Resident Race and Operative Experience in General Surgery Residency: A Mixed-Methods Study

Area of Science:

• Medical Education
• Surgical Training
• Health Inequity

Background:

• Quantitative studies reveal disparities in operative case numbers for Black general surgery residents.
• Addressing underrepresentation in medicine (URiM) requires understanding barriers to surgical training.
• Mixed-methods research is crucial to identify and mitigate inequities in resident operative experience.

Purpose of the Study:

• To explore barriers preventing general surgery residents from operating.
• To identify potential solutions for improving operative experience, particularly for URiM residents.
• To investigate the impact of race and ethnicity on surgical training.

Main Methods:

• Electronic surveys with open-ended and Likert scale questions distributed to residents at 21 US general surgery programs.
• Qualitative analysis of free-text responses by three independent reviewers.
• Quantitative analysis of survey data to compare experiences between URiM and non-URiM residents.

Main Results:

• URiM residents (62%) were significantly more likely than non-URiM residents (13%) to report barriers in obtaining case numbers.
• Floor work and clinical duties were primary barriers to operating room time for all residents.
• Racial bias was a frequently cited barrier for URiM residents, impacting their training quality.
• Increased attending-level mentorship and objective standards for case participation were suggested solutions.

Conclusions:

• URiM residents encounter substantially more barriers to acquiring surgical case numbers than their non-URiM peers.
• Establishing clear operative participation benchmarks and enhancing mentorship are key strategies to promote equitable surgical training.
• Addressing systemic barriers is essential for achieving parity in surgical education for all residents.