Is there a lack of equity, diversity and inclusion in orthopaedic education? - A systematic review

Trauma & Orthopaedics has failed to progress in promoting equity, diversity and inclusion. Only 7 % of orthopaedic consultants are female, and less than 1 % identify as black. Improved equity, diversity and inclusion within healthcare has shown to improve patient outcomes, innovation and reduce unconscious bias within the specialty. Patients within the NHS face significant disparities in the care they receive, and promoting EDI within orthopaedic education will help address this.

A systematic literature search between 2020 and 2025 was performed to identify any literature. The electronic databases of Medline, EBSCO, Web of Science, PubMed and Scopus were utilized. Studies were screened against strict inclusion and exclusion criteria to ensure the literature was relevant and specific to this review. Two independent assessors read the abstracts and full-texts of articles to determine whether or not they were included within this systematic review. This systematic review was registered with PROSPERO (registration number: CRD420251022275).

The studies within this systematic review highlighted the absence of female and minority ethnic representation within the orthopaedic specialty. Additionally, several barriers to the implementation of EDI have been addressed. These include: a lack of female role models, a lack of commitment from staff, difficulties changing previous perceptions of the specialty and difficulty changing a lack of cultural sensitivity.

Women and minority ethnic groups remain markedly underrepresented in orthopaedics, facing structural and cultural challenges that hinder recruitment and retention. Orthopaedic education plays a key role in preventing these issues, as medical students are often discouraged from pursuing this specialty from the outset. Misconceptions and the absence of diverse role models are key factors in deterring students from under-represented backgrounds from entering the specialty. Promoting a culture of inclusion will help change these perceptions and misconceptions. This will aid in enhanced patient-centred care and better healthcare outcomes for all. Despite growing recognition and awareness of the limited diversity in orthopaedics, there remains a shortage of literature that collates data together. This review does this by critically analysing existing research and offers a comprehensive review of this topic.