Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta Hospital, Edmonton, Alberta, Canada.
London Health Sciences Centre, Schulich School of Medicine and Dentistry, Division of General Surgery, Department of Surgery, Western University, East London, Ontario, Canada.
JAMA Surg. 2020 Oct 1;155(10):e202828. doi: 10.1001/jamasurg.2020.2828. Epub 2020 Oct 21.
Within medical specialties, surgical disciplines disproportionately and routinely demonstrate the greatest underrepresentation of women and individuals from racial/ethnic minority groups. Understanding the role that diversity plays in surgical resident training may identify strategies that foster resident resiliency, optimize surgical training, and improve patient outcomes.
To examine the implication of gender and visible minority (VM [ie, nonaboriginal people who are not White individuals]) status for resiliency and training experiences of general surgery residents in Canada.
DESIGN, SETTING, AND PARTICIPANTS: In this survey study, a 129-item questionnaire was emailed from May 2018 to July 2018 to all residents enrolled in all Canadian general surgery training programs during the 2017-2018 training year. Survey responses were extracted and categorized into 5 major themes. The survey was designed by the Resident Committee and reviewed by the Governing Board of the Canadian Association of General Surgeons. French and English versions of the survey were created, distributed, and administered using Google Forms.
Survey questions were formulated to characterize resident diversity and training experience. Self-perceptions of diversity, mentorship, and training experience were evaluated using a 5-point Likert scale (1 for strongly disagree, 2 for disagree, 3 for neither agree or disagree, 4 for agree, and 5 for strongly agree) and open-ended responses. The frequency of perceived unprofessional workplace encounters was evaluated using a 5-point scale (1 for daily, 2 for weekly, 3 for monthly, 4 for annually, and 5 for never).
Of the 510 general surgery residents invited, a total of 210 residents (40.5%) completed the survey. Most respondents were younger than 30 years (119 [56.7%]), were women (112 [53.3%]), reported English as their first language (133 [63.3%]), did not identify as a VM (147 [70.0%]), had no dependents (184 [87.6%]), and were Canadian medical graduates (178 [84.8%]). Women residents who identified as VM compared with male residents who did not identify as a VM were less likely to agree or strongly agree that they had a collegial relationship with staff, (21 [63.6%] vs 61 [89.7%]; P = .01), to feel like they fit in with their training programs (21 [63.6%] vs 56 [82.3%]; P = .003), and to feel valued at work (15 [45.4%] vs 47 [69.1%]; P = .03). Both female residents and female residents who identified as VM described significant concerns about receiving fewer training opportunities because of their gender vs their male peers (54 [48.2%] vs 3 [3.0%]; P < .001). Ninety-one of 112 female residents (81.2%) reported feeling that their medical expertise was dismissed because of their gender at least once annually, with 37 women (33.0%) experiencing dismissal of their expertise at least once every week (P < .001). In contrast, 98% of male residents reported never experiencing dismissal of their medical expertise because of their gender. Similarly, residents with VM status vs those without VM status reported at least monthly dismissal of their expertise because of their race/ethnicity (9 of 63 [14.3%] vs 1 of 147 [0.7%]; P < .001).
In this study, female sex and VM status appeared to be associated with adverse implications for the training experience of general surgery residents. These findings suggest that new strategies focused on the intersectionality of gender and race/ethnicity are needed to improve the training experience of at-risk residents.
在医学专业中，外科学科不成比例且常规地表现出女性和少数族裔（VM[即非白种人]）群体的代表性严重不足。了解多样性在外科住院医师培训中的作用，可以确定培养住院医师适应能力、优化外科培训和改善患者预后的策略。
研究性别和少数族裔（VM[即非白种人]）身份对加拿大普通外科住院医师的适应能力和培训经历的影响。
设计、设置和参与者：在这项调查研究中，2018 年 5 月至 7 月，通过电子邮件向所有参加 2017-2018 年培训年度所有加拿大普通外科培训项目的住院医师发送了一份包含 129 个项目的问卷。提取调查回复并分为 5 个主要主题。该调查由住院医师委员会设计，并由加拿大普通外科医师协会理事会审查。创建了法语和英语版本的调查，并使用 Google 表单进行分发和管理。
通过问卷调查来描述住院医师的多样性和培训经历。使用 5 点李克特量表（1 表示非常不同意，2 表示不同意，3 表示既不同意也不反对，4 表示同意，5 表示非常同意）和开放性回答来评估对多样性、指导和培训经历的自我认知。使用 5 点量表（1 表示每天，2 表示每周，3 表示每月，4 表示每年，5 表示从不）评估感知到的不专业工作场所遭遇的频率。
在邀请的 510 名普通外科住院医师中，共有 210 名（40.5%）完成了调查。大多数受访者年龄在 30 岁以下（119[56.7%]），为女性（112[53.3%]），报告英语为第一语言（133[63.3%]），不是 VM（147[70.0%]），没有家属（184[87.6%]），且为加拿大医学毕业生（178[84.8%]）。与非 VM 身份的男性住院医师相比，VM 身份的女性住院医师更不可能表示他们与工作人员建立了友好的关系（21[63.6%]与 61[89.7%]；P=0.01）、觉得自己与培训计划融为一体（21[63.6%]与 56[82.3%]；P=0.003）和感到工作受到重视（15[45.4%]与 47[69.1%]；P=0.03）。女性住院医师和 VM 身份的女性住院医师都描述了对因性别而获得较少培训机会的严重担忧，而不是她们的男性同行（54[48.2%]与 3[3.0%]；P<0.001）。112 名女性住院医师中有 91 名（81.2%）报告说，他们的医疗专业知识至少每年都会因为他们的性别而受到质疑，其中 37 名女性（33.0%）每周至少会经历一次专业知识被质疑（P<0.001）。相比之下，98%的男性住院医师报告说，他们的医疗专业知识从未因为他们的性别而受到质疑。同样，有 VM 身份的住院医师与没有 VM 身份的住院医师相比，至少每月会因为他们的种族/民族而被质疑他们的专业知识（9 名/63 名[14.3%]与 1 名/147 名[0.7%]；P<0.001）。
在这项研究中，女性性别和 VM 身份似乎与普通外科住院医师培训经历的不利影响有关。这些发现表明，需要制定新的战略，侧重于性别和种族/民族的交叉性，以改善高危住院医师的培训经历。
