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Carson EW, Laurencin CT, Lewis VO, Lindsey RW, Little BE, O'Keefe RJ, Ode GE. Orthopaedic Leadership Through the Anti-Racist Lens (Part 1): Addressing Critical Challenges to Academic Career Development for Black Orthopaedic Surgeons. J Bone Joint Surg Am 2024; 106:643-648. [PMID: 37747992 DOI: 10.2106/jbjs.23.00441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/27/2023]
Affiliation(s)
- Eric W Carson
- Department of Orthopaedics, Harlem Hospital, New York, NY
| | - Cato T Laurencin
- The Cato T. Laurencin Institute for Regenerative Engineering, University of Connecticut, Mansfield, Connecticut
| | - Valerae O Lewis
- Department of Orthopaedic Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Ronald W Lindsey
- Department of Orthopaedic Surgery and Rehabilitation, The University of Texas Medical Branch, University of Texas, Galveston, Texas
| | - Bryan E Little
- Detroit Medical Center Orthopaedics and Sports Medicine, Detroit, Michigan
| | - Regis J O'Keefe
- Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Gabriella E Ode
- Sports Medicine Institute, Hospital for Special Surgery, New York, NY
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Silver CM, Yuce TK, Clarke CN, Schlick CJR, Khorfan R, Amortegui D, Nussbaum M, Turner PL, Bilimoria KY, Hu YY. Disparities in Mentorship and Implications for US Surgical Resident Education and Wellness. JAMA Surg 2024:2817110. [PMID: 38568609 PMCID: PMC10993162 DOI: 10.1001/jamasurg.2024.0533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 01/06/2024] [Indexed: 04/06/2024]
Abstract
Importance Many surgeons cite mentorship as a critical component of training. However, little evidence exists regarding factors associated with mentorship and the influence of mentorship on trainee education or wellness. Objectives To evaluate factors associated with surgical trainees' perceptions of meaningful mentorship, assess associations of mentorship with resident education and wellness, and evaluate programmatic variation in mentorship. Design, Setting, and Participants A voluntary, anonymous survey was administered to clinically active residents in all accredited US general surgery residency programs following the 2019 American Board of Surgery In-Service Training Examination. Data were analyzed from July 2019 to July 2022. Exposure Residents were asked, "Do you have a mentor who genuinely cares about you and your career?" Main Outcomes and Measures Resident characteristics associated with report of meaningful mentorship were evaluated with multivariable logistic regression. Associations of mentorship with education (clinical and operative autonomy) and wellness (career satisfaction, burnout, thoughts of attrition, suicidality) were examined using cluster-adjusted multivariable logistic regression controlling for resident and program factors. Residents' race and ethnicity were self-identified using US census categories (American Indian or Alaska Native, Asian, Black or African American, Native Hawaiian or Other Pacific Islander, and White), which were combined and dichotomized as non-Hispanic White vs non-White or Hispanic. Results A total of 6956 residents from 301 programs completed the survey (85.6% response rate); 6373 responded to all relevant questions (2572 [40.3%] female; 2539 [39.8%] non-White or Hispanic). Of these, 4256 (66.8%) reported meaningful mentorship. Non-White or Hispanic residents were less likely than non-Hispanic White residents to report meaningful mentorship (odds ratio [OR], 0.81, 95% CI, 0.71-0.91). Senior residents (postgraduate year 4/5) were more likely to report meaningful mentorship than interns (OR, 3.06; 95% CI, 2.59-3.62). Residents with meaningful mentorship were more likely to endorse operative autonomy (OR, 3.87; 95% CI, 3.35-4.46) and less likely to report burnout (OR, 0.52; 95% CI, 0.46-0.58), thoughts of attrition (OR, 0.42; 95% CI, 0.36-0.50), and suicidality (OR, 0.47; 95% CI, 0.37-0.60) compared with residents without meaningful mentorship. Conclusions and Relevance One-third of trainees reported lack of meaningful mentorship, particularly non-White or Hispanic trainees. Although education and wellness are multifactorial issues, mentorship was associated with improvement; thus, efforts to facilitate mentorship are needed, especially for minoritized residents.
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Affiliation(s)
- Casey M. Silver
- Department of Surgery, Loyola University Medical Center, Maywood, Illinois
- Northwestern Quality Improvement, Research, and Education in Surgery, Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
- Surgical Outcomes and Quality Improvement Center, Department of Surgery, Indiana University, Indianapolis
| | - Tarik K. Yuce
- Northwestern Quality Improvement, Research, and Education in Surgery, Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
- Surgical Outcomes and Quality Improvement Center, Department of Surgery, Indiana University, Indianapolis
| | | | - Cary Jo R. Schlick
- Northwestern Quality Improvement, Research, and Education in Surgery, Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
- Surgical Outcomes and Quality Improvement Center, Department of Surgery, Indiana University, Indianapolis
| | - Rhami Khorfan
- Northwestern Quality Improvement, Research, and Education in Surgery, Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
- Surgical Outcomes and Quality Improvement Center, Department of Surgery, Indiana University, Indianapolis
| | - Daniela Amortegui
- Surgical Outcomes and Quality Improvement Center, Department of Surgery, Indiana University, Indianapolis
| | | | | | - Karl Y. Bilimoria
- Surgical Outcomes and Quality Improvement Center, Department of Surgery, Indiana University, Indianapolis
- American College of Surgeons, Chicago, Illinois
| | - Yue-Yung Hu
- Northwestern Quality Improvement, Research, and Education in Surgery, Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
- Surgical Outcomes and Quality Improvement Center, Department of Surgery, Indiana University, Indianapolis
- Division of Pediatric Surgery, Ann & Robert H. Lurie Children’s Hospital, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
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Ogunnowo S, Zakrison TL, Baird B, Erben Y, Tung EL, Yang JP, Dorsey C. Exploring Experiences of Traumatic Microaggressions Toward Surgeons and Surgical Residents. J Surg Res 2024; 295:191-202. [PMID: 38035870 PMCID: PMC10922079 DOI: 10.1016/j.jss.2023.10.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 09/09/2023] [Accepted: 10/27/2023] [Indexed: 12/02/2023]
Abstract
INTRODUCTION Studies have suggested that experiences of gender and racial discrimination are widespread among surgeons and surgical residents. This study examines the relationship between experienced microaggressions and traumatic stress. METHODS A one-time, deidentified survey was distributed over email to academic surgical societies. The survey consisted of 35 items including questions on prevalence of microaggressions, perceived job impacts as well as a shortened version of the Trauma Symptoms of Discrimination Scale. Chi-square tests and an independence test for trends were utilized to determine significance. RESULTS We collected data from 130 participants with majority (81%) having experienced microaggressions in the workplace. On measures of worry (P < 0.001), avoidance (P = 0.012), anxiety (P = 0.004), and trouble relaxing (P = 0.002), racial/ethnic minority surgeons and trainees demonstrated significantly higher scores. With perceived job impacts, significant agreement was seen with occurrences of working harder to prove competence (P = 0.005), gaining patient confidence (P < 0.001), reduced career satisfaction (P = 0.011), work-related negative talk (P = 0.018), and burnout at work due to microaggressions (P = 0.019). Among participants who underwent behavioral modifications, female surgeons were more likely to change their nonverbal communication styles (P < 0.001) and spend more time with patients (P < 0.001). CONCLUSIONS Experiences of microaggressions are associated with increased anxiety-related trauma symptoms in racial/ethnic minority surgeons and surgical trainees. Additionally, these experiences of microaggression can influence job satisfaction, burnout, career perceptions and workplace behaviors. As the field of surgery becomes more diverse, this study contributes to growing awareness of the role of implicit discrimination in the attrition and retention of racial/ethnic minority surgeons and female surgeons.
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Affiliation(s)
- Simi Ogunnowo
- Pritzker School of Medicine, University of Chicago, Chicago, Illinois.
| | - Tanya L Zakrison
- Department of Surgery, University of Chicago Medicine, Chicago, Illinois
| | - Brandon Baird
- Department of Surgery, University of Chicago Medicine, Chicago, Illinois
| | - Young Erben
- Department of Surgery, Mayo Clinic, Jacksonville, Florida
| | - Elizabeth L Tung
- Department of Medicine, University of Chicago Medicine, Chicago, Illinois
| | - Joyce P Yang
- Department of Psychology, The University of San Francisco, San Francisco, California
| | - Chelsea Dorsey
- Department of Surgery, University of Chicago Medicine, Chicago, Illinois
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Eruchalu CN, Etheridge JC, Hammaker AC, Kader S, Abelson JS, Harvey J, Farr D, Stopenski SJ, Nahmias JT, Elsaadi A, Campbell SJ, Foote DC, Ivascu FA, Montgomery KB, Zmijewski P, Byrd SE, Kimbrough MK, Smith S, Postlewait LM, Dodwad SJM, Adams SD, Markesbery KC, Meister KM, Woeste MR, Martin RCG, Callahan ZM, Marks JA, Patel P, Anstadt MJ, Nasim BW, Willis RE, Patel JA, Newcomb MR, Stahl CC, Yafi MA, Sutton JM, George BC, Quillin RC, Cho NL, Cortez AR. Racial and Ethnic Disparities in Operative Experience Among General Surgery Residents: A Multi-Institutional Study from the US ROPE Consortium. Ann Surg 2024; 279:172-179. [PMID: 36928294 PMCID: PMC11104265 DOI: 10.1097/sla.0000000000005848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Abstract
OBJECTIVE To determine the relationship between race/ethnicity and case volume among graduating surgical residents. BACKGROUND Racial/ethnic minority individuals face barriers to entry and advancement in surgery; however, no large-scale investigations of the operative experience of racial/ethnic minority residents have been performed. METHODS A multi-institutional retrospective analysis of the Accreditation Council for Graduate Medical Education case logs of categorical general surgery residents at 20 programs in the US Resident OPerative Experience Consortium database was performed. All residents graduating between 2010 and 2020 were included. The total, surgeon chief, surgeon junior, and teaching assistant case volumes were compared between racial/ethnic groups. RESULTS The cohort included 1343 residents. There were 211 (15.7%) Asian, 65 (4.8%) Black, 73 (5.4%) Hispanic, 71 (5.3%) "Other" (Native American or Multiple Race), and 923 (68.7%) White residents. On adjusted analysis, Black residents performed 76 fewer total cases (95% CI, -109 to -43, P <0.001) and 69 fewer surgeon junior cases (-98 to -40, P <0.001) than White residents. Comparing adjusted total case volume by graduation year, both Black residents and White residents performed more cases over time; however, there was no difference in the rates of annual increase (10 versus 12 cases per year increase, respectively, P =0.769). Thus, differences in total case volume persisted over the study period. CONCLUSIONS In this multi-institutional study, Black residents graduated with lower case volume than non-minority residents throughout the previous decade. Reduced operative learning opportunities may negatively impact professional advancement. Systemic interventions are needed to promote equitable operative experience and positive culture change.
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Affiliation(s)
- Chukwuma N Eruchalu
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA
- Department of Surgery, Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - James C Etheridge
- Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
- Ariadne Labs, Harvard T.H. Chan School of Public Health, Brigham and Women's Hospital, Boston, MA
| | - Austin C Hammaker
- Department of Surgery, Cincinnati Research on Education in Surgical Training (CREST), University of Cincinnati, Cincinnati, OH
| | - Sarah Kader
- Department of Surgery, Lahey Hospital and Medical Center, Burlington, MA
| | - Jonathan S Abelson
- Department of Surgery, Lahey Hospital and Medical Center, Burlington, MA
| | - Jalen Harvey
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - Deborah Farr
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | | | - Jeffry T Nahmias
- Department of Surgery, University of California Irvine, Orange, CA
| | - Ali Elsaadi
- Texas Tech University Health Sciences Center School of Medicine, Lubbock, TX
| | - Samuel J Campbell
- Texas Tech University Health Sciences Center School of Medicine, Lubbock, TX
| | - Darci C Foote
- Department of Surgery, Beaumont Health, Royal Oak, MI
| | | | | | - Polina Zmijewski
- Department of Surgery, University of Alabama at Birmingham, Birmingham, AL
| | - Samuel E Byrd
- Department of Surgery, University of Arkansas for Medical Sciences, Little Rock, AR
| | - Mary K Kimbrough
- Department of Surgery, University of Arkansas for Medical Sciences, Little Rock, AR
| | | | | | | | - Sasha D Adams
- Department of Surgery, McGovern Medical School at UTHealth, Houston, TX
| | | | | | | | | | | | - Joshua A Marks
- Department of Surgery, Thomas Jefferson University, Philadelphia, PA
| | - Purvi Patel
- Department of Surgery, Loyola University, Maywood, IL
| | | | - Bilal Waqar Nasim
- Department of Surgery, University of Texas Health Science Center at San Antonio, San Antonio, TX
| | - Ross E Willis
- Department of Surgery, University of Texas Health Science Center at San Antonio, San Antonio, TX
| | - Jitesh A Patel
- Department of Surgery, University of Kentucky, Lexington, KY
| | | | | | - Motaz Al Yafi
- Department of Surgery, University of Toledo, Toledo, OH
| | - Jeffrey M Sutton
- Department of Surgery, Medical University of South Carolina, Division of Oncologic and Endocrine Surgery, Charleston, SC
| | - Brian C George
- Department of Surgery, Center for Surgical Training and Research (CSTAR), University of Michigan, Ann Arbor, MI
| | - Ralph C Quillin
- Department of Surgery, Cincinnati Research on Education in Surgical Training (CREST), University of Cincinnati, Cincinnati, OH
| | - Nancy L Cho
- Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Alexander R Cortez
- Department of Surgery, Cincinnati Research on Education in Surgical Training (CREST), University of Cincinnati, Cincinnati, OH
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Record SM, Chanenchuk T, Altieri M, Cannada L, Guetter CR, Joseph KA, Maxwell J, Reyna C, Sumra H, Tan S, Tasnim S, Yu YR, Plichta JK. One step ahead: Finding mentors at all stages of a surgical career. Am J Surg 2023; 226:729-731. [PMID: 37414608 DOI: 10.1016/j.amjsurg.2023.06.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 05/22/2023] [Accepted: 06/28/2023] [Indexed: 07/08/2023]
Affiliation(s)
- Sydney M Record
- Department of Surgery, Duke University School of Medicine, DUMC Box 3704, 2301 Erwin Rd., Durham, NC, 27710, USA.
| | - Tori Chanenchuk
- Department of Surgery, Duke University School of Medicine, DUMC Box 3704, 2301 Erwin Rd., Durham, NC, 27710, USA.
| | - Maria Altieri
- Department of Surgery, Penn Medicine, 3400 Spruce St, Philadelphia, PA, 19104, USA.
| | - Lisa Cannada
- Department of Orthopedic Surgery, Charlotte Novant Health, University of North Carolina School of Medicine, 1901 Randolph Road, Charlotte, NC, 28207, USA.
| | - Camila R Guetter
- Department of Surgery, Beth Israel Deaconess Medical Center, 110 Francis St., Boston, MA, 02215, USA.
| | - Kathie-Ann Joseph
- Department of Surgery, NYU Grossman School of Medicine, 424 East 34th Street, New York, NY, 10016, USA; NYU Langone Health Institute of Health Equity, 180 Madison Avenue, New York, NY, 10016, USA.
| | - Jessica Maxwell
- Department of Surgery, University of Nebraska Medical Center, 620 S 42nd St, Omaha, NE, 68105, USA.
| | - Chantal Reyna
- Department of Surgery, Crozer Health System, 1 Medical Center Blvd, Upland, PA, 19013, USA.
| | - Hibba Sumra
- Department of Surgery, Advocate Aurora Health, 2535 S Martin Luther King Dr, Chicago, IL, 60616, USA.
| | - Sanda Tan
- Department of Surgery, HCA Florida Healthcare 2130 E Johnson Ave Suite 130-A, Pensacola, FL, 32514, USA.
| | - Sadia Tasnim
- Department of Surgery, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH, 44195, USA.
| | - Yangyang R Yu
- Department of Surgery, University of California Irvine, Gillespie Neuroscience Research Facility, #2226, Irvine, CA, 92617, USA.
| | - Jennifer K Plichta
- Department of Surgery, Duke University School of Medicine, DUMC Box 3704, 2301 Erwin Rd., Durham, NC, 27710, USA; Duke Cancer Institute, Duke University Medical Center, 20 Duke Medicine Cir, Durham, NC, 27710, USA; Department of Population Health Sciences, Duke University Medical Center, 215 Morris St, Durham, NC, 27701, USA.
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Fenton D, Hamzat I, Dimitroyannis R, Nordgren R, Saunders MR, Baroody FM, Baird B, Shogan A. Assessment of Demographic Changes of Workforce Diversity in Otolaryngology, 2013 to 2022. JAMA Otolaryngol Head Neck Surg 2023; 149:628-635. [PMID: 37261840 PMCID: PMC10236323 DOI: 10.1001/jamaoto.2023.1130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Accepted: 04/14/2023] [Indexed: 06/02/2023]
Abstract
Importance Given the growth of minoritized groups in the US and the widening racial and ethnic health disparities, improving diversity remains a proposed solution in the field of otolaryngology. Evaluating current trends in workforce diversity may highlight potential areas for improvement. Objective To understand the changes in gender, racial, and ethnic diversity in the otolaryngology workforce in comparison with changes in the general surgery and neurosurgery workforces from 2013 to 2022. Design, Setting, and Participants This cross-sectional study used publicly available data from the Accreditation Council for Graduate Medical Education and the Association of American Medical Colleges for 2013 to 2022, and included medical students and trainees in all US medical residency programs and allopathic medical schools. Main Outcomes and Measures Average percentages of women, Black, and Latino trainees during 2 intervals of 5 years (2013-2017 and 2018-2022). Pearson χ2 tests compared demographic information. Normalized ratios were calculated for each demographic group in medical school and residency. Piecewise linear regression assessed linear fit for representation across time periods and compared rates of change. Results The study population comprised 59 865 medical residents (43 931 [73.4%] women; 6203 [10.4%] Black and 9731 [16.2%] Latino individuals; age was not reported). The comparison between the 2 study intervals showed that the proportions of women, Black, and Latino trainees increased in otolaryngology (2.9%, 0.7%, and 1.6%, respectively), and decreased for Black trainees in both general surgery and neurosurgery (-0.4% and -1.0%, respectively). In comparison with their proportions in medical school, Latino trainees were well represented in general surgery, neurosurgery, and otolaryngology (normalized ratios [NRs]: 1.25, 1.06, and 0.96, respectively); however, women and Black trainees remained underrepresented in general surgery, neurosurgery, and otolaryngology (women NRs, 0.76, 0.33, and 0.68; Black NRs, 0.63, 0.61, and 0.29, respectively). The percentage of women, Black, and Latino trainees in otolaryngology all increased from 2020 to 2022 (2.5%, 1.1%, and 1.1%, respectively). Piecewise regression showed positive trends across all 3 specialties. Conclusions and Relevance The findings of this cross-sectional study indicate a positive direction but only a modest increase of diversity in otolaryngology, particularly in the context of national demographic data. Novel strategies should be pursued to supplement existing efforts to increase diversity in otolaryngology.
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Affiliation(s)
- David Fenton
- Pritzker School of Medicine, University of Chicago, Chicago, Illinois
| | - Ibraheem Hamzat
- Pritzker School of Medicine, University of Chicago, Chicago, Illinois
| | | | - Rachel Nordgren
- Department of Public Health Sciences, University of Chicago, Chicago, Illinois
| | - Milda R. Saunders
- Department of Medicine, University of Chicago Medicine, Chicago, Illinois
| | - Fuad M. Baroody
- Department of Surgery, Section of Otolaryngology–Head and Neck Surgery, University of Chicago Medicine, Chicago, Illinois
| | - Brandon Baird
- Department of Surgery, Section of Otolaryngology–Head and Neck Surgery, University of Chicago Medicine, Chicago, Illinois
| | - Andrea Shogan
- Department of Surgery, Section of Otolaryngology–Head and Neck Surgery, University of Chicago Medicine, Chicago, Illinois
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Oberoi MK, Reghunathan M, Aref Y, Dinis JJ, Balumuka D, Gosman A. Racial/Ethnic and Gender Disparities Over the Last Decade Within Microsurgery and Craniofacial Fellowship Training. Ann Plast Surg 2023; 90:S281-S286. [PMID: 36752557 DOI: 10.1097/sap.0000000000003403] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
BACKGROUND Racial/ethnic and gender disparities persist in plastic surgery at nearly all levels of training, becoming more pronounced at each stage. Recent studies have demonstrated that the proportion of female plastic surgery residents has increased to nearly 40%, yet only 11% of full professors of plastic surgery are female. Other studies have identified severe declines in underrepresented minority plastic surgery representation between plastic surgery residents and academicians with only 1.6% of Black/African American and 4.9% of Hispanic/Latinx full professors of plastic surgery. Often, residents seek fellowship for advanced training before seeking an academic professorship. This study aims to describe the racial/ethnic and gender representation of microsurgery and craniofacial fellows. METHODS Names and photos of graduated fellows for the past 10 years (2012-2021) were extracted from microsurgery and craniofacial fellowship Web sites. Using a 2-person evaluation method, race/ethnicity and gender were primarily determined by photographic and surname and verified, when possible, through online confirmation methods (articles, social media). Distributions were analyzed with descriptive statistics and compared with the US population. RESULTS Among 30 microsurgery fellowships, 180 graduated fellows (52.7%) were identified, resulting in 66 female fellows (36.7%) and the following racial/ethnic distribution: 113 (62.8%) White, 49 (27.2%) Asian, 12 (6.7%) Hispanic/Latinx, and 6 (3.3%) Black/African American. Among 31 craniofacial fellowships, 136 graduated fellows (45.0%) were identified, resulting in 38 female fellows (27.9%) and the following racial/ethnic distribution: 75 (55.1%) White, 45 (33.1%) Asian, 8 (5.9%) Hispanic/Latinx, and 8 (5.9%) Black/African American. The intersection between race/ethnicity and gender revealed the most disproportionately low representation among Black women. Relative to the US population, Hispanic/Latinx (0.31-fold) and Black/African American (0.48-fold) fellows were underrepresented, White (0.90-fold) fellows were nearly equally represented, and Asian (5.42-fold) fellows are overrepresented relative to the US population. Furthermore, despite pursuing fellowships at a greater rate, Asian and Black fellows are not reaching adequate representation among academic plastic surgeons. CONCLUSION This study demonstrates that female racial/ethnic minorities are disproportionately underrepresented among microsurgery and craniofacial fellowships. Efforts should be made to improve the recruitment of fellows of underrepresented backgrounds and thus improve the pipeline into academic careers.
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Affiliation(s)
- Michelle K Oberoi
- From the Division of Plastic Surgery, Department of Surgery, Baylor Scott & White Healthcare, Texas A&M Health Science Center College of Medicine, Temple, TX
| | - Meera Reghunathan
- Division of Plastic Surgery, Department of Surgery, University of California, San Diego, San Diego, CA
| | - Youssef Aref
- California University of Science and Medicine, Colton, CA
| | - Jacob J Dinis
- Frank H. Netter MD School of Medicine, North Haven, CT
| | - Darius Balumuka
- Division of Plastic & Reconstructive Surgery, Department of Surgery, Oregon Health & Science University School of Medicine, Portland, OR
| | - Amanda Gosman
- Division of Plastic Surgery, Department of Surgery, University of California, San Diego, San Diego, CA
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Girard AO, Lopez CD, Khoo KH, Lake IV, Yusuf CT, Lopez J, Redett RJ, Yang R. The Impact of Socioeconomic Factors on the 2022 Plastic Surgery Match. Ann Plast Surg 2023; 90:366-375. [PMID: 36880766 DOI: 10.1097/sap.0000000000003503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2023]
Abstract
BACKGROUND In 2022, the plastic and reconstructive surgery (PRS) match faced unprecedented system-wide transitions that have redefined conventional measures of applicant success. This challenges the equitable assessment of student competitiveness and diversity in the field. METHODS A survey of demography, application content, and 2022 match outcomes was distributed to applicants to a single PRS residency program. Comparative statistics and regression models were performed to assess the predictive value of factors in match success and quality. RESULTS A total of 151 respondents (response rate 49.7%) were analyzed. Although step 1 and step 2 CK scores were significantly higher among matched applicants, neither examination predicted match success. Most respondents (52.3%) were women, although gender was also not significantly associated with match success. Underrepresented in medicine applicants made up 19.2% of responses and 16.7% of matches, and the plurality of respondents (22.5%) were raised with a household income ≥$300,000. Both Black race and household income ≤$100,000 were associated with lower odds of scoring above a 240 on either step 1 or step 2 CK (Black: OR, 0.03 and 0.06; P < 0.05 and P < 0.001; income: OR, 0.07-0.47 and 0.1 to 0.8, among income subgroups), receiving interview offers (OR, -9.4; P < 0.05; OR, -11.0 to -5.4), and matching into PRS (OR, 0.2; P < 0.05; OR, 0.2 to 0.5), compared with White and high-income applicants, respectively. CONCLUSIONS Systemic inequities in the match process disadvantage underrepresented in medicine candidates and those from lower household incomes. As the residency match continues to evolve, programs must understand and mitigate the impacts of bias in various application components.
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Affiliation(s)
- Alisa O Girard
- From the Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
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Supporting diverse health leadership requires active listening, observing, learning and bystanding. EQUALITY, DIVERSITY AND INCLUSION: AN INTERNATIONAL JOURNAL 2023. [DOI: 10.1108/edi-08-2021-0214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
PurposeFostering diversity in health leadership is imperative as that not only enhances the quality of health care itself, but improves an organization's effectiveness and responsiveness to address the needs of a diverse population. Inequitable structures entrenched in health care such as sexism, racism and settler colonialism undermine efforts made by women from diverse backgrounds to obtain leadership roles. This paper identifies leading practices which support diverse health leadership.Design/methodology/approachA multi-methodological approach involving a targeted published and gray literature search undertaken through both traditional means and a systematic social media search, focused particularly on Twitter. A literature and social media extraction tool was developed to review and curate more than 800 resources. Items chosen included those which best highlighted the barriers faced by diverse women and those sharing tools of how allies can best support the diverse women.FindingsFour core promising practices that help to disrupt the status-quo of health leadership include (1) active listening to hear and amplify voices that have been marginalized, (2) active learning to respond to translation exhaustion, (3) active observing and noticing microaggressions and their consequences and (4) active bystanding and intervention.Social implicationsWhen implemented, these practices can help to dismantle racism, sexism, ableism and otherwise challenge the status-quo in health leadership.Originality/valueThis paper provides an original and value-added review of the published literature and social media analysis of heretofore disparate practices of allyship, all while amplifying the voices of health leaders from marginalized communities.
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Kirksey L, Sorour AA, Duson S, Osman MF, Downing LJ, Ayman A, Rowe V. Racial Diversity and Black Vascular Surgeons in Vascular Surgery Workforce. J Vasc Surg 2023; 77:1322-1329. [PMID: 36791895 DOI: 10.1016/j.jvs.2023.01.211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 01/02/2023] [Accepted: 01/31/2023] [Indexed: 02/16/2023]
Abstract
OBJECTIVES The precise number of actively practicing vascular surgeons who self-identify as Black and the historical race composition trends within the overall profession of vascular surgery are unknown. Limited demographic data has been collected and maintained at the societal or national board level. Vascular Surgery Societal reports suggest that less than 2% of vascular surgeons identify as Black. Blacks make up 13.4% of the American population yet for disorders such as peripheral arterial disease and end stage renal disease, Black communities are disproportionately impacted, and the prevalence of disease is greater on an age adjusted basis. Significant body of research showed that clinical outcomes like medication adherence, shared decision making, and research trial participation are positively impacted by racial concordance especially for communities in whom distrust is high as a consequence of historic experiences. This survey aims to characterize practice and career variables within a network of Black vascular surgeons. METHODS A cross sectional survey was conducted via a questionnaire sent to all participants of a Society of Black Vascular Surgeons (SBVS) that began to convene monthly during the COVID-19 pandemic and experienced subsequent organic growth. The survey included 20 questions with variables quantified including the surgeon's demographics, clinical experience, practice setting, patient demographics and professional society engagement. RESULTS Fifty-nine percent of the SBVS members completed the survey. Males compromised 81% of the responding vascular surgeons. The majority (62%) of respondents are involved in academic practice. Less than 25% percent of the total medical staff was Black in 77% of the respondents' current work practice. The patient racial composition within their respective practice settings: White (47%), Black (34%), Hispanic (13%), Asian (3%), Middle Eastern or North African (2%) and American Indian and Alaskan Natives (0.4%). Forty three percent of respondents have a current active membership in the Society of Vascular Surgery and 24% have regional society membership. Fifty-eight percent of respondents reported that they experienced workplace event that they felt were racially or ethically driven in the 12 months prior to the survey. CONCLUSION This survey describes an underrepresented in medicine (URM) vascular surgeon subgroup that has not heretofore been characterized. Racial and ethnic demographic data are essential to better understand the current demographic makeup of our specialty, and to develop benchmark goals of race composition that mirrors our society at large. In this group of Black vascular surgeons, their patients were more likely to represent a racial minority. Efforts to increase race diversity in vascular surgery have the potential benefit of enhancing care of patients with vascular disease.
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Affiliation(s)
- Levester Kirksey
- Department of Vascular Surgery, Heart Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH; Walter W. Buckley Endowed Chair, Department of Vascular Surgery, Cleveland Clinic, Cleveland, OH.
| | - Ahmed A Sorour
- Department of Vascular Surgery, Heart Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH
| | - Sira Duson
- University of Maryland School of Medicine, Department of Vascular Surgery, Baltimore, MD
| | - Mohamed F Osman
- University of Toledo, Department of Vascular Surgery, Toledo, OH
| | | | - Ahmad Ayman
- University of Toledo, Department of Vascular Surgery, Toledo, OH
| | - Vincent Rowe
- Carilion New River Valley Medical Center, Carilion Clinic, VA
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11
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Slama EM, Arjani S, Sulciner ML, Riner AN, Yu YR, Maxwell J. The Gender Gap in Surgeon Salaries - Striving to achieve pay equity. Am J Surg 2023; 225:436-438. [PMID: 36175195 DOI: 10.1016/j.amjsurg.2022.09.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Revised: 08/26/2022] [Accepted: 09/18/2022] [Indexed: 11/01/2022]
Affiliation(s)
- Eliza M Slama
- Association of Women Surgeons Publication Committee, USA; Department of Surgery, Ascension Saint Agnes Hospital, 900 South Caton Avenue, Baltimore, MD, 21229, USA.
| | - Simran Arjani
- Association of Women Surgeons Publication Committee, USA; Rutgers New Jersey Medical School, 185 South Orange Avenue, Newark, NJ, 07103, USA
| | - Megan L Sulciner
- Association of Women Surgeons Publication Committee, USA; Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA
| | - Andrea N Riner
- Association of Women Surgeons Publication Committee, USA; Department of Surgery, University of Florida College of Medicine, Gainesville, FL, 32610, USA
| | - Yangyang R Yu
- Association of Women Surgeons Publication Committee, USA; Department of Surgery and Division of Pediatric Surgery, Children's Hospital of Orange County, University of California Irvine, Orange, CA, 92868, USA
| | - Jessica Maxwell
- Association of Women Surgeons Publication Committee, USA; Department of Surgery, University of Nebraska Medical Center, Omaha, NE, 68105, USA
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12
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Verduzco-Gutierrez M, Wescott S, Amador J, Hayes AA, Owen M, Chatterjee A. Lasting Solutions for Advancement of Women of Color. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2022; 97:1587-1591. [PMID: 35731581 DOI: 10.1097/acm.0000000000004785] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Despite efforts to improve parity in the biomedical workforce, gender bias persists related to equitable pay, promotion, speaking opportunities, journal editorial positions, research funding, and leadership positions. This bias becomes more prominent for women of color and women with other intersectional identities who come from underrepresented groups. It is critical to understand the barriers that women face and why the pathway is especially challenging for women of color. In this commentary, the authors cite research related to the effects of institutional gender bias in academic medicine, including research on bias against women of color. As academic leaders who come from underrepresented groups, the authors are aware that traditional approaches to reducing this bias have not worked well, and they instead highlight promising strategies aimed at filling the pathway to leadership with women of color who are qualified and ready to take the helm. They address solutions to ensure the academic pathway is supportive. They also provide several recommendations, including: offering more opportunities for mentorship and sponsorship, improving access to formal leadership programming, modeling successful upstander initiatives, recognizing the growing role of minority-based medical societies, implementing early-career education, increasing journal editorial board representation, and expanding promotion criteria. Appropriate training, education, and partnership with internal and external stakeholders are necessary to advance leadership equity for women of color in academic medicine.
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Affiliation(s)
- Monica Verduzco-Gutierrez
- M. Verduzco-Gutierrez is professor and chair, Department of Rehabilitation Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Siobhan Wescott
- S. Wescott is professor, American Indian Health, associate professor, Department of Health Promotion, and director, American Indian Health Program, College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska
| | - Juan Amador
- J. Amador is director, Constituent Engagement, Association of American Medical Colleges, Washington, DC
| | - Andrea A Hayes
- A.A. Hayes is professor and chair, Department of Surgery, Howard University College of Medicine, and surgeon-in-chief, Howard University Hospital, Washington, DC
| | - Mary Owen
- M. Owen is director, Center of American Indian and Minority Health, and assistant professor, Department of Family Medicine and Biobehavioral Health, University of Minnesota Medical School, Duluth, Minnesota
| | - Archana Chatterjee
- A. Chatterjee is professor and dean, Chicago Medical School, and vice president, Medical Affairs, Rosalind Franklin University of Medicine and Science, Chicago, Illinois
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13
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Crown A, Joseph KA. Addressing Breast Cancer Disparities by Improving Diversity of the Oncology Workforce. CURRENT BREAST CANCER REPORTS 2022. [DOI: 10.1007/s12609-022-00456-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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14
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Evaluating the Thematic Nature of Microaggression among Racial and Ethnic Minority Surgeons. J Am Coll Surg 2022; 235:210-216. [PMID: 35839395 DOI: 10.1097/xcs.0000000000000249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND It is well documented that surgeons who identify as racial and ethnic minorities experience discrimination while navigating the surgical environment. There is evidence to suggest that the most prevalent form of discrimination experienced is microaggressions. This study sought to identify common microaggressions experienced in the surgical workplace by racial and ethnic minority surgeons with the use of a validated scale. METHODS A one-time, deidentified survey was administered to surgeons who identified as a racial and ethnic minority via email. The survey included demographic questions and a shortened version of the Racial Microaggressions Scale, a validated 32-item scale developed to measure microaggressions in everyday life. Subscale means were calculated and compared using sample t-tests along with an analysis of variance. RESULTS A total of 185 surgeons completed the survey with 166 included in the final analysis (97 male-identifying, 67 female-identifying). Significantly different microaggression experiences between race and ethnicity were found on the environmental (p < 0.001), foreigner/not belonging (p ≤ 0.001), low achieving/undesirable (p < 0.001), criminality (p < 0.001), and invisibility (p < 0.001) subscales with higher scores denoting more frequent experiences. Black and African American surgeons scored higher than Asian and Asian American and Hispanic and Latino surgeons on the low achieving/undesirable subscale (1.7 vs 0.9 and 1.2, respectively) and the invisibility subscale (1.5 vs 0.8 and 0.8, respectively). In addition, Asian and Asian American and Hispanic and Latino surgeons scored significantly higher on the foreigner/not belonging subscale compared with Black and African American surgeons (1.6 and 1.6 vs 0.9, respectively). CONCLUSIONS The current study suggests that surgeons who identified as a racial and ethnic minority experience microaggressions in various ways. Understanding the specific experience of racial and ethnic minority surgeons is important as the surgical workplace strives to create more inclusive environments by acknowledging the lived experience of its diverse workforce.
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Cain-Shields L, Glover L, Joseph JJ, Bertoni AG, Sims M. Goal-striving stress and repeated measures of adiposity in the Jackson heart study. Stress Health 2022; 38:443-452. [PMID: 34643027 PMCID: PMC9023066 DOI: 10.1002/smi.3105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 10/06/2021] [Accepted: 10/08/2021] [Indexed: 11/10/2022]
Abstract
Psychosocial stressors are determinants of increases in adiposity. Both psychosocial stressors and adiposity are higher among African Americans (AAs). Therefore, clarifying the stress-obesity link in AAs is important. The stress associated with goal striving is particularly relevant to AAs because opportunity for upward mobility is not always equal. Goal-striving stress (GSS) has not been assessed with adiposity, a potential result of GSS. Therefore, the objective of this study was to determine whether GSS would be associated with repeated measures of adiposity [body mass index (BMI), waist circumference (WC), waist-to-height ratio (WHR)] in AAs. Linear mixed models were used to assess the relationship between GSS with repeated measures of adiposity across three exam periods among 2902 AAs, and sex was assessed as a moderator. Models were adjusted for demographics, health behaviours, morbidities, and daily discrimination. GSS was positively associated with repeated measures of adiposity in women but not men: WC [estimate (standard error) p-value] [0.003 (0.001) p < 0.01] and WHR [0.003 (0.0007) p < 0.01]. This suggests that high stress due to goal striving may contribute to greater increases in adiposity in AA women over time. Community-based interventions should continue to consider focused support group models as viable options for goal-striving related stress reduction.
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Affiliation(s)
- Loretta Cain-Shields
- Department of Data Science, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - LáShauntá Glover
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Joshua J. Joseph
- Division of Endocrinology, Diabetes and Metabolism, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Alain G. Bertoni
- Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Mario Sims
- Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi, USA
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16
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Bias and discrimination in surgery: Where are we and what can we do about it? J Pediatr Surg 2022; 57:1315-1320. [PMID: 35307193 DOI: 10.1016/j.jpedsurg.2022.02.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 02/07/2022] [Accepted: 02/15/2022] [Indexed: 11/24/2022]
Abstract
Bias is an inclination or preconceived outlook that favors toward or against an idea, person, or group. It manifests in implicit and explicit ways throughout all aspects and institutions of society. These cognitive shortcuts are often based on stereotypes and can lead to prejudice and discrimination in medicine as they mediate interactions with patients, between providers, and at the institutional level. It is important to understand the drivers and consequences of bias in order to overcome barriers to representation, equity, and inclusion. This paper provides definitions of bias; discusses its manifestations across academic medicine at the institutional and individual levels; and concludes by examining techniques to reduce bias and measure progress. Equity for patients, families, and members of the broader surgical community cannot be achieved without reducing bias and discrimination. We call for action to increase intentional efforts that reduce the influences of bias in healthcare, research, and education, particularly in the field of pediatric surgery.
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McElroy LM, Migaly J. Equity in surgical training: Pipeline or process? Am J Surg 2022; 224:248-249. [PMID: 35000754 PMCID: PMC10105602 DOI: 10.1016/j.amjsurg.2021.12.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 12/24/2021] [Accepted: 12/26/2021] [Indexed: 11/26/2022]
Affiliation(s)
- Lisa M McElroy
- Department of Surgery, Duke University School of Medicine, Durham, NC, United States.
| | - John Migaly
- Department of Surgery, Duke University School of Medicine, Durham, NC, United States.
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18
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Eruchalu CN, He K, Etheridge JC, Wu C, Ashley SW, Nitzschke SL, Smink DS, Cho NL. Gender and Racial/Ethnic Disparities in Operative Volumes of Graduating General Surgery Residents. J Surg Res 2022; 279:104-112. [PMID: 35759927 DOI: 10.1016/j.jss.2022.05.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 04/25/2022] [Accepted: 05/22/2022] [Indexed: 10/31/2022]
Abstract
INTRODUCTION Gender disparities in resident operative experience have been described; however, their etiology is poorly understood, and racial/ethnic disparities have not been explored. This study investigated the relationship between gender, race/ethnicity, and surgery resident case volumes. MATERIALS AND METHODS A retrospective analysis of graduating general surgery resident case logs (2010-2020) at an academic medical center was performed. Self-reported gender and race/ethnicity data were collected from program records. Residents were categorized as underrepresented in medicine (URM) (Black, Hispanic, Native American) or non-URM (White, Asian). Associations between gender and URM status and major, chief, and teaching assistant (TA) mean case volumes were analyzed using t-tests. RESULTS The cohort included 80 residents: 39 female (48.8%) and 17 URM (21.3%). Compared to male residents, female residents performed fewer TA cases (33 versus 47, P < 0.001). Compared to non-URM residents, URM residents graduated with fewer major (948 versus 1043, P = 0.008) and TA cases (32 versus 42, P = 0.038). Male URM residents performed fewer TA cases than male non-URM residents (32 versus 50, P = 0.031). Subanalysis stratified by graduation year demonstrated that from 2010 to 2015, female residents performed fewer chief (218 versus 248, P = 0.039) and TA cases (29 versus 50, P = 0.001) than male residents. However, from 2016 to 2020, when gender parity was achieved, no significant associations were observed between gender and case volumes. CONCLUSIONS Female and URM residents perform fewer TA and major cases than male non-URM residents, which may contribute to reduced operative autonomy, confidence, and entrustment. Prioritizing gender and URM parity may help decrease case volume gaps among underrepresented residents.
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Affiliation(s)
- Chukwuma N Eruchalu
- Harvard Medical School, Boston, Massachusetts; Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Katherine He
- Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - James C Etheridge
- Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Ariadne Labs, Harvard T.H. Chan School of Public Health, Brigham and Women's Hospital, Boston, Massachusetts
| | - Christine Wu
- Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Stanley W Ashley
- Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Stephanie L Nitzschke
- Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Douglas S Smink
- Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Nancy L Cho
- Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
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Revealing hidden experiences: Gendered microaggressions and surgical faculty burnout. Surgery 2022; 172:885-889. [PMID: 35643829 DOI: 10.1016/j.surg.2022.04.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 03/11/2022] [Accepted: 04/21/2022] [Indexed: 11/20/2022]
Abstract
BACKGROUND Studies report higher burnout in women faculty surgeons compared to men. However, few studies have examined underlying mechanisms for these gendered differences. Gendered differences in microaggression experiences may explain part of the relationship between gender and burnout. We aimed to investigate the relationship between gender, gendered microaggressions, and burnout and test the hypothesis that microaggressions contribute to the relationship between gender and burnout. METHODS In this 2021 study, a survey was distributed to surgical faculty at 7 institutions. Variables included gender identity, race, average hours worked recently, the Oldenburg Burnout Inventory, and a modified Racial and Ethnic Microaggressions Scale to assess gendered microaggressions. To assess the relationship between surgical faculty gender and burnout, and if this relationship could be explained by microaggressions, a mediation model was tested. RESULTS A total of 109 participants (40% female) completed the survey and were included in analysis. The hypothesized indirect effect of gender on burnout (M = 2.70/5, SD = 0.81), through gender-based microaggressions (M = 1.7/5, SD = 1.9), was significant, B = -0.25, SE B = 0.09, confidence interval (-0.44 to -0.09): women surgeons reported higher levels of gendered microaggressions, which predicted higher levels of burnout. The overall model was significant (R2 = .16, F[6,102] = 3.33, P < .01). Race, specialty, hours worked, and years of experience were all not significant in the model. CONCLUSION Gendered microaggressions mediate the relationship between gender and burnout, providing a potential mechanism for the higher rates of burnout in women surgeons evident in prior research. These multi-institutional data provide a focus for targeted initiatives that could decrease both burnout rates and the impact of gender bias on surgical faculty.
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Roque DR, Hinchcliff E, Alter R, Barber EL, Marcus J, Tanner E. Surgical Training in Gynecologic Oncology:A Sea Change. J Gynecol Surg 2022. [DOI: 10.1089/gyn.2022.0025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Dario R. Roque
- Department of Obstetrics and Gynecology, Northwestern University, Chicago, Illinois, USA
- Robert H Lurie Comprehensive Cancer Center Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Emily Hinchcliff
- Department of Obstetrics and Gynecology, Northwestern University, Chicago, Illinois, USA
- Robert H Lurie Comprehensive Cancer Center Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Raanan Alter
- Northwestern Medicine Central DuPage Hospital, Winfield, Illinois, USA
| | - Emma L. Barber
- Department of Obstetrics and Gynecology, Northwestern University, Chicago, Illinois, USA
- Robert H Lurie Comprehensive Cancer Center Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Jenna Marcus
- Department of Obstetrics and Gynecology, Northwestern University, Chicago, Illinois, USA
- Robert H Lurie Comprehensive Cancer Center Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
- Northwestern Medicine Central DuPage Hospital, Winfield, Illinois, USA
| | - Edward Tanner
- Department of Obstetrics and Gynecology, Northwestern University, Chicago, Illinois, USA
- Robert H Lurie Comprehensive Cancer Center Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
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Abstract
BACKGROUND Over the past twenty years explicit gender bias towards women in surgery has been replaced by more subtle barriers, which represent indirect forms of discrimination and prevents equality. OBJECTIVE The aim of our scoping review is to summarize the different forms of discrimination towards women in surgery. METHODS The database search consisted of original studies regarding discrimination towards female surgeons. RESULTS Of 3,615 studies meeting research criteria, 63 were included. Of these articles, 11 (18%) were focused on gender-based discrimination, 14 (22%) on discrimination in authorship, research productivity and research funding, 21 (33%) on discrimination in academic surgery, 7 (11%) on discrimination in surgical leadership positions and 10 (16%) on discrimination during conferences and in surgical societies. The majority (n = 53, 84%) of the included studies were conducted in the U.S.A. According to our analysis, female surgeons experience discrimination from male colleagues, healthcare workers, but also from patients and trainees. Possible solutions may include acknowledgement of the problem, increased education of diversity and integration for the younger generations, mentorship, coaching and more active engagement by male and female partners to support women in the surgical field. CONCLUSIONS Gender-based discrimination toward women in the field of surgery has evolved over the past twenty years, from an explicit to a more subtle attitude. A work-environment where diversity and flexibility are valued would allow female surgeons to better realize their full potential.
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Barcellini A, Dal Mas F, Paoloni P, Loap P, Cobianchi L, Locati L, Rodríguez-Luna MR, Orlandi E. Please mind the gap-about equity and access to care in oncology. ESMO Open 2021; 6:100335. [PMID: 34902710 PMCID: PMC8671867 DOI: 10.1016/j.esmoop.2021.100335] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 10/26/2021] [Accepted: 11/11/2021] [Indexed: 12/25/2022] Open
Affiliation(s)
- A Barcellini
- Radiation Oncology Unit, Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - F Dal Mas
- Department of Management, Lincoln International Business School, University of Lincoln, Lincoln, UK; Ipazia Observatory on Gender Research, Rome, Italy; Interdepartmental Research Center "Organization and Governance of the Public Administration", University of Pavia, Pavia, Italy
| | - P Paoloni
- Ipazia Observatory on Gender Research, Rome, Italy; Department of Law and Economics of Productive Activities, Sapienza University of Rome, Rome, Italy
| | - P Loap
- Radiation Oncology Unit, Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy; Department of Radiation Oncology, Institut Curie, Paris, France
| | - L Cobianchi
- Department of General Surgery, IRCCS Policlinico San Matteo Foundation, Pavia, Italy; Department of Clinical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - L Locati
- Unit of Translational Oncology, IRCCS ICS Maugeri, University of Pavia, Pavia, Italy
| | - M R Rodríguez-Luna
- Institute for Research against Digestive Cancer (IRCAD), Strasbourg, France
| | - E Orlandi
- Radiation Oncology Unit, Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy.
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Sharma D, Cotton M. Physician, heal thyself. Trop Doct 2021; 51:470-472. [PMID: 34775870 DOI: 10.1177/00494755211050529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Choubey AP, Bullock B, Choubey AS, Pai K, Ortiz AC, Khan SA, Mishra A, James R, Koizumi N, Pearson T, Ortiz J. Transplant surgery departmental leaders do not represent workforce demographics especially among women and underrepresented minorities - A retrospective analysis. Am J Surg 2021; 224:153-159. [PMID: 34802691 DOI: 10.1016/j.amjsurg.2021.11.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 10/20/2021] [Accepted: 11/04/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION The diversity among surgical directors for liver, kidney, and pancreas transplant departments has not been previously evaluated. We aim to quantify the sex and racial demographics of transplant department leaders and assess the impact on patient outcomes. METHODS Demographics were collected for 116 liver, 192 kidney, and 113 pancreas transplant directors using Organ Procurement and Transplantation Network (OPTN) directory and program websites. Scientific Registry of Transplant Recipients (SRTR) 5-tier program outcomes rankings were obtained for each program and matched to leader demographics. A retrospective analysis of transplant recipients from 2010 to 2019 was performed using the United Network for Organ Sharing (UNOS) database. RESULTS 91.5% of transplant surgical directors were male. 55% of departments had a Non-Hispanic White leader. Asian, Hispanic and Black transplant chiefs were at the helm of 23.3%, 9%, and 5% of divisions respectively. Multivariate cox regression analysis did not identify any differences in patient outcomes by transplant director demographics. CONCLUSION There is a paucity of female and URM leaders in transplant surgery. Initiatives to promote research, mentorship, and career advancement opportunities for women and URM are necessary to address the current leadership disparity.
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Affiliation(s)
- Ankur P Choubey
- Department of Surgery, Rutgers Robert Wood Johnson University Hospital, New Brunswick, NJ, USA.
| | - Brenna Bullock
- Department of Surgery, University of Toledo Medical Center, OH, USA
| | - Apurva S Choubey
- University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Kavya Pai
- Department of Surgery, University of Toledo Medical Center, OH, USA
| | | | - Samar A Khan
- Department of Surgery, University of Toledo Medical Center, OH, USA
| | - Anil Mishra
- Department of Surgery, University of Toledo Medical Center, OH, USA
| | - Rosy James
- Schar School of Policy and Government, George Mason University, Fairfax, VA, USA
| | - Naoru Koizumi
- Schar School of Policy and Government, George Mason University, Fairfax, VA, USA
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Ford HR. Invited Commentary on The Role of Race and Gender in the Career Experiences of Black/African-American Academic Surgeons: A Survey of the Society of Black Academic Surgeons and a Call to Action. Ann Surg 2021; 273:832-833. [PMID: 33630432 DOI: 10.1097/sla.0000000000004826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Henri R Ford
- Miller School of Medicine, Don Soffer Clinical Research Center, University of Miami, Miami, FL 33136
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Moon MR. Equal means equal: Cardiothoracic surgery in its second century. J Thorac Cardiovasc Surg 2020; 161:1381-1389. [PMID: 33487415 DOI: 10.1016/j.jtcvs.2020.12.030] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 11/27/2020] [Accepted: 12/07/2020] [Indexed: 12/22/2022]
Abstract
OBJECTIVE As the specialty of cardiothoracic surgery turns the corner into its second century of existence, there has been an uptick in the number of women and underrepresented minorities entering the field, but we have a long way to go before race and gender equity prevails. METHODS In this report, specific barriers to diversity without exclusion and mechanisms to breakdown these barriers will be explored. RESULTS Barriers to inclusion include a long-standing deficiency in exposure, encouragement, mentorship, and sponsorship to actively attract underrepresented groups to the specialty. Diversity will not occur passively. It will take a concerted effort best employed through a top-down approach at the local and national level, and it has to seem normal. CONCLUSIONS Cardiothoracic surgery is an outstanding field for anyone and everyone who seeks a challenging, rewarding career, regardless of their gender, race, or ethnic background. It is the responsibility of leadership to dispel the tradition that certain individuals are not welcome.
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Affiliation(s)
- Marc R Moon
- Division of Cardiothoracic Surgery, Washington University School of Medicine, St Louis, Mo.
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