Abstract
Introduction
Increasing diversity in the US health care workforce is a topic of increasing scrutiny and interest. This study analyzes the pipeline of demographic diversity for Accreditation Council for Graduate Medical Education (ACGME)-accredited foot and ankle orthopaedic surgery fellowship training.
Methods
This was a cross-sectional study of medical students, orthopaedic surgery residents, and orthopaedic foot and ankle fellows at US-accredited training programs from 2013 to 2022. Self-reported demographic data were available for trainees and compared with the 2020 US Census according to federal guidelines. Participation-to-prevalence ratios (PPRs) were calculated and analyzed to classify representation of demographic groups in orthopaedic foot and ankle surgery training as overrepresented (PPR > 1.2), equivalent (PPR = 0.8-1.2), and underrepresented (PPR < 0.8).
Results
Disparities existed in demographic representation among medical students, orthopaedic surgery residents, and ACGME-accredited orthopaedic foot and ankle fellows among women (48.4% vs 16.1% vs 20.1, P < .001), black (6.9% vs 4.6% vs 4.5%, P < .001), Asian (23.9% vs 14.1% vs 23.9%, P < .001), and Hispanic (6.1% vs 4.6% vs 3.0%, P < .001) trainees. There were no self-reported American Indian/Alaska Native and Native Hawaiian/Pacific Islander trainees in orthopaedic foot and ankle fellowship training (PPR = 0). Women (PPR = 0.40), black (PPR = 0.36), and Hispanic (PPR = 0.16) trainees were underrepresented in orthopaedic foot and ankle training relative to the US population. In contrast, Asian (PPR = 3.45), men (PPR = 1.61), and white (PPR = 1.21) trainees were overrepresented in orthopaedic foot and ankle relative to the US population.
Discussion
There is a lack of gender, racial, and ethnic diversity in orthopaedic foot and ankle training relative to the US patient population and earlier stages of medical training. Increased efforts to recruit underrepresented groups may promote diversity and inclusion in the emerging orthopaedic foot and ankle surgery workforce.
Levels of Evidence:
III
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