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.
Ann Surg. 2024 Jan 1;279(1):172-179. doi: 10.1097/SLA.0000000000005848. Epub 2023 Mar 17.
To determine the relationship between race/ethnicity and case volume among graduating surgical residents.
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.
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.
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.
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.
确定毕业外科住院医师的种族/民族与手术量之间的关系。
少数民族个体在进入和晋升外科领域时面临障碍；然而，目前还没有对少数民族住院医师手术经验进行大规模调查。
对美国住院医师手术经验联盟数据库中 20 个项目的住院医师手术量进行了多机构回顾性分析。纳入了所有 2010 年至 2020 年毕业的住院医师。比较了种族/民族群体之间的总手术量、外科主任手术量、外科住院医师手术量和教学助理手术量。
该队列包括 1343 名住院医师。其中 211 名（15.7%）为亚洲人，65 名（4.8%）为黑人，73 名（5.4%）为西班牙裔，71 名（5.3%）为“其他”（美洲原住民或多种族），923 名（68.7%）为白人。调整分析显示，与白人住院医师相比，黑人住院医师的总手术量减少了 76 例（95%CI，-109 至-43，P<0.001），外科住院医师手术量减少了 69 例（-98 至-40，P<0.001）。比较按毕业年份调整后的总手术量，黑人住院医师和白人住院医师的手术量随着时间的推移都有所增加；然而，每年的增长率没有差异（分别为每年增加 10 例和 12 例，P=0.769）。因此，在整个研究期间，总手术量的差异仍然存在。
在这项多机构研究中，黑人住院医师在过去十年中毕业时的手术量低于非少数族裔住院医师。手术学习机会减少可能会对专业发展产生负面影响。需要采取系统性干预措施，以促进公平的手术经验和积极的文化变革。
