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Olivencia MN, Lam NB, Stewart S, Miller-Hammond K, Johnson S, Nembhard CE, Tee MC. Disparities in Diversity, Equity, and Inclusion in Surgical Residency Education: A Systematic Review. Am Surg 2025:31348251329472. [PMID: 40333052 DOI: 10.1177/00031348251329472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/09/2025]
Abstract
BackgroundIncreasing minority representation in surgical training is an important step toward eliminating health care disparities and access to care for vulnerable patient populations. Underrepresented minorities (URMs) face unique barriers to becoming board-certified surgeons, affecting their recruitment, retention, and overall success. This systematic review aims to consolidate existing literature on these disparities by examining trends affecting URMs across the surgical training continuum.MethodsA systematic literature search was conducted using PubMed/Ovid, Google Scholar, and Elsevier Library. Search terms included "diversity, surgical education, and underrepresented minorities." Articles were screened based on selection criteria focusing on US general surgery residency training, URM recruitment, retention, and performance. Final selection of articles for review were assessed for quality and summarized according to thematic trends.ResultsOf 180 articles reviewed, 42 met the criteria for inclusion. Underrepresented minorities face barriers in educational pathways including lower retention rates and institutional climates that disproportionately impact their experiences and wellbeing. Both URMs and women were less likely to apply, match, and succeed in surgical residency, often due to challenges related to academic performance, lack of mentorship, and institutional support. Additionally, significant gaps were identified in surgical mentorship, leadership, and faculty diversity among these groups.ConclusionsUnderrepresented minority surgical trainees encounter significant barriers along the medical education continuum for successful completion of surgical training and subsequent surgical careers. Our study underscores the need to create a diverse and inclusive workforce that promotes health equity and access to care.
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Affiliation(s)
| | - Natham B Lam
- Department of Surgery, Howard University Hospital, Washington, DC, USA
| | - Shai Stewart
- Department of Surgery, Howard University Hospital, Washington, DC, USA
| | | | - Shaneeta Johnson
- Department of Surgery, Morehouse University School of Medicine, Atlanta, GA, USA
| | | | - May C Tee
- Department of Surgery, Howard University Hospital, Washington, DC, USA
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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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Howard TF, Pike J, Grobman WA. Racial disparities in the selection of chief resident: A cross-sectional analysis of a national sample of senior residents in the United States. J Natl Med Assoc 2024; 116:6-12. [PMID: 38052698 DOI: 10.1016/j.jnma.2023.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Revised: 08/18/2023] [Accepted: 09/25/2023] [Indexed: 12/07/2023]
Abstract
INTRODUCTION Part of the difficulty in recruiting and retaining a diverse physician workforce, as well as within medical leadership, is due to racial disparities in medical education. We investigated whether self-identified race-ethnicity is associated with the likelihood of selection as chief resident (CR). MATERIALS AND METHODS We performed a cross sectional analysis using de-identified person-level data from the GME Track, a national resident database and tracking system, from 2015 through 2018. The exposure variable, self-identified race-ethnicity, was categorized as African American or Black, American Indian or Alaskan Native, Asian, Hispanic, Latino or of Spanish Origin, Native Hawaiian or Pacific Islander, White, and Multi-racial. The primary study outcome was CR selection among respondents in their final program year. Logistic regression was used to estimate the adjusted odds ratios (aOR) and 95% confidence intervals (CI) of CR selection for each racial group, as compared to the White referent group. RESULTS Among the study population (N=121,247), Black, Asian and Hispanic race-ethnicity was associated with a significantly decreased odds of being selected as CR in unadjusted and adjusted analyses. Black, Asian and Hispanic residents had a 26% (aOR=0.74, 95% CI 0.66-0.83), 29% (aOR=0.71, 95% CI 0.66-0.76) and 28% (aOR=0.72, 95% CI 0.66-0.94) decreased likelihood of becoming CR, respectively. Multi-racial residents also had a decreased likelihood, but to a lesser degree (aOR=0.92, 95% CI 0.89-0.95). CONCLUSIONS In as much as CR is an honor that sets one up for future opportunity, our findings suggest that residents of color are disproportionately disadvantaged compared to their White peers.
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Affiliation(s)
- Tera Frederick Howard
- Department of Women's Health, University of Texas at Austin Dell Medical School, Austin Tx
| | - Jordyn Pike
- Texas Advanced Computing Center, University of Texas at Austin Dell Medical School, Austin, TX, United States
| | - William A Grobman
- Department of Obstetrics and Gynecology, The Ohio State University, Columbus, OH, United States.
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Lai SH, Suarez-Pierre A, Jaiswal K, Travis C, Steward L, Nehler M, Zweck-Bronner S, Christian N. Implementation of a Holistic Review Process of US Allopathic Medical Students Eliminates Non-Comparable Metrics and Bias in General Surgery Residency Interview Invitations. JOURNAL OF SURGICAL EDUCATION 2023; 80:1536-1543. [PMID: 37507300 DOI: 10.1016/j.jsurg.2023.07.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 06/18/2023] [Accepted: 07/06/2023] [Indexed: 07/30/2023]
Abstract
OBJECTIVE Use of traditional scoring metrics for residency recruitment creates racial and gender bias. In addition, widespread use of pass/fail grading has led to noncomparable data. To adjust to these challenges, we developed a holistic review (HR) rubric for scoring residency applicants for interview selection. DESIGN Single-center observational study comparing the proportion of underrepresented in medicine (URM) students and their United States Medical Licensing Exam (USMLE) scores who were invited for interview before (2015-2020) and after (2022) implementation of a holistic review process. SETTING General surgery residency program at a tertiary academic center. PARTICIPANTS US allopathic medical students applying for general surgery residency. RESULTS After initial screening, a total of 1514 allopathic applicants were narrowed down to 586 (38.7%) for HR. A total of 52% were female and 17% identified as URM. Based on HR score, 20% (118/586) of applicants were invited for an interview. The median HR score was 11 (range 4-19). There was a fourfold higher coefficient of variation of HR scores (22.3; 95% CI 21.0-23.7) compared to USMLE scores (5.1; 95% Cl 4.8-5.3), resulting in greater spread and distinction among applicants. There were no significant differences in HR scores between genders (p = 0.60) or URM vs non-URM (p = 0.08). There were no significant differences in Step 1 (p = 0.60) and 2CK (p = 0.30) scores between those who were invited to interview or not. On multivariable analysis, USMLE scores (OR 1.01; 95% CI 0.98-1.03), URM status (OR 1.71 95% CI 0.98-2.92), and gender (OR 0.94, 95% CI 0.60-1.45) did not predict interview selection (all p > 0.05). There was a meaningful increase in the percentage of URM interviewed after HR implementation (12.9% vs 23.1%, p = 0.016). CONCLUSION The holistic review process is feasible and eliminates the use of noncomparable metrics for surgical applicant interview invitations and increases the percentage of URM applicants invited to interview.
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Affiliation(s)
- Samuel H Lai
- Department of Surgery, University of Colorado School of Medicine, Aurora, Colorado
| | | | - Kshama Jaiswal
- Department of Surgery, University of Colorado School of Medicine, Aurora, Colorado
| | - Claire Travis
- Department of Surgery, University of Colorado School of Medicine, Aurora, Colorado
| | - Lauren Steward
- Department of Surgery, University of Colorado School of Medicine, Aurora, Colorado
| | - Mark Nehler
- Department of Surgery, University of Colorado School of Medicine, Aurora, Colorado
| | - Steve Zweck-Bronner
- University of Colorado Anschutz Medical Campus, Office of University Counsel, Aurora, Colorado
| | - Nicole Christian
- Department of Surgery, University of Colorado School of Medicine, Aurora, Colorado.
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Ali M, Menard M, Zafar S, Williams BK, Knight OJ, Woreta FA. Sex and Racial and Ethnic Diversity Among Ophthalmology Subspecialty Fellowship Applicants. JAMA Ophthalmol 2023; 141:948-954. [PMID: 37651110 PMCID: PMC10472264 DOI: 10.1001/jamaophthalmol.2023.3853] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 07/06/2023] [Indexed: 09/01/2023]
Abstract
Importance Physician-patient concordance in sex and race is associated with improved patient outcomes. Studies have explored diversity among ophthalmology residents and faculty, but to our knowledge, not among ophthalmology fellows. Objective To assess diversity by sex and race and ethnicity among fellowship applicants in ophthalmology subspecialties and compare match rates by applicants' sex and underrepresented in medicine (URiM) status. Design, Setting, and Participants This cohort study examined ophthalmology subspecialty fellowship data from the 2021 San Francisco Match. Main Outcomes and Measures Applicant characteristics were stratified by sex and URiM status and compared using χ2, Mann-Whitney U, and median tests. For applicants who matched, the percentages of female and URiM applicants were compared among the ophthalmic subspecialties. A multivariable logistic regression model was used to assess the association of applicant characteristics with their match outcomes. Results Included in the sample were 537 candidates who applied for an ophthalmology fellowship using the 2021 San Francisco Match; 224 applicants (42.6%) were female, and 60 applicants (12.9%) had URiM status. Females and males had similar match rates (70.5% [n = 158] and 69.2% [n = 209], respectively; P = .74), but females had a higher median (IQR) US Medical Licensing Examination (USMLE) Step 2 Clinical Knowledge (CK) score (248 [240-258] vs 245 [234-254]; P = .01). The pediatric ophthalmology subspecialty had the highest percentage of female matched applicants (67.5%; 27 of 40 matched applicants), while the retina subspecialty had the highest percentage of males (68.9%; 84 of 122 matched applicants). URiM applicants had lower match rates (55.0%, n = 33) than non-URiM applicants (72.2%, n = 293; P = .007). The URiM applicants had lower median (IQR) scores on the USMLE Step 1 (238 [227-247]) compared with Asian applicants (246 [235-254]) and White applicants (243 [231-252]; P = .04). Additionally, URIM applicants submitted fewer median (IQR) applications (10 [1-23]) than Asian (21 [8-37]) and White (17 [8-32]; P = .001) applicants and completed fewer interviews (median [IQR], 2 [0-11]) than Asian (median [IQR], 12 [3-18]) and White applicants (median [IQR], 8 [1-14]; P = .001). Among matched fellows in each subspecialty, URiM applicants comprised 13.9% (n = 11) in glaucoma, 10% (n = 4) in pediatric ophthalmology, 7.3% (n = 6) in cornea, and 6.6% (n = 8) in retina. Conclusions and Relevance Ophthalmology subspecialty fellowship match rates were lower for URiM vs non-URiM applicants in 2021. Underrepresentation of females exists in the retina subspecialty, while racial and ethnic differences exist in all ophthalmology subspecialty fellowships examined. Monitoring trends in fellowship diversity over time should help inform where targeted efforts could improve diversity.
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Affiliation(s)
- Muhammad Ali
- Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland
| | - Maylander Menard
- School of Medicine, Meharry Medical College, Nashville, Tennessee
| | - Sidra Zafar
- Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland
| | - Basil K Williams
- Cincinnati Eye Institute, University of Cincinnati School of Medicine, Cincinnati, Ohio
| | - O'Rese J Knight
- Department of Ophthalmology, University of California, San Francisco, San Francisco
| | - Fasika A Woreta
- Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland
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Rosenberg JB, Park S, Gibralter R, Shrivastava A, Chuck RS. Success in Increasing Diversity: One Residency Program's Journey. JOURNAL OF ACADEMIC OPHTHALMOLOGY (2017) 2023; 15:e175-e177. [PMID: 37692771 PMCID: PMC10484180 DOI: 10.1055/s-0043-1774401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 08/10/2023] [Indexed: 09/12/2023]
Affiliation(s)
- Jamie B. Rosenberg
- Department of Ophthalmology and Visual Sciences, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Sunju Park
- Department of Ophthalmology and Visual Sciences, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Richard Gibralter
- Department of Ophthalmology and Visual Sciences, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Anurag Shrivastava
- Department of Ophthalmology and Visual Sciences, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Roy S. Chuck
- Department of Ophthalmology and Visual Sciences, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
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O'Sullivan L, Kagabo W, Prasad N, Laporte D, Aiyer A. Racial and Ethnic Bias in Medical School Clinical Grading: A Review. JOURNAL OF SURGICAL EDUCATION 2023; 80:806-816. [PMID: 37019709 DOI: 10.1016/j.jsurg.2023.03.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 02/26/2023] [Accepted: 03/17/2023] [Indexed: 05/23/2023]
Abstract
OBJECTIVE Improving diversity in healthcare is a widely recognized national goal. The diversity of medical student matriculants has increased, yet this trend is not seen in the composition of competitive residency programs. In this review, we examine racial and ethnic disparities in medical student grading during clinical years and explore the consequences of how this may exclude minority students from accessing competitive residency positions. DESIGN Following PRISMA guidelines, we searched PubMed, Embase, Scopus, and ERIC databases using variations of the terms "race," "ethnicity," "clerkship," "rotation," "grade," "evaluation", or "shelf exam." Of 391 references found using the criteria, 29 were related to clinical grading and race/ethnicity and included in the review. The GRADE criteria were used to determine the quality of evidence. SETTING Johns Hopkins School of Medicine, Baltimore MD. RESULTS Five studies examining a total of 107,687 students from up to 113 different schools found racial minority students receive significantly fewer Honors grades in core clerkships compared to White students. Three studies examining 94,814 medical student evaluations from up to 130 different schools found significant disparities in the wording of written clerkship evaluations based on race and/or ethnicity. CONCLUSIONS A large body of evidence suggests the presence of racial bias in subjective clinical grading and written clerkship evaluations of medical students. Grading disparities can disadvantage minority students when applying to competitive residency programs and may contribute to a lack of diversity in these fields. As low minority representation has a negative impact on patient care and research advancement, strategies to resolve this issue must be further explored.
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Affiliation(s)
- Lucy O'Sullivan
- Johns Hopkins Orthopedics, Johns Hopkins University School of Medicine, Baltimore, Maryland.
| | - Whitney Kagabo
- Department of Orthopedics, Johns Hopkins Orthopedics, Johns Hopkins Medicine, Baltimore, Maryland
| | - Niyathi Prasad
- Department of Orthopedics, Johns Hopkins Orthopedics, Johns Hopkins Medicine, Baltimore, Maryland
| | - Dawn Laporte
- Department of Orthopedics, Johns Hopkins Orthopedics, Johns Hopkins Medicine, Baltimore, Maryland
| | - Amiethab Aiyer
- Department of Orthopedics, Johns Hopkins Orthopedics, Johns Hopkins Medicine, Baltimore, Maryland
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Thompson BN, Colbert K, Nussbaum MS, Paget CJ. Practical Strategies for Underrepresented Minority Recruitment in General Surgery Residency. JOURNAL OF SURGICAL EDUCATION 2022; 79:e130-e136. [PMID: 36266229 DOI: 10.1016/j.jsurg.2022.09.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 08/19/2022] [Accepted: 09/10/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVE To analyze the effects of diversification efforts on underrepresented minority in medicine (URiM) resident recruitment in general surgery residency at a single large southeastern United States academic institution with five categorical positions. METHODS A retrospective review of applications from the 2016 to 2022 ACGME match cycles was conducted. In an effort to diversify resident recruitment, multiple new strategies were enacted in 2021. URiM candidates were identified via a more laborious review of individual applications to the program. In addition, a holistic review process was conducted, URiM faculty and residents were prominently featured, previous underperformance in diversity was openly addressed, and URiM applicants were contacted with follow up emails. Cohorts pre- and post-implementation of these strategies were analyzed. The proportion of URiM applicants invited, interviewed, ranked, and matched were compared. RESULTS Pre-intervention during the 2016to 20 match cycles, URiM candidates represented 4% of total applicants invited. Post-intervention during the 2021to 22 match cycles, URiM candidates represented 27% of total applicants invited. Over the past 5 years under the present program director, 1 URiM resident of 24 (4%) matched into the categorical program. Over the past 15 years under the direction of 3 program directors, a total of 6 out of 69 matched residents (9%) identified as URiM. Post intervention, the program matched on average 30% of its incoming categorical class from URiM candidates. CONCLUSION Recruitment and selection of diverse medical school applicants is an ongoing concern of general surgery residency program directors. Historically, URiM candidates are underrepresented in applicants selected for interview. Interventions aimed at increasing the matriculation of URiM include concentrated efforts to identify more URiM candidates for interview. However, importantly, transparency of ongoing diversity efforts and diversifying both faculty and trainees involved in the selection process may also improve general surgery URiM recruitment.
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Affiliation(s)
- Britany N Thompson
- Virginia Tech Carilion School of Medicine, Carilion Clinic, Department of Surgery, Roanoke, Virginia
| | - Kendra Colbert
- Virginia Tech Carilion School of Medicine, Carilion Clinic, Department of Surgery, Roanoke, Virginia
| | - Michael S Nussbaum
- Virginia Tech Carilion School of Medicine, Carilion Clinic, Department of Surgery, Roanoke, Virginia
| | - Charles J Paget
- Virginia Tech Carilion School of Medicine, Carilion Clinic, Department of Surgery, Roanoke, Virginia.
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Pineles S. Racial Diversity among United States Ophthalmology Residents: A Call to Action. Ophthalmology 2022; 129:960-961. [PMID: 35870859 DOI: 10.1016/j.ophtha.2022.04.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 04/22/2022] [Accepted: 04/26/2022] [Indexed: 10/17/2022] Open
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