Advertisement
The American Journal of Surgery
Advanced searchSave search
Original Research Article|Articles in Press

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
    Search for articles by this author
  • 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
    Search for articles by this author
  • 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
    Search for articles by this author
  • 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
    Search for articles by this author
  • Ronan O'Beirne
    Affiliations
    Office of Continuing Medical Education, University of Alabama at Birmingham Marnix E. Heersink School of Medicine, Birmingham, AL, USA
    Search for articles by this author
  • Colin Martin
    Affiliations
    Division of Pediatric Surgery, Department of Surgery, University of Alabama at Birmingham Marnix E. Heersink School of Medicine, Birmingham, AL, USA
    Search for articles by this author
  • 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
    Search for articles by this author
  • 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
Barriers and facilitators for under-represented in medicine (URiM) medical students interested in surgical sub-specialties
Previous ArticlePediatric primary hyperparathyroidism: Surgical pathology and long-term outcomes in sporadic and familial cases
Next ArticleThe pathogenesis of appendicitis in 2022: More than just a fecalith

      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

      Image 1
      Graphical Abstract

      Abbreviations:

      URiM (underrepresented in medicine)
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to The American Journal of Surgery
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Register: Create an account
      Institutional Access: Sign in to ScienceDirect

      References

        • Andriole D.A.
        • Jeffe D.B.
        • Schechtman K.B.
        Is surgical workforce diversity increasing?.
        J Am Coll Surg. 2007 Mar; 204 (PubMed PMID: 17324784): 469-477
        View in Article
        • Butler P.D.
        • Longaker M.T.
        • Britt L.D.
        Major deficit in the number of underrepresented minority academic surgeons persists.
        Ann Surg. 2008 Nov; 248 (PubMed PMID: 18948795): 704-711
        View in Article
        • Julien J.S.
        • Lang R.
        • Brown T.N.
        • et al.
        Minority underrepresentation in academia: factors impacting careers of surgery residents.
        J Racial Ethn Health Disparities. 2014 Dec 1; 1 (PubMed PMID: 25396113. Pubmed Central PMCID: PMC4226069): 238-246
        View in Article
        • Komaromy M.
        • Grumbach K.
        • Drake M.
        • et al.
        The role of black and Hispanic physicians in providing health care for underserved populations.
        N Engl J Med. 1996 May 16; 334 (PubMed PMID: 8609949): 1305-1310
        View in Article
        • Choinski K.
        • Lipsitz E.
        • Indes J.
        • et al.
        Trends in sex and racial/ethnic diversity in applicants to surgery residency and fellowship programs.
        JAMA Surg. 2020 Aug 1; 155 (PubMed PMID: 32459323. Pubmed Central PMCID: PMC7254440): 778-781
        View in Article
        • Freeman B.K.
        • Landry A.
        • Trevino R.
        • et al.
        Understanding the leaky pipeline: perceived barriers to pursuing a career in medicine or dentistry among underrepresented-in-medicine undergraduate students.
        Acad Med. 2016 Jul; 91 (PubMed PMID: 26650673): 987-993
        View in Article
        • Marrast L.M.
        • Zallman L.
        • Woolhandler S.
        • et al.
        Minority physicians' role in the care of underserved patients: diversifying the physician workforce may be key in addressing health disparities.
        JAMA Intern Med. 2014 Feb 1; 174 (PubMed PMID: 24378807): 289-291
        View in Article
        • Roberts S.E.
        • Shea J.A.
        • Sellers M.
        • et al.
        Pursing a career in academic surgery among African American medical students.
        Am J Surg. 2020 Apr; 219 (PubMed PMID: 31470975. Epub 20190817): 598-603
        View in Article
        • Sánchez J.P.
        • Peters L.
        • Lee-Rey E.
        • et al.
        Racial and ethnic minority medical students' perceptions of and interest in careers in academic medicine.
        Acad Med. 2013 Sep; 88 (PubMed PMID: 23887018): 1299-1307
        View in Article
        • Ulloa J.G.
        • Viramontes O.
        • Ryan G.
        • et al.
        Perceptual and structural facilitators and barriers to becoming a surgeon: a qualitative study of african American and Latino surgeons.
        Acad Med. 2018 Sep; 93 (PubMed PMID: 29742613. Pubmed Central PMCID: PMC6113077): 1326-1334
        View in Article
        • Driesen A.
        • Romero Arenas M.A.
        • Arora T.K.
        • et al.
        Do general surgery residency program websites feature diversity?.
        J Surg Educ. 2020 Nov-Dec; 77 (PubMed PMID: 32600889. Epub 20200627): e110-e115
        View in Article
        • Jarman B.T.
        • Borgert A.J.
        • Kallies K.J.
        • et al.
        Underrepresented minorities in general surgery residency: analysis of interviewed applicants, residents, and core teaching faculty.
        J Am Coll Surg. 2020 Jul; 231 (PubMed PMID: 32156654. Epub 20200307): 54-58
        View in Article
        • Yuce T.K.
        • Turner P.L.
        • Glass C.
        • et al.
        National evaluation of racial/ethnic discrimination in US surgical residency programs.
        JAMA Surg. 2020 Jun 1; 155 (PubMed PMID: 32293655. Pubmed Central PMCID: PMC7160741): 526-528
        View in Article
        • National Resident Matching Program
        Charting Outcomes in the Match.
        Washington D. National Resident Matching Program, 2019 (Available from:)
        http://www.nrmp.org
        Date accessed: June 20, 2022
        View in Article
        • Peña A.
        • Estrada C.A.
        • Soniat D.
        • et al.
        Nominal group technique: a brainstorming tool for identifying areas to improve pain management in hospitalized patients.
        J Hosp Med. 2012 May-Jun; 7 (PubMed PMID: 22190453. Epub 20111221): 416-420
        View in Article
        • Weiland G.
        • Cox K.
        • Sweeney M.K.
        • et al.
        What attracts medical students to primary care? A nominal group evaluation.
        South Med J. 2019 Feb; 112 (PubMed PMID: 30708369): 76-82
        View in Article
        • Association of American Colleges (AAMC)
        Medical education fg. Medical education, facts glossary.
        (Available from:)
        https://www.aamc.org/data-reports/students-residents/interactive-data/facts-glossary
        Date accessed: June 3, 2022
        View in Article
        • Crenshaw K.
        • Shewchuk Rm Fau
        • Qu H.
        • Qu H Fau
        • Staton L.J.
        • et al.
        What should we include in a cultural competence curriculum? An emerging formative evaluation process to foster curriculum development.
        Acad Med. 2011; 86: 333-341
        View in Article
        • Schmidt L.E.
        • Cooper C.A.
        • Guo W.A.
        Factors influencing US medical students' decision to pursue surgery.
        J Surg Res. 2016 Jun 1; 203 (PubMed PMID: 27338536. Epub 20160331): 64-74
        View in Article
        • Lindeman B.M.
        • Lipsett Pa Fau
        • Alseidi A.
        • Alseidi A Fau
        • Lidor A.O.
        • Lidor A.O.
        Medical student subinternships in surgery: characterization and needs assessment.
        Am J Surg. 2013; 205: 175-181
        View in Article
        • Chau M.
        • Aziz F.
        Factors affecting the interest in a surgical career among medical students at a Nonurban, tertiary care academic institution.
        Ann Vasc Surg. 2020 Oct; 68 (PubMed PMID: 32569816. Epub 20200620): 57-66
        View in Article
        • Dai J.C.
        • Agochukwu-Mmonu N.
        • Hittelman A.B.
        Strategies for attracting women and underrepresented minorities in urology.
        Curr Urol Rep. 2019 Sep 2; 20 (PubMed PMID: 31478091. Epub 20190902): 61
        View in Article
        • Diatta F.
        • Mellia J.A.
        • Morris M.P.
        • et al.
        Closing the gap: training experiences and career outcomes for underrepresented minorities in plastic surgery.
        Plast Reconstr Surg Glob Open. 2022 May; 10 (PubMed PMID: 35539296. Pubmed Central PMCID: PMC9076446. Epub 20220506)e4300
        View in Article
        • Baker S.
        • Gleason F.
        • Lovasik B.
        • et al.
        Relationship between burnout and mistreatment: who plays a role?.
        Am J Surg. 2021 Dec; 222 (PubMed PMID: 34325910. Epub 20210722): 1060-1065
        View in Article
        • Gleason F.
        • Malone E.
        • Wood L.
        • et al.
        The job demands-resources model as a framework to identify factors associated with burnout in surgical residents.
        J Surg Res. 2020 Mar; 247 (PubMed PMID: 31785888. Epub 20191127): 121-127
        View in Article
        • Mullins C.H.
        • Gleason F.
        • Wood T.
        • et al.
        Do internal or external characteristics more reliably predict burnout in resident physicians: a multi-institutional study.
        J Surg Educ. 2020 Nov-Dec; 77 (PubMed PMID: 33077415. Epub 20201017): e86-e93
        View in Article
        • Theiss L.M.
        • Prather J.C.
        • Porterfield J.R.
        • et al.
        Prevalence, bias, and rank list impact of illegal questions in surgical specialty residency interviews.
        J Surg Educ. 2022 Jan-Feb; 79 (PubMed PMID: 34400121. Epub 20210813): 69-76
        View in Article
        • Williams K.E.
        • Baskin M.L.
        • Brito A.L.
        • et al.
        Supporting trainees by addressing inappropriate behaviors by patients.
        South Med J. 2021 Feb; 114 (PubMed PMID: 33537793): 111-115
        View in Article
        • Rakestraw S.L.
        • Chen H.
        • Corey B.
        • Sutzko D.C.
        Closing the gap: increasing female representation in surgical leadership.
        Am J Surg. 2022 Feb; 223 (PubMed PMID: 33827754. Epub 20210326): 273-275
        View in Article

      Article info

      Publication history

      Published online: October 14, 2022
      Accepted: October 11, 2022
      Received in revised form: September 7, 2022
      Received: August 7, 2022

      Publication stage

      In Press Journal Pre-Proof

      Identification

      DOI: https://doi.org/10.1016/j.amjsurg.2022.10.020

      Copyright

      Published by Elsevier Inc.

      ScienceDirect

      Access this article on ScienceDirect
      We use cookies to help provide and enhance our service and tailor content. To update your cookie settings, please visit the for this site.
      Copyright © 2023 Elsevier Inc. except certain content provided by third parties. The content on this site is intended for healthcare professionals.


      RELX