Available online 18 October 2022

Objective

To analyze the effects of diversification efforts on underrepresented minority in medicine (URiM) resident recruitment in general surgery residency at a single large southeastern United States academic institution with five categorical positions.

Methods

A retrospective review of applications from the 2016 to 2022 ACGME match cycles was conducted. In an effort to diversify resident recruitment, multiple new strategies were enacted in 2021. URiM candidates were identified via a more laborious review of individual applications to the program. In addition, a holistic review process was conducted, URiM faculty and residents were prominently featured, previous underperformance in diversity was openly addressed, and URiM applicants were contacted with follow up emails. Cohorts pre- and post-implementation of these strategies were analyzed. The proportion of URiM applicants invited, interviewed, ranked, and matched were compared.

Results

Pre-intervention during the 2016to 20 match cycles, URiM candidates represented 4% of total applicants invited. Post-intervention during the 2021to 22 match cycles, URiM candidates represented 27% of total applicants invited. Over the past 5 years under the present program director, 1 URiM resident of 24 (4%) matched into the categorical program. Over the past 15 years under the direction of 3 program directors, a total of 6 out of 69 matched residents (9%) identified as URiM. Post intervention, the program matched on average 30% of its incoming categorical class from URiM candidates.

Conclusion

Recruitment and selection of diverse medical school applicants is an ongoing concern of general surgery residency program directors. Historically, URiM candidates are underrepresented in applicants selected for interview. Interventions aimed at increasing the matriculation of URiM include concentrated efforts to identify more URiM candidates for interview. However, importantly, transparency of ongoing diversity efforts and diversifying both faculty and trainees involved in the selection process may also improve general surgery URiM recruitment.

Section snippetsINTRODUCTION

Underrepresented in medicine (URiM) has been defined by the Association of American Medical Colleges (AAMC) as “persons of racial and ethnic populations underrepresented in the medical profession relative to their numbers in the general population”.1 URiM representation in the surgery workforce is decreasing. Despite comprising 13% of the United States (US), African Americans represent only 6% of surgeons. Representation in surgery is slowly increasing for women and Hispanic Americans, however,

METHODS

A retrospective review was conducted of match data from a single large southeastern US academic general surgery residency program with 5 categorical spots and 4 preliminary post graduate year-1 (PGY-1) spots. The 2016 to 2022 ACGME match cycles were analyzed. In an effort to increase URiM resident recruitment, multiple new strategies were employed for the 2021 and 2022 match. The Electronic Residency Application Service (ERAS) application pool was searched to identify candidates identifying as

RESULTS

Historically, prior to the 2021 match cycle, our institution received approximately 800 applications each year to fill 5 categorical positions; of these applications 50 applicants were invited to interview. During the 2021 and 2022 match, over 1200 applications per year were received largely from US allopathic and osteopathic medical schools as well as a small number of international schools. Of these, over the 2021 and 2022 match cycles, an average of 65 applicants were invited and 61

DISCUSSION

URiM remain underrepresented in the field of surgery. Multiple strategies have been proposed to encourage interest and increase recruitment of URiM persons all along the pipeline. While national initiatives and new guidelines have been implemented by governing bodies of medical education aimed at increasing ethnic and racial diversity the results have been modest.22, 23, 24,27 One study, conducted over an 8 year period, found no changes in minority matriculants to surgery residency programs.3

CONCLUSION

URiM are underrepresented in surgery. Diversification efforts along the entirety of the pipeline are needed to improve upon this. Historically, URiM candidates are underrepresented in applicants selected for interview. Here we demonstrate how implementation of practical interventions, readily available to all programs, corresponded to a significant increase in URiM matriculation. These interventions include concentrated efforts to identify more URiM candidates for interview. However,

Declaration of Competing Interest

None

Acknowledgments

We would like to acknowledge the remaining faculty members of the selection committee (Drs. Williams & Lollar), remaining resident members of the selection committee (Drs. Koenig, Howe, & Lamb), members of our Diversity Committee (Drs. Luyimbazi, Salzburg, Williams, Downing, Stams, & Kelly), and program administrators (Meghan Brogan and Caroline Johnson) for their contributions in the residency admissions process.

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