Malapati Harsha, Yusuf Cynthia T, Lopez Christopher D, Jenny Hillary, Barone Angelo L, Redett Richard J, Yang Robin
Division of Plastic and Reconstructive Surgery, Brigham and Women's Hospital, Harvard University, Boston, Massachusetts.
Department of Plastic and Reconstructive Surgery, Johns Hopkins University, Baltimore, Maryland.
J Surg Educ. 2023 Oct;80(10):1432-1444. doi: 10.1016/j.jsurg.2023.07.007. Epub 2023 Aug 13.
The socioeconomic diversity of residents, fellows, and faculty members in any medical or surgical specialty is currently unknown making it difficult to understand socioeconomic status (SES) disparities and create programs to improve diversity. Additionally, the career trajectories of residents and faculty members who come from different SES backgrounds have not been explored. We have performed a survey-based research study to understand the SES composition and career trajectories of residents and faculty members within U.S. Plastic and Reconstructive Surgery (PRS) residency programs.
An anonymous online survey was administered to 754 recipients within plastic surgery residency programs in the United States. Self-reported SES information such as household income prior to age 18 and parental education level was collected. Data regarding career trajectories was obtained through questions about away rotations and research productivity.
A total of 196 fellows, and faculty members participated in the study, with an estimated survey respondent rate of 25.9%. Only 9.9% (10 of 101) of residents and fellows reported a childhood (under age 18) family income less than $40,000. When analyzing parental education and occupation (EO-status), 42.6% (43 of 101) of residents and fellows had at least 1 parent in an executive, managerial, or professional position with a doctorate/professional degree. Low-income and low EO-status were associated with increased utilization of federal and state assistance programs (p = 0.0001) and approval for AAMC's Fee Assistance Program (FAP) (p = 0.0001). Residents and fellows who identified as White were not as likely to be from low EO-status households as those who identified as Asian (OR 0.3 and p = 0.015 vs. OR 2.9 and p = 0.038). Residents and fellows from low EO-status backgrounds were more likely to take a gap in education (87% vs. 65.4%, p = 0.047) compared to their high EO-status peers. Notably, more current residents and fellows performed away rotations and had first-author publications during or before medical school compared to full professors (p = 0.0001).
Understanding the backgrounds and career trajectories of trainees and faculty in medicine is essential, yet it has not been performed at the resident or faculty level. This survey is the first to demonstrate the lack of socioeconomic diversity in a specialty (PRS) and identifies variation in career trajectories among those from different SES backgrounds. Large-scale research efforts are necessary to understand current SES diversity and barriers encountered by trainees and educators from low-SES backgrounds in all medical and surgical specialties.
目前尚不清楚任何医学或外科专业中住院医师、研究员和教员的社会经济多样性，这使得难以理解社会经济地位（SES）差异并制定改善多样性的计划。此外，来自不同SES背景的住院医师和教员的职业轨迹尚未得到探索。我们进行了一项基于调查的研究，以了解美国整形外科住院医师培训项目中住院医师和教员的SES构成及职业轨迹。
对美国整形外科住院医师培训项目中的754名接收者进行了一项匿名在线调查。收集了自我报告的SES信息，如18岁之前的家庭收入和父母教育水平。通过关于异地轮转和研究产出的问题获取了有关职业轨迹的数据。
共有196名研究员和教员参与了该研究，估计调查回复率为25.9%。只有9.9%（101人中的10人）住院医师和研究员报告童年（18岁以下）家庭收入低于40,000美元。在分析父母的教育和职业（EO状况）时，42.6%（101人中的43人）住院医师和研究员至少有一位父母担任高管、经理或拥有博士/专业学位的专业职位。低收入和低EO状况与联邦和州援助项目的利用率增加相关（p = 0.0001）以及美国医学协会（AAMC）费用援助计划（FAP）的获批相关（p = 0.0001）。与亚洲人相比，自我认定为白人的住院医师和研究员来自低EO状况家庭的可能性较小（OR为0.3，p = 0.015；而亚洲人OR为2.9，p = 0.038）。与高EO状况的同行相比，来自低EO状况背景的住院医师和研究员更有可能有教育间隔（87%对65.4%，p = 0.047）。值得注意的是，与正教授相比，更多现任住院医师和研究员在医学院期间或之前进行了异地轮转并发表了第一作者论文（p = 0.0001）。
了解医学领域学员和教员的背景及职业轨迹至关重要，但在住院医师或教员层面尚未开展此类研究。这项调查首次证明了一个专业（整形外科）中社会经济多样性的缺乏，并确定了来自不同SES背景的人在职业轨迹上的差异。有必要进行大规模研究，以了解所有医学和外科专业中来自低SES背景的学员和教育工作者目前的SES多样性及所遇到的障碍。
