors prioritized increasing diversity, although 40% of these respondents did not have a plan or resources. Program culture was cited as a barrier to recruiting a diverse workforce. The median website score for inclusion and health equity content was 4.0 out of 18.0, with a health disparities curriculum offered in <10% of websites for most specialties.

Conclusions

To advance diversity in cardiovascular specialties, training programs must have inclusive learning environments perceived by prospective applicants. Barriers to recruiting a diverse physician workforce may be decreased by addressing training program culture with an emphasis on modifying training program website content to attract more diverse applicant pools. Health disparities curricula are underutilized resources in cardiovascular specialties that may support recruitment of a more diverse physician workforce.

Representation Quotients to Examine Diversity in Ophthalmology Residency Applicants and Matriculants

Importance

A diverse ophthalmic workforce is key to equitable care, and identifying areas of underrepresentation is important in tackling vision care disparities.

Objective

To evaluate the diversity of applicants and matriculants in ophthalmology residency programs relative to medical school graduates and analyze the intersection of race and gender within this pathway.

Design, Setting, and Participants

This retrospective cross-sectional study conducted from 2022 to 2024 used representation quotients (RQs) using reports from the Association of University Professors of Ophthalmology and San Francisco Match, along with demographic data from the Association of American Medical Colleges from 2008 to 2021. RQs measure equity by dividing a racial, ethnic, or gender group's proportion in a specific population by its proportion in a larger reference population. Individuals who graduated from US medical schools from 2008 to 2021 or who applied to or matriculated into US ophthalmology residency programs from 2015 to 2021 and from 2008 to 2021, respectively, were eligible for inclusion.

Exposure

Applying to or matriculating into ophthalmology residency.

Main Outcomes and Measures

The primary outcome was median RQs and trends among racial, ethnic, and gender groups for ophthalmology applicants (RQapp) and matriculants (RQmat), with RQ differences evaluated using Mann-Whitney U tests.

Results

Among total applicants (n = 5304) and matriculants (n = 6139), 36% and 42% of applicants and matriculants, respectively, were female (applicants: 28% Asian, 4% Black, 7% Hispanic, and 47% White; matriculants: 31% Asian, 3% Black, 5% Hispanic, and 57% White). Self-identified Black individuals had the lowest median (IQR) RQs (RQapp, 0.604 [0.437-0.771]; RQmat, 0.469 [0.341-0.597]). Regression analysis revealed increased representation for male applicants (slope, 0.036; 95% CI, 0.015-0.057; P = .007) and matriculants (slope, 0.009; 95% CI, 0.002-0.016; P = .02), but decreased representation for female applicants (slope, -0.031; 95% CI, -0.010 to -0.102; P = .01) and matriculants (slope, -0.009; 95% CI, -0.016 to -0.002; P = .02). Black (RQapp, 0.604 vs RQmat, 0.469; P = .047) and Hispanic (RQapp, 1.46 vs RQmat, 1.04; P = .03) groups experienced a decrease between applicant and matriculants.

Conclusions and Relevance

This cross-sectional retrospective study found persistent underrepresentation of Black and female individuals in ophthalmology residency programs, with increases in Black and Hispanic applicants failing to translate into higher matriculation rates. Barriers that female or Black medical students face when applying or matriculating into ophthalmology residency may contribute to their underrepresentation in the field.

Serve Coffee, Hold Clamps, Do Not Complain: Student Perceptions and Experiences Regarding Surgery

OBJECTIVE

To explore medical students' perceptions and experiences regarding the surgery clerkship and surgeons.

DESIGN

Between November 2021 and February 2022, an anonymous prepost survey study was performed among 2 consecutive cohorts of medical students. The survey was taken 6 weeks prior to the surgery clerkship and repeated shortly after the surgery clerkship.

SETTING

Single-center prepost survey study.

PARTICIPANTS

Medical students studying at Erasmus Medical Center entering a 6-week surgery education block directly followed by a ten-week surgery clerkship.

RESULTS

The preclerkship response rate was 100% (n=145). One out of 5 students considered a surgical career (21%). Half of the students expected to be negatively treated (55%), mainly in terms of hierarchy and offensive language. The postclerkship response rate was 70% (n=101). Interest in a surgical career increased significantly from 21% to 50% (p<0.001). Thirteen students (13%) reported being negatively treated during their surgery clerkship, mainly in terms of poor supervision of their learning process and nonconstructive feedback.

CONCLUSIONS AND RELEVANCE

Stereotypes of surgeons and the surgical clerkship are strongly prevalent among medical students. Half of the students enter the surgery clerkship with negative perceptions. Fortunately, the surgery clerkship debunked prejudices and increased interest in surgery. Poor supervision and feedback during the surgery clerkship were experienced as negative treatment, emphasizing the importance of cultivating a safe learning climate.

Sense of Belonging Among Medical Students, Residents, and Fellows: Associations With Burnout, Recruitment Retention, and Learning Environment

PURPOSE

This study examines sense of belonging (belongingness) in a large population of medical students, residents, and fellows and associations with learner burnout, organizational recruitment retention indicators, and potentially modifiable learning environment factors.

METHOD

All medical students, residents, and fellows at Mayo Clinic sites were surveyed between October and November 2020 with items measuring sense of belonging in 3 contexts (school or program, organization, surrounding community), burnout (2 Maslach Burnout Inventory items), recruitment retention indicators (likelihood of recommending the organization and accepting a job offer), potentially modifiable learning environment factors, and demographics (age, gender, race and ethnicity, LGBTQ+ identification, disability, socioeconomic background).

RESULTS

Of 2,257 learners surveyed, 1,261 (56%) responded. The percentage of learners reporting a somewhat or very strong sense of belonging was highest in the school or program (994 of 1,227 [81%]) followed by the organization (957 of 1,222 [78%]) and surrounding community (728 of 1,203 [61%]). In adjusted analyses, learners with very strong organization belongingness had lower odds of burnout (odds ratio [OR], 0.05; 95% CI, 0.02-0.12) and higher odds of being likely to recommend the organization (OR, 505.23; 95% CI, 121.54-2,100.18) and accept a job offer (OR, 38.68; 95% CI, 15.72-95.15; all P < .001). School or program and community belongingness also correlated strongly with these outcomes. In multivariable analyses, social support remained associated with higher odds of belongingness in all 3 contexts; favorable ratings of faculty relationships and leadership representation remained associated with higher odds of belongingness in 2 contexts (school or program and organization); and favorable ratings of diversity, equity, and inclusion learning climate remained associated with belongingness in 1 context (community).

CONCLUSIONS

Sense of belonging among medical students, residents, and fellows varies across contexts, correlates strongly with burnout and organizational recruitment retention indicators, and is associated with multiple potentially modifiable learning environment factors.

A retrospective analysis of medical student authorship in highest impact radiology journal publications

OBJECTIVES

To assess medical student authorship in radiology research, focusing on the prevalence and impact of student articles, demographic trends, and potential barriers and opportunities for involvement.

METHODS

We retrospectively assessed original research and review papers from 2018 to 2022 in the top five radiology journals based on their 2022 Impact Factor. Three reviewers manually validated and classified articles by medical student (MS) and non-MS authorship. Data collected included publication and authorship metrics. Thematic analysis of articles was performed from keywords and SCOPUS topic clusters. Significant associations were identified using chi-squared and two-tailed z-tests.

RESULTS

Of the 2533 publications from all five journals, only 0.47 % were MS-authored, of which 83.3 % had a Field Weighted Citation Impact (FWCI) > 1. Of the 19 MS authors, 68.42 % had prior publications, with the same proportion holding prior first authorship. Female students averaged a higher FWCI (2.47 ± 2.31) but comprised only 26.32 % of all students. Only 16.67 % of MS articles had a female senior author (SA). This was consistent in non-MS articles, with females representing 19.9 % to 25.2 % of SAs across all journals. Of the 2521 non-MS articles, 92 % were classified into themes, revealing that 47.89 % of publications primarily focused on machine learning, while another 42.26 % incorporated some machine learning concepts.

CONCLUSION

Compared to non-medical student publications in radiology, those by medical students were disproportionately limited but impactful. Both demographic and academic factors hinder student engagement in publishing. Hence promoting, supporting, and sponsoring student involvement in research is pivotal for the discipline.

Trends in Underrepresented Race and Ethnicity Among Internal Medicine-Pediatrics Residents and Related Specialties: 2005-2020

Background Increased diversity of race and ethnicity in internal medicine-pediatrics (med-peds) and related specialties may improve health disparities in the United States (US). Family medicine (FM), internal medicine (IM), and pediatric residencies have demonstrated variable and inconsistent trends in the representation of underrepresented minorities in medicine (URiM), but information about URiM med-peds trainees is limited. The primary aim was to compare trends in URiM representation from 2005 to 2020 among US med-peds residents to FM, IM, and pediatrics. The secondary aim was to compare these trends to the US population. Methods Self-reported race and ethnicity data was obtained from annual graduate medical education census reports and the US Census Bureau. A cross-sectional analysis of African American/Black (AA), American Indian/Alaskan Native, Native Hawaiian/Pacific Islander, and Hispanic representation among the US population and med-peds, FM, IM, and pediatric residents was performed. Trends in proportions of URiM representation among residents and the US population were evaluated using the Cochran-Armitage test. Results There was a significant positive trend in the proportion of total URiM residents in med-peds (11.0% (n = 156) to 15.1% (n = 226), p = 0.01), FM (16.5% (n = 1,550) to 18.7% (n = 2,565), p = 0.04), IM (12.3% (n = 2,688) to 15.5% (n = 4,455), p < 0.001), and pediatrics (14.9% (n = 1,187) to 18.4% (n = 1,670), p < 0.001). Total URiM med-peds representation remained below other specialties throughout the study. Med-peds residencies demonstrated a significant positive trend in Hispanic representation (3.3% (n = 47) to 7.7% (n = 116), p < 0.001) and a significant negative trend in AA representation (6.9% (n = 98) to 7.1% (n = 107), p = 0.01). Total URiM representation remained below the US population for all specialties throughout the study. Conclusion The total proportion of URiM med-peds, FM, IM, and pediatric residents improved. For med-peds, this improvement was largely due to increased Hispanic resident representation. However, URiM med-peds resident representation is consistently below related specialties. URiM resident representation in med-peds and related specialties poorly reflects the diversity of the US population and should be urgently addressed.

The Future Face of Surgery-Demographics of Students Interested in Surgery at an Academic Medical Center

Background

The demographics of medical schools reveal a growing trend towards greater gender and underrepresented in medicine (UIM) representation among students, yet surgical residency lags behind. This study explores the demographics of first-year medical students (M1s) and their initial career interests.

Methods

A panel of faculty physicians and fourth-year medical students in surgical and nonsurgical specialties was held for M1s during orientation week. Demographic differences and career interests were collected.

Results

Fifty-six M1s, 31 (55%) female and 13 (24%) UIM, attended the event. While 35 students (62.5%) reported interest in surgery, only 7 (20%) identified as UIM and 16 (46%) as female.

Conclusion

Initial interest in surgery is comprised of mostly male and non-UIM students. Throughout medical school, this pattern persists, with current match rates into surgery not reflecting the population of students. Focusing on initial interest to surgery is crucial as it is the foundation for the pipeline of diversifying future surgeons.

Assessing the Experiences of Sexual and Gender Minority Applicants to Orthopaedic Surgery Residency

Introduction

The rate of sexual and gender minority (SGM) orthopaedic surgeons is far less than in other specialties, and the field has, in part, had significant difficulty attracting SGM applicants. To provide a more welcoming environment, identifying where applicants experience discrimination along medical training must be of paramount concern. Our objective was to understand the challenges faced by SGM medical students applying into orthopaedic surgery.

Methods

An anonymous survey was sent to applicants of a single orthopaedic residency program in 2023, soliciting demographics, exposure to lesbian, gay, bisexual, transgender, and/or queer (LGBTQ) mentors, and experiences with discrimination. Data were stratified by sexual orientation, and univariate analysis was conducted using chi-squared tests. Afterward, logistic regressions adjusted for gender, age, and race were performed.

Results

The overall response rate was 15.4% (n = 136/881). Fifteen percent (n = 20/135) identified as LGBTQ. Sixty-one percent of LGBTQ-identifying applicants experienced slurs and/or hurtful comments during orthopaedic rotations and research experiences, compared with 28% of their heterosexual peers (p < 0.001). In adjusted logistic regression models, LGBTQ respondents were 3.8 times more likely to report experiencing a hostile environment during training (p = 0.04) and 4.9 times more likely to have reported facing discrimination (p = 0.04) compared with heterosexual participants. Approximately 58% of respondents reported never having interacted with an LGBTQ-identifying orthopaedic attending, with only 5% reporting frequent interaction.

Conclusion

LGBTQ-identifying orthopaedic surgery applicants experience barriers related to their sexual identity, including derogatory comments, hostile clinical environments, and lack of LGBTQ mentorship. These findings highlight challenges inherent to the residency application process that may disproportionately affect persons from sexual minority groups. The recognition of such challenges can help to optimize the establishment of informed policies regarding mistreatment and practices regarding diversity and inclusion.

The Impact of Virtual Interviews on Satisfaction and Diversity in the Orthopedic Surgery Residency Match

INTRODUCTION

The recent pandemic necessitated virtual interviews for residency applications. While the travel restrictions have eased, the future of virtual interviews remains uncertain, and more information is needed regarding their impact. The purpose of this study was to assess the impact of virtual interviews on both matched applicants' and program directors' satisfaction with match outcomes. Secondarily, we assessed the impact of virtual interviews on resident diversity.

METHODS

This study received endorsement from COERG (Collaborative Orthopedic Education and Research Group). It consisted of surveys distributed to 24 orthopedic surgery residency program directors and residents in their programs, administered at the midpoint of their second year of residency. The surveys were conducted in 2 rounds: the first round targeted the class of 2025, who completed all interviews in person and served as the control group. The second round, conducted the following year, targeted the class of 2026, who underwent all interviews virtually. Each round involved 2 similar surveys to the ones conducted the year before, 1 for program directors and one for residents. Demographics, including resident race and socioeconomic measures, were also collected along with these surveys. Satisfaction was rated on a scale of 1 to 5, and mean satisfaction scores were calculated. Mann-Whitney U-test was performed for statistical analysis.

RESULTS

We received a total of 96 responses from residents, 60 in-person and 36 virtual interviewees. Of the 24 residency program directors who received surveys, 23 responded to the first-round survey (95.8%), while 18 responded to the second-round survey (75%), resulting in an overall response rate of 85.4%. Residents who interviewed virtually reported lower overall satisfaction with their residency program (p < 0.01), less satisfaction with a good fit between the applicant and the program (p < 0.01), faculty feedback (p < 0.05), research opportunities (p < 0.05), and the educational curriculum at their program (p < 0.01). Program directors were less satisfied with the timeliness of residents from the virtual cohort (p < 0.05) and the knowledge of the virtual cohort (p < 0.05). We found no significant difference in resident diversity between the 2 cohorts of matched residents.

CONCLUSION

Virtual interviews were associated with a reduction in both resident and program director satisfaction with match outcomes. Further, virtual interviews did not significantly increase residency diversity. These findings do not support the use of virtual interviews in the orthopedic surgery match process.

Gender, Racial, and Ethnic Diversity in Plastic Surgery: Evaluating Effective Initiatives and Identifying Areas for Improvement

ABSTRACT

Women and racial and ethnic minorities have historically been underrepresented in medicine, making up a minority of all physicians and a smaller subset of plastic surgeons. Furthermore, these groups represent an even smaller fraction of plastic surgeons in research and leadership roles. Parallel to the general recognition of the importance of increasing diversity in the medical field, there has been a surge in the literature detailing current issues and highlighting potential areas for intervention within plastic surgery. Various initiatives have been piloted to address the underrepresentation of certain demographic groups in the field. These have largely targeted the medical student level, with a focus on increasing mentorship, targeted recruitment, exposure to the field, and scholarly opportunities. With the growing body of research conducted in this realm, this review seeks to synthesize our understanding of the modern landscape of gender, racial, and ethnic diversity within plastic surgery, with an emphasis on identifying successful initiatives that have positively impacted representation and inclusivity.

A cross sectional analysis of residents by race/ethnicity and specialty from 2020-2023

BACKGROUND

Minorities are underrepresented in all areas of medical education relative to the United States general population, and minority physicians are more likely to practice in disadvantaged areas and in primary care settings. Many individual and structural factors contribute to this discrepancy. We aimed to demonstrate how resident race/ethnicity representation differs across the various resident specialties.

METHODS

We used publically available data from the Association of American Medical College's Report on Residents data series and averaged the four academic years from 2019 to 2020 through 2022-2023. We then calculated the odds ratio (OR) of self-reported race/ethnicity (alone and in combination) in thirty-four specialties.

RESULTS

Across the four-year study period, there were, on average, 147026 unduplicated resident trainees. The average number of duplicated residents by self-identified ethnic category (alone and in combination) include: American Indian or Alaska Native (839, 0.6%), Asian (31627, 21.5%), Black or African American (7935, 5.4%), Hispanic, Latino, or of Spanish Origin (10900, 7.4%), Native Hawaiian or Other Pacific Islander (296, 0.2%), White (76289, 51.9%), Other (4879, 3.3%), Unknown (522, 0.4%), and Non-US Citizens (23914, 16.3%). Across race/ethnicity, there are differences in ORs of representation in different specialties. Key findings include high representation in Public Health and Preventative Medicine by Black and African American (OR=3.7) and Native Hawaiian (OR=2.6) residents, and Family Medicine in Native Americans (OR=1.9), Native Hawaiian (OR=1.7), Black (OR=1.5), and Hispanic (OR=1.3) residents. Psychiatry also had high ORs of representation in minority residents.

CONCLUSION

This study illustrates relative resident ethnic representation across training specialties. Minorities ethnicities were more likely to be represented in primary care and public health domains. This has implications for creating a physician workforce suitable to serve the United States Population.

Asian American Representation in Medicine by Career Stage and Residency Specialty

IMPORTANCE

Asian American individuals are not underrepresented in medicine; however, aggregation in prior workforce analyses may mask underlying disparities.

OBJECTIVE

To assess representation by Asian race and disaggregated subgroups in the US allopathic medical school workforce.

Design, Setting, and Participants

This cross-sectional study used Association of American Medical Colleges (AAMC) special reports, generated using the AAMC Applicant-Matriculant Data File, Student Records System, Graduate Medical Education Track Survey, and faculty roster. Participants included medical school applicants, matriculants, graduates, residents, and faculty enrolled or employed at US allopathic medical schools between 2013 and 2021. Data were analyzed between March and May 2024.

EXPOSURE

Asian race or ethnic subgroup as per AAMC and US Census Bureau Office of Management and Budget criteria, including Bangladeshi American, Cambodian American, Chinese American, Filipino American, Indian American, Indonesian American, Japanese American, Korean American, Pakistani American, Taiwanese American, and Vietnamese American.

MAIN OUTCOMES AND MEASURES

Representation quotients (RQ) were used to indicate representation that was equivalent (RQ of 1), higher (RQ greater than 1), or lower (RQ less than 1) than expected representation based on US population estimates. One-way analysis of variance and linear regression models assessed mean RQ differences by career stage and over time, with Bonferroni correction for multiple comparisons.

RESULTS

In this study, Asian American individuals accounted for 94 934 of 385 775 applicants (23%), 39 849 of 158 468 matriculants (24%), 37 579 of 152 453 graduates (24%), 229 899 of 1 035 512 residents (22%), and 297 413 of 1 351 187 faculty members (26%). The mean (SD) RQ was significantly greater among Asian American residents (3.44 [0.15]) and faculty (3.54 [0.03]) compared with Asian applicants (3.3 [0.04]), matriculants (3.37 [0.03]), or graduates (3.31 [0.06]). Upon disaggregation, RQ was significantly lower among residents and faculty in 10 of 12 subgroups. Although subgroups, such as Taiwanese American, Indian American, and Chinese American, had RQs greater than 1 (eg, Chinese American graduates: mean [SD], RQ, 3.90 [0.21]), the RQs were less than 1 for Laotian, Cambodian, and Filipino American subgroups (eg, Filipino American graduates: mean [SD], RQ, 0.93 [0.06]) at almost every career stage. No significant RQ changes were observed over time for Laotian American and Cambodian American trainees, with a resident RQ of 0 in 8 of 25 and 4 of 25 specialties, respectively. Faculty RQ increased in 9 of 12 subgroups, but Cambodian American, Filipino American, Indonesian American, Laotian American, and Vietnamese American faculty (eg, Vietnamese American faculty: mean [SD], RQ, 0.59 [0.08]) had RQs less than 1.

CONCLUSIONS AND RELEVANCE

In this cross-sectional study of Asian representation in US allopathic medical schools, Laotian American, Cambodian American, and Filipino American individuals were underrepresented at each stage of the physician workforce pathway. Efforts to promote diversity in medicine should account for these disparities to avoid perpetuating inequities.

Money, Mentorship, and Misinformation: Barriers and Facilitators to Veterinarians' Pursuit of Postdoctoral Training in Laboratory Animal Medicine

Since 2015, it has become progressively more difficult for programs to recruit residents in laboratory animal medicine (LAM). Veterinarians are a necessary part of animal research, and having a shortage in veterinarians trained to work in this field has the potential to negatively impact research progress as well as animal welfare. With a goal to increase recruitment, we performed this study to better understand the barriers and facilitators that veterinarians experience when navigating the decision to pursue postdoctoral training in LAM. To do this, we recruited first-year LAM residents to participate in semistructured interviews, and performed thematic analysis on their responses. Key barriers included participants' awareness of perceived drawbacks of the field, inaccessibility of information about opportunities within the field, and misinformation about animal research both within the veterinary field and society at large. Key facilitators included participants' awareness of perceived benefits of the field, relationships with professionals involved in laboratory animal science, and formative predoctoral clinical experiences. Overall, we found evidence that information flow is particularly important in recruitment, suggesting that future recruitment strategies may want to target improved communication about LAM and animal research in general.

A 10-year analysis of the racial distribution of authors in plastic surgery research and the impact of minority mentorship

BACKGROUND

This study evaluates the racial distribution in Plastic and Reconstructive Surgery (PRS) publication authorship and illustrates the impact underrepresented in medicine (URiM) mentorship has on increasing diverse trainee contributions to the PRS peer-reviewed literature.

METHODS

Articles published in the seven highest-impact PRS peer-reviewed journals within the last 10 years (2012-2022) were reviewed and analyzed for first and senior authors' race and ethnicity, publication year, and citation count.

RESULTS

A total of 23,549 publications were identified of which 8250 were from the US-based institutions. A random sampling of 778 publications (∼10 ​%) were scrutinized for first and senior author race and ethnicity. Across all journals, 64.5 ​% of senior authors were White, 29.9 ​% Asian, 4.6 ​% Hispanic, and 1.0 ​% Black. First authors were 59.5 ​% White, 32.8 ​% Asian, 5.2 ​% Hispanic, and 2.6 ​% Black (p=<0.0001). The presence of a URiM senior author increased the likelihood of a URiM first author 7-fold (p=<0.0001); 95 ​% CI [3.5-14.0]). There was no statistically significant difference in the total citation count relative to author race or ethnicity. The Aesthetic Surgery Journal had the greatest proportion of White senior authors (73.6 ​%), while Microsurgery had the highest percentage of URiM senior authors (8.7 ​%).

CONCLUSIONS

URiM authorship of PRS publications is limited and mentorship is essential to improve underrepresented perspectives in the PRS peer-reviewed literature.

Diversity Scholarships for Plastic Surgery Subinternships: A National Review of US Residency Programs

Background

Residency programs have developed monetary initiatives for students underrepresented in medicine (URiM). Our team sought to provide a centralized resource for URiM students seeking plastic surgery subinternships with funded opportunities.

Methods

A cross sectional analysis of URiM scholarships offered by US integrated plastic surgery programs (n = 91) between July and September 2023. The study used residency program web domains. Investigators collected information on the monetary value of scholarship, eligibility criteria, and required application documents. Inferential analyses were conducted to investigate whether programs' geographic region or Doximity ranking played a role in likelihood of scholarship existence.

Results

The study found that approximately 52.7% (n = 48) of programs have in place monetary support for underrepresented visiting medical students (eg, stipend or reimbursement). The average monetary support was $1670. A univariate test demonstrated that programs with lower rankings in both reputation and research were less likely to have a scholarship available than higher ranking programs (P = 0.002; P = 0.02, respectively). Programs located in the Midwest regions were 3.5 times more likely to have a diversity scholarship available (P = 0.034). In our multivariate analysis, reputation ranking and geographic region remained significant. A Pearson chi square test showed the greatest proportions of scholarships among geographically similar programs to be in the Midwest (70%), however, not statistically significant.

Conclusions

This study provides a centralized resource for URiM students interested in completing away rotations. Further investigation into development of these scholarship opportunities would be of much benefit and could guide other programs in the funding their own diversity scholarships.

How Do Plastic Surgery Program's Websites Feature Diversity and Inclusion Elements? An Analysis of 89 Integrated Plastic Surgery Programs' Websites

INTRODUCTION

Plastic surgery residency programs leverage their websites as platforms for promoting their commitment to diversity and inclusion to potential candidates. Medical students who are seeking residency positions, including individuals from underrepresented backgrounds, place significant importance on the alignment of program culture and diversity. The authors assessed how these programs showcased diversity and inclusion efforts on their websites.

METHODS

The authors analyzed 89 plastic surgery integrated residency program websites for the presence of 12 elements, (1) nondiscrimination, (2) diversity and inclusion statement, (3) community resources, (4) extended resident biographies, (5) faculty biographies, (6) faculty photos, (7) resident photos, (8) additional financial resources for trainees, (9) wellness, (10) mental health resources, (11) health disparities/community engagement, and (12) presence of a diversity council. Additionally, we examined the presence of these 12 elements by geographic region (West, Midwest, South, and Northeast). Our analyzed use chi-squared, t-tests, and Mann-Whitney U; significance level was p = 0.005. The independent plastic surgery programs were excluded, considering their websites were combined with the integrated-residency programs.

RESULTS

We reviewed 89 websites from February 9, 2024 until February 24, 2024 and on average had 6.32 ± 1.1 diversity and inclusion elements. Resident photos (n = 84, 94.4%), community resources (n = 55, 61.8%), faculty photos (n = 63, 70.8%), and additional financial resources for trainees (n = 56, 62.9%) were the most common. The least common diversity and inclusion elements were diversity councils (n = 12, 13.5%), wellness resources (n = 36, 40.4%), and diversity and inclusion statements (n = 42, 47.2%). The primary analysis revealed that programs with higher number of incoming positions (3 or more) (5.2 ± 1.8) had a significantly higher diversity and inclusion scores when compared to programs with lower number of incoming positions (3.6 ± 2.1) (p = 0.002). Furthermore, based on the geographic regions from the U.S. Census, there was no significant difference between geographic regions.

CONCLUSIONS

Characterizing the number of program websites and quantifying the number of diversity elements on each site provide an opportunity for more residency programs to further commit to diversity and inclusion. Displaying different diversity and inclusive initiatives on program websites may attract more diverse applicants, particularly individuals from underrepresented populations in medicine.

Examining the Role of Gender and Ethnic Concordance in Medical Student Specialty Selection

Introduction

Representation of female and minority physicians varies across specialties and may influence career selection by medical students. To investigate the effect of demographic concordance between medical students and clinical role models on specialty selection, we conducted a survey of graduating medical students to assess the perceived importance and influence of third-year clerkship experiences with demographically concordant preceptors on their choice of specialty for post-graduate training.

Methods

An 11-question survey was shared nationally through AAMC Organizational Student Representatives to medical students in the Class of 2023. Information gathered included demographics; specialty of choice; extent of exposure to preceptors of the same gender, race, or ethnicity during clinical clerkships; and perceived importance and influence of those interactions (Likert 1-5, Low-High) on specialty selection.

Results

A total of 84 students responded. Female students ascribed more importance to gender concordance with preceptors on the third-year clerkship most associated with their specialty of choice than males [3.4 (SD 1.2) vs. 1.3 (SD 0.8) respectively, p < 0.0001] and greater influence to gender concordance on final specialty selection [2.37 (SD 1.1) vs. 1.31 (SD 0.8) respectively, p < 0.0001]. Non-Caucasians ascribed more importance to race/ethnicity concordance than Caucasians [2.8 (SD 1.4) vs. 1.2 (SD 0.5) respectively, p < 0.0001] and greater influence to race/ethnicity concordance on final specialty selection [2.0 (SD 1.3) vs. 1.1 (SD 0.4) respectively, p < 0.0001]. Caucasian females ascribed the greatest importance to gender concordance (p < 0.001), non-Caucasian females ascribed the greatest influence of gender concordance (p < 0.001), and non-Caucasian females ascribed both the greatest importance (p < 0.001) and influence (p < 0.001) to race/ethnicity concordance.

Conclusions

We found that gender and race/ethnicity concordance between students and clinical preceptors during third year clerkships is perceived as especially important and influential in specialty selection by minority and female medical students. These findings highlight the importance of diversity in gender and race/ethnicity representation by preceptors on clinical clerkships.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40670-024-02044-6.

LGBTQIA+ Outness in Otolaryngology Residency Applications

Lesbian, gay, bisexual, transgender, queer, intersex, and asexual/aromantic (LGBTQIA+) providers improve health outcomes of sexual and gender minority (SGM) patients, which demonstrates the importance of understanding the state of LGBTQIA+ representation at all levels of medical training. The U.S. does not systematically collect sexual orientation and gender identity (SOGI) data from applicants, trainees, and attending physicians, prompting us to wonder whether SGM representation in surgical fields, such as otolaryngology, is adequate. Personal statements submitted to an otolaryngology program from 2019 to 2021 were searched for LGBTQIA+ terms, and those containing LGBTQIA+ terms underwent full text review to determine whether applicants identified themselves as LGBTQIA+. Across these 2 application cycles, the sampled residency program received 928 applications. Only 2 applicants of 928 (0.2%) self-disclosed their LGBTQIA+ identities in their personal statements. These results signify a scarcity of SGM diversity in otolaryngology and warrant deeper exploration into factors preventing residency applicants from self-disclosure of LGBTQIA+ identities.

Racial and Ethnic Disparities in Otolaryngology Applicants and Residents: Recruiting a Diverse Workforce

OBJECTIVE

The purpose of this study is to examine the racial and ethnic representation of otolaryngology applicants and residents and determine if there have been any improvements in recruiting a diverse workforce over the past several years.

METHODS

A retrospective study was conducted on self-reported race and ethnicity data of otolaryngology applicants to United States residency programs from 2016 to 2022 from the Association of American Medical Colleges (AAMC) and residents from 2011 to 2022 from the Accreditation Council for Graduate Medical Education (ACGME). The changes in proportions of applicants and residents by race and ethnicity separately was compared as well as the proportion of applicants to residents. Descriptive analyses and chi-square tests were used to compare proportions of groups by race and ethnicity.

RESULTS

There was no statistically significant difference in the proportion of applicants by race or ethnicity from 2016-2017 to 2021-2022. There was a decrease in the proportion of White residents from 58.1% to 54.5% from 2011-2012 to 2018-2019. There were higher proportions of White residents than applicants and lower proportions of Black residents than applicants in the two cycles analyzed. In the most recent cycle analyzed, the proportion of Hispanic or Latino residents was higher than the proportion of Hispanic or Latino applicants.

CONCLUSION

While there may be improvements to increase representation of otolaryngology applicants and residents, there continues to be inequalities and a lack of diversity. Further initiatives are needed to ensure diversity in the field improves moving forward.

Identification, Characterization, and Ranking of Candidate Metrics for Selection to Anesthesiology Residency: An Iterative Survey of Program Directors

Background

The primary aim of this study was to identify and stratify candidate metrics used by anesthesiology residency program directors (PDs) to develop their residency rank lists through the National Resident Matching Program.

Methods

Sixteen PDs comprised the participants, selected for diversity in geography and program size. We used a 3-round iterative survey to identify and stratify candidate metrics. In the first round, participants listed metrics they planned to use to evaluate candidates. In the second round, metrics from the first round were ranked by importance, and criteria were solicited to define an exceptional, strong, average, marginal, and uncompetitive candidate for each metric. In the third round, aggregated results were presented and participants refined their rankings.

Results

Of the 16 PDs selected, 15 participated in the first and second survey rounds, and 10 in the third. Eighteen candidate metrics were indicated by 8 or more PDs for residency selection. All 10 PDs from the final round identified passing Step 1 of the United States Medical Licensing Exam (USMLE) and the absence of "red flags" like a failed rotation as key selection metrics, both averaging an importance score of 4.9 out of 5. Other metrics identified by all PDs included clerkship evaluation comments, USMLE Step 2 scores, class rank, letters of recommendation, personal statement, and program and geographical signals.

Conclusions

The study reveals key metrics anesthesiology residency PDs use for candidate ranking, which may offer candidates insights into their competitiveness for anesthesiology residency.

Racial/Ethnic and Gender Diversity of Orthopaedic Journal Editorial Boards

BACKGROUND

In the current era of evidence-based medicine, scientific publications play a crucial role in guiding patient care. While the lack of diversity among orthopaedic surgeons has been well documented, little is known about the diversity of orthopaedic journal editorial boards. The purpose of this study was to assess the racial/ethnic and gender diversity of U.S. orthopaedic journal editorial boards.

METHODS

The editorial boards of 13 orthopaedic journals were examined, including 10 subspecialty and 3 general orthopaedic journals. Race/ethnicity and gender were determined for each editorial board member. The representation observed on orthopaedic journal editorial boards was compared with representation at other phases of the orthopaedic pipeline, as well as within the various subspecialty fields of orthopaedics. Logistic regression and t tests were used to evaluate these comparisons.

RESULTS

We identified 876 editorial board members of the 13 journals; 14.0% were Asian, 1.9% were Black, 1.9% were Hispanic, 2.4% were multiracial/other, and 79.7% were White. Racial/ethnic representation was similar across the subspecialty fields of orthopaedics (p > 0.05). The representation of women on orthopaedic editorial boards was 7.9%, with differences in gender diversity observed across subspecialty fields (p < 0.05). Among journals in the subspecialty fields of spine and trauma, female editorial board representation was lower than expected, even after taking into account the representation of women in these subspecialty fields (2.0% versus 9.0% [p = 0.002] and 3.8% versus 10.0% [p = 0.03], respectively).

CONCLUSIONS

In this study of 13 subspecialty and general orthopaedic journals, the representation of racial/ethnic minorities and women on editorial boards was similar to their representation in academic orthopaedics. However, these values remain low in comparison with the population of patients treated by orthopaedic surgeons. Given the importance of scientific publications in the current era of evidence-based medicine, orthopaedic journals should continue working to diversify the membership of their editorial boards.

Exploring Underrepresentation: The Role of Diversity Statements in Ophthalmology Residency Programs

INTRODUCTION

The underrepresentation of underrepresented minorities (URMs) in the medical field, particularly in ophthalmology, poses a critical challenge to achieving diversity and equity. While URMs constitute 19% of medical school attendees, their presence is markedly lower in ophthalmology residency programs and among practicing ophthalmologists. This study seeks to investigate the prevalence of diversity statements on ophthalmology residency program websites and their role in the underrepresentation of URMs within the field.

METHODS

This observational, cross-sectional study analyzed the websites of 126 ophthalmology residency programs listed on the San Francisco (SF) Match website. Diversity statements were categorized based on their inclusion of specific underrepresented groups (race or ethnicity, gender, sexual orientation, and disability) and analyzed for correlation with program characteristics. Descriptive statistics and Chi-squared tests were utilized to assess the prevalence of diversity statements and their association with program size, ranking, geographical location, and institutional nature.

RESULTS

Of the 126 programs analyzed, 21 (16.7%) had diversity statements specific to the ophthalmology residency program, and 115 (91.3%) featured institutional-level diversity statements. Race or ethnicity was the most commonly addressed category in diversity statements (75.3%), followed by gender (65.9%), sexual orientation (61.1%), and disability (53.2%). Statistical analyses revealed no significant correlation between program size and the presence of diversity statements. However, higher-ranked programs were more likely to mention sexual orientation and disability. Significant differences were observed at the institutional level, with public institutions more likely to include specific diversity categories.

CONCLUSION

The study highlights a significant disparity in the presence and focus of diversity statements across ophthalmology residency programs. Despite a high prevalence of institutional-level diversity statements, program-specific initiatives are lacking, particularly in addressing disability inclusion. The findings suggest a need for a more comprehensive and targeted effort to address underrepresentation in ophthalmology.

Strategies to Increase the Spanish-Speaking Workforce in Orthopaedic Surgery within the United States

ABSTRACT

Language-concordant care improves patient satisfaction. Given the increase in Spanish-speaking persons requiring orthopaedic care in the United States, it is essential to increase the Spanish-speaking workforce in orthopaedic surgery. We have proposed strategies to improve the proportion of Spanish-speaking orthopaedic surgeons in the U.S. through early exposure to orthopaedic surgery, by creating collaborative advancement and mentorship opportunities, by endorsing Spanish-language immersion opportunities, and by increasing workforce diversity awareness. Furthermore, we have suggested a strategy to better equip non-Spanish-speaking orthopaedic surgeons while caring for Spanish-speaking patients. Together, the suggested strategies offer a variety of approaches that can have a direct, tangible impact on optimizing orthopaedic care while enhancing patient-physician communication in the Spanish language.

What Goes In, Must Come Out: Generative Artificial Intelligence Does Not Present Algorithmic Bias Across Race and Gender in Medical Residency Specialties

Objective Artificial Intelligence (AI) has made significant inroads into various domains, including medicine, raising concerns about algorithmic bias. This study investigates the presence of biases in generative AI programs, with a specific focus on gender and racial representations across 19 medical residency specialties. Methodology This comparative study utilized DALL-E2 to generate faces representing 19 distinct residency training specialties, as identified by the Association of American Medical Colleges (AAMC), which were then compared to the AAMC's residency specialty breakdown with respect to race and gender. Results Our findings reveal an alignment between OpenAI's DALL-E2's predictions and the current demographic landscape of medical residents, suggesting an absence of algorithmic bias in this AI model. Conclusion This revelation gives rise to important ethical considerations. While AI excels at pattern recognition, it inherits and mirrors the biases present in its training data. To combat AI bias, addressing real-world disparities is imperative. Initiatives to promote inclusivity and diversity within medicine are commendable and contribute to reshaping medical education. This study underscores the need for ongoing efforts to dismantle barriers and foster inclusivity in historically male-dominated medical fields, particularly for underrepresented populations. Ultimately, our findings underscore the crucial role of real-world data quality in mitigating AI bias. As AI continues to shape healthcare and education, the pursuit of equitable, unbiased AI applications should remain at the forefront of these transformative endeavors.

Sociodemographics Impact Competitiveness in the Neurosurgical Match: Survey Results

BACKGROUND

The neurosurgical match involves selecting future neurosurgeons who will comprise the future national workforce, based on a competitive ranking process of applicants. We aimed to identify which sociodemographic and academic factors influence competitiveness and rank position in the match.

METHODS

A Council of State Neurosurgical Societies (CSNS) survey was distributed to current U.S. neurosurgical residents. The primary outcome measure was self-reported rank position of matched program. Variables included sociodemographic and academic metrics. Fisher exact, logistic regression, and t tests were performed.

RESULTS

Among the 72 respondents, median United States Medical Licensing Examination Step 1 score was 248, 34.7% were Alpha Omega Alpha inductees, 77.8% completed 1-3 sub-internship rotations, median number of publications was 5, and 13.9% had a Ph.D. Sociodemographic analysis demonstrated that 69.4% were male and 30.6% were female. Applicants with a home neurosurgery program or of female gender had statistically significantly higher odds of matching into a top 3 program on their rank list (odds ratio = 9 and odds ratio = 6, respectively). Female applicants exhibited similar mean, but less variance, compared with male respondents for United States Medical Licensing Examination Step 1 scores and number of publications. Respondents with a top 3 program match were more likely to agree that the home program supported their pursuance of neurosurgery.

CONCLUSIONS

Two sociodemographic factors were independently associated with high match rank: presence of home neurosurgery program and female gender. Female respondents reported consistently strong academic metrics (similar mean, but less variance, compared with male respondents).

Diversity in the Cardiothoracic Surgery Workforce: What I Can Do

Within the cardiothoracic surgery workforce, there are significant gaps in the numbers of women and underrepresented in medicine minorities, but some progress has been made in gender diversity at the resident level. Individual surgeons play an important role in combatting discrimination and harassment, while also promoting women and minorities through mentorship and sponsorship. More importantly, a multifaceted and structured approach is needed to increase diversity at the institutional level with strategies to create a culture of inclusion, working to retain underrepresented minority and female surgeons, and eliminating bias in the recruitment process.

Underrepresented Applicants Post-USMLE Pass/Fail: A National Survey of Competitive Residency Directors

Objective

To report the selection criteria important to residency program directors (PDs) and whether they believe pass/fail scoring will impact underrepresented in medicine (URM), International Medical Graduate (IMG), or osteopathic (DO) residency applicants after the United States Medical Licensing Examination (USMLE) changed Step 1 score reporting to pass/fail in January 2022.

Methods

A Qualtrics survey was sent between August 2022 and January 2023 to 1141 US PDs from specialties with traditionally low residency selection rates: dermatology, ophthalmology, otolaryngology, orthopedic surgery, neurosurgery, interventional radiology, diagnostic radiology, radiation oncology, thoracic surgery, vascular surgery, plastic surgery, and urology. Contact information was obtained from AMA, FRIEDA, or program websites.

Results

We received 433 responses (38%). When asked to anticipate the difficulty student groups will face matching into their specialty, PDs reported: for URM, 24.0% increased, 46.0% unchanged, and 30.0% decreased; for DO, 49.19% increased, 44.58% unchanged, and 6.23% decreased and for IMG, 56.35% increased, 39.72% unchanged, and 3.93% decreased. When asked to rank the most important selection factors, the top two responses were Step 2 CK score and away rotation participation at their site.

Conclusion

PDs overwhelmingly believed residency selection difficulty would either increase or remain unchanged for DO (93.77%) and IMG (96.07%). In contrast, 76.0% reported difficulty for URM students would either decrease or remain unchanged. PDs ranked Step 2 CK score and away rotation participation as the most important selection factors. Despite PDs' belief that the Step 1 pass/fail scoring system may mitigate one barrier for URM students, emphasis on Step 2 CK and away rotations place additional barriers.

Aligning our actions with our words: A systematic review of gender and racial diversity in surgical subspecialties

Introduction

Persistent racial and gender disparities are prevalent within the higher education and medical training system, notably seen in the underrepresentation of Hispanic or Latinos, Black Americans, and female surgeons compared to their respective population proportions. This study aims to quantify publications addressing ethnic or gender diversity across various surgical specialties, analyze publication trends, and explore specific topics within medical literature.

Database

The Database includes PubMed, Google Scholar, and Scopus.

Methods

Employing the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), we conducted a systematic literature review utilizing the PubMed, Google Scholar, and Scopus databases. A broad inclusion criterion for both ethnic and gender diversity of plastic surgery, neurosurgery, otolaryngology, dermatology, orthopedic surgery, and gender surgery was utilized. The literature was selected between 2014 and 2024. In the content of our study, diversity in articles was defined as any article that focused on addressing gender or racial/ethnicity in the subspecialty.

Results

Of 1529 initially screened articles, 346 were included. Orthopedic surgery had the most diversity publications (n = 86), followed by general surgery (n = 67) and plastic surgery (n = 51). Significant increases in diversity publications were observed across all specialties. Orthopedic surgery showed the highest growth (+0.17 publications/year, p < 0.001), followed by plastic surgery (+0.12, p = 0.002) and general surgery (+0.11, p = 0.003). Race/ethnicity was the primary focus (51.4%), with fewer articles on gender (19.7%) or both (28.9%). Diversity topics included demographics, pipeline/recruitment, application process, training experience, leadership, and workplace treatment.

Conclusion

These insights underscore the importance of continued efforts to promote diversity within surgical specialties to enhance patient care and outcomes. Further research and initiatives are needed to ensure equitable representation in surgical fields. Addressing diversity issues in surgical specialties is essential for improving healthcare outcomes and reducing disparities.

Examining Racial and Gender Diversity in the Plastic Surgery Pipeline: Where is the Leak?

Background

There is limited information about minority representation throughout the plastic and reconstructive surgery (PRS) pipeline. The aim of this study was to examine trends in representation among minorities at different stages of the PRS training pathway, starting with potential candidates in high school through practicing physicians.

Methods

The PRS pipeline was defined as high school; college; medical school applicants, matriculants, and graduates; PRS residency applicants, matriculants, and active residents; and PRS practicing physicians. Racial data for each stage were obtained from the US Census and Association of American Medical Colleges. The proportion of races at each stage were divided by their US population counterpart proportions to produce representation quotients (RQs). Medians and interquartile ranges (IQRs) are reported. Mann-Whitney U tests compared RQ values within identities between successive stages.

Results

Black students had high representation in high school (RQ = 1.26 [IQR: 1.21-1.29]) but had significant, stepwise decreases in representation in subsequent stages. A similar trend was observed for Hispanic individuals, who had their highest representation in high school (1.43 [1.37-1.50]), followed by significant decreases in RQ at nearly every subsequent stage up to and including practicing physicians (0.30 [0.28-0.31). Asian individuals were overrepresented at every stage (high school RQ: 1.01 [1.00-1.03]; practicing physician RQ: 2.30 [2.27-2.32]). White individuals were underrepresented before residency but had an RQ that approximated 1 in subsequent stages.

Conclusions

Racial minorities experienced decreases in representation at each successive stage in the PRS pipeline following high school. Ongoing diversity efforts should focus on premedical recruitment and professional support for minority students.

The 2021 ACR/Radiology Business Management Association Workforce Survey: Diversity in Radiology

The landscape of the radiology workforce is changing, especially in the diversity of the demographics of practicing radiologists across subspecialties, practice types, and leadership positions in both academic and nonacademic settings. The 2021 ACR/Radiology Business Management Association Workforce Survey examines these facets in detail and contributes to our understanding of the current state of diversity in the radiology workforce and potential barriers to change. The results suggest opportunities and future directions for improving diversity, equity, and inclusion.

Diversity in Radiology Residents Relative to Other Specialties- Trends Over the Past Decade

RATIONALE AND OBJECTIVES

The objective of this study was to assess diversity among radiology residents relative to other specialties and compare it with historical trends.

MATERIALS AND METHODS

The Graduate Medical Education results from 2010-2011 to 2020-2021 were accessed for demographic information for major medical specialties (number of residents > 500 as of the 2020-2021 report). Subspecialties and fellowship programs were not included in this analysis. The racial and ethnicity breakdowns were extracted, including Black, White/Caucasian, Asian, Hispanic, and others. The changes in racial and ethnicity composition of residents in radiology was compared to other specialties using the Chi Squared test using a significance level of p < 0.05.

RESULTS

In 2020-2021, radiology ranked ninth in total resident enrollment among the 21 largest ACGME training programs, unchanged when compared to 2010-2011. Amongst all specialties, Radiology ranked 10th for Black and 9th for Hispanic representation in 2020-2021.The percentage of Black residents increased from 3.07% in 2010-2011 to 3.83% in 2020-2021. The percentage of Hispanic Radiology residents increased from 4.83% to 7.35%, constituting the third largest increase amongst all specialties.

CONCLUSION

The representation of Blacks and Hispanics in Radiology has improved relative to other medical specialties in the last decade.

Operative management of rotator cuff tears: identifying disparities in access on a national level

BACKGROUND

The purpose of this study was to identify nationwide disparities in the rates of operative management of rotator cuff tears based on race, ethnicity, insurance type, and socioeconomic status.

METHODS

Patients diagnosed with a full or partial rotator cuff tear from 2006 to 2014 were identified in the Healthcare Cost and Utilization Project's National Inpatient Sample database using International Classification of Diseases, Ninth Revision diagnosis codes. Bivariate analysis using chi-square tests and adjusted, multivariable logistic regression models were used to evaluate differences in the rates of operative vs. nonoperative management for rotator cuff tears.

RESULTS

This study included 46,167 patients. When compared with white patients, adjusted analysis showed that minority race and ethnicity were associated with lower rates of operative management for Black (adjusted odds ratio [AOR]: 0.31, 95% confidence interval [CI]: 0.29-0.33; P < .001), Hispanic (AOR: 0.49, 95% CI: 0.45-0.52; P < .001), Asian or Pacific Islander (AOR: 0.72, 95% CI: 0.61-0.84; P < .001), and Native American patients (AOR: 0.65, 95% CI: 0.50-0.86; P = .002). In comparison to privately insured patients, our analysis also found that self-payers (AOR: 0.08, 95% CI: 0.07-0.10; P < .001), Medicare beneficiaries (AOR: 0.76, 95% CI: 0.72-0.81; P < .001), and Medicaid beneficiaries (AOR: 0.33, 95% CI: 0.30-0.36; P < .001) had lower odds of receiving surgical intervention. Additionally, relative to those in the bottom income quartile, patients in all other quartiles experienced nominally higher rates of operative repair; these differences were statistically significant for the second quartile (AOR: 1.09, 95% CI: 1.03-1.16; P = .004).

CONCLUSION

There are significant nationwide disparities in the likelihood of receiving operative management for rotator cuff tear patients of differing race/ethnicity, payer status, and socioeconomic status. Further investigation is needed to fully understand and address causes of these discrepancies to optimize care pathways.

Updates on Diversity Among Cardiology-Related Fellowships

Within the United States (US) medical system, diversity in healthcare is a growing concern although studies have shown improved patient outcomes when healthcare teams are diverse. We were interested in cardiology-related fellowships from internal medicine and surgical specialties to understand how females, osteopaths (DOs), and non-US graduates were represented compared to males, allopathic medical doctors (MD), and US-graduated peers. We obtained data about accredited cardiology fellowship programs from the Fellowship and Residency Electronic Interactive Database Access System (FRIEDA™) for 2022-2023 and determined statistical significance for male/female, DO/MD, and US/non-US graduate status by reviewing program sites. Statistical analysis utilized SAS Studio 3.8, version 9.4 (SAS Institute, Inc., Cary, NC) and Wilson score for confidence intervals. Cardiology-related fellowships from internal medicine and surgery backgrounds showed generalized marked disparities (p<0.001) with only a couple of exceptions. For Interventional Cardiology, non-US graduates were well represented (p=0.3775), and for Heart Failure & Transplant Cardiology, females were represented equally (p=0.0863). For all other specialties and values, females, DOs, and non-US graduates were underrepresented. Despite conversations about diversity, underrepresentation persists. We encourage further steps to address barriers preventing underrepresented groups from advancing to their full potential in leadership and careers. Increasing diversity promotes competence, empathy, communication, and inclusive patient care.

Diversity Within the Field of Orthopedic Sports Medicine: A Systematic Review

BACKGROUND

Orthopedic surgery is among the least diverse specialties in medicine. This systematic review analyzes gender, racial, and ethnic diversity within orthopedic sports medicine and aims to raise awareness and provide guidance for future strategies that support underrepresented minorities in medicine (URMs) and women in joining the orthopedic sports medicine workforce. We hypothesize that at all tiers of training, there is a lack of gender, racial, and ethnic parity in academic rank, leadership positions, and research productivity.

METHODS

A search of all published literature in the English language from PubMed, Embase, Cochrane, and Scopus databases, between January 1, 2010, and August 18, 2023, was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Included studies presented demographics regarding diversity within orthopedic sports medicine and provided trends in applicants, attendings, leadership, and/or research. Bias was assessed using the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) study checklist.

RESULTS

Thirteen studies published between 2016 and 2023 with STROBE scores 15.5 to 21.5 (70.5% to 97.7%) met criteria, and pertinent data were extracted. The percent of female orthopedic sports medicine surgeons from 2010 to 2019 increased from 5% (n = 138) to 6% (n = 206) with a compound annual growth rate of 0.2% (r2 = 0.97; p < 0.001). Females and URMs are underrepresented at the highest levels of orthopedic sports medicine leadership including department chair (female: 0% [n = 0]), division chief (female: 4% [n = 4]; URM: 3% [n = 3]), and fellowship director (female: 3.3% [n = 3]; URM: 4.4% [n = 4]). Studies from prominent orthopedic sports medicine journals (American Journal of Sports Medicine, Arthroscopy, Journal of Shoulder and Elbow Surgery, and Sports Health) show a 12.1% increase in female involvement in orthopedic sports medicine research from 1972 to 2018; however, this increase captures 59.3% (n = 2,953) females with degrees other than an MD.

CONCLUSIONS

Although increasingly more females and underrepresented minorities are joining orthopedic sports medicine, the rate of diversification remains slow and current involvement in leadership and research is minimal. Targeted efforts aimed at increasing research opportunities and inspiring interest through mentorship for URMs and females in orthopedics is essential to drive change toward parity.

LEVEL OF EVIDENCE

Level IV. Systematic Review. See Instructions for Authors for a complete description of levels of evidence.

The Importance of Research Experience With a Scoreless Step 1: A Student Survey at a Community-Based Medical School

PURPOSE

As of January 26, 2022, the United States Medical Licensing Examination (USLME) step 1 exam went from a scored test to pass-fail step 1 (PFS1). The authors were interested in surveying medical students at a community-based medical school to observe their perceptions of the importance of student research given this recent change.

METHOD

A Qualtrics survey was disseminated to medical students (years 1-4) via school emails. Data were analyzed using the Mann-Whitney test to assess Likert scale scores, and narrative comments were grouped as qualitative feedback. Survey dissemination and analysis of data were both conducted at a large community-based medical school.

RESULTS

The survey sampled 104 students categorized into pre-clerkship (PC) and clerkship (CL) years, with a response rate of 33%. A contradiction was found, as indicated by the higher number (p = 0.047) of clerkship students interested in Primary Care/Family medicine residency compared to pre-clerkship students at 41% and 59%, respectively. Whereas participants who indicated they are interested in pursuing a competitive specialty for residency were 51% of pre-clerkship students over 41% of clerkship students (p = 0.047). Additionally, given the assessment change to pass/fail, students did in fact believe that residencies would now view research as a higher assessed component than before (79% pre-clerkship and 72% clerkship). However, a minority of students said that they increased their research efforts (41% and 47%). Most students supported the research opportunity improvements proposed in our survey.

CONCLUSIONS

Efforts to make the step 1 exam pass/fail may have alleviated some stress related to performance but may have increased the perception of the importance of other components in a student's residency application. Our survey highlights how medical students at a community-based medical school perceive this change and how it has affected their research efforts.

Racial and Ethnic Bias in Letters of Recommendation and Personal Statements for Application to Otolaryngology Residency

INTRODUCTION

The persistent lack of racial and ethnic diversity within the field of otolaryngology calls for an analysis of potential bias within the residency application system. Letters of recommendation (LORs) and personal statements (PSs) are the most important subjective application constituents. This subjectivity predisposes these components to implicit bias. In applications to various surgical subspecialties, prior linguistic studies assessing bias in reviews of LOR show race-based differences. Thus far, racial and ethnic linguistic differences in LORs for otolaryngology applicants have not been analyzed in the literature.

METHODS

LORs and PSs were abstracted from otolaryngology - head and neck surgery applications in the Electronic Residency Application Service for the 2019-20 and 2020-21 application cycles. Linguistic Inquiry and Word Count 2015 was used for quantitative analysis of emotional, cognitive, and structural components of written text.

RESULTS

Race-pair analysis of the 2019-2021 application cycles revealed higher mean "teaching" scores for LORs for Asian, black, Hispanic, and white applicants when compared to applicants who self-identified as Other. White applicants had lower scores for the terms "research" and "analytic" when compared to Asian and black applicants, respectively. Analysis of PSs revealed greater scores for an "authentic" writing style for white versus Asian applicants. White applicants were found to have higher scores for "tone" compared to black applicants.

CONCLUSION

Minor racial and ethnic language differences exist in both LORs and PSs. A statistically significant difference was observed among LORs, with the "teaching" term used more frequently for Asian, black, Hispanic, and white applicants compared to self-identified Other individuals. For PSs, statistically significant differences were observed among white applicants, who wrote about themselves using more "authentic" language when compared with Asian applicants and who also had higher scores for "tone" compared to black applicants. Although these differences were statistically significant, the practical impact of the variances is likely small.