Division of Vascular and Endovascular Surgery, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA.
Department of Surgery, University of Cincinnati Medical Center, Cincinnati, OH, USA.
Am J Surg. 2022 Jul;224(1 Pt B):250-256. doi: 10.1016/j.amjsurg.2021.11.006. Epub 2021 Nov 11.
Recent initiatives have emphasized the importance of diversity, equity, and inclusion in academic surgery. Racial/ethnic disparities remain prevalent throughout surgical training, and the "diversity pipeline" in resident recruitment and retention remains poorly defined.
Data was retrospectively collected using two separate datasets. The Association of American Medical Colleges database was used to obtain demographic data on US medical school graduates. The US Graduate Medical Education annual report was used to obtain demographic data on surgical residents. Wilcoxon signed-rank test was used to compare racial/ethnic distribution within surgical residency programs with graduating medical students. Linear regression analysis was performed to analyze population trends over time.
The study population included 184,690 surgical residents from 2011 to 2020. Nine resident cohorts were created according to surgical specialty - general surgery, neurosurgery, ophthalmology, orthopedic surgery, otolaryngology, plastic surgery, cardiothoracic surgery, urology, and vascular surgery. Among surgical programs, White residents were overrepresented in 8 of 9 specialties compared to the concurrent graduating medical student class for all years (p < 0.01 each, no difference in ophthalmology). Black residents were underrepresented in 8 of 9 specialties (p < 0.01 each, no difference in general surgery). Asian representation was mixed among specialties (4 overrepresented, 1 equal, 4 underrepresented), as was Hispanic representation (5 overrepresented, 4 equal) (p < 0.01 each).
These data suggest that racial/ethnic disparities are inherent to the process of recruitment and retention of surgical residents. Efforts to improve the "diversity pipeline" should focus on mentorship and development of minority medical students and creating an equitable learning environment.
最近的倡议强调了学术外科领域多样性、公平性和包容性的重要性。种族/民族差异在外科培训中仍然普遍存在，而居民招聘和留用的“多样性渠道”仍未得到明确界定。
使用两个独立数据集回顾性收集数据。美国医学院协会数据库用于获取美国医学院毕业生的人口统计学数据。美国住院医师医学教育年度报告用于获取外科住院医师的人口统计学数据。采用 Wilcoxon 符号秩检验比较外科住院医师项目与毕业医学生的种族/民族分布。进行线性回归分析以分析随时间的人口趋势。
研究人群包括 2011 年至 2020 年的 184690 名外科住院医师。根据外科专业，创建了 9 个住院医师队列 - 普通外科、神经外科、眼科、骨科、耳鼻喉科、整形外科、心胸外科、泌尿科和血管外科。在外科项目中，与所有年份的同期毕业医学生相比，白人居民在 9 个专业中的 8 个专业中比例过高（p<0.01 ，眼科除外）。黑人居民在 9 个专业中的 8 个专业中比例过低（p<0.01 ，普通外科除外）。亚洲人的代表性在专业中各不相同（4 个代表过多，1 个相等，4 个代表不足），西班牙裔的代表性也是如此（5 个代表过多，4 个相等）（p<0.01 ）。
这些数据表明，种族/民族差异是外科住院医师招聘和留用过程中的固有问题。改善“多样性渠道”的努力应侧重于少数族裔医学生的指导和发展，并创造公平的学习环境。
