Chen Xi, Matsumoto Hiroko, Haruno Lee S, Metzger Melodie F, Lin Carol A, Little Milton T M, Poon Selina C
Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania.
Department of Orthopedic Surgery and Sports Medicine, Boston Children's Hospital, Boston, Massachusetts.
JB JS Open Access. 2025 Sep 17;10(3). doi: 10.2106/JBJS.OA.24.00135. eCollection 2025 Jul-Sep.
Underrepresented minority (URM) and female orthopaedic surgical residents have an increased risk of attrition. The purpose of this study was to investigate the relationship between orthopaedic faculty demographic diversity and resident attrition.
Demographic data for full-time faculty in departments or divisions of Orthopaedic Surgery at accredited medical schools in the United States and demographic and attrition data for 13,785 affiliated orthopaedic residents were sourced from the Association of American Medical Colleges. Faculty diversity was defined by the number of female and/or URM faculty at medical school affiliated with residency. The faculty per year (FPY) was calculated by dividing the total number of female and URM faculty by the number of years in residency for each resident. The average FPY across all programs was calculated to assess whether programs had above-average FPY (greater faculty diversity) or below-average FPY. This stratification was used to investigate the relationship between faculty diversity and resident attrition. Diverse faculty was defined as the aggregate of URM and female faculty. A p-value of <0.05 was considered statistically significant.
Overall resident attrition was 3.2%. Female and URM residents had attrition rates of 6.2% and 6.3%, respectively. The average URM FPY for all orthopaedic surgery departments was 2.0; the average female FPY was 5.8; and the average diverse FPY was 7.5. Residents in programs with above-average female and URM FPY had a decreased risk of attrition (relative risk [RR] = 0.25, p < 0.001; RR = 0.23, p < 0.001, respectively). Programs with below-average female, URM, and diverse FPY significantly increased the risk of all resident attrition by 82% (RR = 1.82, p < 0.001), 47% (RR = 1.47, p < 0.001), and 88% (RR = 1.88, p < 0.001), respectively.
Programs with increased racial and gender faculty diversity are associated with lower resident attrition, regardless of resident race or sex. Below-average faculty diversity is associated with the greatest risk of attrition among female and URM residents.
代表性不足的少数族裔（URM）和女性骨科住院医师流失的风险更高。本研究的目的是调查骨科教员人口统计学多样性与住院医师流失之间的关系。
美国认可医学院校骨科系或部门全职教员的人口统计学数据，以及13785名附属骨科住院医师的人口统计学和流失数据，均来自美国医学院协会。教员多样性由与住院医师培训相关的医学院校中女性和/或URM教员的数量来定义。每年教员数量（FPY）的计算方法是，将女性和URM教员的总数除以每名住院医师的培训年限。计算所有项目的平均FPY，以评估项目的FPY是高于平均水平（教员多样性更高）还是低于平均水平。这种分层用于研究教员多样性与住院医师流失之间的关系。多样化教员被定义为URM教员和女性教员的总和。p值<0.05被认为具有统计学意义。
总体住院医师流失率为3.2%。女性和URM住院医师的流失率分别为6.2%和6.3%。所有骨科手术科室的URM平均FPY为2.0；女性平均FPY为5.8；多样化平均FPY为7.5。女性和URM FPY高于平均水平的项目中，住院医师流失风险降低（相对风险[RR]=0.25，p<0.001；RR=0.23，p<0.001）。女性、URM和多样化FPY低于平均水平的项目，分别使所有住院医师流失风险显著增加82%（RR=1.82，p<0.001）、47%（RR=1.47，p<0.001）和88%（RR=1.88，p<0.001）。
无论住院医师的种族或性别如何，种族和性别教员多样性增加的项目与较低的住院医师流失率相关。教员多样性低于平均水平与女性和URM住院医师中最高的流失风险相关。
