RESUMO
PURPOSE: International Medical Graduates (IMGs) face challenges in securing orthopaedic surgery residencies in the U.S. This study examines residency matching trends and geographic distribution for U.S. and non-U.S. citizen IMGs. METHODS: The National Resident Matching Program (NRMP) data from 2008 to 2022 were analyzed for USMLE scores, publication counts, and match rates, using linear regression. The proportion of non-US IMGs in orthopaedic surgery residency was compared with the foreign-born population of each region based on the 2021 American Community Survey. RESULTS: The overall IMG fill rate decreased significantly from 2.04% in 2008 to 1.26% in 2022 (P = 0.002). The number of publications for matched US IMGs was at least three times that of matched MD seniors and about two times that of unmatched US IMGs. Matched non-US IMGs had approximately five and three times the number of publications as matched MD seniors and unmatched non-US IMGs, respectively. Mississippi had the highest IMG-to-all-filled-position ratio (6.7%) and New York matched the most IMGs (36 residents). Although the foreign-born population comprises approximately 13.72% of the US population, non-US IMGs accounted for less than 1% of total matched residents. When compared to the foreign-born population, non-US IMGs were underrepresented in the US. This underrepresentation was observed in all nine geographic divisions, particularly in the West South Central and Pacific regions. CONCLUSIONS: While IMGs constitute a low percentage of matched MDs in orthopaedic surgery, they show three to five times more publications than MD seniors. IMGs should recognize the importance of higher publication numbers in the matching process as well as states with higher IMG matching rates.
Assuntos
Médicos Graduados Estrangeiros , Internato e Residência , Ortopedia , Internato e Residência/estatística & dados numéricos , Internato e Residência/tendências , Médicos Graduados Estrangeiros/estatística & dados numéricos , Médicos Graduados Estrangeiros/tendências , Humanos , Estados Unidos , Ortopedia/educação , Ortopedia/tendênciasRESUMO
BACKGROUND: Disparities exist in underrepresented in medicine (URiM) resident representation. This review examines recent trends in resident diversity, URiM recruitment strategies, and identifies research gaps in equity, diversity, and inclusion (EDI) for URiM residents. METHODS: MEDLINE, EMBASE, Web of Science, and ERIC databases were searched for studies published from 2017 to 2022 on URiM resident prevalence and recruitment initiatives. RESULTS: 3634 abstracts were reviewed, and 52 articles were included. 35 (67 â%) studies reported on prevalence of URiM residents, demonstrating URiM resident composition is lower than residency applicant demographics, particularly in surgery. Seventeen (33 â%) studies reported on URiM recruitment interventions, such as visiting clerkship programs, holistic review, and targeted outreach, and demonstrated success in increasing recruitment of URiM candidates to programs. CONCLUSIONS: URiM residents remain disproportionately underrepresented, and markedly so among surgical residency programs. Further research should focus on implementing EDI interventions in surgery and assess URiM resident attrition post-matriculation.
Assuntos
Internato e Residência , Seleção de Pessoal , Internato e Residência/estatística & dados numéricos , Internato e Residência/tendências , Humanos , Seleção de Pessoal/tendências , Seleção de Pessoal/estatística & dados numéricos , Grupos Minoritários/estatística & dados numéricos , Diversidade Cultural , Prevalência , Cirurgia Geral/educação , Estados UnidosRESUMO
INTRODUCTION: The Plastic Surgery Integrated track remains one of the most competitive fields in the National Residency Match Program. Match trends during the COVID-19 pandemic featured a distinct rise in regional and home program matches among plastic surgery applicants. The purpose of this study is to evaluate whether these trends have continued into the most recent residency match cycle in 2024. METHODS: Residency match data from 2019 to 2024 was gathered through the Accreditation Council for Graduate Medical Education, Electronic Residency Application Service, integrated plastic surgery program websites, and plastic surgery residency program social media accounts. Current trends were compared with match cycles before and during the pandemic. RESULTS: After COVID, the number of students matching at their home institution decreased to rates consistent with prepandemic norms. In the 2024 cycle, 46.9% of applicants matched at integrated plastic surgery programs within the geographical region of their medical school, which is similar to pre-COVID rates. Further, the emergence of a female-predominant plastic surgery match cohort during the pandemic has continued. In 2024, 125 (58.7%) of 213 matched applicants into integrated plastic surgery programs were female, which represents a continuation of female-majority resident cohorts since 2021. Our data showed that a sizable component of matched applicants completed visiting student electives at their matched institution. Finally, a large number of matched applicants completed a research fellowship, and a historically stable number completed research fellowships at their matched institution. CONCLUSION: Our group reports stabilization in plastic surgery match trends in the wake of the COVID-19 pandemic, along with the continuation of growth in the number of female plastic surgery residents. Although home institution retention rates returned to the baseline proportionality exhibited prior to COVID-19, medical school geographical region may continue to play an important role in the integrated plastic surgery residency match.
Assuntos
COVID-19 , Internato e Residência , Cirurgia Plástica , Humanos , COVID-19/epidemiologia , Cirurgia Plástica/educação , Cirurgia Plástica/tendências , Internato e Residência/tendências , Internato e Residência/estatística & dados numéricos , Feminino , Masculino , Estados Unidos/epidemiologia , Pandemias , SARS-CoV-2 , Educação de Pós-Graduação em Medicina/tendências , Escolha da ProfissãoRESUMO
BACKGROUND: There has been concern among colon and rectal surgery residency programs in the United States that IPAA procedures have been decreasing, but evidence is limited. OBJECTIVE: The study aimed to evaluate the number of IPAAs performed by colon and rectal surgery residents in the United States and analyze the distribution of these cases on a national level. DESIGN: Retrospective. SETTINGS: The Accreditation Council for Graduate Medical Education Case Log National Data Reports were used to evaluate the number of IPAAs performed by residents from 2005 to 2021. The Nationwide Inpatient Sample database was used to identify all patients undergoing these procedures from 2005 to 2019. PATIENTS: All IPAA procedures regardless of indication. MAIN OUTCOME MEASURES: The primary outcome was the number of IPAAs performed by residents yearly. The secondary outcome was the national distribution of these procedures. RESULTS: Among colon and rectal surgery residents, case log data revealed an increase in mean and total number of IPAAs from 2005 to 2013, followed by a decline in both metrics after 2013. Despite the decrease, the mean number of cases per resident remained fewer than 6 between 2011 and 2021. A weighted national estimate of 48,532 IPAA patients were identified in the Nationwide Inpatient Sample database. A significant decrease was noted in the number of IPAAs after 2015 that persisted through 2019. There was a significant decrease in rural and urban nonteaching hospitals (from 2.1% to 1.6% and 25.6% to 4.3%, respectively; p < 0.001) and an increase in urbanteaching hospitals (from 72.4% to 94.1%; p < 0.001). LIMITATIONS: Nonrandomized retrospective study design. CONCLUSIONS: Despite the recent increase in the percentage of IPAAs performed at urban academic centers, there has been a decrease in cases performed by colon and rectal surgery residents. This can have significant implications for residents who graduate without adequate experience in performing this complex procedure independently, as well as training programs that may face challenges with maintaining accreditation. See Video Abstract. TENDENCIAS Y DISTRIBUCIN DE LA ANASTOMOSIS ANAL CON BOLSA ILEAL EN LOS ESTADOS UNIDOS SE EST VOLVIENDO MS DIFCIL DE ENCONTRAR EN LA CAPACITACIN DE RESIDENCIA EN CIRUGA DE COLON Y RECTO: ANTECEDENTES:Ha habido preocupación entre los programas de capacitación de residencia en cirugía de colon y recto en los Estados Unidos porque los procedimientos de anastomosis anal con bolsa ileal han estado disminuyendo; sin embargo, la evidencia es limitada.OBJETIVO:Evaluar el número de anastomosis anales con bolsa ileal realizadas por residentes de cirugía de colon y recto en los Estados Unidos y examinar la distribución de estos casos a nivel nacional.DISEÑO:Retrospectivo.AJUSTES:Se utilizaron los informes de datos nacionales del registro de casos de educación médica de posgrado del Consejo de Acreditación para examinar el número de anastomosis anales con bolsa ileal realizadas por residentes de 2005 a 2021. Se utilizó la base de datos de muestra nacional de pacientes hospitalizados para identificar a todos los pacientes sometidos a estos procedimientos de 2005 a 2019.PACIENTES:Todos los procedimientos de anastomosis anal con bolsa ileal independientemente de la indicación.MEDIDA DE RESULTADO PRINCIPAL:El resultado primario es el número de anastomosis anales con bolsa ileal realizadas por los residentes anualmente. El resultado secundario es la distribución nacional de estos procedimientos.RESULTADOS:Entre los residentes de cirugía de colon y recto, los datos de los registros de casos revelaron un aumento en el número medio y total de anastomosis anal con bolsa ileal de 2005 a 2013, seguido de una disminución en ambas métricas después de 2013. A pesar de la disminución, el número medio de casos por El residente permaneció >6 entre 2011 y 2021. Se identificó una estimación nacional ponderada de 48 532 pacientes con anastomosis anal con bolsa ileal en la base de datos de la Muestra Nacional de Pacientes Hospitalizados. Se observó una disminución significativa en el número de anastomosis anales con bolsa ileal después de 2015 que persistió hasta 2019. Hubo una disminución significativa en los hospitales no docentes rurales y urbanos (del 2,1% al 1,6% y del 25,6% al 4,3% respectivamente, p < 0,001) y un aumento en los hospitales universitarios urbanos (del 72,4% al 94,1%, p < 0,001).LIMITACIONES:Estudio retrospectivo no aleatorizado.CONCLUSIÓN:A pesar del reciente aumento en el porcentaje de anastomosis anal con bolsa ileal realizadas en centros académicos urbanos, ha habido una disminución en los casos realizados por residentes de cirugía de colon y recto. Esto puede tener implicaciones significativas para los residentes que se gradúan sin la experiencia adecuada en la realización de este complejo procedimiento de forma independiente, así como para los programas de capacitación que pueden enfrentar desafíos para mantener la acreditación. (Traduccion-AI-generated).
Assuntos
Cirurgia Colorretal , Internato e Residência , Humanos , Internato e Residência/estatística & dados numéricos , Internato e Residência/tendências , Estados Unidos , Estudos Retrospectivos , Cirurgia Colorretal/educação , Cirurgia Colorretal/estatística & dados numéricos , Cirurgia Colorretal/tendências , Proctocolectomia Restauradora/estatística & dados numéricos , Proctocolectomia Restauradora/tendências , Educação de Pós-Graduação em Medicina/tendências , Educação de Pós-Graduação em Medicina/estatística & dados numéricos , Feminino , MasculinoRESUMO
INTRODUCTION: International medical graduates (IMGs) make up a small but important percentage of the U.S. surgical workforce. Detailed and contemporary studies on IMGs matching into U.S. general surgery residency positions are lacking. Our objective was to study these trends over a 30-y period. METHODS: We utilized the National Resident Matching Program reports from 1994 to 2023 to analyze the trends of U.S. M.D. seniors, D.O. seniors, and U.S. citizen and non-U.S. citizen IMGs matching into first-year categorical and preliminary general surgery residency positions. The percent of positions filled were calculated and trended over time using linear regression, where ß coefficient estimated the percentage of annual change in matched positions, and the R2 coefficient measured the amount of variance explained (perfect regression R2 = 1.0). RESULTS: Over the last 30 y, IMG match percentages have increased for both categorical (ß = 0.218%, R2 = 0.49, P < 0.001) and preliminary (ß = 0.705%, R2 = 0.76, P < 0.001) general surgery positions, with a greater increase in preliminary positions (ß = 0.705%). The percentage of positions filled by M.D. U.S. seniors in categorical positions has steadily decreased over the 30-y period (ß = -0.625%, R2 = 0.79, P < 0.001), and this decrease has largely occurred with a concurrent greater increase in U.S. D.O. seniors match percentage rates (ß = 0.430%, R2 = 0.64, P < 0.001), rather than IMGs (ß = 0.218%). Allopathic M.D. U.S. seniors preliminary match percentages have steadily decreased at the steepest rate (ß = -0.927%, R2 = 0.80, P < 0.001). In categorical positions, non-U.S. citizen IMGs' match percentages (ß = 0.069%, R2 = 0.204, P = 0.012) increased at a slightly slower rate than U.S. citizen IMGs (ß = 0.149%, R2 = 0.607, P < 0.001). In preliminary positions, non-U.S. citizen IMGs' match percentages (ß = 0.33%, R2 = 0.478, P < 0.001) increased at a similar rate as U.S. citizen IMGs (ß = 0.375%, R2 = 0.823, P < 0.0.001). In the 2023 National Resident Matching Program match, U.S. citizen and non-U.S. citizen IMGs together made up 10.3% of the categorical and 44.5% of the preliminary general surgery positions that were filled. For categorical positions in 2023, there was no major difference between positions matched by U.S. citizen IMGs (4.62%) and non-U.S. citizen IMGs (5.72%); on the other hand, for preliminary positions in 2023, non-U.S. citizen IMGs (31.96%) filled 2.5× times the number of positions as U.S. citizen IMGs (12.54%). CONCLUSIONS: Over the last 30 y, U.S. allopathic M.D. seniors matching into categorical general surgery positions have steadily decreased, while both U.S. osteopathic D.O. seniors and IMGs matching have increased. These data have important implications for the future U.S. surgical workforce.
Assuntos
Médicos Graduados Estrangeiros , Cirurgia Geral , Internato e Residência , Internato e Residência/estatística & dados numéricos , Internato e Residência/tendências , Médicos Graduados Estrangeiros/estatística & dados numéricos , Médicos Graduados Estrangeiros/tendências , Cirurgia Geral/educação , Cirurgia Geral/estatística & dados numéricos , Estados Unidos , HumanosRESUMO
STUDY OBJECTIVE: To study the race, ethnicity, and sex representation and annual trends of AAGL FMIGS fellows and graduates. DESIGN: A retrospective cross-sectional study. SETTING: AAMC databases were queried for demographic information between 2011 and 2023. PATIENTS/SUBJECTS: AAGL FMIGS fellows and graduates. INTERVENTIONS: N/A MEASUREMENTS AND MAIN RESULTS: Descriptive statistical analysis and the actual-to-expected (AE) ratio of each race, ethnicity, and sex were performed. AE ratio was calculated by dividing the 13-year average actual percentage of FMIGS trainees and graduates by the expected percentage based demographics of OBGYN residents and the US general population. 477 fellows graduated or were in training between 2011 and 2023; race and ethnicity information was obtained for 347 (72.7%) individuals, and sex information was available for 409 (85.7%). Representation of females ranged from 66.7% in 2017 to 93.3% in 2022. There was a significantly increasing slope for the representation of females (+1.3% per year; 95% CI 0.00-0.03; p = .027). Compared to their distribution among US OBGYN residents, White fellows' representation was lower [AE ratio, 95% CI 0.60 (0.44-0.81)] and of Asian fellows was higher [AE ratio, 95% CI 2.17 (1.47-3.21)]. Female fellows' representation was lower than expected [AE ratio, 95% CI 0.68 (0.48-0.96)] compared to their distribution among US OBGYN residents. Compared to the general US population, White fellows [AE ratio, 95% CI 0.65 (0.48-0.87)] and Hispanic fellows [AE ratio, 95% CI 0.53 (0.34-0.83)] representation was lower. Asian fellows' representation was higher compared to the general US population [AE ratio, 95% CI 5.87 (3.48-9.88)]. CONCLUSION: White and Hispanic fellows' representation was lower than expected, while Asian fellows' representation was higher in AAGL-accredited FMIGS programs. Female representation increased throughout the years, but overall, female fellows' representation was lower than expected compared to their distribution among OBGYN residents. These findings may help develop equitable recruitment strategies for FMIGS programs and reduce health disparities within complex gynecology.
Assuntos
Bolsas de Estudo , Ginecologia , Internato e Residência , Adulto , Feminino , Humanos , Masculino , Estudos Transversais , Etnicidade/estatística & dados numéricos , Bolsas de Estudo/estatística & dados numéricos , Bolsas de Estudo/tendências , Procedimentos Cirúrgicos em Ginecologia/educação , Ginecologia/educação , Internato e Residência/tendências , Internato e Residência/estatística & dados numéricos , Procedimentos Cirúrgicos Minimamente Invasivos/educação , Grupos Raciais/estatística & dados numéricos , Estudos Retrospectivos , Estados UnidosRESUMO
BACKGROUND: Groin hernia repair is one of the most commonly performed surgical procedures and is often performed by surgical interns and junior residents. While traditionally performed open, minimally invasive (MIS) groin hernia repair has become an increasingly popular approach. The purpose of this study was to determine the trends in MIS and open inguinal and femoral hernia repair in general surgery residency training over the past two decades. METHODS: Accreditation Council for Graduate Medical Education (ACGME) national case log data of general surgery residents from 1999 through 2022 were reviewed. We collected means and standard deviations of open and MIS inguinal and femoral hernia repairs. Linear regression and ANOVA were used to identify trends in the average annual number of open and MIS hernia repairs logged by residents. Cases were distinguished between level of resident trainees: surgeon-chief (SC) and surgeon-junior (SJ). RESULTS: From July 1999 to June 2022, the average annual MIS inguinal and femoral hernia repairs logged by general surgery residents significantly increased, from 7.6 to 47.9 cases (p < 0.001), and the average annual open inguinal and femoral hernia repairs logged by general surgery residents significantly decreased, from 51.9 to 39.7 cases (p < 0.001). SJ resident results were consistent with this overall trend. For SC residents, the volume of both MIS and open hernia repairs significantly increased (p < 0.001). CONCLUSIONS: ACGME case log data indicates a trend of general surgery residents logging overall fewer numbers of open inguinal and femoral hernia repairs, and a larger proportion of open repairs by chief residents. This trend warrants attention and further study as it may represent a skill or knowledge gap with significant impact of surgical training.
Assuntos
Hérnia Inguinal , Herniorrafia , Internato e Residência , Humanos , Hérnia Inguinal/cirurgia , Herniorrafia/educação , Herniorrafia/tendências , Herniorrafia/estatística & dados numéricos , Herniorrafia/métodos , Internato e Residência/tendências , Procedimentos Cirúrgicos Minimamente Invasivos/educação , Procedimentos Cirúrgicos Minimamente Invasivos/estatística & dados numéricos , Procedimentos Cirúrgicos Minimamente Invasivos/tendências , Cirurgia Geral/educação , Cirurgia Geral/tendências , Acreditação , Educação de Pós-Graduação em Medicina/tendências , Educação de Pós-Graduação em Medicina/métodos , Competência Clínica , Laparoscopia/educação , Laparoscopia/tendências , Laparoscopia/estatística & dados numéricos , Estados Unidos , Estudos RetrospectivosRESUMO
BACKGROUND: Gastric surgery is a crucial component of general surgery training. However, there is a paucity of high-quality data on operative volume and the diversity of surgical procedures that general surgery residents are exposed to. METHODS: We conducted a retrospective analysis of operative case logs of all general surgery residents graduating from the American College of Graduate Medical Education-accredited program from 2009 to 2022. Data on the mean number of gastric procedures, including the mean in each subcategory, were retrieved. A Mann-Kendall trend test was used to investigate trends in operative volume. RESULTS: Between 2009 and 2022, the mean overall logged gastric procedures rose significantly (τ = 0.722, P < .001) from 36.2 in 2009 to 49.2 in 2022 (35.9% increase). The most substantial growth was seen in laparoscopic gastric reduction for morbid obesity (mean 1.9 in 2017 to 19 in 2022; τ = 0.670, P = .009). A statistically significant increase was also seen in laparoscopic partial gastric resections, repair of gastric perforation, and "other major stomach procedures" (P < .05 for all comparisons). Open gastrostomy, open partial gastric resections, and open vagotomy all significantly decreased (P < .05 for all comparisons). There was no significant change in the volume of laparoscopic gastrectomy, total gastric resections, and non-laparoscopic gastric reductions for morbid obesity (P > .05 for all comparisons). CONCLUSION: There has been a substantial increase in the volume of gastric surgery during residency over the past 14 years, driven mainly by an increase in laparoscopic gastric reduction. However, there may still be a need for further gastric surgical training to ensure well-rounded general surgeons.
Assuntos
Competência Clínica , Cirurgia Geral , Internato e Residência , Humanos , Estudos Retrospectivos , Internato e Residência/estatística & dados numéricos , Internato e Residência/tendências , Estados Unidos , Cirurgia Geral/educação , Cirurgia Geral/tendências , Competência Clínica/estatística & dados numéricos , Laparoscopia/tendências , Laparoscopia/estatística & dados numéricos , Laparoscopia/educação , Gastrectomia/tendências , Gastrectomia/educação , Gastrectomia/estatística & dados numéricos , Feminino , MasculinoRESUMO
BACKGROUND: Within the current medical workforce, diversity is limited among surgical specialties. However, diversity allows physicians to provide culturally competent care. This paper discusses the trends in racial, ethnic, and gender representation within different surgical subspecialties with an emphasis on neurosurgery over a 20-year time frame. METHODS: A retrospective review of data collected by the Accreditation Council for Graduate Medical Education over the past twenty years, as reported in Journal of the American Medical Association, was conducted. Residents from 5 surgical specialties were evaluated based on gender, race, and ethnic identifications from 2002 to 2022. One-way analysis of variance was performed to compare the levels and retention rates of racial, ethnic, and gender diversity within these specialties. RESULTS: Analysis of resident demographics of the 5 surgical specialties reveals an overall trend of increasing diversity over the study period. Over the past 20 years, neurosurgery had an overall increase in Asian (+5.1%), Hispanic (+3.0%), and female (+11.4%) residents, with a decrease in White residents by 2.1% and Black residents by 1.1%. Among the surgical specialties analyzed, otolaryngology had the greatest overall increase in minority residents. Notably, there has been an overall increase in female residents across all 5 surgical specialties, with the highest in otolaryngology (+20.3%) which was significantly more than neurosurgery (P < 0.001). CONCLUSIONS: This chronological analysis spanning 20 years demonstrates that neurosurgery, like other specialties, has seen a growth in several racial and ethnic categories. Relative differences are notable in neurosurgery, including Black, Asian, Hispanic, and White ethnic categories, with growth in females, but at a significantly lesser pace than seen in otolaryngology and plastic surgery.
Assuntos
Diversidade Cultural , Educação de Pós-Graduação em Medicina , Neurocirurgia , Otolaringologia , Especialidades Cirúrgicas , Feminino , Humanos , Masculino , Acreditação , Asiático/estatística & dados numéricos , Negro ou Afro-Americano/estatística & dados numéricos , Educação de Pós-Graduação em Medicina/estatística & dados numéricos , Educação de Pós-Graduação em Medicina/tendências , Etnicidade/estatística & dados numéricos , Hispânico ou Latino/estatística & dados numéricos , Internato e Residência/estatística & dados numéricos , Internato e Residência/tendências , Grupos Minoritários/educação , Grupos Minoritários/estatística & dados numéricos , Neurocirurgia/educação , Neurocirurgia/estatística & dados numéricos , Neurocirurgia/tendências , Otolaringologia/educação , Otolaringologia/estatística & dados numéricos , Estudos Retrospectivos , Fatores Sexuais , Especialidades Cirúrgicas/educação , Especialidades Cirúrgicas/estatística & dados numéricos , Estados Unidos/epidemiologia , Brancos/estatística & dados numéricosRESUMO
INTRODUCTION: Studies on diversity in orthopaedic surgery have exclusively examined challenges from a race or sex perspective. This study examines trends in the diversity of entering orthopaedic surgery residents from the intersection of race and sex. METHODS: The American Association of Medical Colleges was queried for individuals entering orthopaedic surgery residencies in the United States from 2001 to 2020. Deidentified data on self-reported sex and race were collected. Proportions by the intersection of sex and race were calculated for 5-year intervals. RESULTS: From 2001 to 2020, most of the new female residents identified as White (mean, 71.0%). The average proportion of White female residents was lower in 2016 to 2020 than in 2001 to 2005 (71.0% vs. 73.2%) but higher than that in 2011 to 2015 (66.8%). The 2016 to 2020 average was lower than that of 2001 to 2005 for those who identified as Asian (11.7% vs. 14.9%), Black (4.1% vs. 4.8%), Hispanic (3.0% vs. 4.4%), and American Indian/Alaska Native (0.0% vs. 1.5%). Most of the new male orthopaedic surgery residents from 2001 to 2020 identified as White (mean, 74.1%), but the average decreased across every 5-year interval from 2001 to 2005 (76.1%) to 2016 to 2020 (71.1%). The 2016 to 2020 average was lower than that of 2001 to 2005 for those who identified as Asian (12.2% vs. 13.6%), Black (3.5% vs. 4.2%), Hispanic (3.0% vs. 3.4%), American Indian/Alaska Native (0.0% vs. 0.6%), and Native Hawaiian/Other Pacific Islander (0.1% vs. 0.3%). In 2020, White male residents made up to 54.2% of new residents. White female residents were the second highest group represented (12.1%). CONCLUSION: Increases in representation were observed for some subgroups of new orthopaedic surgery residents from 2001 to 2020. Although the proportion of both White female and male residents decreased by 11.5% during the 20-year study period, these individuals still made up most of the trainees in 2020. These results underscore the need for conversations and recruitment practices to take into consideration the intersectionality of identities.
Assuntos
Internato e Residência , Ortopedia , Feminino , Humanos , Masculino , Asiático/estatística & dados numéricos , Hispânico ou Latino/estatística & dados numéricos , Havaiano Nativo ou Outro Ilhéu do Pacífico/estatística & dados numéricos , Ortopedia/educação , Ortopedia/estatística & dados numéricos , Ortopedia/tendências , Estados Unidos/epidemiologia , Internato e Residência/estatística & dados numéricos , Internato e Residência/tendências , Indígena Americano ou Nativo do Alasca/estatística & dados numéricos , Negro ou Afro-Americano/estatística & dados numéricos , Brancos/estatística & dados numéricos , Distribuição por SexoRESUMO
BACKGROUND: Local, regional, and national diversity, equity, and inclusion (DEI) initiatives have been established to combat barriers to entry and promote retention in surgery residency programs. Our study evaluates changes in diversity in general surgery residency programs. We hypothesize that diversity trends have remained stable nationally and regionally. MATERIALS AND METHODS: General surgery residents in all postgraduate years were queried regarding their self-reported sex, race, and ethnicity following the 2020 ABSITE. Residents were then grouped into geographic regions. Data were analyzed utilizing descriptive statistics, Kruskal-Wallis test, and chi-square analyses. RESULTS: A total of 9276 residents responded. Nationally, increases in female residents were noted from 38.0 to 46.0% (P < .001) and in Hispanic or Latinx residents from 7.3 to 8.3% (P = .031). Across geographic regions, a significant increase in female residents was noted in the Northwest (51.9 to 58.3%, P = .039), Midwest (36.9 to 43.3%, P = .006), and Southwest (35.8 to 47.5%, P = .027). A significant increase in black residents was only noted in the Northwest (0 to 15.8%, P = .031). The proportion of white residents decreased nationally by 8.9% and in the Mid-Atlantic, Southeast, and Southwest between 5.5 and 15.9% (P < .05). DISCUSSION: In an increasingly diverse society, expanding the numbers of underrepresented surgeons in training, and ultimately in practice, is a necessity. This study shows that there are region-specific increases in diversity, despite minimal change on a national level. This finding may suggest the need for region-specific DEI strategies and initiatives. Future studies will seek to evaluate individual programs with DEI plans and determine if there is a correlation to changing demographics.
Assuntos
Diversidade Cultural , Cirurgia Geral/estatística & dados numéricos , Internato e Residência/estatística & dados numéricos , /estatística & dados numéricos , Povo Asiático/estatística & dados numéricos , População Negra/estatística & dados numéricos , Feminino , Cirurgia Geral/tendências , Hispânico ou Latino/estatística & dados numéricos , Humanos , Internato e Residência/tendências , Masculino , Havaiano Nativo ou Outro Ilhéu do Pacífico/estatística & dados numéricos , Razão de Masculinidade , Estados Unidos , População Branca/estatística & dados numéricos , Indígena Americano ou Nativo do Alasca/estatística & dados numéricosRESUMO
Importance: Monitoring the evolution of gender diversity within medicine is essential to understanding the medical workforce and anticipating its future. Objective: To evaluate gender distribution and trends among trainees and practicing physicians in the field of otolaryngology-head and neck surgery (OHNS) across Canada. Design, Setting, and Participants: This cross-sectional study collected demographic data on the Canadian population, medical students, resident physicians, fellows, practicing physicians, and full-time professors from the following publicly available databases: the Canadian Post-MD Education Registry, the Canadian Medical Education Statistics from the Association of Faculties of Medicine of Canada, the Canadian Medical Association Masterfile, the Canadian Resident Matching Service archives, and the Canadian Institute for Health Information from 2000 to 2019. Information about the gender distribution in leadership positions and fellowships was obtained through publicly available websites where gender was either listed or assigned by authors. Main Outcomes and Measures: The primary outcomes were the proportion of women in OHNS and the evolution of gender diversity over time. Results: In 2019, 65 of 155 of OHNS trainees were female (41.9%), whereas female representation among all surgical trainees combined was 1225 of 2496 (49.1%). Female OHNS trainees and practicing physicians are underrepresented despite a 13.3% increase in female trainees and a 14.3% increase in female staff physicians from 2000 to 2019. Proportionally fewer female graduates pursued a fellowship during a 10-year period compared with their male counterparts, with otology and neurotology having the lowest female representation (6 of 27 [22.2%]). A minimal increase occurred in the number of women holding academic leadership positions (eg, 4 of 13 residency training programs had a previous or current female director). Conclusions and Relevance: Despite the overall increase in the representation of women in the field of OHNS in Canada, these findings suggest that persistent gender gaps remain with respect to academic leadership positions and fellowship training. Continuous monitoring of the surgical workforce is important to highlight and address gender disparities within OHNS.
Assuntos
Escolha da Profissão , Educação de Pós-Graduação em Medicina/tendências , Educação de Graduação em Medicina/tendências , Internato e Residência/tendências , Otolaringologia/educação , Médicas/tendências , Recursos Humanos/tendências , Canadá , Estudos Transversais , Feminino , Humanos , Masculino , Razão de MasculinidadeRESUMO
BACKGROUND: In March 2020, the COVID-19 virus global pandemic forced healthcare systems to institute regulations including the cancellation of elective surgical cases, which likely decreased resident operative experience. The objective of this study was to determine whether the COVID-19 pandemic affected operative experiences of US general surgery residents. METHODS: The operative experience of general surgery residents was examined nationally and locally. Aggregate Accreditation Council for Graduate Medical Education (ACGME) case logs for 2018 to 2019 (pre-COVID) and 2019 to 2020 (COVID) graduates were compared using national mean cumulative operative volume for total major and surgeon chief cases. Locally, ACGME case logs were used to analyze the operative experience among residents at a single, academic center. Average operative volumes per month per resident during peak COVID-19 quarantine months were compared with those the previous year. RESULTS: Compared with 2019 graduates, 2020 graduates completed 1.5% fewer total major cases (1055 ± 155 vs 1071 ± 150, P = .011). This was most evident during chief year, with 8.4% fewer surgeon chief cases logged in 2020 compared with 2019 (264 ± 67 vs 289 ± 69, P < .001). Institutional data revealed that during the peak of the pandemic, residents across all levels completed 42.5% fewer total major operations (12 ± 11 vs 20 ± 14, P < .001). This effect was more pronounced among junior residents compared with senior and chief residents. CONCLUSION: The COVID-19 pandemic was associated with decreased resident case volume. The ramifications of the COVID-19 pandemic for operative competency and autonomy should be carefully examined.
Assuntos
COVID-19/prevenção & controle , Cirurgia Geral/educação , Internato e Residência/tendências , Pandemias/prevenção & controle , Procedimentos Cirúrgicos Operatórios/educação , Procedimentos Cirúrgicos Operatórios/tendências , COVID-19/epidemiologia , Competência Clínica , Feminino , Cirurgia Geral/tendências , Humanos , Masculino , Quarentena , Estados Unidos/epidemiologiaRESUMO
Most institutions have mitigated the impact of the COVID-19 pandemic on residency education by transitioning to web-based educational platforms and using innovative solutions, such as surgical video libraries, telehealth clinics, online question banks via social media platforms, and procedural simulations. Here, we assess the perceived impact of COVID-19 on Canadian surgical residency education and discuss the unique challenges in adapting to a virtual format and how novel training methods implemented during the pandemic may be useful in the future of surgical education.
Assuntos
COVID-19 , Educação a Distância , Cirurgia Geral/educação , Internato e Residência , Pandemias , Canadá , Educação a Distância/métodos , Educação a Distância/tendências , Previsões , Humanos , Internato e Residência/métodos , Internato e Residência/tendências , SARS-CoV-2 , Inquéritos e QuestionáriosRESUMO
BACKGROUND: The coronavirus disease of 2019 (COVID-19) pandemic has had a profound effect on surgical training programs, reflecting decreases in elective surgical cases and emergency restructuring of clinical teams. The effect of these measures on U.S. plastic surgery resident education and wellness has not been characterized. METHODS: An institutional review board-exempted anonymous survey was developed through expert panel discussion and pilot testing. All current U.S. plastic surgery trainees were invited to complete a cross-sectional 28-question survey in April of 2020. Respondents were queried regarding demographic information, educational experiences, and wellness during the COVID-19 pandemic. RESULTS: A total of 668 residents responded to the survey, corresponding to a 56.1 percent response rate. Sex, training program type, postgraduate year, and region were well represented within the sample. Nearly all trainees (97.1 percent) reported restructuring of their clinical teams. One-sixth of respondents were personally redeployed to assist with the care of COVID-19 patients. A considerable proportion of residents felt that the COVID-19 pandemic had a negative impact on their education (58.1 percent) and wellness (84.8 percent). Residents found virtual curriculum effective and meaningful, and viewed an average of 4.2 lectures weekly. Although most residents did not anticipate a change in career path, some reported negative consequences on job prospects or fellowship. CONCLUSIONS: The COVID-19 pandemic had a considerable impact on U.S. plastic surgery education and wellness. Although reductions in case volume may be temporary, this may represent a loss of critical, supervised clinical experience. Some effects may be positive, such as the development of impactful virtual lectures that allow for cross-institutional curriculum.
Assuntos
Atitude do Pessoal de Saúde , COVID-19 , Nível de Saúde , Internato e Residência , Estudantes de Medicina/psicologia , Cirurgia Plástica/educação , Adulto , Escolha da Profissão , Estudos Transversais , Currículo , Educação a Distância/métodos , Educação a Distância/organização & administração , Educação a Distância/tendências , Feminino , Humanos , Internato e Residência/métodos , Internato e Residência/organização & administração , Internato e Residência/tendências , Masculino , Saúde Mental , Distanciamento Físico , Apoio Social , Estresse Psicológico , Cirurgia Plástica/organização & administração , Cirurgia Plástica/tendências , Inquéritos e Questionários , Estados UnidosRESUMO
Ateneo del Equipo de Psicopedagogía del Centro de Salud Nº 13, del Área Programática del Hospital General de Agudos P. Piñero, de la Ciudad de Buenos Aires, centrado en la problemática de la violencia en la clínica psicopedagógica con niños/as, y en cómo se verán atravesados los procesos de aprendizaje de los/as niños/as víctimas o testigos de violencia con los/as que trabaja el Equipo. Se realiza un breve recorrido histórico del concepto de violencia, para intentar una posible conceptualización de la misma, y se analiza la dimensión socio-cultural e histórica de la violencia, enmarcada en el sistema patriarcal e influida por las relaciones de poder. Se hace hincapié en la violencia familiar y, más particularmente en la violencia de género y se profundiza en las distintas formas de maltrato infantil.