PURPOSE: The paucity of underrepresented in medicine (URiM) plastic surgeons is well recognized; Black and Hispanic individuals comprise 3.6% and 5.7% of the workforce, compared to 12% and 15% of the population, respectively.(1,2) Despite recognition of this discrepancy, the racial and ethnic composition of trainees has not changed significantly over the past several decades.(3) To investigate this inconsistency, we performed a qualitative study aimed at gaining deeper insights into how residency program directors (PDs) perceive the importance of racial and ethnic diversity in training. Our primary outcome included identification of PD views and deliberate initiatives around the recruitment of URiM residents.
METHODS: Integrated plastic surgery residency PDs and assistant PDs were invited to participate in individual semi-structured interviews. Interview questions focused on applicant selection for interview, interview day, and strategies to improve resident diversity. Interviews were deidentified, transcribed, and analyzed inductively to generate themes based on patterns observed across narratives.
RESULTS: In this ongoing study, we have interviewed eight PDs, all from university-based programs in the West (n=2), Midwest (n=2), and Northeast (n=4) regions of the US. We identified three key themes: 1) Creating Exposure and Mentorship Opportunities for URiM Candidates, 2) Unique Qualities and Contribution of URiM Candidates, and 3) Building a Culture of Inclusion and Acceptance of URiM Candidates. With respect to theme one, PDs describe how the disproportionately low number of URiM plastic surgery residents is a pipeline issue that originates well before medical school. There is a consensus among PDs that intentional exposure and mentorship efforts are necessary to facilitate early recruitment to the specialty and residency preparation. Regarding theme two, PDs overwhelmingly agree that scholastic achievements be retained while enhancing diversity. In other words, equity and excellence can be achieved simultaneously. Additionally, attributes such as grit, distance-travelled, and leadership warrant consistent consideration. Furthermore, PDs recognize that diversity is important for patient care and innovation, and it is possible that the unique qualities that URiM candidates can offer are not captured in current application processes. Finally, related to theme three, PDs consistently acknowledge that explicit commitment to a culture of diversity and inclusion is important to attract and maintain URiM candidates in their programs. They understand that the presence of multiple URiM residents in a program is a poignant indication of a welcoming culture, while the presence of one or no URiM residents may raise concern for tokenism.
CONCLUSIONS: We identified several themes critical to the recruitment and retention of URiM trainees to plastic surgery residency. Early exposure and mentorship, including funded research opportunities, could facilitate preparation for the competitive residency application process. Program-specific and institution-wide efforts are both necessary to demonstrate support for diversity and inclusion. Additional initiatives are needed to generate interest among URiM students, enhance review of applications, and adopt innovative recruitment strategies to support diversity, equity, and inclusion in plastic surgery residencies.
REFERENCES:
1. Butler PD, Britt LD, Longaker MT. Ethnic Diversity Remains Scarce in Academic Plastic and Reconstructive Surgery. Plast Recontr Surg 2009; 123: 1618-1627.
2. Chawla S, Chawla A, Hassain M, et al. The State of Diversity in Academic Plastic Surgery Across North America. Plast Reconstr Surg Glob Open 2021; e3928
3. Santosa KB, Preist CR, Oliver JD, et al. Influence of faculty diversity on resident diversity across surgical subspecialties. Am J Surg. 2022; 224:273-281.