Demographic Landscape of Cardiothoracic Surgeons and Residents at United States Training Programs

Olive, Jacqueline K.; Mansoor, Sanaa; Simpson, Keith; Cornwell, Lorraine D.; Jiménez, Ernesto; Ghanta, Ravi K.; Groth, Shawn S.; Burt, Bryan M.; Rosengart, Todd K.; Coselli, Joseph S.; Preventza, Ourania

doi:10.1016/j.athoracsur.2021.07.076

Cited by 30 publications

(6 citation statements)

References 37 publications

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“…However, the internal validity of our study was maintained given successful randomization of surgeons into the 3 vignette study groups. Participants in this study also broadly match the demographic characteristics of cardiothoracic surgeons nationally, which supports external validity . Second, our vignettes did not allow for surgeons to ask for additional preoperative testing, such as cardiopulmonary exercising testing, which some surgeons may use as supplementary tests to guide decision-making.…”

Section: Discussionmentioning

confidence: 67%

Clinical Implications of Removing Race-Corrected Pulmonary Function Tests for African American Patients Requiring Surgery for Lung Cancer

et al. 2023

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ImportanceRemoval of race correction in pulmonary function tests (PFTs) is a priority, given that race correction inappropriately conflates race, a social construct, with biological differences and falsely assumes worse lung function in African American than White individuals. However, the impact of decorrecting PFTs for African American patients with lung cancer is unknown.ObjectivesTo identify how many hospitals providing lung cancer surgery use race correction, examine the association of race correction with predicted lung function, and test the effect of decorrection on surgeons’ treatment recommendations.Design, Setting, and ParticipantsIn this quality improvement study, hospitals participating in a statewide quality collaborative were contacted to determine use of race correction in PFTs. For hospitals performing race correction, percent predicted preoperative and postoperative forced expiratory volume in 1 second (FEV1) was calculated for African American patients who underwent lung cancer resection between January 1, 2015, and September 31, 2022, using race-corrected and race-neutral equations. US cardiothoracic surgeons were then randomized to receive 1 clinical vignette that differed by the use of Global Lung Function Initiative equations for (1) African American patients (percent predicted postoperative FEV1, 49%), (2) other race or multiracial patients (percent predicted postoperative FEV1, 45%), and (3) race-neutral patients (percent predicted postoperative FEV1, 42%).Main Outcomes and MeasuresNumber of hospitals using race correction in PFTs, change in preoperative and postoperative FEV1 estimates based on race-neutral or race-corrected equations, and surgeon treatment recommendations for clinical vignettes.ResultsA total of 515 African American patients (308 [59.8%] female; mean [SD] age, 66.2 [9.4] years) were included in the study. Fifteen of the 16 hospitals (93.8%) performing lung cancer resection for African American patients during the study period reported using race correction, which corresponds to 473 African American patients (91.8%) having race-corrected PFTs. Among these patients, the percent predicted preoperative FEV1 and postoperative FEV1 would have decreased by 9.2% (95% CI, −9.0% to −9.5%; P &lt; .001) and 7.6% (95% CI, −7.3% to −7.9%; P &lt; .001), respectively, if race-neutral equations had been used. A total of 225 surgeons (194 male [87.8%]; mean [SD] time in practice, 19.4 [11.3] years) were successfully randomized and completed the vignette items regarding risk perception and treatment outcomes (76% completion rate). Surgeons randomized to the vignette with African American race–corrected PFTs were more likely to recommend lobectomy (79.2%; 95% CI, 69.8%-88.5%) compared with surgeons randomized to the other race or multiracial–corrected (61.7%; 95% CI, 51.1%-72.3%; P = .02) or race-neutral PFTs (52.8%; 95% CI, 41.2%-64.3%; P = .001).Conclusions and RelevanceGiven the findings of this quality improvement study, surgeons should be aware of changes in PFT testing because removal of race correction PFTs may change surgeons’ treatment decisions and potentially worsen existing disparities in receipt of lung cancer surgery among African American patients.

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Section: Discussionmentioning

confidence: 67%

Clinical Implications of Removing Race-Corrected Pulmonary Function Tests for African American Patients Requiring Surgery for Lung Cancer

et al. 2023

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“…6 Cardiothoracic surgery fellowship programs report a sizeable rise in women and URiM in trainee populations, with more significant discrepancies in academic environments. 7…”

Section: Introductionmentioning

confidence: 99%

“…4 Studies of fellowship programs following general surgery training show conflicting results with an underlying struggle to achieve balanced demographics. [5][6][7] For instance, vascular surgery fellowship programs have shown no increase in female trainee representation from 2011 to 2020. 5 Advanced gastrointestinal and minimally invasive surgery groups reported a slight increase in female trainees (28% to 31%) over 5 years.…”

Section: Introductionmentioning

confidence: 99%

Gender and Race Demographics of Fellowships After General Surgery Training in the United States: A Five-Year Analysis in Applicant and Resident Trends

Mueller

Morenas

Loe

et al. 2022

The American Surgeon™

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Introduction The gender and minority gap in general surgery residency is narrowing; however, literature lacks comprehensive data regarding the demographics of fellowship programs following general surgery training. Methods Data from 2017 to 2021 for gender, ethnicity, and surgical subspecialty are publicly available from the ERAS database and ACGME yearly data reports. Cochran-Armitage trend tests were used to determine statistical significance in trends for female and minority applicants and trainees. Results The overall trend of female applicants to surgical specialties remained stagnant. However, female applicants to vascular surgery increased significantly from 25% to 35% (P = .045). There was no significant increase in female trainees in any surgical specialties evaluated. Furthermore, the overall trend of minority applicants to surgical specialties also remained stagnant, except for pediatric surgery, which showed significantly fewer minority applicants. Despite pediatric surgery having fewer applicants, minority trainees in this specialty increased significantly from 8% to 19% (P = .008). Conclusion Several current initiatives, such as intentional mentorship, are being reported to promote diverse and equal representation among female and minority applicants and trainees. However, the current overall margin of increase in diversity among surgical specialty applicants and trainees is minimal, indicating that continued efforts are needed to diversify surgical specialty training programs.

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“…Moreover, women get less podium time in meetings [ 9 ]. This lack of inclusivity seems to exist already in the grass root level of academia since despite half of the medical students being female, only 24% of cardiothoracic residents are women [ 10 ]. Factors contributing to obstacles in the education pipeline of potential women surgeons are, e.g.…”

mentioning

confidence: 99%

“…Factors contributing to obstacles in the education pipeline of potential women surgeons are, e.g. concerns related work-life balance and lack of especially same-sex mentors [ 10 ]. ‘I do not wish to give (women) a first place, still less a second one—but the complete freedom to take their true place, whatever it may be’.—Elizabeth Blackwell …”

mentioning

confidence: 99%

Breakfast at Tiffany’s: encouraging all the best and brightest diamonds into cardiothoracic surgery

Lehtinen

Eid

2022

Interactive CardioVascular and Thoracic Surgery

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Demographic Landscape of Cardiothoracic Surgeons and Residents at United States Training Programs

Cited by 30 publications

References 37 publications

Clinical Implications of Removing Race-Corrected Pulmonary Function Tests for African American Patients Requiring Surgery for Lung Cancer

Clinical Implications of Removing Race-Corrected Pulmonary Function Tests for African American Patients Requiring Surgery for Lung Cancer

Gender and Race Demographics of Fellowships After General Surgery Training in the United States: A Five-Year Analysis in Applicant and Resident Trends

Breakfast at Tiffany’s: encouraging all the best and brightest diamonds into cardiothoracic surgery

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