Abstract
Purpose of Review
To frame the nature and extent of barriers adequately in order to raise awareness about the challenges to creating diversity in a surgical subspecialty. We hope to inspire new strategies to augment efforts towards inclusion.
Recent Findings
Experiencing microaggressions has been linked to elevated cortisol levels, as well as numerous health conditions such as hypertension, pulmonary disease, pain, depression, and suicidal ideation.
Summary
Otolaryngology is currently one of the least diverse fields of medicine. We sought to examine some of the structural phenomena in society that might explain this trend. Understanding causation is a key to developing remedies.
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References
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United Nations. Department of Economic and Social Affairs. Population division., World population prospects. United Nations: New York. p. CD-ROM;2002.
Adam D. World population hits eight billion - here’s how researchers predict it will grow. Nature. 2022.
Association of American Medical Colleges and AAMC Data Services. AAMC data book : statistical information related to medical schools and teaching hospitals. AAMC: Washington, D.C. p. volumes.
Reid J. Religion, postcolonialism, and globalization: a sourcebook. London; New York: Bloomsbury Academic. xiv. 2015;247 pages.
Albee GW. The psychological origins of the white male patriarchy. J Prim Prev. 1996;17(1):75–97.
• Truesdale CM, et al. Prioritizing diversity in Otolaryngology-Head and Neck Surgery: starting a conversation. Otolaryngol Head Neck Surg. 2021;164(2):229–233. Findings in this study highlighted the relatively low success rate for Otolaryngology in terms of achieving a diverse workforce reflective of the population.
•• Johnson BC. et al. Hurdles in diversifying otolaryngology: a survey of medical students. Otolaryngol Head Neck Sur. 2022;166(6):1161–1165. Their findings confirmed low rates of racial and ethnic diversity in Otolaryngology and they found that historically under-represented (or overlooked) applicants had trouble finding mentors and were discouraged from applying.
Ester PV, et al. Factors associated to infant mortality in sub-Saharan Africa. J Public Health Afr. 2011;2(2): e27.
Harrington JA. The effect of high infant and childhood mortality on fertility: the West African case. Concerned Demogr. 1971;3(1):22–35.
Simmons RA, Anthopolos R, O’Meara WP. Effect of health systems context on infant and child mortality in sub-Saharan Africa from 1995 to 2015, a longitudinal cohort analysis. Sci Rep. 2021;11(1):16263.
Kirby RS. The US Black-White infant mortality gap: marker of deep inequities. Am J Public Health. 2017;107(5):644–5.
Cote-Gendreau M, Donnelly Moran K. Geographic heterogeneity in Black-white infant mortality disparities. Front Public Health. 2022;10:995585.
Barnes JC, Motz RT. Reducing racial inequalities in adulthood arrest by reducing inequalities in school discipline: evidence from the school-to-prison pipeline. Dev Psychol. 2018;54(12):2328–40.
•• Hemez, P, Brent JJ, Mowen TJ. Exploring the school-to-prison pipeline: how school suspensions influence incarceration during young adulthood. Youth Violence Juv Justice, 2020;18(3):235–255. Findings are critical to understand institutional bias and how any attempt to diversify the applicant pool for a surgical subspecialty should also consider policies and practices that derail careers in middle school. Suspension in 7th grade increases the odds of incarceration in young adulthood.
Gilliam WS. Preschool promises: an introduction, commentary, and charge. Psychol Sci Public Interest. 2009;10(2):i–v.
Harnett NG. Neurobiological consequences of racial disparities and environmental risks: a critical gap in understanding psychiatric disorders. Neuropsychopharmacology. 2020;45(8):1247–50.
Teye SO, et al. Exploring persistent racial/ethnic disparities in lead exposure among American children aged 1–5 years: results from NHANES 1999–2016. Int Arch Occup Environ Health. 2021;94(4):723–30.
Halabicky OM. Childhood lead exposure: ongoing exposures and health disparities. Workplace Health Saf. 2023;71(2):96.
Elks ML, Johnson K, Anachebe NF. Morehouse school of medicine case study: teacher-learner relationships free of bias and discrimination. Acad Med. 2020;95 (12S Addressing Harmful Bias and Eliminating Discrimination in Health Professions Learning Environments):S88-S92.
Fuchs VR, Newhouse JP. National Bureau of Economic Research conference on the economics of physician and patient behavior. The conference and unresolved problems. J Hum Resour. 1978;13(Suppl):5–18.
Jolly P. Academic achievement and acceptance rates of underrepresented-minority applicants to medical school. Acad Med. 1992;67(11):765–9.
Nguyen M, et al. Association of sociodemographic characteristics with US medical student attrition. JAMA Intern Med. 2022;182(9):917–24.
Iceland J, Silver E, Goff K. Moral intuitions and attitudes towards affirmative action in college admissions. Soc Sci Res. 2023;110: 102848.
Cabrera NL, Franklin JD, Watson JS. Whiteness in higher education : the invisible missing link in diversity and racial analyses. ASHE High Educ Rep. Hoboken, NJ: Wiley Subscription Services, Inc. 2017;136.
Catenaccio E, et al. Lifetime earning potential and workforce distribution in developmental and behavioral pediatrics. Acad Pediatr. 2022.
Catenaccio E, Rochlin JM, Simon HK. Differences in lifetime earning potential for pediatric subspecialists. Pediatrics. 2021;147(4).
Sutton E, et al. The ergonomics of women in surgery. Surg Endosc. 2014;28(4):1051–5.
Tran M, et al. Operation-related musculoskeletal injuries among United States surgeons: a gender-stratified national survey. Plast Reconstr Surg Glob Open. 2022;10(2): e4142.
Giantini Larsen AM, et al. Barriers to pursuing a career in surgery: an institutional survey of Harvard Medical School students. Ann Surg. 2021;273(6):1120–6.
Guille C, et al. Work-family conflict and the sex difference in depression among training physicians. JAMA Intern Med. 2017;177(12):1766–72.
Cole S, et al. Pregnancy during otolaryngology residency: experience and recommendations. Am Surg. 2009;75(5):411–5.
Altieri MS, et al. Perceptions of surgery residents about parental leave during training. JAMA Surg. 2019;154(10):952–8.
Snyder RA, et al. The case for on-site child care in residency training and afterward. J Grad Med Educ. 2013;5(3):365–7.
Nama N, et al. Medical students’ perception of lesbian, gay, bisexual, and transgender (LGBT) discrimination in their learning environment and their self-reported comfort level for caring for LGBT patients: a survey study. Med Educ Online. 2017;22(1):1368850.
Tinmouth J, Hamwi G. The experience of gay and lesbian students in medical school. JAMA. 1994;271(9):714–5.
Sitkin NA, Pachankis JE. Specialty choice among sexual and gender minorities in medicine: the role of specialty prestige, perceived inclusion, and medical school climate. LGBT Health. 2016;3(6):451–60.
Heiderscheit EA, et al. Experiences of LGBTQ+ residents in US general surgery training programs. JAMA Surg. 2022;157(1):23–32.
Ryus CR, et al. Burnout and perception of medical school learning environments among gay, lesbian, and bisexual medical students. JAMA Netw Open. 2022;5(4): e229596.
Samuels EA, et al. Association between sexual orientation, mistreatment, and burnout among US medical students. JAMA Netw Open. 2021;4(2): e2036136.
Baams L, Grossman AH, Russell ST. Minority stress and mechanisms of risk for depression and suicidal ideation among lesbian, gay, and bisexual youth. Dev Psychol. 2015;51(5):688–96.
Igartua KJ, Gill K, Montoro R. Internalized homophobia: a factor in depression, anxiety, and suicide in the gay and lesbian population. Can J Commun Ment Health. 2003;22(2):15–30.
Westafer LM, et al. Experiences of transgender and gender expansive physicians. JAMA Netw Open. 2022;5(6): e2219791.
Kugler EG. Debunking the middle-class myth: why diverse schools are good for all kids. 2002, Lanham, Md: Scarecrow Press. 1 online resource (xxvii, 163 p.).
Payne-Sturges DC, et al. Student hunger on campus: food insecurity among college students and implications for academic institutions. Am J Health Promot. 2018;32(2):349–54.
Zhou AG, et al. Food insecurity in medical students: preliminary data from Yale School of Medicine. Acad Med. 2021;96(6):774–6.
Flynn MM, et al. Assessing food insecurity in medical students. Fam Med. 2020;52(7):512–3.
Shappell E, Schnapp B. The F word: how “fit” threatens the validity of resident recruitment. J Grad Med Educ. 2019;11(6):635–6.
•• Bailey ZD, et al. Structural racism and health inequities in the USA: evidence and interventions. Lancet. 2017;389(10077):1453–1463. Excellent overview and explanation of structural racism and how these factors influence life expectancy, poverty, incarceration, and multiple factors that decimate under-represented minority communities long before they can become applicants to Otolaryngology.
Eastman Kodak Company. Kodak color handbook; materials, processes, techniques. Kodak color data books. Rochester, N.Y. 68, 56, 64, 60 p;1950.
Eastman Kodak Company. [from old catalog], Kodak color dataguide. Rochester, N.Y. 1960;40.
Funding
Heather M. Weinreich receives funding from the NIH Office of Research on Women’s Health—UIC BIRCWH grant K12HD101373. Her work pertains to sex differences and instrument design. This specific grant did not fund work for this project.
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Pankey, A., Martin, E., Weinreich, H.M. et al. The Impact of Bias on the Pathway to Otolaryngology: Time to Level Up. Curr Otorhinolaryngol Rep 11, 78–85 (2023). https://doi.org/10.1007/s40136-023-00457-2
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DOI: https://doi.org/10.1007/s40136-023-00457-2