GS14 - Everyone Wants to be a General Surgeon: Changes in General Surgery Graduate Medical Education That Have Influenced an Increased Interest in the Specialty

Primary Presenter(s)

DA

Deepthi S. Akella, M.S.

Medical Student
University of the Incarnate Word School of Osteopathic Medicine
Johnston, Iowa, United States

Co-Presenter(s)

RH

Rachael Holtzman, M.S.

Medical Student
University of the Incarnate Word School of Osteopathic Medicine
San Antonio, Texas, United States

Author(s)

JD

Jacqueline Danisi, M.S.

Medical Student
University of the Incarnate Word School of Osteopathic Medicine
San Antonio, Texas, United States
JE

John E. Etlinger, M.D., FACS

General Surgery Clerkship Director
University of the Incarnate Word School of Osteopathic Medicine
San Antonio, Texas, United States

Introduction/Purpose:

Diverse surgical teams have proven to be more effective and have resulted in better patient outcomes. In 2021, general surgery residents Underrepresented in Medicine (UIM) only made up 13.1% of the general surgery trainees nationally. Additionally, female practicing general surgeons make up as little as 22% of surgical attendings. According to NRMP Match Data from 2012 to 2022, applications and match rates into General Surgery-Categorical positions increased every year. Females are making up a rising proportion of these residents entering general surgery programs in the United States. Although there has been an increase in female interest in applying to general surgery residency, historically, female general surgeons have been disadvantaged compared with their male colleagues in objective metrics of gender equity such as leadership positions, financial compensation, and career advancement. In this study, a systematic review of literature was conducted to identify changes implemented by general surgery residency programs that encouraged females and medical students belonging to underrepresenting minorities to gain interest in applying, and ultimately entering, a general surgery residency. It is critical that general surgery graduate medical education continues to implement factors that encourage more diverse trainees to enter the field and further foster excellence in high-quality surgical care.

Methods or Case Description: A systematic review was performed focusing on published literature that addressed factors implemented by general surgery residency programs which positively encouraged more individuals to pursue a general surgery residency. The literature search was conducted using the search engines Pubmed and Google Scholar. Inclusion criteria included: scholarly papers, general surgery residency, written after 2003, articles written in English, and research based in the United States. Exclusion criteria included: research focusing on post-residency environment, studies written before 2003, and studies not available in English. The search was conducted between June 7, 2022, and July 1, 2022. Articles were further screened utilizing the PRISMA flow diagram. Once screened, the articles included were reviewed by two members of the research team and a PICO-style analysis was used for each article. After the initial screening, a total of 12 articles were included in this systematic review.

Outcomes:
A total of 18 articles were collected in our initial primary literature search. After excluding six of the articles based on our exclusion criteria, we discovered three overarching themes that were shown to positively influence diverse individuals to apply to general surgery residencies. The first theme was the need for increased mentorship. Some ways to increase mentorship is providing medical students opportunities to rotate with female surgeons in attending positions, as well as promote more diverse surgeons to leadership positions within residency programs. The second theme is the promotion of inclusion through addressing discrimination. Increasing female representation amongst attendings within training programs, in addition to collaborative discussions and cases, can help address common stereotypes of surgeons. The final theme was providing adequate maternity leave and childcare resources for trainees. Women and family-oriented trainees are positively drawn to general surgery programs when provided structured and adequate maternity leave, childcare options, and accommodations for lactation.

Conclusion: General surgery residency programs should be applauded for their efforts in fostering a more inclusive working environment. Data shows that compared to other surgical specialties like Orthopedic Surgery, Urology, and Neurosurgery; General surgery stands apart in increasing representation and it should continue to set an example for other surgical specialties to follow. Although there have been positive changes to general surgery residency programs, there is a need to increase diversity. General surgery residency programs that foster an inclusive environment and true commitment to diversity, equity, and inclusion help establish an enriching environment for not only the residents, but all involved in surgical training and in patient care. Some key factors that were shown to influence individuals to pursue general surgery are early specialty exposure and an inclusive cultural environment. Regarding females, access to female-led mentorship and decreased gender discrimination were also viewed positively. Unfortunately, not all medical students get access to early exposure and mentorship from surgeons or surgical residencies. NREMP data shows that Osteopathic medical school students interested in surgical specialties are at a disadvantage due to the widespread lack of access to ACGME-approved surgical residency programs directly affiliated with their medical school. Nevertheless, there has been a notable increase in Osteopathic applicants for General Surgery- Categorical positions, and these students should be supported. Although there is increasing representation within general surgery, residency programs should continue to implement and conduct further studies to examine what factors would positively and negatively influence medical students’ interest in general surgery.