Demographics Of Residents Research Articles

The Impact of Diversity, Equity, and Inclusion Scholarships for Acting Interns on the Diversity of Orthopaedic Surgery Residency Programs

Background Improving diversity, equity, and inclusion (DEI) in orthopaedic surgery is a priority as statistics continue to demonstrate it as the least diverse surgical subspecialty. DEI scholarships for Acting Interns have been recently developed to recruit more diverse candidates. Objective To determine the impact of DEI scholarships on the orthopaedic surgery residency application process. Design An anonymous survey was distributed to program directors at ACGME accredited orthopaedic residencies that offered DEI scholarships for visiting medical students. The survey inquired about factors involved in scholarship implementation, source of funding, number of scholarship applications received, factors considered in selecting recipients, number of DEI scholarships awarded, program results in the 2023 Match, demographics of incoming first-year residents, and program directors’ observations following implementation. Results Of the 49 programs with known DEI scholarships, 16 (32.7%) completed the survey. During the 2023 Match cycle, respondents matched an average of 5 residents (SD 0.5, Range 3 – 8) consisting of 36.7% female (SD 31.7%, Range 0 – 100%) and 36.9 (SD 28.2%, Range 0 – 100%) underrepresented minority (URM) residents. Following scholarship implementation, most program directors (56.2%) observed a rise in URM student rotators with an associated 18.8% increase in the number of URM residents. Additionally, 18.8% of programs claimed that scholarship recipients either matched at their program or another orthopaedic residency program. Respondents reported that 68.8% (SD 41.5%, Range 0 – 100%) of scholarship recipients received an invitation to interview at the awarding program. Of the three programs (18.8%) that claimed recipients matched at their program, two (13.3%) reported they matched one DEI scholar, while the other (6.7%) stated that five DEI scholars matched into their program. Conclusion DEI scholarships may be an effective strategy for promoting diversity in orthopaedics. However, longitudinal data and increased institutional GME funding are required to increase the proportion of orthopaedic residency programs that offer these scholarships for visiting students.

The incidence of pleural infections in Finland

BackgroundThe incidence of pleural infections appears to be increasing in Western countries for unclear reasons. The aim of the study was to describe the incidence and treatment patterns of pleural infections in Finland over three decades. MethodsData regarding each treatment episode for pleural infections in the Finnish special medical care between January 1994 and December 2016 was obtained from a national database and compared to the demographics of Finnish residents obtained from the national census bureau. The annual incidence rates, type of treatment given, as well as the lengths of the hospitalization were analyzed. ResultsA total of 28,463 episodes were reported, of which 55% were inpatient episodes. Of these, 76% concerned males, and the median age of patients was 60 (interquartile range 49–70) years. The overall incidence of pleural infections was 23.4 per 100.000 patient-years, with a male-to-female -ratio of 3.3:1. The annual incidence rates increased throughout the study period with an average annual percentage change of +11.4% (95% CI ±7.4%). The highest incidence rates (>200 per 100.000 patient-years) were observed in men aged 80 or more. Altogether 88% of patients were treated conservatively. The proportion of patients treated by mini-invasive surgery significantly increased during study period (0–5.9%, p < 0.001) and was associated with shorter hospitalization (median 6 [interquartile range 4–12] days) than open surgery (median 7 [4.5–13] days) (p < 0.001). ConclusionThe incidence of pleural infections has increased significantly over the previous decades in Finland and appears to be higher than previously reported, particularly in elderly men.

Race, Ethnicity, and Sex Representation Trends Among Minimally Invasive Gynecologic Surgery Fellowship Trainees and Graduates

Study ObjectiveTo study the race, ethnicity, and sex representation and annual trends of AAGL FMIGS fellows and graduates. DesignA retrospective cross-sectional study. SettingAAMC databases were queried for demographic information between 2011 and 2023. Patients/subjectsAAGL FMIGS fellows and graduates. InterventionsN/A Measurements and Main ResultsDescriptive statistical analysis and the actual-to-expected (AE) ratio of each race, ethnicity, and sex were performed. AE ratio was calculated by dividing the 13-year average actual percentage of FMIGS trainees and graduates by the expected percentage based demographics of OBGYN residents and the US general population.477 fellows graduated or were in training between 2011 and 2023; race and ethnicity information was obtained for 347 (72.7%) individuals, and sex information was available for 409 (85.7%). Representation of females ranged from 66.7% in 2017 to 93.3% in 2022. There was a significantly increasing slope for the representation of females (+1.3% per year; 95% CI 0.00–0.03; p = .027). Compared to their distribution among US OBGYN residents, White fellows’ representation was lower [AE ratio, 95% CI 0.60 (0.44–0.81)] and of Asian fellows was higher [AE ratio, 95% CI 2.17 (1.47–3.21)]. Female fellows’ representation was lower than expected [AE ratio, 95% CI 0.68 (0.48–0.96)] compared to their distribution among US OBGYN residents.Compared to the general US population, White fellows [AE ratio, 95% CI 0.65 (0.48–0.87)] and Hispanic fellows [AE ratio, 95% CI 0.53 (0.34–0.83)] representation was lower. Asian fellows’ representation was higher compared to the general US population [AE ratio, 95% CI 5.87 (3.48–9.88)]. ConclusionWhite and Hispanic fellows’ representation was lower than expected, while Asian fellows’ representation was higher in AAGL-accredited FMIGS programs. Female representation increased throughout the years, but overall, female fellows’ representation was lower than expected compared to their distribution among OBGYN residents. These findings may help develop equitable recruitment strategies for FMIGS programs and reduce health disparities within complex gynecology.

Spatial and social inequality of hierarchical healthcare accessibility in urban system: A case study in Shanghai, China

Urbanization is intensifying in cities, accompanied by burgeoning inequalities, notably in the healthcare sector. Limited research offers a granular examination of healthcare resource accessibility across diverse population groups. In this study, we employ census data from all 6164 communities in Shanghai to investigate the relationship between multi-scalar spatial dimensions and the socio-economic (dis)advantage of populations concerning healthcare resource accessibility. Distinct from previous studies, this research quantifies social inequality by considering the demographics of community residents and their interactions with healthcare facilities. We elucidate the stratified spatial distribution of healthcare accessibility across various spatial scales in Shanghai, leveraging Web Application Programming Interface (API) technology and examine the pervasive social inequalities across sub-district, district, and the central urban-suburban divide, focusing on specific population subgroups including gender, age, education level, wealth, household registration, ethnicity, occupation, and housing living facilities. Findings reveal that disparities in healthcare accessibility correlate with the quality of healthcare facilities, the socio-spatial attributes of localities, and the socio-economic and demographic profiles of the populations. The insights from this research will aid policymakers in enhancing the distribution and provision of healthcare resources, thereby promoting spatial and social equity in public healthcare system planning and implementation.

Interrogating the Effects of Covid-19 Pandemic on Livelihoods Demographics and Health of Residents of South-East Nigeria

This study focused on the effects of covid-19 pandemic on livelihoods, demographics and health of residents of South-East Nigeria. The study specifically investigated: the effects of covid-19 pandemic on livelihoods; demographic conditions; and health conditions of residents in South-East Nigeria; and how the livelihoods of such residents can be improved. It was hypothesized that “there is a significant relationship between Covid-19 lockdown and increase in fertility among couples; and that there is a significant relationship between Covid-19 pandemic and access to healthcare facilities. A cross-sectional survey design was adopted. Data were collected through questionnaire and FGD. Multi-stage sampling was used to select 865 respondents for quantitative study while 12 FGDs were conducted for the qualitative data. The quantitative data were processed using SPSS Version 20.0 and analyzed using descriptive and inferential statistics. The qualitative data were analyzed with content analysis. The hypotheses were tested using ANOVA to determine the variation between outbreak of COVID-19 and lack of access to healthcare facilities. It was found that the pandemic affected the livelihoods of half of the southeastern Nigeria’s residents, and a majority of them could easily pay their children’s fees before covid-19 than after; fed better before COVID-19 than after; had a better income before COVID-19 than after; were bereaved because of the poverty orchestrated by covid-19; had their movement curtailed; neglected the use of contraceptive; and was healthier before covid-19 than after. There is a significant increase in fertility due to COVID-19 lockdown at p = .012; and a significant difference between outbreak of COVID-19 and lack of access to healthcare facilities at p = .001. This means that excessive lockdowns and work-from-home orchestrated by covid-19 made couples to meet more frequently, thereby resulting in more births given the difficulty in accessing contraceptives and family planning services at that pandemic period. Besides, the lockdowns resulted in the lockup of so many healthcare facilities, and hindered access to healthcare facilities It was therefore recommended that awareness creation about opportunities that Covid-19- orchestrated changes have brought in Southeast should commence without wasting time.

A decade of diversity: using statistical indices to compare neurosurgery to other surgical specialties

OBJECTIVE Studies have demonstrated the benefits of diversity in neurosurgery. However, recruitment of minoritized groups within the neurosurgical workforce consistently lags other surgical specialties. While racial and gender demographics of neurosurgical residents are well documented, there has been minimal exploration into the multidimensional nature of diversity. The current study will evaluate the longitudinal diversity changes in neurosurgery residency programs compared with other surgical fields with validated diversity indices. METHODS Nationwide reports including data about resident physicians were obtained from the American Medical Association and the Association of American Medical Colleges for the academic years 2008–2021. Self-reported race, biological sex, and medical school affiliation were recorded for surgical residents in the 10 commonly recognized surgical fields. The Gini-Simpson Diversity Index was used to calculate the effective counts (ECs) of races, sexes, and medical school types for each field. A Composite Diversity Index (CDI) comprising the aforementioned diversity traits was used to calculate the percentage of characteristics upon which two randomly selected residents within each specialty would differ. CDIs were calculated for each field in every year from 2008 to 2021. Median CDIs were compared between fields using Kruskal-Wallis testing, and p values &lt; 0.05 were deemed statistically significant. RESULTS Plastic surgery had the highest median sex EC (1.92, interquartile range [IQR] 1.78–1.95), indicating greater diversity, while neurosurgery had the third lowest sex EC (1.40, IQR 1.35–1.41). All surgical fields examined had fewer than 3 races effectively represented among their residents, despite there being 8 races present. Neurosurgery ranked among the top fields in effective racial diversity (EC 2.17, IQR 2.09–2.21) and medical school type diversity (EC 1.25, IQR 1.21–1.26). There were statistically significant differences in the sex, race, and school ECs between surgical specialties. While neurosurgery had a relatively low median overall diversity (CDI = 32.7, IQR 32.0–34.6), there was a consistent longitudinal increase in CDI from 2015 to 2021. CONCLUSIONS Neurosurgery resident physicians have become increasingly diverse in the past decade but are more homogenous than residents in other surgical fields. The continued use of diversity indices to more accurately track diversity progress over time may better inform leaders in the field of how they may best focus their equity and inclusion efforts.

Understanding and assessing demographic (in)equity resulting from extreme heat and direct sunlight exposure due to lack of tree canopies in Norfolk, VA using agent-based modeling

Prolonged exposure to extreme heat and direct sunlight can result in illness and death. In urban areas of dense concentrations of pavement, buildings, and other surfaces that absorb and retain heat, harmful environmental exposures to extreme heat and direct sunlight for residents can occur on a daily basis during certain parts of the year. Tree canopies provide shade and help to cool the environment, making mature trees with large canopies a simple and effective way to reduce urban heat and avoid direct sunlight. We develop a demographically representative agent-based model to understand the extent to which different demographics of residents in Norfolk, VA are (in)equitably shaded from direct sunlight and extreme heat conditions during a walk on a clear summer day. In the model each agent represents a different resident of Norfolk, VA. We use the model to assess the extent to which the city’s tree planting plan will be effective in remediating any existing inequities. Our results show that inequitable conditions exist for residents at (1) different education levels, (2) different income levels, and (3) living in different census tracts. Norfolk’s Tree Planting Program effectively reduces the distance residents of all demographics walk in extreme heat and are exposed to direct sunlight. However, residents of the city at lower income levels still experience statistically significantly more extreme heat and direct sunlight exposure due to a lack of tree canopies in summer months than those at higher income levels.

Using a Multidimensional Statistical Approach to Evaluate Diversity Trends Among U.S. Neurology Residents Between 2008–2020 (S13.001)

<h3>Objective:</h3> To develop a multidimensional statistical model to quantify diversity within neurology residency. <h3>Background:</h3> Studies have demonstrated the benefits of diversity in medicine. However, recruitment and retention within neurology consistently lags behind other medical specialties. While demographics of neurology graduates has been studied, no statistical models exist to objectively assess diversity among graduates entering into the neurological workforce. <h3>Design/Methods:</h3> Demographics of neurology residents between 2008–2020 across 3 categories (sex, medical school affiliation, race/ethnicity) was measured. Within each category, <i>μ</i> (the probability that two randomly individuals represent a different sex, medical school affiliation [US MD, DO, IMG, or Canadian], or race/ethnicity), and true diversity, <i>D</i> (the effective number of equally populated categories per variable), were calculated. All 3 categories were combined using the Sullivan composite diversity index (CDI) to produce <i>A</i>_<i>w</i> (the proportion of attributes on which two random residents will differ). Linear regressions of <i>D</i> for each variable across time was calculated. <h3>Results:</h3> There were an average of 2,326 residents/year, with 36% female, 95% US MD graduate, and 70% White. The probability that two random residents represented a different: sex was 49.6%; medical school affiliation was 56.4%; and racial/ethnic group was 60.9%. This corresponded to an effective number of 1.98 sexes, 2.29 medical school types, and 2.56 races/ethnicities. True diversity <i>D</i> increased over time for medical school affiliation only (+0.016/year), while <i>D</i> remained constant for sex and race/ethnicity. Lastly, two random residents differed on about 55.6% of all attributes (<i>A</i>_<i>w</i>), suggesting relative heterogeneity. <h3>Conclusions:</h3> Both sexes are nearly equally represented across neurology residents, and neurology residency programs were represented by effectively two different medical school affiliations. However, despite the presence of seven races in the population, neurology residents were only as diverse as a cohort with 2.5 equally represented races. Leaders in neurology should consider additional strategies to improve the neurology residency recruitment. <b>Disclosure:</b> Mr. Persad-Paisley has received research support from NIH National Heart, Lung, Blood Institute (NHLBI) . Ms. Paracha has nothing to disclose. Ms. Moges has nothing to disclose. Dr. Daruvala has nothing to disclose. Dr. Mahta has nothing to disclose. The institution of Dr. Ayub has received research support from Brown Physicians Incorporated.

Innovative Models of Geriatric Mental Health Services

The demographics of residents residing in long term care facilities is changing in many ways. There is a substantial increase of those admitted with serious mental illness, and at a younger age. Greater than 50% of residents have a neurodegenerative illness, such as dementia, and subsequently they all will experience behavioral and psychological symptoms of dementia during their admission. The new ICD-10 codes are integral to quality care and outcomes for this population. Most current approaches to the behavioral health needs of this population fall short of meeting resident and facility needs. This presentation seeks to consider a bold, interprofessional, and integrated approach to the bedside care of geriatric mental health services in long term care. Consideration includes proper ICD-10 code diagnosis and a culture of care that emphasizes the patient as an individual to improve quality of life and quality of care. This falls directly in line with the President's Commission on Aging Quality and Best Practices in Geriatric Psychiatric services and includes: a multidisciplinary team approach, specific geriatric expertise, individualized assessment, collaborative treatment planning between the consultant and facility staff, as well as a strong educational component. Current barriers to success will be explored to improve overall performance of the mental healthcare team.

Characterizing the Next Generation of Neurosurgeons: A Descriptive Analysis and Publicly Available Web Application of Neurosurgery Residency Programs’ Website Data

Neurosurgery program websites serve as a valuable resource for applicants. However, each website exists in isolation, and it can be difficult to understand the general trends in U.S. neurosurgery resident demographics. In the present study, we collected data from program websites and analyzed the trends in the demographics of the current U.S. neurosurgery residents. We used a program list obtained from the American Association of Medical Colleges Electronic Residency Application System to extract data from the current resident complement listed in each program's website, including program, year in program, medical school, sex (male vs. female), graduate and/or PhD degrees, and assessed the trends during 7 years of resident data using linear regression. We identified 116 neurosurgery residency programs in the United States, with 111 providing information on their current resident complement, yielding a dataset of 1599 residents. Of these 1599 residents, 348 (22%) were female, 301 (19%) had a graduate degree in addition to an MD or DO degree, 151 (9.4%) had a PhD degree, 300 (19%) had matched at the program affiliated with their medical school, and 121 (7.6%) had graduated from a foreign medical school. The proportion of matriculating female residents had increased an average of 2.1% annually (95% confidence interval, 0.6%-3.7%) from 2015 to 2021. The other demographic data had not changed significantly during the same period. In addition to summarizing the current resident demographics, our analysis identified a significant increase in the proportion of female residents between 2015 (15.1%) and 2021 (25.6%). This publicly available dataset should enable additional analyses of the evolution of neurosurgery resident demographics.

Just Do It: Participation in Structured Online Curricula Reliably Improves Low ABSITE Scores

We hypothesized residents enrolled in an Accelerated Clinical Education in Surgery (ACES) program would improve their scores to above the 30th percentile. We analyzed which components of ACES correlated with improvement. A retrospective review of three academic cycles (2018-2021) at an academic general surgery residency. Residents scoring ≤30th percentile on the ABSITE were enrolled in ACES. Baseline demographics including STEP scores were collected. ACES included: (1) SCORE and DeckerMed assignments (2) Weekly faculty review sessions and (3) Monthly meeting with assigned mentor. Data were analyzed by Student's t-test, one-way ANOVA and Fisher's exact test. Twenty-six surgical residents enrolled in ACES. Compared to residents not in ACES, there was no significant difference females (15 vs. 15; p = 0.19) and STEP 2 scores (241 vs. 246; p = 0.06). Residents in ACES had significantly lower STEP 1 (225 vs. 237; p < 0.001) and STEP 3 (212 vs. 223; p < 0.001) scores. Demographics of ACES residents who subsequently scored >30th percentile were similar to those who didn't, except for STEP 3 scores (216 vs. 204; p = 0.008). For residents in ACES, the completion of assignments between July and January was significantly higher for those who subsequently achieved an ABSITE score >30th percentile: TWIS, 77% vs. 53% (p = 0.022), Decker WC, 80% vs. 49% (p = 0.009) and Decker MR, 53% vs. 29% (p = 0.016). Completion of an online practice exam prior to ABSITE also correlated with score >30th percentile (57% vs. 13%, p = 0.007). There was also no correlation between the number of faculty review sessions and ABSITE (11.5 vs.11.9, p = 0.931). Participation in a structured online program of reading and quizzes was durably effective in improving ABSITE scores >30th percentile. Completion of online assignments, rather than scores on practice tests or review sessions, appeared to be the most important factor for success.

Strengthening Urban Food Systems Through Extension Programming and Community Engagement: A Case Study of New Brunswick, New Jersey

Cooperative Extension (Extension) can, and in many cases already does, engage in well-rooted partnerships with urban audiences. Yet, it is important to recognize that there are many layers to the diversity that exists within urban audiences– there is no single “urban community.” This article presents a case study of food security programming in New Brunswick, New Jersey, including collaborations between Rutgers Cooperative Extension and multiple community organizations to illustrate important considerations for engaging in urban Extension initiatives. Specifically, challenges exist in identifying urban audiences, including those who are hidden, especially as the demographics of city residents can vary greatly within a single geographic area. Solutions include the development of deep community partnerships and creative engagement of university students, with the latter participating as both an audience to benefit from Extension programming and as partners in program implementation. Evaluating urban Extension programming can provide important information as to whether a particular program is meeting the needs of the target audience, but a challenge exists in distinguishing the impact of a single Extension program operating in what is often an ecosystem of programs addressing food insecurity in an urban area.

Trends in Racial and Ethnic Diversity of Ophthalmology Residents and Residency Applicants

The proportions of individuals who are underrepresented in medicine (URiM) in ophthalmology lag behind their proportions within the US population. Diversity trends have been studied in other specialties, but literature examining trends in ophthalmology is lacking. In this study, we investigate trends in the racial and ethnic demographics of ophthalmology residents and residency applicants. Trend study. Demographic data of all residency programs across all specialties were extracted from Accreditation Council for Graduate Medical Education yearly reports from 2011 to 2019. Data from 2016 to 2019 on ophthalmology match applicants were analyzed using the 2020 Ophthalmology Residency Match Summary Report and the 2020 Association of University Professors of Ophthalmology Residency Gender & Ethnicity Summary. Linear trends were examined by the Cochran-Armitage test. From 2011 to 2019, the raw percentage of URiM ophthalmology residents increased from 4.7% (66/1419) to 5.8% (85/1473) (P < .001) whereas that of surgical specialties decreased from 9.9% (2164/21,967) to 9.1% (2370/26,082) (P < .001). The percentage of URiM ophthalmology match applicants increased from 5.9% (43/726) of all applicants to 11.8% (87/741) from 2016 to 2019 (P < .001), and the percentage of URiMs matching into ophthalmology increased from 4.9% (23/467) of all participants to 10.8% (52/484) from 2016 to 2019 (P < .001). Although there has been a positive trend in the percentage of URiMs applying and matching into ophthalmology, a lack of racial and ethnic diversity relative to other specialties persists. Strategies are needed to increase diversity in the field.

Comparative Analysis of Racial and Gender Diversity in Orthopedic Surgery Applicants and Residents from 2007 and 2019

Introduction Since 1999, orthopedic surgery has noted significant gaps in racial and gender diversity. A 2007 study demonstrated that diversity in orthopedic surgery lagged behind other specialties. Our study’s purpose was to evaluate changes in orthopedic surgery applicant and resident diversity from 2007 to 2019 and to compare current levels of diversity between applicants and residents alongside 7 other specialties. Methods Using public demographic data, our study evaluated racial and gender demographics of medical school graduates, residency applicants, and residents from 2007 to 2019 for orthopedic surgery and 7 additional specialties. Furthermore, diversity metrics between orthopedic surgery applicants and residents were compared. Results From 2007 to 2019, the proportion of minority applicants increased by 26%, while the proportion of female applicants increased by 64% (p&lt;0.001). Orthopedic surgery experienced a 10% decrease in minority resident representation, despite individual increases in some areas (p=0.004). Meanwhile, female representation increased 24% among orthopedic residents (p&lt;0.001). When compared to other specialties in 2019, orthopedic surgery had the lowest proportions of minority and female residents (p&lt;0.001*). Discussion Since 2007, orthopedic surgery experienced growths in minority and female applicant representation. However, additional efforts are needed to address the gaps in minority and female representation in orthopedic residencies compared to other specialties.

Metropolis in the Making: A Planning History of Amsterdam in the Dutch Golden Age

Metropolis in the Making: A Planning History of Amsterdam in the Dutch Golden Age

Theorizing Gentrification as a Process of Racial Capitalism

Academics largely define gentrification based on changes in the class demographics of neighborhood residents from predominately low-income to middle-class. This ignores that gentrification always occurs in spaces defined by both class and race. In this article, I use the lens of racial capitalism to theorize gentrification as a racialized, profit-accumulating process, integrating the perspective that spaces are always racialized to class-centered theories. Using the prior literature on gentrification in the United States, I demonstrate how the concepts of value, valuation, and devaluation from racial capitalism explain where and how gentrification unfolds. Exposure to gentrification varies depending on a neighborhood’s racial composition and the gentrification stakeholders involved, which contributes to racial differences in the scale and pace of change and the implications of those changes for processes of displacement. Revising our understanding of gentrification to address the racialization of space helps resolve seemingly contradictory findings across qualitative and quantitative studies.

In Search of Workforce Diversity? A Program's Successful Approach.

The persistence of health care disparities along racial and ethnic lines highlights the complex and multifactorial nature of this national concern. The paucity of physicians ethnically underrepresented in medicine to treat an ever-growing heterogeneous population inherently contributes to these ongoing disparities. The authors proposed an approach to improve the representation of physicians underrepresented in medicine in their plastic surgery residency program. With a renewed commitment to ethnic diversity and inclusion, a multifaceted recruitment and retention approach was implemented at the University of Pennsylvania plastic and reconstructive surgery residency program from 2015 to 2020 (5 academic years). A retrospective review of the demographics of the program's residents was then assessed over the past 9 academic years for comparison (2011 to 2020). The representation of underrepresented-in-medicine residents within the plastic and reconstructive surgery residency program steadily increased with the implementation of this multifaceted approach, reaching an unprecedented high. Currently, 29 percent of all residents are underrepresented in medicine and 29 percent are female, some of whom are also underrepresented in medicine. Although the female representation is on par with the national average, the underrepresented-in-medicine representation is far greater than the national average. As a result of this multifaceted approach, the representation of African American and Latino plastic surgery residents at the University of Pennsylvania now far exceeds current national averages. Unfortunately, the representation of Native American and Alaskan Natives is still lacking, despite the program's broadened recruitment efforts. The success of this experience describes a successful strategy that institutions can implement to enhance underrepresented-in-medicine representation among its plastic surgery trainees.

A Statewide Survey of Massachusetts Rest Homes and Their Residents

Rest homes, one of the oldest models of long-term care, were originally designed to provide housing for seniors lacking family support. To better understand the types of residents currently served by Massachusetts rest homes, a statewide Web-based survey was conducted. The purpose of the survey was to provide a comprehensive description of the characteristics and demographics of rest home residents. This single-state study demonstrates that the rest home industry is supporting an aging population with many complex care needs. Data from this survey will be used to help determine appropriate funding and regulatory oversight that sustain the industry.

National trends in gender and ethnicity in dermatology training: 2006 to 2018

To the Editor: Sex and race concordance between physicians and patients is associated with improved perceptions of clinical care.1Street R.L. O'Malley K.J. Cooper L.A. Haidet P. Understanding concordance in patient-physician relationships: personal and ethnic dimensions of shared identity.Ann Fam Med. 2008; 6: 198-205Crossref PubMed Scopus (341) Google Scholar In 2017, 48.9% and 64.5% of dermatology attendings and residents, respectively, were female.2Bae G. Qiu M. Reese E. Nambudiri V. Huang S. Changes in sex and ethnic diversity in dermatology residents over multiple decades.JAMA Dermatol. 2016; 152: 92-94Crossref PubMed Scopus (41) Google Scholar Academic dermatology leadership positions are underrepresented in sex and ethnic diversity.3Jayakumar K.L. Lipoff J.B. Trends in the dermatology residency match from 2007 to 2018: implications for the dermatology workforce.J Am Acad Dermatol. 2019; 80: 788-790Abstract Full Text Full Text PDF PubMed Scopus (4) Google Scholar,4McDonald T.C. Drake L.C. Replogle W.H. Graves M.L. Brooks J.T. Barriers to increasing diversity in orthopaedics: the residency program perspective.JB JS Open Access. 2020; 5: e0007PubMed Google Scholar We examined sex and ethnicity trends of dermatology residents and fellows compared to other medical and surgical trainees. Demographics of dermatology residents and fellows and other of medical/surgical trainees were obtained from the Accreditation Council for Graduate Medical Education annual census, 2006 to 2018. Underrepresented minority (URM) was defined as Black/African American, Hispanic, or Native American. A 2-sample z-test was used to compare sex and ethnicity proportions in 2006 and 2018 (α level, <.05). Female representation in dermatology residency was stable at approximately 60% (Supplemental Table I; available via Mendeley at https://doi.org/10.17632/m3hs3dyr2n.1), and the overall residency census national average increased from 44% to 46% (P < .01) during the study period. Proportions of women in procedural dermatology and dermatopathology increased from 27% to 44% and from 46% to 54%, respectively (P > .05) (Fig 1). Female representation increased in all fellowship comparator groups; however, proportions of female fellows were consistently less than those of corresponding residencies in internal medicine, plastic surgery, and general surgery (Supplemental Table II; available via Mendeley at https://doi.org/10.17632/m3hs3dyr2n.1). All fields trended toward a narrowing of residency-fellowship gender gaps. Average URM representation in the overall residency national census increased from 12.5% in 2006 to 13.6% in 2018 (P < .05) (Supplemental Table I). URM representation in dermatology residency and fellowship increased from 8.2% to 9.3% and decreased from 9.5% to 3.1% (P > .05), respectively. URM representation in dermatology residency was consistently below the national average (Fig 2). URM residency-fellowship disparities persist in other fields (Supplemental Table II); however, only dermatology experienced a downward trend of URM fellowship representation over time. This study is limited by use of self-reported data and unknown rates of fellowship application by candidates of differing gender/ethnicity. We did not have access to pediatric dermatology fellowship data or total number of dermatology residency/fellowship positions. Our study showed significant narrowing of female residency-fellowship gaps and persistent URM dermatology residency underrepresentation and residency-fellowship gaps compared to the national average. Physician diversity is essential in addressing health care disparities.5Pritchett E.N. Pandya A.G. Ferguson N.N. Hu S. Ortega-Loayza A.G. Lim H.W. Diversity in dermatology: roadmap for improvement.J Am Acad Dermatol. 2018; 79: 337-341Abstract Full Text Full Text PDF PubMed Scopus (50) Google Scholar Lack of URMs in leadership positions, mentorship, racism, and implicit bias have been cited as barriers for URMs pursuing subspecialties. Female and URM residents should be encouraged to seek mentorship from leaders of concordant and discordant gender and ethnicity. Mentorship programs, through the American Academy of Dermatology and Women's Dermatologic Society, which support URM medical students interested in pursuing dermatology and female resident dermatologists pursuing subspecialties, likely contributed to some of the upward trends observed. The Perry and student to resident institutional vehicle for excellence initiatives, Nth Dimension programs, and near-peer mentors have been successful in encouraging URMs to apply for competitive fields, subspecialties, and academic faculty positions. Similar initiatives should be adopted for dermatology. Early exposure of URMs to dermatology, updated curricula including skin of color topics, and rethinking residency selection criteria are also essential.5Pritchett E.N. Pandya A.G. Ferguson N.N. Hu S. Ortega-Loayza A.G. Lim H.W. Diversity in dermatology: roadmap for improvement.J Am Acad Dermatol. 2018; 79: 337-341Abstract Full Text Full Text PDF PubMed Scopus (50) Google Scholar Our study highlights positive trends for women in dermatology residency/fellowships and significant deficiencies in URM representation in dermatology residency/fellowships. Increased efforts are needed to understand barriers to pursuing subspecialties and initiatives taken to promote mentorship and guidance to underrepresented groups. None disclosed.

Women and Minorities Underrepresented in Academic Cardiothoracic Surgery: It’s Time for Next Steps

Women and racial and ethnic minorities are underrepresented among U.S. physicians, but are limited data on cardiothoracic surgery diversity. This study characterizes current racial and ethnic and gender diversity in academic cardiothoracic surgery. Accreditation Council for Graduate Medical Education and Association of American Medical Colleges databases were queried for racial and ethnic and gender demographics of residents and faculty. Cardiothoracic surgery was compared with other surgical subspecialties and medicine overall. A total of 17% of cardiothoracic faculty were women, compared with 27% of surgical faculty (P < .01) and 43% of clinical faculty (P < .01). A total of 63% of cardiothoracic faculty were White, compared with 70% of surgical faculty (P < .01) and 66% of clinical faculty (P= .10). A total of 24% of cardiothoracic faculty were Asian American/Pacific Islander, compared with 18% of surgical faculty (P < .01) and 20% of clinical faculty (P= .03). Black/African American and Hispanic physicians composed 3% and 5% of cardiothoracic faculty, respectively, similar to surgical and clinical faculty. A total of 24% of cardiothoracic trainees were women, compared with 36% of surgical residents (P < .01) and 46% of all residents (P < .01). A total of 66% of cardiothoracic residents were White, compared with 55% of residents overall (P < .01) and 65% of surgery residents (P= .68). A total of 18% of cardiothoracic residents were Asian American/Pacific Islander, compared with 17% of surgery residents (P= .87) and 24% of residents overall (P < .01). Black/African American and Hispanic residents composed 4% and 5% of cardiothoracic residents, respectively, similar to surgery and residents overall. Women and racial and ethnic minorities are significantly underrepresented among trainees and faculty in academic cardiothoracic surgery compared with surgery and medicine overall, demonstrating a need for concerted action.