Institute for Technology Assessment, Massachusetts General Hospital, Boston, MA, USA.
Division of Surgical Oncology, Medical College of Wisconsin, Milwaukee, WI, USA.
Ann Surg Oncol. 2023 Aug;30(8):4579-4586. doi: 10.1245/s10434-023-13499-z. Epub 2023 Apr 20.
Cancer incidence is expected to increase in coming decades, disproportionately so among minoritized communities. Racially and ethnically concordant care is essential to addressing disparities in cancer outcomes within at-risk groups. Here, we assess trends in racial and ethnic representation of medical students (MS), general surgery (GS) residents, and complex general surgical oncology (CGSO) fellows.
This is a retrospective review of data from the American Association of Medical Colleges and the Accreditation Council of Medical Education (ACGME) from 2015 to 2020. Self-reported race and ethnicity was obtained for MS, GS, and CGSO trainees. Race and ethnicity proportions were compared with respective representation in the 2020 US Census. Mann-Kendall, Wilcoxon rank sum, and linear regression were used to assess trends, as appropriate.
A total of 316,448 MS applicants, 128,729 MS matriculants, 27,574 GS applicants, 46,927 active GS residents, 710 CGSO applicants, and 659 active CGSO fellows were included. With every progressive stage in training, there was a smaller proportion of URM active trainees than applicants. Further, URM, Hispanic/Latino, and Black/African American trainees were significantly underrepresented compared with 2020 Census data. While the proportion of White CGSO fellows increased over time (54.5-69.2%, p = 0.009), the proportion of Black/African American and Hispanic/Latino (URM) CGSO fellows did not significantly change over the study period, though URM representation was lower in 2020 as compared with 2015.
From 2015 to 2020, minority representation decreased at every advancing stage in surgical oncology training. Efforts to address barriers for URM applicants to CGSO fellowships are needed.
预计未来几十年癌症发病率将上升，少数族裔群体的发病率不成比例地上升。在高危人群中，实现癌症结局差异的关键是提供种族和民族一致的医疗服务。在此，我们评估了医学专业学生（MS）、普通外科（GS）住院医师和复杂普通外科肿瘤学（CGSO）研究员中种族和民族代表性的趋势。
这是对美国医学院协会和医学教育认证委员会（ACGME） 2015 年至 2020 年数据的回顾性分析。MS、GS 和 CGSO 受训者的自我报告种族和民族情况。将种族和民族比例与 2020 年美国人口普查中的相应比例进行比较。使用 Mann-Kendall、Wilcoxon 秩和和线性回归评估趋势，视情况而定。
共有 316448 名 MS 申请人、128729 名 MS 入学学生、27574 名 GS 申请人、46927 名活跃 GS 住院医师、710 名 CGSO 申请人和 659 名活跃 CGSO 研究员被纳入研究。随着培训的每一个渐进阶段，URM 活跃学员的比例都低于申请人。此外，与 2020 年人口普查数据相比，URM、西班牙裔/拉丁裔和非裔美国人受训者的代表性严重不足。尽管白人 CGSO 研究员的比例随着时间的推移而增加（54.5-69.2%，p=0.009），但黑人/非裔美国人和西班牙裔/拉丁裔（URM）CGSO 研究员的比例在研究期间并没有显著变化，尽管与 2015 年相比，2020 年 URM 的代表性更低。
从 2015 年到 2020 年，在普通外科肿瘤学培训的每一个高级阶段，少数民族的代表性都在下降。需要努力解决 URM 申请 CGSO 研究员职位的障碍。
