Key Points
Question
How has gender, racial, and ethnic representation in the otolaryngology workforce changed during the past 10 years compared with neurosurgery and general surgery workforces?
Findings
This cross-sectional study of data from the US Accreditation Council for Graduate Medical Education found statistically significant increases in the rates of change in representation of women and Black individuals in otolaryngology and general surgery, and for Latino individuals in general surgery and neurosurgery.
Meaning
The findings of this cross-sectional study demonstrate a positive direction but only modest progress in diversity representation in the otolaryngology workforce; therefore, additional initiatives should be pursued to support and foster future trainees who are women and/or from underrepresented groups.
Abstract
Importance
Given the growth of minoritized groups in the US and the widening racial and ethnic health disparities, improving diversity remains a proposed solution in the field of otolaryngology. Evaluating current trends in workforce diversity may highlight potential areas for improvement.
Objective
To understand the changes in gender, racial, and ethnic diversity in the otolaryngology workforce in comparison with changes in the general surgery and neurosurgery workforces from 2013 to 2022.
Design, Setting, and Participants
This cross-sectional study used publicly available data from the Accreditation Council for Graduate Medical Education and the Association of American Medical Colleges for 2013 to 2022, and included medical students and trainees in all US medical residency programs and allopathic medical schools.
Main Outcomes and Measures
Average percentages of women, Black, and Latino trainees during 2 intervals of 5 years (2013-2017 and 2018-2022). Pearson χ2 tests compared demographic information. Normalized ratios were calculated for each demographic group in medical school and residency. Piecewise linear regression assessed linear fit for representation across time periods and compared rates of change.
Results
The study population comprised 59 865 medical residents (43 931 [73.4%] women; 6203 [10.4%] Black and 9731 [16.2%] Latino individuals; age was not reported). The comparison between the 2 study intervals showed that the proportions of women, Black, and Latino trainees increased in otolaryngology (2.9%, 0.7%, and 1.6%, respectively), and decreased for Black trainees in both general surgery and neurosurgery (−0.4% and −1.0%, respectively). In comparison with their proportions in medical school, Latino trainees were well represented in general surgery, neurosurgery, and otolaryngology (normalized ratios [NRs]: 1.25, 1.06, and 0.96, respectively); however, women and Black trainees remained underrepresented in general surgery, neurosurgery, and otolaryngology (women NRs, 0.76, 0.33, and 0.68; Black NRs, 0.63, 0.61, and 0.29, respectively). The percentage of women, Black, and Latino trainees in otolaryngology all increased from 2020 to 2022 (2.5%, 1.1%, and 1.1%, respectively). Piecewise regression showed positive trends across all 3 specialties.
Conclusions and Relevance
The findings of this cross-sectional study indicate a positive direction but only a modest increase of diversity in otolaryngology, particularly in the context of national demographic data. Novel strategies should be pursued to supplement existing efforts to increase diversity in otolaryngology.
This cross-sectional study compares changes in gender, racial, and ethnic representation in the otolaryngology workforce with those of general surgery and neurology from 2013 to 2022.
Introduction
Police brutality and health care disparities revealed by the COVID-19 pandemic in the US prompted a re-evaluation of structural racism in 2020 and a rising call to action to improve diversity and inclusion in medicine.1,2,3 Several studies have shown that surgical fields still lag behind national demographic diversity and other medical specialties, with subspecialties such as otolaryngology (OTO) having particularly low numbers of practitioners of underrepresented minority groups (UMGs).4,5,6 Given this context and the history of low rates of diversity, several OTO societies, including the Society of University Otolaryngologists and the American Otological and Neurotology Society have made public statements against systemic racism and made a call to action for improving diversity within the otolaryngologic workforce.7,8
The value and necessity of diversity is multipronged. Diversity and inclusion, particularly the inclusion of historically underrepresented populations and women, may increase creativity, spur productivity, and foster better patient care. It has been shown that patients have better outcomes, more positive interactions with physicians, and lower health care expenditures when they are treated by physicians of their own racial and/or ethnic background.9 Individuals of UMGs are also more likely to work in underserved communities and care for poor and underinsured US residents than their counterparts from racial and ethnic majority groups.10 Moreover, diverse training environments may better equip future clinicians to serve growing diverse patient populations.11 Given that in the US, individuals who identify with a racial and/or ethnic minority group are expected to outnumber White individuals by 2045, progress toward racial and ethnic concordance may yield improved patient outcomes.12
Health care disparities in OTO have been well established. For example, African American or Black (hereafter, Black) and Hispanic or Latino (hereafter, Latino) patients have higher rates of head and neck cancers and delayed presentation of malignant neoplasms.13,14 Yet despite progressive improvements in chemoradiotherapy and free-tissue reconstruction, the disparities in outcomes persist.13 While inequities are multifactorial and can be attributed to systemic barriers in access to health care, socioeconomic status, and physician bias, improving health workforce diversity remains an important solution to addressing racial and ethnic disparities in patient care quality and satisfaction.15,16 In 2012, Schwartz and colleagues described the current state of diversity as a “collective failure to correct long-standing disparities in minority and female representation in the otolaryngology health care workforce.”4 Since then, several studies have not only evaluated contemporary trends in the OTO workforce, but also highlighted research-based strategies to address the slow-moving progress.17,18,19
The aim of this study was to describe the recent demographic changes in OTO medical residents from 2012 to 2022 in comparison with neurosurgery (NS) and general surgery (GS) and to compare the ratio of UMG trainees with medical students and practicing otolaryngologists. Secondarily, we aimed to characterize immediate changes in UMG representation following the evolving perspectives on structural racism and diversity in medicine since 2020.
Methods
This study was exempted from institutional review because it analyzed only publicly available data that did not qualify as human participant research; informed consent was also waived for this reason.
Study Population
We evaluated data regarding OTO, GS, and NS trainees using the US Accreditation Council for Graduate Medical Education (ACGME) records from 2013 to 2022.20 These public reports contain the gender, race, and ethnicity of trainees (both residents and fellows) at accredited training programs. From these surgical specialties, we collected data regarding the representation of female, Black, and Latino trainees. Because they represent different levels of engagement in diversity, equity, and inclusion efforts, GS and NS were chosen to compare with OTO. Prior research has determined that NS continuously displays low levels of gender, racial, and ethnic diversity, whereas GS has had recent increases in diversity.21,22 Data on gender and race and/or ethnicity of medical students and practicing otolaryngologists were gathered from the 2018 Association of American Medical Colleges (AAMC), the US Medical Student Enrollment Reports, and the most recent (2018) US Physician Workforce data.23
Statistical Analysis
To assess diversity, the proportions of women, Black and Latino trainees were calculated by dividing the number of trainees in each subgroup by the total trainees per year in 2013 to 2022. The effect size (ES) was expressed as the magnitude of difference in proportions between interval years, and the 95% CIs around the difference were calculated as a measure of the precision of the estimate. A piecewise linear regression was conducted to assess a linear fit for gender and racial−ethnic proportions in each time period and to compare the rate of change of representation. Differences in demographic composition from 2020 to 2022 were also compared to determine how the summer of 2020 affected surgical subspecialty training representation. To address the issue of representation, we then created a normalized ratios for minority representation from medical school to surgical specialty per the method developed by Dorsey and colleagues.24 This was done by dividing the ratio of a certain group in a surgical specialty by their ratio in medical school. Minority groups that were represented equally in residency and medical schools have a normalized ratio of 1, with lower values signifying underrepresentation and higher values signifying overrepresentation in residency or academic practice.
Data analyses were performed in December 2022 using SPSS, version 28 (IBM Corp), and R (The R Foundation for Statistical Computing). The threshold for statistical significance was set at α = .05.
Results
The study population comprised 59 865 medical residents (43 931 [73.4%] women; 6203 [10.4%] Black and 9731 [16.2%] Latino individuals). Data on resident and medical student age were not released by the ACGME and AAMC.
Trainee Diversity by Time Period
Proportions of women, Black, and Latino trainees in GS, NS, and OTO in 2013 to 2017 and in 2018 to 2022 are shown in Table 1. Compared across the 5-year periods, the total percentages of women increased in all assessed specialties: OTO (ES, 2.9%; 95% CI, 1.4% to 4.4%), GS (ES, 5.2%; 95% CI, 4.6% to 5.9%), and NS (ES, 2.6%; 95% CI, 1.3% to 3.8%). Representation of Black trainees increased in OTO (ES, 0.7%; 95% CI, 0.2% to 1.2%) but decreased in GS (ES, −0.4%; 95% CI, −0.7% to −0.1%) and NS (ES, −1.0%; 95% CI, −0.7% to −0.21%). Representation of Latino trainees increased in OTO (ES, 1.6%; 0.85% to 2.3%), GS (ES, 2.4%; 95% CI, 2.0% to 2.9%), and NS (ES, 1.3%; 95% CI, 0.5% to 2.2%).
Table 1. Comparison of Percentages of Trainees, by Gender and Race and/or Ethnicity, in Surgical Specialties During the Past 10 Years (2013-2017 vs 2018-2022)a.
| Demographic variable and specialty | 2013-2017 | 2018-2022 | % Effect size (95% CI) |
|---|---|---|---|
| No./total (%) | No./total (%) | ||
| Women | |||
| Otolaryngology | 2555/7387 (34.6) | 3141/8377 (37.5) | 2.9 (1.4 to 4.4) |
| General surgery | 15 360/40 531 (37.9) | 20 294/47 033 (43.1) | 5.2 (4.6 to 5.9) |
| Neurosurgery | 1096/6520 (16.8) | 1463/7551 (19.3) | 2.6 (1.3 to 3.8) |
| Black | |||
| Otolaryngology | 157/7387 (2.1) | 234/8377 (2.8) | 0.7 (0.2 to 1.2) |
| General surgery | 2430/40 531 (6.0) | 2626/47 033 (5.6) | −0.4 (−0.7 to −0.1) |
| Neurosurgery | 384/6520 (5.9) | 372/7551 (4.9) | −1.0 (−1.7 to −0.21) |
| Latino | |||
| Otolaryngology | 384/7387 (5.2) | 569/8377 (6.8) | 1.6 (0.85 to 2.3) |
| General surgery | 3373/40 531 (8.3) | 4390/40 733 (9.3) | 2.4 (2.0 to 2.9) |
| Neurosurgery | 424/6520 (6.5) | 591/7551 (7.8) | 1.3 (0.5 to 2.2) |
First interval is report year 2012-2013 through 2016-2017; second interval, 2017-2018 through 2021-2022.
Year-to-Year Trends in Trainee Diversity Since 2013
When assessing year-to-year trends in the 3 surgical fields (Figure 1 and eTable in Supplement 1), the percentage of women increased steadily in all 3 specialties (Figure 1A). Of note, GS had the greatest increase in representation of women and had a steep increase after 2017; OTO and NS had smaller increases. Representation of Black trainees in the 3 specialties showed a different pattern (Figure 1B). Representation in GS decreased between 2012 to 2013 (6.6%) and 2017 to 2018 (5.1%). Since then, there has been a steady increase to 6.4% in 2021 to 2022. For NS, there has been a near continuous decline between 2012 to 2013 (6.2%) to 2012 to 2022 (4.7%). In OTO there has been a steady increase between 2016 to 2017 (2.1%) to 2021 to 2022 (3.9%). Representation of Latino trainees shows steady increase for all 3 specialties (Figure 1C). For GS and NS, the increases began around 2017 to 2018, while for OTO, the increase has been stable across the entire time period.
Figure 1. Trends in Gender, Race, and Ethnic Diversity in 3 Specialties, Year to Year (2012-2022).
Percentages were calculated by dividing the number of trainees in each demographic group by the total number of trainees in each year.
The piecewise model demonstrated increases in rates of change between 2013 to 2017 and 2018 to 2022 in the representation of women in all 3 specialties, with GS showing the largest difference in rate change and OTO with the next largest (Table 2). Among Black trainees, both GS and OTO demonstrated large increases in representation, whereas NS showed a small increase. Among Latino trainees, GS and NS showed large changes, whereas OTO had virtually no change.
Table 2. Piecewise Changes in Representation, by Gender and Race and/or Ethnicity, in 2013 to 2017 vs 2018 to 2022, and Rate of Change Differencesa.
| Demographic variable and specialty | 2013-2017 | 2018-2022 | Comparison | |||
|---|---|---|---|---|---|---|
| Rate change | 95% CI | Rate change | 95% CI | Rate change difference | 95% CI | |
| Women | ||||||
| Otolaryngology | 0.04 | −0.36 to 0.44 | 0.88 | 0.57 to1.19 | 0.84 | 0.21 to 1.48 |
| General surgery | 0.30 | 0.18 to 0.42 | 1.54 | 1.45 to1.63 | 1.24 | 1.06 to 1.42 |
| Neurosurgery | 0.32 | −0.01 to 0.65 | 0.75 | 0.49 to1.01 | 0.44 | −0.09 to 0.96 |
| Black | ||||||
| Otolaryngology | −0.09 | −0.26 to 0.07 | 0.31 | 0.18 to 0.44 | 0.40 | 0.14 to 0.66 |
| General surgery | −0.36 | −0.53 to 0.19 | 0.20 | 0.06 to 0.33 | 0.56 | 0.28 to 0.83 |
| Neurosurgery | −0.24 | −0.33 to 0.16 | −0.14 | −0.20 to 0.07 | 0.11 | −0.03 to 0.24 |
| Latino | ||||||
| Otolaryngology | 0.28 | 0.13 to 0.42 | 0.30 | 0.19 to 0.42 | 0.03 | −0.20 to 0.26 |
| General surgery | −0.02 | −0.14 to 0.10 | 0.38 | 0.29 to 0.48 | 0.40 | 0.21 to 0.59 |
| Neurosurgery | 0.05 | −0.14 to 0.24 | 0.44 | 0.29 to 0.59 | 0.39 | 0.09 to 0.69 |
First interval is report year 2012-2013 through 2016-2017; second interval, 2017-2018 through 2021-2022.
Medical School and Surgical Trainee Diversity in 2018
Calculated ratios demonstrated differences in demographic diversity across medical students and residency trainees in 2018 (Figure 2). Normalized ratios for women in all 3 specialties were less than 1 (GS, 0.76; OTO, 0.68; NS, 0.33; Figure 2A). Normalized ratios for Black trainees demonstrated underrepresentation in all 3 specialties (GS, 0.63; OTO, 0.29; NS, 0.61; Figure 2B). Normalized ratios for Latino trainees demonstrated overrepresentation in GS (1.25) and NS (1.06), with near parity in OTO (0.91) (Figure 2C).
Figure 2. Relative Ratio of Individuals From Underrepresented Minority Groups in Medical School vs Surgical Specialty, 2018.
Comparison of Diversity in 2020 vs 2022
Changes in gender, racial, and ethnic representation for medical students and surgical residency trainees between 2020 and 2022 are shown in Table 3. Among medical students, there was a large increase in the proportion of women (ES, 2.2%; 95% CI, 1.7% to 2.6%), and smaller increases of Black (ES, 0.8%; 95% CI, 0.6% to 1.1%) and Latino (ES, 0.4%; 95% CI, 0.2% to 0.6%) individuals. The proportion of women increased in all 3 surgical specialties, with GS showing the largest increase (ES, 3.0%; 95% CI, 1.6% to 4.4%), followed by OTO (ES, 2.5%; 95% CI, −0.8% to 5.8%). The proportion of Black trainees increased in all specialties, with OTO showing the largest increase (ES, 1.6%; 95% CI, 0.4% to 2.8%). The percentage of Latino trainees increased in all 3 specialties, with GS showing the largest increase (ES, 1.1%; 95% CI, 0.3% to 2.3%), followed by OTO (ES, 0.6%; 95% CI, −1.1% to 2.3%).
Table 3. Comparison of Percentages of Trainees, by Gender and Race and/or Ethnicity, in Surgical Specialties Between 2020 and 2022a.
| Demographic variable and training | 2020 | 2022 | % Effect size (95% CI) |
|---|---|---|---|
| No./total (%) | No./total (%) | ||
| Women | |||
| Medical student | 46 837/92 634 (50.6) | 50 328/95 475 (52.7) | 2.1 (1.7 to 2.6) |
| Otolaryngology | 642/1703 (37.7) | 700/1741 (40.2) | 2.5 (−0.8 to 5.8) |
| General surgery | 4041/9374 (43.1) | 4564/9900 (46.1) | 3.0 (1.6 to 4.4) |
| Neurosurgery | 297/1529 (19.4) | 334/1563 (21.4) | 1.9 (−0.9 to 4.8) |
| Black | |||
| Medical student | 6698/92 634 (7.2) | 7711/95 475 (8.1) | 0.9 (0.6 to 1.1) |
| Otolaryngology | 41/1703 (2.4) | 69/1741 (4.0) | 1.6 (0.4 to 2.8) |
| General surgery | 504/9374 (5.4) | 638/9900 (6.4) | 1.1 (0.4 to 1.7) |
| Neurosurgery | 75/1529 (4.9) | 74/1563 (4.7) | −0.2 (−1.4 to 1.7) |
| Latino | |||
| Medical student | 5922/92 634 (6.4) | 6465/95 475 (6.8) | 0.4 (0.2 to 0.6) |
| Otolaryngology | 115/1703 (6.6) | 128/1741 (7.4) | 0.6 (−1.1 to 2.3) |
| General surgery | 870/9374 (9.3) | 1029/9900 (10.4) | 1.1 (0.3 to 2.3) |
| Neurosurgery | 120/1529 (7.8) | 136/1563 (8.7) | 0.8 (−1.1 to 2.8) |
First interval is report year 2012-2013 through 2016-2017; second interval, 2017-2018 through 2021-2022.
Discussion
In this study, we sought to evaluate trends in gender, racial, and ethnic diversity, and to compare relative ratios of medical student and surgical residency trainees in OTO, GS, and NS. We found large increases in the proportions of women and Latinos in all 3 specialties, whereas the proportions of Black representation increased very slightly in OTO. Moreover, the rate of change of women and Latinos in all 3 specialties increased over time. The rate of change for Black trainees increased in GS and OTO; however, it decreased in NS. Latino medical students were found to enter surgical training at higher rates than their proportions in medical school. Proportions of women and Black surgical trainees lagged medical student diversity. Lastly, between 2020 and 2022, the rates of change in representation of women and Black individuals in OTO were large, with the rate of increase greater for Black individuals across 3 specialties.
Recent studies evaluating the rates of women entering surgical specialties have found substantial increases in representation, ultimately narrowing the gender gap in trainees.25,26,27,28 From 1970 to 2016, female representation in surgical specialties increased from less than 6% to approximately 30% across all surgical specialties.26 Although these findings showed varied representation in each of the 3 fields, substantial increases in representation remain consistent with this prior work. However, in comparison with medical student diversity, women remain underrepresented, likely because of barriers to entry into surgery. Lack of female mentors in surgery, gender stereotyping, and harassment remain commonly reported issues.25 Later within their career, however, women may face unequal referral patterns, inequitable pay, and poorer opportunities for negotiation and sponsorship.29,30,31 Although we found lower proportions of women in OTO than in GS, NS remained lowest in representation. Compared with other surgical disciplines, OTO may be perceived as a lifestyle specialty with greater work-life balance and the flexibility to build predominantly outpatient or elective surgical practices.25 Thus, a higher proportion of women in OTO than NS would be expected, given the contrasting perceptions of each specialty. However, the greater representation of women trainees in GS than OTO may be associated with the parallel representation in the physician workforce. In 2018, we found a greater number of practicing women physicians in GS compared with OTO (5396 vs 1702 women), which may allow for increased visibility and mentorship.
Compared with the representation of women in surgery, the racial gap across many surgical specialties is more pronounced. Despite recent positive trends and ongoing efforts to recruit and retain diverse cohorts of medical students, Black trainees remain underrepresented in surgical disciplines.32 In contrast, nonsurgical specialties—internal medicine, pediatrics, and family medicine—have actually experienced substantial increases in the representation of Black trainees.33 Moreover, we found that OTO remains the least represented for Black trainees compared with GS and NS. This may be associated with the limited preclinical and clerkship opportunities to engage with OTO in medical school and its lower visibility as a specialty. A study by Kim and colleagues evaluated trends in surgical disciplines discussed the greatest level of attrition for Black individuals occurring between medical school and residency.34 Moreover, even after residency, UMG medical students are more likely to experience a lack of inclusion.34,35 These findings are compounded by higher reports of gender and racial−ethnic bias within academic surgery workplaces, increased rates of attrition after residency, and low availability of faculty positions than for other groups.36,37 This necessitates a closer inspection of pipeline trends between residency and academic faculty in OTO and other surgical subspecialties.
These study findings also illustrated that Latino surgical trainees remained represented at greater proportions than medical students in NS and GS. This is consistent with findings of higher proportions of Latino trainees than medical students in GS, vascular surgery fellowship, and vascular surgery residency having higher proportions of Latino trainees than medical student makeup.24 They hypothesize this overrepresentation may be owing to recruitment of Hispanic/Latino international graduates. Additionally, this group may be heterogenous given the countries of origin and the potential intersection of multiple races and ethnicities (eg, Latino and White, Latino and Black). Nonetheless, these findings suggest that representation of Latino trainees has made promising progress, and furthermore, recruitment efforts should be pursued to support women and Black applicants in other surgical disciplines.
Despite increases in the diversity of trainees in OTO, representation in comparison with the US population points to an opportunity for improvement. As of 2022, women, Black, and Latino individuals compose 50.5%, 13.6%, and 18.9% of the population vs their OTO trainee proportions of 40.2%, 4.0%, and 7.4%, respectively.38 Even with current positive trends after 2020 and the transition of the United States Medical Licensing Examination Step 1 to a pass or fail format, novel strategies to improve diversity in this field may supplement existing efforts.39 Within the context of our findings, we present the following strategies aimed at supporting the growing diversity in the field.
Pathway Programs
Offered to first-year or second-year medical students with longitudinal opportunities, pathway programs have demonstrated measurable success in recruiting minorities.40,41,42 Pathway programs directly provide exposure, education, and informal mentoring opportunities to students. For example, Nth Dimension Summer Internship, a successful longitudinal program in orthopedic surgery, divides its program into 3 stages: (1) clinical correlations lectures and hands-on skill workshops, (2) summer internship in the field, and (3) ongoing mentoring and professional development through longitudinal didactics. Women and UMG participants who engaged in this program were both 50 times and 15 times more likely to apply to orthopedic surgery than their medical student counterparts.43 Moreover, 76% of graduates from the program matched into the specialty.43 Other pathway programs (eg, Leadership Exposure for the Advancement of Gender and Underrepresented Minority Equity in Surgery, Bringing Orthopaedics to New England Students Initiative, and the Underrepresented Trainees Entering Residency program) have demonstrated measurable success on recruitment of women and UMGs for surgical residencies.41,42,44 Although some efforts exist within OTO, such as the American Academy of Otolaryngology−Head and Neck Surgery “mENTor” program, they lack a robust structure and fail to demonstrate measurable effects on recruitment or retention.
Renewed Investment in Mentorship
One-third of a group composed of mostly Black medical students cited a lack of mentorship as a reason for being discouraged from pursuing OTO.45 There are several ways the field of OTO can bridge this gap. Recruitment of diverse faculty may be an important first step for improving mentorship. Faculty members of UMGs are more likely to uphold antiracism within surgical education, build research programs focused on improving health disparities, and support UMG students.6 Otolaryngology departments should make concerted efforts to engage directly with local chapters of affinity groups for medical students, such as the Student National Medical Association, the Latino Medical Student Association, and the American Medical Women’s Association. Involvement in these societies will increase exposure to OTO by UMG students and improve their chances for pursuing the specialty for residency. However, building workforce diversity is not solely the responsibility of UMG physicians. All OTO physicians, regardless of racial and/or ethnic background, can build skills and find opportunities to provide mentorship. Investing in mentorship may demystify training pathways, facilitate shadowing or research opportunities, and fuel interest within the field.
Financial Incentives to Offset Cost Barriers in Training
Several surgical societies provide scholarships to women and UMG students to increase diversity within the field and offset potential financial barriers associated with medical school. Owing to historic and ongoing structural racism, UMG populations have considerably less wealth than their White counterparts and are also more likely to graduate medical school with more debt.46,47 Scholarship opportunities may be especially important owing to the long delays in entering the workforce in comparison to other training pathways. Given the competitiveness of the field, medical students may face additional costs with subinternships and travel for interviews. Although some societies in OTO provide scholarships for summer research and away rotations, these opportunities are limited in number and funding. Expansion of financial efforts to support conference travel, housing costs, and/or tuition for UMGs may be crucial to increasing access into the field.
Limitations
This cross-sectional study had several limitations. First, data used from this study were collected from the AAMC and ACGME public records. Because these were self-reported variables, they may not include individuals who did not report gender and/or race. Data provided by the AAMC categorized Hispanic or Latino as an ethnicity rather than a race; thus, students who ethnically identify as Hispanic or Latino and identifying as another racial group (ie, Black, White) may affect the total percentages of UMG representation in this study. The AAMC data were limited to US allopathic medical schools and lacked inclusion of osteopathic, international, and nonsenior medical student graduates. Although these populations are small in surgical specialties, they remain vastly understudied in OTO. Our inclusion of these groups may contribute to an overestimation of representation within these specialties. Finally, an in-depth analysis of the relative makeup of the applicant pool feeding into OTO, GS, and NS was unable to be performed because of the databases used. This may be an additional area of attrition and should be assessed when generating new recruitment strategies.
Conclusion
The findings of this cross-sectional study suggest that representation of female, Black, and Latino trainees in GS, NS, and OTO during the past 10 years has made modest progress, with increases of diversity in several specialties. The comparisons of medical student pipelines illustrated that women and Black trainees remain underrepresented. These findings highlight the need for the continued support of women and minority trainees while fostering new initiatives to increase diversity.
eTable. Percentage of Minority Demographics Over 10 Years
Data Sharing Statement
References
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Associated Data
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Supplementary Materials
eTable. Percentage of Minority Demographics Over 10 Years
Data Sharing Statement