James Chrystina L, Kasto Johnny, Mazeh Mahdi, Sanii Ryan, Burdick Gabriel, Fathima Bushra, Jiang Eric, Muh Stephanie
Department of Orthopaedic Surgery, Henry Ford Health System, Detroit, USA.
Department of Orthopaedic Surgery, University of Southern California, Los Angeles, USA.
Cureus. 2025 Jun 21;17(6):e86490. doi: 10.7759/cureus.86490. eCollection 2025 Jun.
Background and objective Despite ongoing efforts to increase diversity in the field, orthopaedic surgery continues to be the least diverse specialty in all of medicine. This study aimed to assess experiences in medical school and their impact on the decision to pursue orthopaedic surgery residency, and specifically, if these experiences varied by race, including underrepresented minority (URM), or gender. We hypothesized that male and Caucasian residents would report earlier exposure to orthopaedics and mentorship, contributing to earlier decisions to pursue the field. Methods A voluntary survey assessing factors influencing the decision to pursue orthopaedic surgery was sent to 2,122 orthopaedic surgery residents. We compared differences in response between male and female genders as well as three different racial groups (URM, Asian, and Caucasian). Differences in ordinal variables between independent groups were compared using independent t-tests for normally distributed data and Mann-Whitney U tests for non-normally distributed data. Differences in categorical data were analyzed using the χ2 test or Fisher's exact test as appropriate. Results A total of 337 residents completed the survey, yielding a response rate of 15.9%. Males were more likely than females to agree that a role model or mentor of the same sex and race positively influenced their decision [median interquartile range: (IQR): 4 (2-5) vs. 2 (2-4); Mann-Whitney U=8807, p<0.001, r=0.32] and were more likely to disagree they experienced gender-based discrimination [1 (1-2) vs. 3 (2-4); U=7834, p<0.001, r=0.38). Interest in orthopaedics before medical school was higher in males (n=145, 64.7%) than females (n=56, 49.6%), while 15.0% (n=17) of females became interested during elective rotations compared to 7.1% (n=16) of males [χ²(3, N=337)=9.10, p=0.028, V=0.16]. More Caucasian residents (n=166, 64.3%) became interested in orthopaedic surgery before medical school compared to URM (n=22, 57.9%) and Asian (n=13, 31.7%) residents, while 7.7% (n=20) of Caucasians became interested during elective rotations compared to 12.2% (n=5) of Asians and 21.0% (n=8) of URM residents [χ²(6, N=337)=25.11, p<0.001, V=0.22]. Conclusions There are several significant differences in the experiences of female and URM medical students who chose to pursue orthopaedic surgery relative to male and Caucasian students. The low response rate may reflect self-selection bias and should be taken into account when interpreting these findings.
背景与目的 尽管一直在努力提高该领域的多样性，但整形外科仍然是所有医学专业中多样性最低的专业。本研究旨在评估医学院的经历及其对决定攻读整形外科住院医师培训的影响，特别是这些经历是否因种族（包括少数族裔[URM]）或性别而有所不同。我们假设男性和白人住院医师会报告更早接触整形外科和导师指导，这有助于更早做出进入该领域的决定。方法 一项评估影响攻读整形外科决定因素的自愿调查被发送给2122名整形外科住院医师。我们比较了男性和女性以及三个不同种族群体（URM、亚洲人和白人）之间的回答差异。对于正态分布数据，使用独立t检验比较独立组之间有序变量的差异；对于非正态分布数据，使用曼-惠特尼U检验。分类数据的差异根据情况使用χ²检验或费舍尔精确检验进行分析。结果 共有337名住院医师完成了调查，回复率为15.9%。男性比女性更有可能同意同性和同种族的榜样或导师对他们的决定有积极影响[中位数四分位距：(IQR)：4(2 - 5) 对 2(2 - 4)；曼-惠特尼U = 8807，p < 0.001，r = 0.32]，并且更有可能不同意他们经历过基于性别的歧视[1(1 - 2) 对 3(2 - 4)；U = 7834，p < 0.001，r = 0.38]。医学院前对整形外科的兴趣男性（n = 145，64.7%）高于女性（n = 56，49.6%），而15.0%（n = 17）的女性在选修轮转期间产生兴趣，相比之下男性为7.1%（n = 16）[χ²(3, N = 337) = 9.10，p = 0.028，V = 0.16]。与URM（n = 22，57.9%）和亚洲（n = 13，31.7%）住院医师相比，更多白人住院医师（n = 166，64.3%）在医学院前对整形外科手术产生兴趣，而7.7%（n = 20）的白人在选修轮转期间产生兴趣，相比之下亚洲人为12.2%（n = 5），URM居民为21.0%（n = 8）[χ²(6, N = 337) = 25.11，p < 0.001，V = 0.22]。结论 相对于男性和白人学生，选择攻读整形外科的女性和URM医学生的经历存在一些显著差异。低回复率可能反映了自我选择偏差，在解释这些发现时应予以考虑。
