Diversity in Orthopaedic Orthopaedic Surgery

1
Diversity in Orthopaedic Orthopaedic Surgery

• Kim Templeton, MD
• Residency Program Director
• University of Kansas Medical Center
• Kansas City, KS

2
Where Do We Go From Here?Opportunities for the
Future

• Current Status
• Applicant Pool
• Pipeline

3
RRC and Beyond

• Recognizing value and importance of recruiting
  women and minorities
• Committed to promoting inclusion of women and
  minorities
• Attracting best and brightest of medical school
  classes
• Enhancing knowledge and experience of all
  orthopaedic surgeons

4
Women in Surgical Residencies1970-2001 (women as
percentages of total)

• Orthopaedics 0.61 8.97
• Thoracic 0.61 6.95
• Neurosurgery 0.90 10.59
• Urology 0.27 12.69
• ENT 0.64 18.55
• General 2.36 23.74
• Ophthalmology 3.69 32.41
• Ob/Gyn 4.79 71.41
• All residents 6.77 38.36
• no significant difference in change in
  percentage of women compared to orthopaedic
  surgery
• Blakemore et al JBJS(A), 2003

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Women in Surgical Residencies

• All fields except thoracic and neurosurgery
  demonstrated significantly greater increases in
  proportion of women from 1970-2001
• Blakemore et al, JBJS(A), 2003

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Women in Surgical ResidenciesMore Recent Data
(2005-2007)

• Orthopaedics 12.4
• Neurosurgery 12
• Urology 20
• ENT 25
• General surgery 25-30

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Minorities in Surgical Subspecialities
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Orthopaedic Surgery Residents1998, 2001, 2005,
2007

• 
  
• African-American 4 5 3.97
  4.0
• Asian 9.4 10.6
  11.0 11.6
• Hispanic 2.8 3.5
  3.7 2.6
• Native American 0.5 0.7 0.45
  0.53
• Caucasian 78.8 76.9 74.8
  74.9
• Women 7.6 9.8
  11.3 12.4

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Graduating Medical Students1998, 2001,2004

• African-American 7.5 6.9 6.5
• Asian/Pacific Islander 17.7 19.8 20
• Hispanic 6.5 6.0
  6.4
• Native American 0.8 0.6 0.6
  
• Caucasian 66.1 65.4 64
• Women (all races) 41.3 42.9 46

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Graduating Medical Students

• Significant increases in total percentage of
  minority and female medical students
• Significant increase in graduating Asian/Pacific
  Islander
• Significant increases in women entering/graduating
  medical school

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Potential Applicant Pool

• Statistically significant differences between
  graduating medical school classes and orthopaedic
  residencies among
• African-Americans
• Asian/Pacific Islanders
• Hispanics
• Women
• Caucasians
• No differences in Native Americans, other

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Residency Applications

• ERAS (2002)- orthopaedic residency
• 14 of applicants female
• 13.7 from racial/ethnic minority group

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Women in Surgery

• Study of Canadian medical schools 1996-2005
• Significantly more men than women applied to all
  surgical fields
• No significant difference in acceptance rates
  between the sexes
• Baerlocher 2007

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Women in Orthopaedic Residency

• 10 female ERAS applications
• Reference to gender changed to male
• Reviewed by 121 faculty at 14 programs
• No statistically significant difference in
  rankings
• Fewer orthopaedic residents due to number of
  applications or results of interview process?
• Scherl et al JBJS(A), 2001

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Women and Minorities in (Orthopaedic) Residencies

• Exposure to field
• Availability of mentoring/role models
• Results of interview process?
• (Perceived) lifestyle
• Experienced/observed discrimination

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Women and Minorities in Orthopaedic
Residency-Exposure

• 55 of medical school graduates had mandatory
  exposure to musculoskeletal topics
• No significant impact overall in number who
  applied to orthopaedic residency
• Increase from 1.1 to 2.0 among graduating women
  (p0.002)
• 35 relative increase among minority students
• Bernstein et al JBJS(A), 2004

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Women and Minorities

• Different issues
• application rates
• pipeline
• Similar approaches
• Early interest
• High school programs
• Exposure during medical school
• Involvement of orthopaedic surgeons/departments

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Where Do We Go From Here?

• Increased emphasis/exposure
• Step 2 exam
• new shelf exam
• Project 100
• Emphasis of AAMC
• MSOP (2005)
• Mentoring programs
• Increasing the pipeline

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ABOS/AAOS

• Membership in AAOS essential to getting your
  voice heard
• Impacts present and future of profession
• 98 of ABOS-certified orthopaedic surgeons belong
  to AAOS
• Goal- passing parts 1 and 2 of ABOS exam

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ABOS

• Not track passing rates by sex/gender or
  race/ethnicity
• To facilitate their practices, diversity of AAOS,
  need to assure that those who are attracted to
  orthopaedic surgery and complete residencies are
  able to pass ABOS exams
• Do all residents who match eventually become ABOS
  certified?
• If not, are their ways to intervene?

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ARCOS Survey

• No information available from AAOS or ABOS of
  sex or racial/ethnic differences in Board pass
  rates
• Information on composition of graduating classes
  (2001-2004), number sitting for exams, number
  passing (with number of attempts)
• 36 of 153 programs

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ARCOS Survey

• Data reviewed for internal consistency
• Data not used for a given program/year if
  resident(s) could not be tracked through both
  parts of the Board exam (e.g., new residents
  added, some left program)

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Part 1

• 438 men graduated
• 430 passed Part 1, most on first attempt
• 26 women graduated
• 25 passed Part 1, 3 after 2-3 attempts

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Part 2

• 411 men sat for the exam
• 397 passed (364 on first attempt)
• 4 pending results
• 25 women sat for the exam
• 24 passed, 20 on the first attempt
• 1 pending result

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Sex-Based Data

• Men
  Women
• Graduated 438
  26
• Passed Part 1 430
  25
• Sat for Part 2 411
  25
• Passed Part 2 397
  24
• 4 pending results
• 1 pending result

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Race/Ethnicity Data

• No Native Americans listed as graduating from a
  residency program
• Most graduates were Caucasian

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Caucasians

• 398 graduated from residency
• 391 passed Part 1 of Boards
• 378 sat for Part 2
• 365 passed Part 2 of Boards

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African-Americans

• No female residents
• 15 men graduated
• 12 passed Part 1
• 11 sat for Part 2
• 10 passed Part 2 (result on 1 is pending)

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African-Americans-2001

• 2 graduated
• 2 passed Part 1, 1 on 3rd attempt
• 2 sat for Part 2
• Both passed (1 on 2nd attempt)

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African-Americans-2002

• 3 graduated from residency
• All sat for Part 1, one passed
• None sat for Part 2

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African-Americans-2003

• 8 graduated from residency
• 8 sat for Part 1, 7 passed (all on first attempt)
• 7 sat for Part 2, all passed on first attempt

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African-Americans-2004

• 2 graduated from residency
• Both passed Part 1 on first attempt
• Both sat for Part 2
• 1 passed on first attempt, result for 2nd surgeon
  is pending

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Asian-American/Pacific Islander

• All male residents
• 35 graduated from residency programs
• 34 passed Part 1
• 32 sat for Part 2
• 30 passed Part 2
• one resident in military-not taken exam
• one result is pending

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Hispanic-2004

• No Hispanic residents noted as graduating

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Hispanic/Latino/Latina

• 11 residents graduated from residency programs
• 10 male and one female resident
• 10 passed Part 1, all sat for Part 2
• 9 passed Part 2

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Results

• Men 90.6 (91.6 if assume pending result is
  positive)
• Women 92.3 (96.2 if pending result is positive)
• Racial/Ethnic minorities 80.3 (85.2)

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Results

• Numbers too small to determine significance,
  especially in race/ethnicity categories
• Need responses from additional institutions

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Next Steps

• Continue to develop pipeline to medicine early
• Participate in medical student education (early)
• Encourage students to rotate on orthopaedics,
  shadow, etc.
• Focus on qualified women and racial/ethnic
  minority students
• Support residents through the ABOS process

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Thank You!