Disparities Across the CREOG Districts: Annual Variations of Wellness and Inclusivity Efforts in Obstetrics & Gynecology Residency Websites

Abstract

Over the past few years, CREOG has emphasized improving resident well-being, decreasing physician burnout, and supporting efforts toward inclusivity. This focus has also been shared by various medical specialties and their training programs. The recent emphasis on wellness and inclusivity partly stems from the concern for burnout and higher attrition rates among Underrepresented In Medicine (URIM) learners. However, limited assessment exists of how residency programs have addressed this focus nationally. As virtual interviews have become the ‘current’ standard, timely updates have become critical as websites are an essential resource for residency applicants. As the perceived value of some updates differs by program, an assessment of the inclusivity and wellness variations over the years has been limited, especially across Obstetrics and Gynecology (ObGyn) residency program websites. This study aimed to identify the annual variations in website depictions of wellness and inclusivity across CREOG districts in the past two years, while suggesting optimized platforms to convey the commitment to such efforts. Methods: This study is a cross-sectional analysis of the websites of ACGME-accredited ObGyn residency programs across the United States in April 2022 and again in April 2023. The assessment was based on a compilation of 22 attributes devised by a nine-person focus group and piloted and tested on a 40-person focus group. Six medical students and two residents at Louisiana State University in Shreveport and the University of Toledo conducted the website benchmarking comparison. All cohorts were racially, ethnically, and gender diverse to ensure representative benchmarking. Racial diversity in this study was defined by visual representation as identified by the medical student researcher’s self-perceived report of at least one African-American/Black, Hispanic/Latino, American Indian/Alaska Native, or Native Hawaiian/Pacific Islander faculty member and resident among their colleagues based on publicly-accessible website photographic representation. Gender diversity was defined similarly by visual representation as identified by the medical student researcher’s photo-based self-perceived report of at least one member of a differing gender compared to the majority (a minimum of female and/or one male) within the faculty members and resident class. Percentages were used to compare the data due to the program count discrepancy across both years, as a result of an increase in accredited programs and website accessibility. Results: A total of 560 websites were analyzed. Minimal change in inclusivity sections of websites was noted across the two years, but a reduction in leadership referencing inclusivity (by 30%) and wellness (by 22%) occurred in 2023. Wellness efforts remained unchanged in both years from the standpoint of website investment, dedicated support personnel, and group activities. Wellness support was persistently the highest in District 5, with overall wellness efforts appearing unchanged between the two years across all districts. Similarly, District 5 had the highest DEI referencing with dedicated staff and webpage support across both years. References to holistic reviews were less identified in 2023 (by 7%), while curricula referenced DEI less frequently in their mission statement (by 15%). Similarly, a 14% reduction in DEI-focused research was noted on the websites, with an 8% reduction in resident testimonies to such efforts. District I showed the highest incorporation (32%) and increase (7%) in inclusive pronoun usage between the two years, whereas District 5 had the highest increase in supplementary LGBTQI verbiage (8%) on their website. A 17% increase in the use of inclusive pronouns was noted, whereas a reduction in gender diversity was identified in 9% of faculty and 5% of residents. Similarly, a 6-7% reduction in URIM faculty and residents was noted. Regarding racial representation, District 4 had the highest loss of resident body diversity (21%), whereas District 3 had the highest loss of faculty diversity (22%). Regarding gender diversity, District 1 was impacted by a 30% decline in gender diversity, while District 3 by 23%. Conclusion: This study demonstrates the variations in support across the country and the past two years. With some components of inclusivity being adopted more readily, the hope is that websites ultimately provide an accurate reflection of the investment in resident wellness and equity efforts across all districts.