Bias in Surgical Residency Evaluations: A Scoping Review

Helliwell, Lydia A.; Hyland, Colby J.; Gonte, Madeleine R.; Malapati, Sri Harshini; Bain, Paul; Ranganathan, Kavitha; Pusic, Andrea L.

doi:10.1016/j.jsurg.2023.04.007

Cited by 8 publications

(4 citation statements)

References 99 publications

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“…As a field, we must acknowledge that biases in our current evaluation methods contribute to known racial, ethnic, and gender disparities in autonomy and milestone attainment. [30][31][32] Finally, our findings suggest the need for surgery residents to be active participants in their unions to ensure that their unique needs are considered. Representation is necessary to ensure that any third-party union executive understands all employees' needs.…”

Section: Jama Network Open | Surgerymentioning

confidence: 81%

“…Regardless of unionization status, active support of the resident-faculty relationship, emphasizing the mutual goal of training competent surgeons, by residents, faculty, educational leadership, and the union alike, is critical to both the education and well-being of residents. As a field, we must acknowledge that biases in our current evaluation methods contribute to known racial, ethnic, and gender disparities in autonomy and milestone attainment …”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Experiences With Unionization Among General Surgery Resident Physicians, Faculty, and Staff

Foote,

Rosenblatt,

Amortegui

et al. 2024

JAMA Netw Open

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ImportanceLabor unions are a mechanism for employee advocacy, but their role in surgery resident wellness is poorly characterized.ObjectiveTo understand experiences with unionization among general surgery residents and residency program faculty and staff.Design, Setting, and ParticipantsThis exploratory qualitative study included data from the Surgical Education Culture Optimization Through Targeted Interventions Based on National Comparative Data (SECOND) trial. In the exploratory phase of the SECOND trial (from March 6, 2019, to March 12, 2020), semistructured interviews about wellness were conducted with residents, faculty (attending physicians), and staff (program administrators) at 15 general surgery residency programs. Unionization was identified as an emergent theme in the interviews. Data analysis was performed from March 2019 to May 2023.Main Outcomes and MeasuresThe main outcome was resident and faculty experience with resident labor unions. In the qualitative analysis, lexical searches of interview transcripts identified content regarding resident labor unions. A codebook was developed inductively. Transcripts were coded by dyads, using a constant comparative approach, with differences reconciled by consensus.ResultsA total of 22 interview transcripts were identified with relevant content. Of these, 19 were individual interviews conducted with residents (n = 10), faculty (n = 4), administrative staff (n = 1), a program director (n = 1), a department chair (n = 1), and designated institutional officials (n = 2), and 3 were from resident focus groups. Residents from all postgraduate year levels, including professional development (ie, research) years, were represented. Interviewees discussed resident unions at 2 programs (1 recently unionized and 1 with a decades-long history). Interviewees described the lack of voice and the lack of agency as drivers of unionization (“Residents…are trying to take control of their well-being”). Increased salary stipends and/or housing stipends were the most concretely identified union benefits. Unanticipated consequences of unionization were described by both residents and faculty, including (1) irrelevance of union-negotiated benefits to surgical residents, (2) paradoxical losses of surgery department–provided benefits, and (3) framing of resident-faculty relationships as adversarial. Union executives were noted to be nonphysician administrators whose participation in discussions about clinical education progression may increase the time and effort to remediate a resident and/or reduce educators’ will to meaningfully intervene. Active surgical resident participation within the union allows for an understanding of surgical trainees’ unique needs and reduced conflict.Conclusions and RelevanceIn this qualitative study, unionization was a mechanism for resident voice and agency; the desire to unionize likely highlighted the lack of other such mechanisms in the training environment. However, these findings suggest that unionization may have had unintended consequences on benefits, flexibility, and teaching. Effective advocacy, whether within or outside the context of a union, was facilitated by participation from surgical residents. Future research should expand on this exploratory study by including a greater number of institutions and investigating the evolution of themes over time.

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Section: Jama Network Open | Surgerymentioning

confidence: 81%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Experiences With Unionization Among General Surgery Resident Physicians, Faculty, and Staff

Foote,

Rosenblatt,

Amortegui

et al. 2024

JAMA Netw Open

View full text Add to dashboard Cite

show abstract

“…14 One possible explanation for the male majority of MD/MBA surgical subspecialists is a female sex bias within these specialties which can not only make women feel segregated into certain fields but also hinder residency offers, job opportunities, and promotions. [15][16][17] It is equally probable that historical disparities in women's representation and ability to pursue careers in business decrease their interest in applying to MBA programs. The male predominance noted in this study is consistent with the gender composition of MD/MBA programs across the country.…”

Section: Discussionmentioning

confidence: 99%

Exploring a Masters of Business Administration’s Impact on Surgical Subspecialists

McCarter,

Martin,

Coello

et al. 2024

Orthopedic Reviews

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Objectives and Study Design As healthcare evolves, more physicians are taking on administrative roles and pursuing additional graduate education, particularly obtaining a Master’s in Business Administration (MBA.) To facilitate a better understanding of these practitioners, we conducted a comparative study of MD/MBA clinicians in multiple surgical fields. Methods This study aims to compare clinicians with MD/MBAs across multiple surgical subspecialties. Reported metrics include demographics, MBA program structure, salary changes, and professional pursuits. Nine studies were obtained from the PubMed, Cochrane, and Embase databases. Four studies met the inclusion criteria and were analyzed. Results The majority of MD/MBA degree holders in plastic surgery (95%), orthopedic surgery (89-96%), and ophthalmology (80%) are male. Ophthalmology (37%) demonstrates the highest number of subjects obtaining an MBA via a synchronous MD/MBA. Most clinicians return to clinical practice after degree completion and show high levels of non-clinical pursuits after receiving their MBAs. Conclusions Though there appear to be differences across surgical subspecialties regarding how an MBA is applied, most maintain clinical duties. Of those that do not, the largest portion transition to administrative duties, consulting, entrepreneurial endeavors, or other professional opportunities. Despite the financial ambiguity of an MBA, physicians value the transformative experience it offers.

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A proposed roadmap: one department of surgery’s plan for diversity, equity, and inclusion

Walsh,

Hoyos Gomez,

Thanawala

et al. 2024

Global Surg Educ

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Purpose Disparities remain in academic surgery that negatively impact our patients and our community in multiple ways. The Department of Surgery (DoS) at Oregon Health & Sciences University (OHSU) formally established a Diversity, Equity, and Inclusion (DEI) Council in 2020 to address the multifaceted etiologies of these inequities. This manuscript describes the steps taken by this council to create a more diverse, equitable, and inclusive workspace, which were guided by the framework provided in the white paper “Ensuring Equity, Diversity, and Inclusion in Academic Surgery” by West et al. Methods The DEI Council was constructed into four working groups: Antiracism, Gender Equity, LGBTQIA + , and Community Engagement. Each group is charged with a unique mission statement to address pertinent inequalities. Various initiatives include educational lectures, workshops, quality improvement and health advocacy projects. Results The DEI Council has achieved progress by modifying hiring, promotion, and tenure policies and facilitating mentorship. Changes have been made to call expectations and lactation policies for residents and faculty who are expecting or new parents. Nine observerships and financially supported subinternships for underrepresented groups have been completed and will continue. DEI professional development modules, retreats, and monthly cultural humility discussions have been established. Cultural humility and competence of the DoS cohort has been measured through validated tools. Conclusion There is much work ahead to achieve our DEI goals. This manuscript demonstrates progress that can be replicated and improved at other institutions as we all strive toward a more diverse, equitable, and inclusive world of academic surgery.

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Bias in Surgical Residency Evaluations: A Scoping Review

Cited by 8 publications

References 99 publications

Experiences With Unionization Among General Surgery Resident Physicians, Faculty, and Staff

Experiences With Unionization Among General Surgery Resident Physicians, Faculty, and Staff

Exploring a Masters of Business Administration’s Impact on Surgical Subspecialists

A proposed roadmap: one department of surgery’s plan for diversity, equity, and inclusion

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