Abstract
Representation of female surgical residents has slowly increased, but underrepresented in medicine (URiM) representation remains disappointingly low. National residency matching reports suggest that meaningful research experience improves surgical residency match success - therefore, formal funding opportunities and early mentorship for URiM medical students. In this study, we catalog medical student (MS) funding opportunities (funding type, eligibility by year, mission, compensation, length of commitment, number of awardees, and dollar investment amount per student) from 7 surgical departments (general surgery, thoracic surgery, vascular surgery, plastic surgery, otorhinolaryngology, orthopedic surgery, neurosurgery) within 196 US medical schools and 20 professional surgical educational organizations through manually searching web pages. We recorded 146 surgical funding opportunities from medical school surgical departments and 16 surgical funding opportunities from professional organizations. Overall, we find that medical institutions' surgical departments and professional surgical educational organizations may not be effectively utilizing recruitment strategies in MS funding opportunities.
Keywords: Cultural diversity, Funding, Medical students, Research, Residency and internship, Surgery subspecialities
Introduction
Improving the diversity of the surgical workforce is associated with better patient outcomes [1]. Although diversity has improved over the years with more women entering surgical subspecialties, there remains a need for further efforts as the proportion of underrepresented in medicine (URM) surgical residents has been steady [2]. National reports suggest a strong emphasis on research output to improve surgical residency match success. Coupled with strong correlation between early mentorship and funding opportunities, there is a need for early formalized funding opportunities for URM applicants to improve diversity in the surgical workforce [3]. Cataloging medical student (MS) funding opportunities can guide educators in addressing the gaps in early surgical mentorship aimed at improving surgical workforce diversity and implement new programs and opportunities for URM students interested in surgical subspecialties.
Methods
Using AAMC's 2022 Medical School Members database, we manually searched US medical school (allopathic n = 155; osteopathic n = 42). Similarly, using the American Board for each surgical specialty, we searched associated professional surgical educational organization (n = 20) webpages for MS funding opportunities (types: research, travel award, clerkship, recognition, mentorship) until 12/01/2022. We captured secondary data related to eligibility by year, mission, compensation, length of commitment, number of awardees, and dollar investment amount per student. Overall, we explored 7 surgical departments (general, thoracic, vascular, plastic, otorhinolaryngology (ENT), orthopedic, and neurosurgery). Unrestricted funding opportunities and incomplete data (<6 %) were excluded. This study followed SRQR guidelines and was IRB-exempt due to public data use.
Results
Medical school opportunities
In total, we inventoried 146 funding opportunities from 7 surgical departments for each of the 196 medical schools (Table 1). Funding was most common in general surgery (39.3 %; n = 70), orthopedic surgery (22.5 %; n = 40) and ENT (21.3 %; n = 38). Most funding was intended to cover research (56.5 %; n = 146), and fewer addressed clerkship expenses (14.4 %; n = 16), academic recognition (14.1 %; n = 24) and conference travel costs (12.9 %; n = 22). Most opportunities were offered to MS4s (30 %; n = 92) with an average of 3+ students typically selected (40.9 %; n = 76). More mission-based funding aimed to bolster URiM representation (43.5 %; n = 74) vs. gender (12.9 %; n = 22). Most funding sponsored ≥1 month of research (71.1 %; n = 104) with general surgery (40.0 %; n = 28) and ENT (42.1 %; n = 16) favoring ≥3 month commitments. Monetarily, $2000+ compensations (32.2 %; n = 56) were popular, and surgical departments invested an average $2260.2 (n = 146) per student in funding with neurosurgery ($2750; n = 14) trending as the highest.
Table 1.
Inventory of MS surgical funding opportunities from medical schools.
| Medical School Surgical Departments |
||||||||
|---|---|---|---|---|---|---|---|---|
| TOTAL | General Surgery | Neurosurgery | Orthopedic Surgery | Otolaryngology | Plastic Surgery | Thoracic Surgery | Vascular Surgery | |
| Number of medical schools | 196 | 196 | 196 | 196 | 196 | 196 | 196 | 196 |
| Number of funding opportunities | 178 | 70 | 14 | 40 | 38 | 8 | 4 | 4 |
| 2021 NMRP Match to gauge student surgical interest (Senior applicants/positions) | 4113/3333 | 1872/1569 | 283/234 | 1106/868 | 391/350 | 259/187 | 95/46 | 107/79 |
| Funding type | ||||||||
| Research | 56.5 % | 48.6 % | 57.1 | 75.0 % | 57.9 % | 25.0 % | 50.0 % | 25.0 % |
| Travel Award | 12.9 % | 22.9 % | 0.0 % | 10.0 % | 5.3 % | 0.0 % | 25.0 % | 50.0 % |
| Clerkship | 14.4 % | 10.7 % | 33.6 % | 15.0 % | 10.3 % | 30.0 % | 25.0 % | 0.0 % |
| Recognition | 14.1 % | 20.0 % | 14.3 % | 5.0 % | 10.5 % | 25.0 % | 0.0 % | 0.0 % |
| Mentorship | 1.2 % | 0.0 % | 0.0 % | 0.0 % | 5.3 % | 0.0 % | 0.0 % | 0.0 % |
| Unknown | 5.9 % | 2.8 % | 0.0 % | 0.0 % | 15.7 % | 25.0 % | 0.0 % | 25.0 % |
| Eligibility by year (MS) | ||||||||
| Y1 | 19.9 % | 22.4 % | 30.8 % | 17.6 % | 10.3 % | 25.0 % | 0.0 % | 20.0 % |
| Y2 | 22.1 % | 22.4 % | 15.4 % | 29.4 % | 20.7 % | 25.0 % | 25.0 % | 20.0 % |
| Y3 | 19.9 % | 21.1 % | 15.4 % | 20.6 % | 20.7 % | 0.0 % | 50.0 % | 20.0 % |
| Y4+ | 30.0 % | 30.2 % | 30.8 % | 26.5 % | 31.1 % | 25.0 % | 25.0 % | 20.0 % |
| LOA | 7.1 % | 3.9 % | 7.6 % | 5.9 % | 17.2 % | 0.0 % | 0.0 % | 20.0 % |
| Unknown | 1.0 % | 0.0 % | 0.0 % | 0.0 % | 0.0 % | 25.0 % | 0.0 % | 0.0 % |
| Eligibility by mission | ||||||||
| Gender | 12.9 % | 17.1 % | 0.0 % | 25.0 % | 0.0 % | 0.0 % | 25.0 % | 0.0 % |
| URM | 43.5 % | 31.4 % | 71.4 % | 45.0 % | 47.4 % | 75.0 % | 0.0 % | 0.0 % |
| Other | 9.4 % | 8.6 % | 14.3 % | 15.0 % | 5.2 % | 0.0 % | 25.0 % | 0.0 % |
| Unknown | 34.2 % | 42.9 % | 14.3 % | 15.0 % | 47.4 % | 25.0 % | 50.0 % | 100.0 % |
| Compensation ($USD) | ||||||||
| 0–500 | 5.7 % | 2.9 % | 14.3 % | 8.7 % | 0.0 % | 25.0 % | 25.0 % | 25.0 % |
| 501–1000 | 8.0 % | 14.3 % | 0.0 % | 8.7 % | 5.3 % | 0.0 % | 0.0 % | 25.0 % |
| 1001–2000 | 5.7 % | 2.9 % | 0.0 % | 4.3 % | 10.5 % | 25.0 % | 25.0 % | 25.0 % |
| 2001–5000 | 16.1 % | 25.7 % | 28.6 % | 4.3 % | 10.5 % | 0.0 % | 50.0 % | 0.0 % |
| 5001+ | 16.1 % | 17.1 % | 14.3 % | 8.7 % | 26.3 % | 0.0 % | 0.0 % | 0.0 % |
| Unknown | 48.4 % | 37.1 % | 42.8 % | 65.2 % | 47.4 % | 50.0 % | 0.0 % | 25.0 % |
| Length of commitment (month) | ||||||||
| 1 | 15.3 % | 11.4 % | 28.6 % | 15.0 % | 15.8 % | 25.0 % | 0.0 % | 25.0 % |
| 1–3 | 28.3 % | 34.3 % | 42.8 % | 30.0 % | 10.5 % | 25.0 % | 75.0 % | 25.0 % |
| 3+ | 32.9 % | 40.0 % | 28.6 % | 15.0 % | 42.1 % | 25.0 % | 25.0 % | 25.0 % |
| Unknown | 23.5 % | 14.3 % | 0.0 % | 40.0 % | 31.6 % | 25.0 % | 0.0 % | 25.0 % |
| Number of awardees | ||||||||
| 1 | 14.0 % | 18.6 % | 28.6 % | 5.0 % | 5.3 % | 25.0 % | 50.0 % | 25.0 % |
| 2–3 | 7.5 % | 9.3 % | 0.0 % | 10.0 % | 5.3 % | 0.0 % | 0.0 % | 0.0 % |
| 3+ | 40.9 % | 46.5 % | 42.8 % | 35.0 % | 36.8 % | 25.0 % | 25.0 % | 25.0 % |
| Unknown | 37.6 % | 25.6 % | 28.6 % | 50.0 % | 52.6 % | 50.0 % | 25.0 % | 50.0 % |
| USD Investment per | $2260.2 | $2328.6 | $2750.0 | $2333.3 | $2388.9 | $1500.0 | $1650.0 | $1412.5 |
| Organizations per student | (1857.2- | (2190.4- | (2281.6–3218.4) | (2183.5- | (2199.4–2578.5) | (727.5- | (471.9- | (683.1- |
| (95 % CI) | 2662.8) | 2465.6) | 2483.1) | 2272.5) | 2828.0) | 2141.9) | ||
Professional organization opportunities
We identified sixteen funding opportunities from 20 professional organizations each representing a surgical field (Table 2). Most funding covered research (46.7 %; n = 7), although general surgery (25.0 %; n = 2) and neurosurgery (25.0 %; n = 2) also offered travel awards, and orthopedic surgery (33.3 %; n = 1) and ENT (33.3 %; n = 1) sponsored mentorship awards. Overall, opportunities were offered with equal frequency to all MS years. General surgery (50.0 %; n = 2) and neurosurgery (50.0 %; n = 2) typically awarded 1 student, while general surgery (50.0 %; n = 2), orthopedic surgery (66.7 %; n = 2) and ENT (100 %; n = 3) commonly awarded ≥3 students. More mission-based funding aimed to improve URiM representation (37.5 %; n = 6) vs. gender (25.0 %; n = 4), similar to medical schools. We observed no commitment duration difference across specialties. Across opportunities, compensation typically ranged from $0–500 (46.7 %; n = 7) to $501–1000 (20.0 %; n = 3), and professional surgical organizations invested an average $885.35 (n = 26) per student in funding.
Table 2.
Inventory of MS surgical funding opportunities from professional surgical organizations.
| Professional surgical educational organizations |
||||||||
|---|---|---|---|---|---|---|---|---|
| TOTAL | General surgery | Neurosurgery | Orthopedic surgery | Otolaryngology | Plastic surgery | Thoracic surgery | Vascular surgery | |
| Number of organizations | 20 | 5 | 4 | 5 | 1 | 2 | 2 | 1 |
| Number of funding opportunities | 26 | 4 | 4 | 3 | 3 | 0 | 1 | 1 |
| 2021 NMRP main residency match to gauge student surgical interest (senior applicants / positions offered) | 4113/3333 | 1872/1569 | 283/234 | 1106/868 | 391/350 | 259/187 | 95/46 | 107/79 |
| Funding type | ||||||||
| Research | 46.7 % | 50.0 % | 50.0 % | 33.3 % | 33.3 % | 0.0 % | 100.0 % | 100.0 % |
| Travel Award | 20.0 % | 25.0 % | 25.0 % | 0.0 % | 33.3 % | 0.0 % | 0.0 % | 0.0 % |
| Clerkship | 6.7 % | 25.0 % | 0.0 % | 0.0 % | 0.0 % | 0.0 % | 0.0 % | 0.0 % |
| Recognition | 6.7 % | 0.0 % | 25.0 % | 0.0 % | 0.0 % | 0.0 % | 0.0 % | 0.0 % |
| Mentorship | 13.3 % | 0.0 % | 0.0 % | 33.3 % | 33.3 % | 0.0 % | 0.0 % | 0.0 % |
| Unknown | 6.7 % | 0.0 % | 0.0 % | 33.3 % | 0.0 % | 0.0 % | 0.0 % | 0.0 % |
| Eligibility by year (MS) | ||||||||
| Y1 Y2 Y3 Y4+ LOA Unknown |
21.2 % 19.2 % 19.2 % 21.2 % 17.3 % 1.9 % |
22.2 % 11.1 % 11.1 % 0.0 % 44.4 % 11.1 % 0.0 % |
21.1 % 21.1 % 21.1 % 15.6 % 21.1 % 0.0 % |
28.6 % 14.3 % 14.3 % 14.3 % 14.3 % 14.3 % |
20.0% 20.0 % 20.0 % 20.0 % 20.0 % 0.0 % |
0.0% 0.0 % 0.0 % 0.0 % 0.0 % 0.0 % |
0.0 % 50.0 % 50.0 % 0.0 % 0.0 % 0.0 % |
20.0% 20.0 % 20.0 % 20.0 % 20.0 % 0.0 % |
| Eligibility by mission | ||||||||
| Gender URM Other Unknown |
25.0 % 37.5 % 37.5 % 0.0 % |
40.0 % 40.0 % 20.0 % 0.0 % |
25.0 % 0.0 % 75.0 % 0.0 % |
33.3 % 66.7 % 0.0 % 0.0 % |
0.0 % 33.3 % 66.7 % 0.0 % |
0.0 % 0.0 % 0.0 % 0.0 % |
0.0 % 100.0 % 0.0 % 0.0 % |
33.3 % 33.3 % 33.3 % 0.0 % |
| Compensation ($USD) | ||||||||
| 0–500 501–1000 1001–2000 2001–5000 Unknown |
46.7 % 20.0 % 13.3 % 13.3 % 6.7 % 0.0 % |
50.0 % 25.0 % 25.0 % 0.0 % 0.0 % 0.0 % |
25.0 % 25.0 % 0.0 % 50.0 % 0.0 % 0.0 % |
66.7 % 33.3 % 0.0 % 0.0 % 0.0 % 0.0 % |
66.7 % 33.3 % 0.0 % 0.0 % 0.0 % 0.0 % |
0.0% 0.0 % 0.0 % 0.0 % 0.0 % 0.0 % |
0.0 % 0.0 % 0.0 % 0.0 % 100.0 % 0.0 % |
0.0 % 0.0 % 100.0 % 0.0 % 0.0 % 0.0 % |
| Length of commitment (month) | ||||||||
| 1 1–3 3+ Unknown |
29.4 % 23.6 % 17.6 % 29.4 % |
0.0 % 33.3 % 0.0 % 66.7 % |
25.0 % 25.0 % 50.0 % 0.0 % |
33.3 % 33.3 % 0.0 % 33.3 % |
100.0 % 0.0 % 0.0 % 0.0 % |
0.0 % 0.0 % 0.0 % 0.0 % |
0.0 % 0.0 % 100.0 % 0.0 % |
100.0 % 0.0 % 0.0 % 0.0 % |
| Number of awardees | ||||||||
| 1 2–3 3+ Unknown |
26.7 % 6.7 % 53.3 % 13.3 % |
50.0 % 0.0 % 50.0 % 0.0 % |
50.0 % 25.0 % 25.0 % 0.0 % |
0.0 % 0.0 % 66.7 % 33.3 % |
0.0 % 0.0 % 100.0 % 0.0 % |
0.0 % 0.0 % 0.0 % 0.0 % |
0.0 % 0.0 % 0.0 % 100 % |
0.0 % 0.0 % 100.0 % 0.0 % |
| USD investment per organizations per student (95 % CI) | $885.25 (229.1–1541.4) |
$1250.0 (538.9–1961.0) |
$1625.0 (1025.4–2224.6) |
$166.7 (16.7–317.0) |
$500.0 (170.9–829.1) |
$0.0 (Undefined CI) |
$20,000.0 (Undefined CI) |
$1000.0 (Undefined CI) |
Discussion
Our study suggests funding opportunities that target MSs earlier on in their career, provide for longitudinal research experiences and diversify funding types may improve representation among MSs interested in a surgical career.
Over the past decade, medical school surgical departments have created multiple initiatives to increase diversity in surgery which has led to a rising number of women entering surgery with minimal changes in URM [2]. While mission based funding predominately shows more funding for URM as compared to gender, it remains unclear when these opportunities were established or if a student's socioeconomic status would be considered [4]. With students from disadvantaged backgrounds to be more likely to be cross-cultural, efforts in retaining students could be boostered by providing longer longitudinal research, clerkship travel awards and mentorship opportunities.
The health resources and services administration (HRSA) and professional surgical educational organizations have called to increase the surgical pipeline for diverse trainees in order to mitigate surgical workforce shortages and improve the supply of surgeons practicing in underserved areas [5]. Efforts from professional organizations to increase fundings in conference travel awards and structured cross-culture mentorship earlier on in medical school may positively influence student decision making in surgical career choice. By fostering networking opportunities at conferences, interpersonal bonds in career planning may be forged between students and faculty of different institutions in ameliorating surgical stereotypes and improve surgery experiences [6].
Several limitations should be considered. First, not all websites reported when it was last updated. Websites not reporting MS research opportunities or lack sufficient details of the selection process and funding process does not indicate a lack of funding. Different medical schools and professional surgical organizations may have different announcement practices that may not have been fully captured. Second, our study does not attempt to capture interdisciplinary surgical fields which may limit the generalizability of our findings. Future qualitative outreach to individual medical surgical departments and professional organizations may be warranted.
We find medical institution's surgical departments and professional surgical educational organizations may not be effectively utilizing recruitment strategies in MS funding opportunities. Intentional and thoughtfully constructed funding initiatives should remain a priority at all stages of medical training, and this can only be accomplished through active communication among stakeholders including MSs, educators, and professional surgical educational organizations.
Ethical approval
UCLA South General Campus IRB exempt.
Funding
AANS Young Neurosurgeons Committee MISSION Fellowship (A.W.)
CRediT authorship contribution statement
Andrew Wang - co-first author; study concept and design; drafting of the manuscript; acquisition of data; administrative, technical or material support; analysis and interpretation of data; critical revision of the manuscript.
Keshav Goel - co-first author; study concept and design; drafting of the manuscript; acquisition of data; administrative, technical or material support; analysis and interpretation of data; critical revision of the manuscript.
Timothy Liu - acquisition of data; and critical revision of the manuscript.
Nathan A. Shlobin - acquisition of data; analysis and interpretation of data; and critical revision of the manuscript.
Mandy Liou - acquisition of data; and critical revision of the manuscript.
Jasmine A.T. DiCesare - study concept and design; analysis and interpretation of data; and critical revision of the manuscript.
Oscar J. Hines - co-supervisor; study concept and design; analysis and interpretation of data; and critical revision of the manuscript.
Langston T. Holly - principal investigator; co-supervisor; study concept and design; analysis and interpretation of data; and critical revision of the manuscript.
Declaration of competing interest
None.
Acknowledgements
We are grateful to the AANS Young Neurosurgeons Committee MISSION Fellowship (A.W.) for providing support to the study.
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