Racial and Sex Disparities in Resident Attrition in Orthopaedic Surgery

Haruno, Lee S.; Chen, Xi; Metzger, Melodie F.; Lin, Carol A.; Little, Milton T. M.; Kanim, Linda E.A.; Poon, Selina

doi:10.2106/jbjs.oa.22.00148

Cited by 9 publications

(7 citation statements)

References 27 publications

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“…Among women residents, the rates of overall and unintentional friction were 6.0% and 2.1%, respectively, while among residents who were men, they were 2.8% and 1.0%, respectively. Among residents from ethnic minorities, the rates of overall and unintentional friction were 6.2% and 3.1%, respectively, compared to 2.7% and 0.8%, respectively, for their colleagues of white etnicity [26]. In our study, 84.8% of women orthopaedists reported having experienced some form of professional conflict, with the majority indicating that the conflict occurred with another orthopaedist, and 70.7% said they had been referred to as 'bossy, overly assertive, pushy, overly demanding, or difficult to deal with'.…”

Section: Discussionmentioning

confidence: 85%

“…Among orthopaedists in training, the scenario is no different, with a significant risk of friction. Haruno et al investigated the trends in racial and gender diversity and in friction rates in orthopaedic training programmes from 2001 to 2018 [26]. Among women residents, the rates of overall and unintentional friction were 6.0% and 2.1%, respectively, while among residents who were men, they were 2.8% and 1.0%, respectively.…”

Section: Discussionmentioning

confidence: 99%

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The Perspective of Brazilian Women Orthopaedic Surgeons on Gender Discrimination: Initial Insights to Understand Gender Bias in the Brazilian Healthcare System

Amaral,

Calcado,

Gomez

et al. 2024

Cureus

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Despite the societal progress made in recent years, gender discrimination is still common in healthcare, especially in some surgical specialties such as orthopaedics. In Brazil, where the participation of women in the medical profession has been increasing, little is known about women's perceptions on the issue of gender discrimination. This study aims to examine women orthopaedic surgeons' experiences in dealing with conflict in the workplace and contextualize the impact that gender discrimination has had or currently has on their careers and well-being. As a secondary objective, the work seeks to understand whether there are differences in the perception of the issue among practicing women orthopaedic surgeons and those in training. For a cross-sectional qualitative study, a survey was distributed exclusively to 300 practicing orthopaedic surgeons and orthopaedists in training (residents and fellows). A total of 99 women participated in the survey, of whom 66 were practicing orthopaedic surgeons and 33 were orthopaedists in training. The study showed that women orthopaedic surgeons in training in Brazil have a lower number of publications and a moderate level of involvement in academic society activity. In addition, orthopaedic surgeons in training experience a statistically significantly higher number of conflicts in the workplace. The comments from the questionnaires highlighted the physical and psychological consequences arising from these situations of professional conflict, most frequently occurring with orthopaedic surgeons who are men. Our findings indicate that respondents expressed a feeling of inequality towards women in the workplace, ultimately reducing the level of job satisfaction among female orthopaedic surgeons, which may contribute to disinterest and abandonment of the specialty. The results of this work support recent evidence that there is an implicit and often overlooked bias against the participation of women and ethnic minorities in the orthopaedic community in Brazil.

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Section: Discussionmentioning

confidence: 85%

Section: Discussionmentioning

confidence: 99%

The Perspective of Brazilian Women Orthopaedic Surgeons on Gender Discrimination: Initial Insights to Understand Gender Bias in the Brazilian Healthcare System

Amaral,

Calcado,

Gomez

et al. 2024

Cureus

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“…However, studies continue to show that narrative letters contain significant demographic bias that may adversely affect underrepresented minorities and women. This is particularly relevant in the context of ongoing efforts to improve diversity in orthopaedic surgery [10,11,36]. To combat this trend and move in the direction of parity, the AOA introduced the SLOR in 2017 to assist with objective comparisons among applicants.…”

Section: Discussionmentioning

confidence: 99%

How Prominent Is Score Inflation, Gender, and Racial Bias in Orthopaedic Surgery Residency Recommendation Letters? A Systematic Review

Burkhart,

Lavu,

Hecht II

et al. 2024

Clin Orthop Relat Res

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Introduction Letters of recommendation are considered an important factor in the holistic ranking of orthopaedic residency applications. The standardized letter of recommendation (SLOR) was introduced in 2017 in response to the inherent bias and limited comparative value of traditional LORs. It includes standardized questions about an applicant’s orthopaedic qualifications, designed to enable fair comparisons among candidates. However, disparate and inconsistent findings have made it difficult to draw meaningful conclusions from individual studies on the SLOR and narrative letter of recommendation. Question/purposes In this systematic review we asked: (1) What is the distribution of applicant SLOR rating among nine domains and summative scores? (2) Are there applicant characteristics associated with SLOR ratings? (3) Is there gender and racial bias in the SLOR and narrative letter of recommendation? Methods PubMed, EBSCO, and Google Scholar electronic databases were queried on March 20, 2023, to identify all studies evaluating SLOR and narrative letter of recommendations between January 1, 2017, and March 20, 2023. Articles that evaluated orthopaedic SLOR or narrative LORs were included. Systematic reviews, case reports, duplicate studies between databases, and grey literature such as abstracts and articles on preprint servers were excluded. Eight studies including 6179 applicants and 18,987 letters of recommendation were included in the final analysis. The applicant classes ranged from years 2014 to 2020. Two reviewers independently evaluated the quality of the included studies using the Joanna Briggs Institute (JBI) tool for cross-sectional studies. The mean JBI score of included studies was 7.4 out of a maximum of 8, with higher scores indicating better quality. The primary outcome was to determine the distribution of applicant SLOR rankings in their summative score. Summative scores were separated into ranked to match, top one-third, middle one-third, lower one-third, and not a fit. Four studies reported the summative SLOR scores of applicants. Our secondary study goal was to assess applicant characteristics associated with SLOR summative scores and assess any bias present in the SLOR or narrative recommendation. Five studies compared SLOR ratings across applicant characteristics including gender, race, USMLE Step 1 score, USMLE Step 2 score, Alpha Omega Alpha (AΩA) membership, clerkship grades, and publications. Gender and racial bias were also assessed across five studies. Four studies utilized a linguistic analysis software to search letters of recommendation for differences in word category use by gender and race. Results Studies consistently found that a higher percentage of candidates were identified in the top percentile blocks than is mathematically possible. For example, the two studies that tallied the proportion of candidates ranking in the top 10% of applicants found that 36% and 42% were rated as being in the top 10%. Similarly, articles found more than 87% of applicants scored in the top one-third. Studies had mixed results, but in general, they suggested that AΩA status, higher Step 1 scores, and more research publications have a slightly positive association with increased SLOR scores. We found no evidence of gender bias against women, and in fact, most studies evaluating word choices found word choices for women candidates generally were stronger. Similarly, no consistent disparities were identified in word categories utilized in SLORs based on applicant race. Conclusion Most notably, a mathematically impossible proportion of applicants were counted in the top percentiles in letters of recommendation. This compromises readers’ abilities to differentiate candidates. Factors like AOA status and research publications displayed a modest positive correlation with SLOR scores. Gender bias against women or candidates from racial minority groups was not evident. Clinical Relevance We suggest that group SLOR authorship, with a consensus assessment by clerkship or residency directors, should be considered. We also recommend the incorporation of mean and SD scores for each letter writer (or group) alongside their letters. Furthermore, studies indicate that submitting all four SLOR letters can substantially improve an applicant’s chances of success. We advise students to choose strategically and submit the maximum allowable number of SLORs.

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“…Further, the included barriers were chosen based on their consistent mention in discussions on impediments to women in orthopaedic surgery, yet they are not all inclusive. Future research should expand the current work to explore global perspectives on retention within the field, as new investigations have revealed over twofold higher attrition rates for women residents and practicing surgeons [34][35][36].…”

Section: Discussionmentioning

confidence: 99%

The Importance of Perceived Barriers to Women Entering and Advancing in Orthopaedic Surgery in the US and Beyond

Xu,

Humbyrd,

De Mattos

et al. 2023

World j. surg.

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Background Global perceptions of barriers to women in orthopaedics have not been assessed. The purpose of this study was to determine the importance of international barriers to women entering and advancing within orthopaedic surgery. Methods An anonymous, online survey was distributed to women medical students, trainees, and practicing surgeons via Women in Orthopaedics Worldwide, the ''Women in Ortho'' Facebook page, and individual programmes.Participants were asked to rate perceived barriers to (1) pursuing training and (2) career advancement on a scale of 1-5, with 5 being the most important and relative to other barriers. Descriptive statistics and univariate analyses were employed. ResultsThe survey yielded 237 US (84.0%) and 45 international (16.0%) respondents. Per entering orthopaedic surgery, the most important barriers were male-dominated culture, lack of a strong women mentor, and lack of female representation at home institution. Compared with the US surgeons/trainees, international respondents cited greater societal disapproval (2.8 ± 1.2 vs. 3.4 ± 1.3, P = 0.01). Medical students assigned less importance to lack of exposure, more to lack of resources for creating competitive applications (P \ 0.05). Regarding career advancement, lack of women leadership, family responsibilities, and gender-biased selection for promotion were the most important. International surgeons/trainees noted greater concern for societal disapproval (3.5 ± 1.5 vs. 2.6 ± 1.3, P = 0.003) and were more likely to rank sexual harassment in their top three (17.6 vs. 4.2%, P = 0.02). Conclusion While notable differences exist, there is striking similarity across countries and position levels in perceived barriers to women entering and advancing in orthopaedic surgery. Level of evidence: III.

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Racial and Sex Disparities in Resident Attrition in Orthopaedic Surgery

Cited by 9 publications

References 27 publications

The Perspective of Brazilian Women Orthopaedic Surgeons on Gender Discrimination: Initial Insights to Understand Gender Bias in the Brazilian Healthcare System

The Perspective of Brazilian Women Orthopaedic Surgeons on Gender Discrimination: Initial Insights to Understand Gender Bias in the Brazilian Healthcare System

How Prominent Is Score Inflation, Gender, and Racial Bias in Orthopaedic Surgery Residency Recommendation Letters? A Systematic Review

The Importance of Perceived Barriers to Women Entering and Advancing in Orthopaedic Surgery in the US and Beyond

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