Rama Essam, Ekhtiari Seper, Thevendran Gowreeson, Green Jennifer, Weber Kristy, Khanduja Vikas
University of Cambridge, Cambridge, United Kingdom.
Addenbrooke's-Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom.
J Bone Joint Surg Am. 2023 Dec 6;105(23):1910-1919. doi: 10.2106/JBJS.23.00238. Epub 2023 Aug 28.
Diversity in orthopaedics continues to lag behind that in other surgical specialties. This pattern exists globally and is not unique to gender or race. This review offers a global perspective on overcoming the barriers to diversity in orthopaedics.
A literature search of MEDLINE and Embase was conducted and a narrative review was undertaken. Publications that discussed any aspect of diversity or solutions to diversity within orthopaedics or academic orthopaedics were identified.
A total of 62 studies were included. Studies showed that diversity in orthopaedic training is limited by structural barriers such as long hours, requirements to relocate during training, training inflexibility, and a lack of exposure to orthopaedics. Implicit bias during the selection process for training, discrimination, and a lack of role models are additional barriers that are experienced by both minority and female surgeons. The global lack of diversity suggests that there are also inherent "cultural barriers" that are unique to orthopaedics; however, these barriers are not uniformly experienced. Perceptions of orthopaedics as promoting an unhealthy work-life balance and the existence of a "boys' club" must be addressed. Strong, committed leaders can embed cultural norms, support trainees, and act as visible role models. Targeted efforts to increase diverse recruitment and to reduce bias in selection processes for medical school and specialty training will increase diversity in the "training pipeline."
Diversity in orthopaedics continues to lag behind that in other specialties. Increasing diversity is important for providing a more inclusive training environment, improving patient care, and reducing health disparities. Structural and cultural barriers need to be addressed to improve diversity in orthopaedics. Promoting a culture supportive of all surgeons is essential to reframing perceptions that may prevent individuals from even considering a career as an orthopaedic surgeon. Changing attitudes require focused efforts from committed leadership in a "top-down" approach that prioritizes diversity. The efforts from national bodies seeking to tackle the lack of diversity, as well as the establishment of organizations committed to diversity, such as the International Orthopaedic Diversity Alliance, provide reasons to be optimistic for the future.
骨科领域的多样性仍落后于其他外科专科。这种情况在全球范围内都存在，并非性别或种族所特有。本综述从全球视角探讨克服骨科领域多样性障碍的方法。
对MEDLINE和Embase进行文献检索，并进行叙述性综述。确定了讨论骨科或学术骨科领域多样性的任何方面或多样性解决方案的出版物。
共纳入62项研究。研究表明，骨科培训的多样性受到诸如长时间工作、培训期间需要重新安置、培训缺乏灵活性以及缺乏骨科接触机会等结构性障碍的限制。培训选拔过程中的隐性偏见、歧视以及缺乏榜样是少数族裔和女性外科医生都会遇到的额外障碍。全球范围内多样性的缺乏表明，骨科还存在固有的“文化障碍”；然而，这些障碍并非普遍存在。必须解决将骨科视为不利于健康的工作与生活平衡的观念以及“男性俱乐部”的存在问题。强有力、有奉献精神的领导者可以树立文化规范、支持学员并成为可见的榜样。有针对性地努力增加多样化招聘，并减少医学院校和专科培训选拔过程中的偏见，将增加“培训渠道”的多样性。
骨科领域的多样性仍落后于其他专科。增加多样性对于提供更具包容性的培训环境、改善患者护理以及减少健康差距至关重要。需要解决结构性和文化障碍，以提高骨科领域的多样性。营造支持所有外科医生的文化对于重塑可能阻止个人考虑从事骨科外科医生职业的观念至关重要。改变态度需要有奉献精神的领导层以“自上而下”的方式做出重点努力，将多样性作为优先事项。国家机构为解决多样性不足问题所做的努力，以及致力于多样性的组织（如国际骨科多样性联盟）的成立，为未来带来了乐观的理由。
