Available online 12 May 2023

Author links open overlay panel, , , , , , , Objective

Racial and gender biases exist within academic surgery; bias negatively impacts patient care, reimbursement, student training, and staff retention. Few studies have investigated the potential for bias in surgical fellowship recruitment. We aimed to compare the racial and gender diversity at our hepatopancreatobiliary (HPB) surgery fellowship program to nationwide standards. We further aimed to investigate differences in the demographics of resident interviewees versus matriculants to our HPB fellowship.

Design

Retrospective review.

Setting

North American HPB fellowship training programs.

Participants

Mayo Clinic's HPB surgery fellowship interviewees and North American HPB surgery fellowship graduates from 2013 to 2020.

Results

When compared to general surgery residency graduates during the study period (in 2019), a lower proportion of North American HPB surgery fellowship graduates were female (26% HPB fellowship graduates vs. 43.1% residents, p = 0.005), with no difference in proportion of racially under-represented in medicine (rURM) HPB fellowship graduates (10.7%) compared to rURM proportion of general surgery residents nationally (14.5%). There was an upward trend in female representation among North American HPB fellowship graduates from 11% in 2013 to 32% in 2020, but proportions of rURM HPB fellows remained steadily low. When comparing HPB interviewees at our institution to national general surgery residents, no differences were observed in proportions of female (34.4% interviewees vs. 43.1% residents, p = 0.17) or rURM (interviewees = 6.8%, residents = 14.5%, p = 0.09) applicants. Additionally, there was no significant difference between the proportion of female or rURM interviewees and matriculants to our HPB program.

Conclusions

While fewer female graduating surgeons are pursuing HPB fellowship training than male graduates, this gender gap has narrowed over time. In contrast, the national percentage of rURM HPB fellowship graduates has remained low, mirroring stagnant proportions of rURM surgical residency graduates. When comparing HPB fellowship interviewees at our own institution to North American fellowship graduates, we observed similar proportions of female interviewees but lower proportions of rURM interviewees. Locally, these data will drive process change toward more intentional examination of our interview selection process. Nationally, more work is needed to increase the racial diversity of surgical residency and fellowship trainees to best reflect and serve our diverse patient populations.

Section snippetsINTRODUCTION

Studies have repeatedly demonstrated the prevalence of implicit and explicit gender and racial discrimination within academic surgery.1, 2, 3, 4 While medical students have had equal gender representation for the past decade, women remain under-represented in surgical residencies and academic positions.5,6 Because unconscious bias can impact residency selection in covert ways, the residency and fellowship selection process likely contributes to gaps in representation. For example, gender- and

MATERIAL AND METHODS

We conducted a retrospective review of data from institutional HPB surgery fellowship interviewees and matriculants, along with North American HPB surgery fellowship graduates. The Mayo Clinic Institutional Review Board (IRB) reviewed this study and deemed it exempt. Data from interviewees at the HPB fellowship at Mayo Clinic in Rochester, Minnesota in 2013, 2014, 2016 to 2018, and 2020 were reviewed. We were unable to review interviewee data at our HPB fellowship program in 2015 and 2019 due

RESULTS

There were 171 national HPB surgery fellowship graduates from 2013 to 2020, of whom 44 were female (26%) and 18 were rURM (11%) (Fig. 1). While variable between years, the overall proportion of female graduating HPB fellows nationally increased from 2013 to 2020, from 11% to 32%. With respect to race, the proportion of under-represented national HPB fellowship graduates remained relatively consistent and low over time, ranging from 0% to 18% (Fig. 2).

Sixty-one applicants interviewed at Mayo's

CONCLUSIONS

Despite trends toward increased diversity in medicine over the last decade, there remains substantial opportunity for improvement in gender and racial diversity within surgery and surgical subspecialties. This study aimed to describe the current national state of HPB fellowship graduates with respect to gender and race. We demonstrated that there is a significantly lower proportion of female fellows nationally that graduated HPB surgery fellowships than graduated surgical residency, indicating

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