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Barriers and facilitators for under-represented in medicine (URiM) medical students interested in surgical sub-specialties

  • Author Footnotes
    1 Soto and Lewis performed equal work and are considered first authors.
    Edgar Soto
    Footnotes
    1 Soto and Lewis performed equal work and are considered first authors.
    Affiliations
    University of Alabama at Birmingham Marnix E. Heersink School of Medicine, Birmingham, AL, USA
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  • Author Footnotes
    1 Soto and Lewis performed equal work and are considered first authors.
    Marshall Lewis
    Footnotes
    1 Soto and Lewis performed equal work and are considered first authors.
    Affiliations
    University of Alabama at Birmingham Marnix E. Heersink School of Medicine, Birmingham, AL, USA
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  • Carlos A. Estrada
    Correspondence
    Corresponding author. BDB 420. 1808 7th Avenue South, Birmingham, AL, 35233, USA.
    Affiliations
    Division of General Internal Medicine, Department of Medicine, University of Alabama at Birmingham Marnix E. Heersink School of Medicine, Birmingham, AL, USA

    Birmingham Veterans Affairs Medical Center, Birmingham, AL, USA
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  • Jorge I. de la Torre
    Affiliations
    Birmingham Veterans Affairs Medical Center, Birmingham, AL, USA

    Division of Plastic Surgery, Department of Surgery, University of Alabama at Birmingham Marnix E. Heersink School of Medicine, Birmingham, AL, USA
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  • Ronan O'Beirne
    Affiliations
    Office of Continuing Medical Education, University of Alabama at Birmingham Marnix E. Heersink School of Medicine, Birmingham, AL, USA
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  • Colin Martin
    Affiliations
    Division of Pediatric Surgery, Department of Surgery, University of Alabama at Birmingham Marnix E. Heersink School of Medicine, Birmingham, AL, USA
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  • Britney Corey
    Affiliations
    Birmingham Veterans Affairs Medical Center, Birmingham, AL, USA

    Division of Gastrointestinal Surgery, Department of Surgery, University of Alabama at Birmingham Marnix E. Heersink School of Medicine, Birmingham, AL, USA
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  • Author Footnotes
    1 Soto and Lewis performed equal work and are considered first authors.
Published:October 14, 2022DOI:https://doi.org/10.1016/j.amjsurg.2022.10.020

      Highlights

      • We interviewed 17 under-represented medical students about factors associated with going into surgery.
      • Mentorship, demonstrating grit, and a sense of community are important positive experiences.
      • Minority experience included micro-aggressions, lack of mentorship and representation, low confidence, and feeling invisible
      • Minority experience, toxic environment, and self-worth must be addressed to increase diversity, equity, and inclusion.

      Abstract

      Background

      Little is known on drivers and detractors underrepresented in medicine (URiM) medical students face.

      Methods

      Using the nominal group technique (NGT), we explored experiences that strengthen or weaken the enthusiasm to pursue a career in surgery among URiM medical students (October 2021–April 2022); participants voted on the three most important experiences (weight of 3 = top rated, = 1 for the lowest rated). Responses from NGT with at least one vote were weighted, ranked, and categorized.

      Results

      Seventeen students participated. Experiences that strengthen enthusiasm (36 responses with at least one vote) involved mentorship and role models (weighted sum percentage, 35%), demonstrating grit (15%), lifestyle (15%), patient interactions (14%), technical skills (11%), community and team (10%), and intellectual stimulation (1%). Experiences that weaken enthusiasm (33 responses with at least one vote) include the minority experience (weighted sum percentage, 51%), quality of life (25%), toxic environment (13%), lack of information (7%), and finances (5%).

      Conclusions

      Mentorship, demonstrating grit, and feeling a sense of community were important positive experiences or attitudes. The minority experience, toxic environment, perceptions of self-worth, and lifestyle misconceptions perceived by URiM must be addressed to increase diversity, equity, and inclusion.

      Graphical abstract

      Abbreviations:

      URiM (underrepresented in medicine)
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