Invited Commentary: Achieving Health Equity in Trauma and Acute Care Surgery: The Need to Implement an Intersectionality Framework in the Analysis of All Patient Outcomes
Women Surgeon-Scientists-Applying an Intersectional Lens to the Current Status of National Institutes of Health Funding
Shattering Glass Ceilings: Three Black women surgeons ascend to Chairs of Departments of Surgery
Berry, Cherisse; Gantt, Nancy
A disturbing trend: An analysis of the decline in surgical critical care (SCC) fellowship training of Black and Hispanic surgeons
Hambrecht, Amanda; Berry, Cherisse; DiMaggio, Charles; Chiu, William; Inaba, Kenji; Frangos, Spiros; Krowsoski, Leandra; Greene, Wendy Ricketts; Issa, Nabil; Pugh, Carla; Bukur, Marko
BACKGROUND:Underrepresented minorities in medicine (URiM) are disproportionally represented in surgery training programs. Rates of URiM applying to and completing General Surgery residency remain low. We hypothesized that the patterns of URiM disparities would persist into Surgical Critical Care (SCC) fellowship applicants, matriculants and graduates. METHODS:We performed a retrospective analysis of SCC applicants, matriculants and graduates from 2005-2020 using the Graduate Medical Education (GME) resident survey and analyzed applicant characteristics using the Surgical critical care and Acute care surgery Fellowship Application Service (SAFAS) from 2018-2020. The data were stratified by race/ethnicity and gender. Indicator variables were created for Asian, Hispanic, White and Black trainees. Yearly proportions for each race/ethnicity and gender categories completing or enrolling in a program were calculated and plotted over time with Loess smoothing lines and overlying 95% confidence bands. The yearly rate and statistical significance of change over time were tested with linear regression models with race/ethnicity and gender proportion as the dependent variables and year as the explanatory variable. RESULTS:From 2005-2020, there were a total of 2,481 graduates. Black men accounted for 4.7% of male graduates with a significant decline of 0.3% per year for the study period of those completing the fellowship (p = 0.02). Black women comprised 6.4% of female graduates and had a 0.6% decline each year (p < 0.01). A similar trend was seen with Hispanic men, who comprised 3.2% of male graduates and had a 0.3% annual decline (p = 0.02). White men had a significant increase in both matriculation to and graduation from SCC fellowships during the same interval. Similarly, Black and Hispanic applicants declined from 2019 to 2020, while the percentage of White applicants increased. CONCLUSIONS:Disparities in URiM representation remain omnipresent in surgery and extend from residency training to SCC fellowship. Efforts to enhance the recruitment and retention of URiM in SCC training are warranted. LEVEL OF EVIDENCE/METHODS:Level IV - Therapeutic/Care Management.
Disparity in Transport of Critically Injured Patients to Trauma Centers: Analysis of the National Emergency Medical Services Information System (NEMSIS)
Escobar, Natalie; DiMaggio, Charles; Frangos, Spiros G; Winchell, Robert J; Bukur, Marko; Klein, Michael J; Krowsoski, Leandra; Tandon, Manish; Berry, Cherisse
BACKGROUND:Patient morbidity and mortality decrease when injured patients meeting CDC Field Triage Criteria (FTC) are transported by emergency medical services (EMS) directly to designated trauma centers (TCs). This study aimed to identify potential disparities in the transport of critically injured patients to TCs by EMS. STUDY DESIGN/METHODS:We identified all patients in the National EMS Information System (NEMSIS) database in the National Association of EMS State Officials East region from January 1, 2018, to December 31, 2019, with a final prehospital acuity of critical or emergent by EMS. The cohort was stratified into patients transported to TCs or non-TCs. Analyses consisted of descriptive epidemiology, comparisons, and multivariable logistic regression analysis to measure the association of demographic features, vital signs, and CDC FTC designation by EMS with transport to a TC. RESULTS:A total of 670,264 patients were identified as sustaining an injury, of which 94,250 (14%) were critically injured. Of those 94,250 critically injured, 56.0% (52,747) were transported to TCs. Among all critically injured women (n = 41,522), 50.4% were transported to TCs compared with 60.4% of critically injured men (n = 52,728, p < 0.001). In a multivariable logistic regression model, critically injured women were 19% less likely to be taken to a TC compared with critically injured men (OR 0.81, 95% CI 0.71-0.93, p = 0.003). CONCLUSIONS:Critically injured female patients are less likely to be transported to TCs when compared with their male counterparts. Performance improvement processes that assess EMS compliance with field triage guidelines should explicitly evaluate for sex-based disparities. Further studies are warranted.
Discrimination Toward Women Surgeons in the Workplace Through an Intersectional Lens: Are Institutions Ready for Diversity?
A Geospatial Evaluation of 9-1-1 Ambulance Transports for Children and Emergency Department Pediatric Readiness
Newgard, Craig D; Malveau, Susan; Mann, N Clay; Hansen, Matthew; Lang, Benjamin; Lin, Amber; Carr, Brendan G; Berry, Cherisse; Buchwalder, Kyle; Lerner, E Brooke; Hewes, Hilary A; Kusin, Shana; Dai, Mengtao; Wei, Ran
Examination of Intersectionality and the Pipeline for Black Academic Surgeons
Keshinro, Ajaratu; Butler, Paris; Fayanju, Oluwadamilola; Khabele, Dineo; Newman, Erika; Greene, Wendy; Ude Welcome, Akuezunkpa; Joseph, Kathie-Ann; Stallion, Anthony; Backhus, Leah; Frangos, Spiros; DiMaggio, Charles; Berman, Russell; Hasson, Rian; Rodriguez, Luz Maria; Stain, Steven; Bukur, Marko; Klein, Michael J; Henry-Tillman, Ronda; Barry, Linda; Oseni, Tawakalitu; Martin, Colin; Johnson-Mann, Crystal; Smith, Randi; Karpeh, Martin; White, Cassandra; Turner, Patricia; Pugh, Carla; Hayes-Jordan, Andrea; Berry, Cherisse
Importance/UNASSIGNED:The lack of underrepresented in medicine physicians within US academic surgery continues, with Black surgeons representing a disproportionately low number. Objective/UNASSIGNED:To evaluate the trend of general surgery residency application, matriculation, and graduation rates for Black trainees compared with their racial and ethnic counterparts over time. Design, Setting, and Participants/UNASSIGNED:In this nationwide multicenter study, data from the Electronic Residency Application Service (ERAS) for the general surgery residency match and Graduate Medical Education (GME) surveys of graduating general surgery residents were retrospectively reviewed and stratified by race, ethnicity, and sex. Analyses consisted of descriptive statistics, time series plots, and simple linear regression for the rate of change over time. Medical students and general surgery residency trainees of Asian, Black, Hispanic or Latino of Spanish origin, White, and other races were included. Data for non-US citizens or nonpermanent residents were excluded. Data were collected from 2005 to 2018, and data were analyzed in March 2021. Main Outcomes and Measures/UNASSIGNED:Primary outcomes included the rates of application, matriculation, and graduation from general surgery residency programs. Results/UNASSIGNED:Over the study period, there were 71â€¯687 applicants, 26â€¯237 first-year matriculants, and 24â€¯893 graduates. Of 71â€¯687 applicants, 24â€¯618 (34.3%) were women, 16â€¯602 (23.2%) were Asian, 5968 (8.3%) were Black, 2455 (3.4%) were Latino, and 31â€¯197 (43.5%) were White. Women applicants and graduates increased from 29.4% (1178 of 4003) to 37.1% (2293 of 6181) and 23.5% (463 of 1967) to 33.5% (719 of 2147), respectively. When stratified by race and ethnicity, applications from Black women increased from 2.2% (87 of 4003) to 3.5% (215 of 6181) (Pâ€‰<â€‰.001) while applications from Black men remained unchanged (3.7% [150 of 4003] to 4.6% [284 of 6181]). While the matriculation rate for Black women remained unchanged (2.4% [46 of 1919] to 2.3% [52 of 2264]), the matriculation rate for Black men significantly decreased (3.0% [57 of 1919] to 2.4% [54 of 2264]; Pâ€‰=â€‰.04). Among Black graduates, there was a significant decline in graduation for men (4.3% [85 of 1967] to 2.7% [57 of 2147]; Pâ€‰=â€‰.03) with the rate among women remaining unchanged (1.7% [33 of 1967] to 2.2% [47 of 2147]). Conclusions and Relevance/UNASSIGNED:Findings of this study show that the underrepresentation of Black physicians at every stage in surgical training pipeline persists. Black men are especially affected. Identifying factors that address intersectionality and contribute to the successful recruitment and retention of Black trainees in general surgery residency is critical for achieving racial and ethnic as well as gender equity.
Reassessing career pathways of surgical leaders: An examination of surgical leaders' early accomplishments
Meer, Elana; Hughes, Byron D; Martin, Colin A; Rios-Diaz, Arturo J; Patel, Viren; Pugh, Carla M; Berry, Cherisse; Stain, Steven C; Britt, L D; Stein, Sharon L; Butler, Paris D
BACKGROUND:The American College of Surgeon (ACS), American Surgical Association (ASA), Association of Women Surgeons (AWS), and Society of Black Academic Surgeons (SBAS) partnered to gain insight into whether inequities found in surgical society presidents may be present earlier. METHODS:ACS, ASA, AWS, and SBAS presidents' CVs were assessed for demographics and scholastic achievements at the time of first faculty appointment. Regression analyses controlling for age were performed to determine relative differences across societies. RESULTS:66 of the 68 presidents' CVs were received and assessed (97% response rate). 50% of AWS future presidents were hired as Instructors rather than Assistant professors, compared to 29.4% of SBAS, 25% of ASA and 29.4% of ACS. The future ACS, ASA, and SBAS presidents had more total publications than the AWS presidents, but similar numbers of 1st and Sr. author publications. CONCLUSION/CONCLUSIONS:Gender inequities in academic surgeon hiring practices and perceived scholastic success may be present at first hire.
The Role of Race and Gender in the Career Experiences of Black/African-American Academic Surgeons: A Survey of the Society of Black Academic Surgeons and a Call to Action
Crown, Angelena; Berry, Cherisse; Khabele, Dineo; Fayanju, Oluwadamilola M; Cobb, Adrienne; Backhus, Leah; Smith, Randi; Sweeting, Raeshelle; Hasson, Rian; Johnson-Mann, Crystal; Oseni, Tawakalitu; Newman, Erika A; Turner, Patricia; Karpeh, Martin; Pugh, Carla; Jordan, Andrea Hayes; Henry-Tillman, Ronda; Joseph, Kathie-Ann
OBJECTIVE:To determine the role of race and gender in the career experience of Black/AA academic surgeons and to quantify the prevalence of experience with racial and gender bias stratified by gender. SUMMARY OF BACKGROUND DATA/BACKGROUND:Compared to their male counterparts, Black/African American (AA) women remain significantly underrepresented among senior surgical faculty and department leadership. The impact of racial and gender bias on the academic and professional trajectory of Black/AA women surgeons has not been well-studied. METHODS:A cross-sectional survey regarding demographics, employment, and perceived barriers to career advancement was distributed via email to faculty surgeon members of the Society of Black American Surgeons (SBAS) in September 2019. RESULTS:Of 181 faculty members, 53 responded (29%), including 31 women (58%) and 22 men (42%). Academic positions as a first job were common (men 95% vs women 77%, p = 0.06). Men were more likely to attain the rank of full professor (men 45% vs women 7%, p = 0.01). Reports of racial bias in the workplace were similar (women 84% vs men 86%, NS); however, reports of gender bias (women 97% vs men 27%, p < 0.001) and perception of salary inequities (women 89% vs 63%, p = 0.02) were more common among women. CONCLUSIONS AND RELEVANCE/CONCLUSIONS:Despite efforts to increase diversity, high rates of racial bias persist in the workplace. Black/AA women also report experiencing a high rate of gender bias and challenges in academic promotion.