Haruno Lee S, Chen Xi, Metzger Melodie, Lin Carol A, Little Milton T M, Kanim Linda E A, Poon Selina C
Department of Orthopaedic Surgery, Cedars Sinai Medical Center, Los Angeles, California.
Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania.
JB JS Open Access. 2023 Jun 20;8(2). doi: 10.2106/JBJS.OA.22.00148. eCollection 2023 Apr-Jun.
Studies have suggested that female individuals and individuals from backgrounds under-represented in medicine (URiM) are at increased risk of attrition during residency. This likely exacerbates the lack of diversity in our field. The aims of this study were to (1) characterize demographic composition in orthopaedic residency from 2001 to 2018 and (2) determine the race/ethnicity and identify any disparities.
Demographic and attrition data from 2001 to 2018 were obtained from the Association of American Medical Colleges. Attrition data comprised the following categories: withdrawals, dismissals, and transfers to another specialty. Analysis compared demographic composition and determined attrition rates with subgroup analysis by race/ethnicity and sex.
From 2001 to 2018, female orthopaedic residents increased from 8.77% to 15.54% and URiM residents from 9.49% to 11.32%. The overall and unintended attrition rates in orthopaedic surgery were 3.20% and 1.15%, respectively. Among female residents, the overall and unintended attrition rates were 5.96% and 2.09% compared with 2.79% and 1.01%, respectively, in male residents. URiM residents had overall and unintended attrition rates of 6.16% and 3.11% compared with 2.71% and 0.83%, respectively, for their White counterparts. Black/African American residents had an attrition rate of nearly 10%. Female residents averaged 12.9% of all residents but 24% of those leaving orthopaedics. URiM residents were 10.14% of all residents but 19.51% of those experiencing attrition. In logistic regression models, female residents had a relative risk (RR) of 2.20 (p < 0.001) for experiencing all-cause attrition and 2.09 (p < 0.001) for unintended attrition compared with male residents. Compared with their White male counterparts, URiM residents had a RR for overall and unintended attrition of 2.36 and 3.84 (p < 0.001), respectively; Black/African American residents had a RR for the same of 3.80 and 7.20 (p < 0.001), respectively.
Although female resident percentage has increased, orthopaedics continues to train fewer female surgeons than all other fields. Female and URiM residents in orthopaedic surgery are disproportionately affected by attrition. While recruitment has been the primary focus of diversity, equity, and inclusion efforts, this study suggests that resident retention through appropriately supporting residents during training is equally critical.
研究表明，女性个体以及医学领域中代表性不足背景的个体（URiM）在住院医师培训期间流失的风险增加。这可能会加剧我们这个领域缺乏多样性的状况。本研究的目的是：（1）描述2001年至2018年骨科住院医师培训中的人口统计学构成；（2）确定种族/民族并识别任何差异。
2001年至2018年的人口统计学和流失数据来自美国医学院协会。流失数据包括以下类别：退学、开除和转至其他专业。分析比较了人口统计学构成，并通过种族/民族和性别进行亚组分析来确定流失率。
从2001年到2018年，女性骨科住院医师从8.77%增加到15.54%，URiM住院医师从9.49%增加到11.32%。骨科手术的总体和意外流失率分别为3.20%和1.15%。在女性住院医师中，总体和意外流失率分别为5.96%和2.09%，而男性住院医师分别为2.79%和1.01%。URiM住院医师的总体和意外流失率分别为6.16%和3.11%，而其白人同行分别为2.71%和0.83%。黑人/非裔美国住院医师的流失率接近10%。女性住院医师平均占所有住院医师的12.9%，但占离开骨科的住院医师的24%。URiM住院医师占所有住院医师的10.14%，但占经历流失的住院医师的19.51%。在逻辑回归模型中，与男性住院医师相比，女性住院医师全因流失的相对风险（RR）为2.20（p < 0.001），意外流失的相对风险为2.09（p < 0.001）。与白人男性同行相比，URiM住院医师总体和意外流失的RR分别为2.36和3.84（p < 0.001）；黑人/非裔美国住院医师的RR分别为3.80和7.20（p < 0.001）。
尽管女性住院医师的比例有所增加，但骨科培养的女外科医生仍比所有其他领域少。骨科手术中的女性和URiM住院医师受流失的影响尤为严重。虽然招聘一直是多元化、公平和包容努力的主要重点，但本研究表明，在培训期间通过适当支持住院医师来留住他们同样至关重要。
