Premier Health Orthopedics, Centerville, Ohio.
Department of Neurosurgery, Division of Spine, Duke University Medical Center, Durham, North Carolina.
J Surg Educ. 2021 Sep-Oct;78(5):1400-1405. doi: 10.1016/j.jsurg.2021.01.003. Epub 2021 Jan 14.
Diversifying clinical residencies, particularly in fields that are historically dominated by majority male (M/M) cohorts, is critical to improve both the training experiences of residents and the overall physician workforce. Orthopedic surgery in particular has low numbers of females and under-represented minorities (F/URM) at all levels of training and practice. Despite efforts to increase its diversity, this field has become more homogeneous in recent years. To highlight potential barriers and disparate training environments that may contribute to this dynamic, we present 25 years' worth of institutional data on standardized exam performance throughout residency. We report that despite starting residency with standardized exam scores that were comparable to their M/M peers, F/URM orthopedic surgery residents performed progressively worse on Orthopaedic In-service Training Exams throughout residency and had lower first pass rates on the American Board of Orthopedic Surgery Part 1. Given these findings, we propose that disparate performance on standardized test scores throughout residency could identify trainees that may have different experiences that negatively impact their exam performance. Shedding light on these underlying disparities provides opportunities to find meaningful and sustained ways to develop a culture of diversity and inclusion. It may also allow for other programs to identify similar patterns within their training programs. Overall, we propose monitoring test performance on standardized exams throughout orthopedic surgery residency to identify potential disparities in training experience; further, we acknowledge that interventions to mitigate these disparities require a broad, systems wide approach and a firm institutional commitment to reducing bias and working toward sustainable change.
多元化临床住院医师培训，尤其是在历史上主要由男性（M/M）群体主导的领域，对于改善住院医师的培训体验和整体医生队伍至关重要。特别是在骨科手术领域，在各个培训和实践层面，女性和代表性不足的少数族裔（F/URM）的数量都很低。尽管为了增加多样性，该领域近年来变得更加同质化。为了强调可能导致这种动态的潜在障碍和不同的培训环境，我们展示了 25 年来在整个住院医师培训期间进行标准化考试成绩的机构数据。我们报告说，尽管 F/URM 骨科住院医师在开始住院医师培训时的标准化考试成绩与 M/M 同龄人相当，但他们在整个住院医师培训期间在骨科住院医师年度考核中的表现逐渐恶化，并且在骨科住院医师年度考核中的首次通过率较低美国骨科委员会第 1 部分。鉴于这些发现，我们提出在整个住院医师培训期间标准化考试成绩的差异表现可能可以识别出可能具有不同经历的学员，这些经历可能会对他们的考试成绩产生负面影响。揭示这些潜在的差异为寻找有意义和可持续的方法来培养多元化和包容性文化提供了机会。它还可以使其他计划在其培训计划中识别类似的模式。总体而言，我们建议在整个骨科住院医师培训期间监测标准化考试的考试成绩，以识别培训经历中的潜在差异；此外，我们承认干预这些差异需要广泛的、系统范围的方法以及坚定的机构承诺，以减少偏见并努力实现可持续变革。
