Bernstein Joseph, Dicaprio Matthew R, Mehta Samir
Department of Orthopedic Surgery, Veterans' Hospital, University of Pennsylvania, 424 Stemmler Hall, Philadelphia, PA 19104-6081.
J Bone Joint Surg Am. 2004 Oct;86(10):2335-8. doi: 10.2106/00004623-200410000-00031.
Orthopaedic residency programs lack gender and race diversity. This study examines the hypothesis that exposure to a required course in musculoskeletal medicine in medical school is associated with a higher rate of application to orthopaedic surgery residency programs by underrepresented groups.
All 122 medical schools in the United States were surveyed in 2001 to determine whether they required dedicated course work in musculoskeletal medicine, defined as a preclinical module or clinical clerkship in orthopaedic surgery, rheumatology, or physiatry. Data from the Electronic Residency Application Service were obtained for the class of 2002. From these two sources, the rate of applications from students to orthopaedic surgery residency programs was calculated as a function of exposure to a required course in musculoskeletal medicine. Subgroup analysis was further carried out for women and for African Americans, Latinos, and Native Americans.
In 2002, there were 16,294 graduates of American medical schools, of whom approximately 55% had mandatory instruction in musculoskeletal medicine. The rate of application to orthopaedic surgery residency programs was 5.7% among the students with required instruction compared with a rate of 5.1% for students without such required instruction. The rate of application for female students was 2.0% for those who had required courses and 1.1% for the female students who had not had the required courses. The rate of application for minority students in schools with required courses was 8.2% compared with a rate of 6.1% for those students without such exposure.
Required instruction in musculoskeletal medicine was associated with a 12% higher rate of application to orthopaedic surgery residency programs among all students (5.7% of those who received required instruction compared with 5.1% of those who did not). The relative difference was more pronounced among women (a 75% difference in the rate of application) and minorities (a 35% difference in the rate of application). This study suggests that required instruction in musculoskeletal medicine can help to promote diversity in orthopaedic surgery residency programs.
骨科住院医师培训项目缺乏性别和种族多样性。本研究检验了这样一个假设，即医学院开设的肌肉骨骼医学必修课与代表性不足群体申请骨科手术住院医师培训项目的比例较高有关。
2001年对美国所有122所医学院进行了调查，以确定它们是否要求开设肌肉骨骼医学的专门课程，该课程定义为骨科手术、风湿病学或物理医学与康复学的临床前模块或临床实习。获取了2002届学生的电子住院医师申请服务数据。从这两个来源，计算学生申请骨科手术住院医师培训项目的比例与接受肌肉骨骼医学必修课学习情况的函数关系。对女性以及非裔美国人、拉丁裔和美国原住民进行了亚组分析。
2002年，美国医学院有16294名毕业生，其中约55%接受了肌肉骨骼医学的强制性教学。接受必修课教学的学生申请骨科手术住院医师培训项目的比例为5.7%，而未接受此类必修课教学的学生这一比例为5.1%。有必修课的女学生申请比例为2.0%，没有必修课的女学生申请比例为1.1%。在有必修课的学校中，少数族裔学生的申请比例为8.2%，而没有此类学习经历的学生申请比例为6.1%。
肌肉骨骼医学的必修课与所有学生申请骨科手术住院医师培训项目的比例高出12%有关（接受必修课教学的学生中有5.7%申请，未接受的学生中有5.1%申请）。女性（申请比例相差75%）和少数族裔（申请比例相差35%）之间的相对差异更为明显。这项研究表明，肌肉骨骼医学的必修课有助于促进骨科手术住院医师培训项目的多样性。
