Gender and Diversity Trends Among Hand Fellowship Training Programs in the United States

Lack of diversity in healthcare teams can lead to poorer patient outcomes and quality of care. This study analyzed fellowship trainee demographics to examine current gender and racial diversity trends among hand surgery fellowship programs.

American Medical Association Graduate Medical Education reports from 2007 to 2024 were queried to determine diversity trends among hand surgery fellowships. Trainees from 3 primary residency types were evaluated: plastic, orthopedic, and general surgery. Microsoft Excel and IBM SPSS were used to trend and analyze the data using χ² analysis, Fisher-Freeman-Halton exact tests, and Cochran-Mantel-Haenszel tests.

Hand fellowship programs increased 42% from 2007 to 2024. Female trainees rose to 38% in 2024 but remained significantly fewer than males (P < 0.01). Gender distribution was similar across orthopedic and plastic programs (P = 0.06). Programs had significantly smaller percentages of Asian (2007 = 12.9%, 2024 = 17.8%; P < 0.01), Pacific Islander (2007 = 0%, 2024 = 0%; P < 0.01), African American (2007 = 3.1%, 2024 = 5.2%; P < 0.01), American Indian (2007 = 0.0%, 2024 = 0.0%; P < 0.01), and Hispanic trainees (2007 = 5.3%, 2024 = 0.6%; P < 0.01) compared with White trainees (2007 = 68.9%, 2024 = 64.3%). Osteopathic (2007 = 8.3%, 2024 = 8.9%) and international medical graduate trainees (2007 = 13.6%, 2024 = 1.3%) also remained low.

Although hand fellowship programs have improved female representation, trainees underrepresented in medicine remain low.