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

Abstract

To the Editor, We read a recent report by Rahman et al. [7] on medical students’ perceptions of diversity in orthopaedic residency and surgery with great interest. The authors suggest that underrepresentation and underappreciation of women in orthopaedics is deeply rooted and perpetuated by residency programs, orthopaedic organizations, and medical schools, as demonstrated by the consistently low number of women applicants. No specialty has a lower percentage of women than does orthopaedics; the most recent data suggest that within the United States, the distribution of orthopaedic surgeons ranges from 0% to 15% [2]. Similar results have been observed in Canada over a 25-year period, with only 24.9% of applicants in orthopaedics being women [5]. Barriers that women in orthopaedic surgery experience likely are compounded by a system that fails to adequately address systemic gender bias. Women with intersectional identities (for example, women from racial/ethnic minority groups) are likely to confront additional discrimination. As a fundamental step, systemic gender bias and racism need to be addressed through system-level changes that include, but are not limited to, increased mentorship, sponsorship, and career development programs for women to further attract them to the field [4]. Prior studies have highlighted how applicants who are women are just as likely to match into orthopaedic surgery as their counterparts who are men [6]; unfortunately, not enough women are applying for the residency. The marked gender disparities in the specialty therefore suggest that an important factor to consider is recruiting women earlier throughout medical school. As Rahman et al. [7] highlight, the intentional recruitment and support of women medical students, particularly women with intersectional identities, into orthopaedic rotations may be one avenue that supports change. When women are able to view firsthand the level of diversity in orthopaedic surgery that medical organizations strive for, they expand their perception of what is possible. Unfortunately, the “predominantly male nature of the field” [1] and a lack of acceptance by senior faculty are reasonable deterrents to women with an interest in the field [3]. Since gaps have not closed on their own, leaders at the top will have to take specific steps to change the culture of medical school and residency programs and promote greater diversity and inclusion. The benefits of a more diverse physician workforce are well documented and range from improved quality of care to reduced disparities among underserved populations [7]. As rotations have the largest influence on specialty choice among students, women in medical schools need to be participating in orthopaedic rotations or other musculoskeletal curricula more frequently [7]. One way to address this is by including orthopaedics as a core rotation during the clinical years of medical school. For organizations that have already implemented rotations, it is critical to ask: How well are women who take these rotations mentored and encouraged to advance in the field, and is there an opportunity to offer further support? Medical students across the gender spectrum may not have the same experience during an orthopaedic rotation [7]; therefore, an increase in women participants may be a necessary, but insufficient, factor for recruitment into the specialty. Support and exposure are both needed for women to advance in the field. In a society that is increasingly becoming more heterogenous and dependent on its healthcare institutions, the time is now to commit much-needed resources to overcoming insufficient exposure and mentorship for women in orthopaedic surgery.