Reply to the Letter to the Editor: How Do Medical Students Perceive Diversity in Orthopaedic Surgery, and How Do Their Perceptions Change After an Orthopaedic Clinical Rotation?

To the Editor,

We appreciate the comments from Aggarwal et al. on our recent study exploring medical student perceptions of diversity and inclusion in orthopaedics [8]. We would like to clarify that our study does not directly evaluate “underrepresentation and underappreciation of women in orthopaedics” and where these things may be perpetuated, as your letter suggests. Rather, we explore how students of multiple underrepresented backgrounds perceive diversity in the field and what the role of a clinical rotation may be in changing these perceptions.

Still, we agree that substantial steps need to be taken to remedy the gaps in diversity that exist and that previous reports and studies have demonstrated in terms of gender and race/ethnicity [1-3, 6]. To this end, our study was motivated by a desire to understand what medical students’ perceptions of the field were and whether increased exposure to the field might be one way to improve any negative perceptions. Based on our findings, we theorize that clinical rotations may serve as a way to encourage a more diverse applicant pool. Furthermore, we agree that it is important to identify the relevant stakeholders who may be positioned to enact the appropriate changes. This includes but is not limited to medical schools, residency programs, and the broader organizations in medical education.

As Aggarwal et al. aptly point out, not all students will have the same experience during an orthopaedic rotation. While we saw the rotation as having a positive impact on perceptions of diversity in the field on average among students, this certainly will not be the case for everyone. For this reason and others, a clinical rotation is but one of many strategies that will need to be employed to address lack of diversity. Other areas to focus on include the resident selection process [7], diversity of faculty in the department, structured and informal mentorship [5], and ensuring an inclusive environment [4].

We also thank the authors for highlighting the added challenges that individuals with intersectional identities may face. While our study did not have the sufficient sample size to explore this population, future research should seek to understand this experience, as well as the experience of sexual orientation minorities in the field.

We are glad that our study has garnered your interest and enthusiasm, and we look forward to the important work that can be accomplished on this topic moving forward. Thank you for your time in sharing your thoughts and support.