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The Impact of Bias on the Pathway to Otolaryngology: Time to Level Up

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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

Papers of particular interest, published recently, have been highlighted as: •  Of importance •• Of major importance

  1. United Nations. Department of Economic and Social Affairs. Population division., World population prospects. United Nations: New York. p. CD-ROM;2002.

  2. Adam D. World population hits eight billion - here’s how researchers predict it will grow. Nature. 2022.

  3. 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.

  4. Reid J. Religion, postcolonialism, and globalization: a sourcebook. London; New York: Bloomsbury Academic. xiv. 2015;247 pages.

  5. Albee GW. The psychological origins of the white male patriarchy. J Prim Prev. 1996;17(1):75–97.

    Article  CAS  PubMed  Google Scholar 

  6. • 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.

  7. •• 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.

  8. Ester PV, et al. Factors associated to infant mortality in sub-Saharan Africa. J Public Health Afr. 2011;2(2): e27.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Harrington JA. The effect of high infant and childhood mortality on fertility: the West African case. Concerned Demogr. 1971;3(1):22–35.

    CAS  PubMed  Google Scholar 

  10. 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.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Kirby RS. The US Black-White infant mortality gap: marker of deep inequities. Am J Public Health. 2017;107(5):644–5.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Cote-Gendreau M, Donnelly Moran K. Geographic heterogeneity in Black-white infant mortality disparities. Front Public Health. 2022;10:995585.

  13. 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.

    Article  CAS  PubMed  Google Scholar 

  14. •• 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.

  15. Gilliam WS. Preschool promises: an introduction, commentary, and charge. Psychol Sci Public Interest. 2009;10(2):i–v.

    Article  PubMed  Google Scholar 

  16. Harnett NG. Neurobiological consequences of racial disparities and environmental risks: a critical gap in understanding psychiatric disorders. Neuropsychopharmacology. 2020;45(8):1247–50.

    Article  PubMed  PubMed Central  Google Scholar 

  17. 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.

    Article  CAS  PubMed  Google Scholar 

  18. Halabicky OM. Childhood lead exposure: ongoing exposures and health disparities. Workplace Health Saf. 2023;71(2):96.

    Article  PubMed  Google Scholar 

  19. 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.

  20. 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.

  21. Jolly P. Academic achievement and acceptance rates of underrepresented-minority applicants to medical school. Acad Med. 1992;67(11):765–9.

    Article  CAS  PubMed  Google Scholar 

  22. Nguyen M, et al. Association of sociodemographic characteristics with US medical student attrition. JAMA Intern Med. 2022;182(9):917–24.

    Article  PubMed  Google Scholar 

  23. Iceland J, Silver E, Goff K. Moral intuitions and attitudes towards affirmative action in college admissions. Soc Sci Res. 2023;110: 102848.

    Article  PubMed  Google Scholar 

  24. 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.

  25. Catenaccio E, et al. Lifetime earning potential and workforce distribution in developmental and behavioral pediatrics. Acad Pediatr. 2022.

  26. Catenaccio E, Rochlin JM, Simon HK. Differences in lifetime earning potential for pediatric subspecialists. Pediatrics. 2021;147(4).

  27. Sutton E, et al. The ergonomics of women in surgery. Surg Endosc. 2014;28(4):1051–5.

    Article  PubMed  Google Scholar 

  28. 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.

    PubMed  PubMed Central  Google Scholar 

  29. 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.

    Article  PubMed  Google Scholar 

  30. Guille C, et al. Work-family conflict and the sex difference in depression among training physicians. JAMA Intern Med. 2017;177(12):1766–72.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Cole S, et al. Pregnancy during otolaryngology residency: experience and recommendations. Am Surg. 2009;75(5):411–5.

    Article  PubMed  Google Scholar 

  32. Altieri MS, et al. Perceptions of surgery residents about parental leave during training. JAMA Surg. 2019;154(10):952–8.

    Article  PubMed  Google Scholar 

  33. 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.

    Article  PubMed  PubMed Central  Google Scholar 

  34. 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.

    Article  PubMed  PubMed Central  Google Scholar 

  35. Tinmouth J, Hamwi G. The experience of gay and lesbian students in medical school. JAMA. 1994;271(9):714–5.

    Article  CAS  PubMed  Google Scholar 

  36. 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.

    Article  PubMed  PubMed Central  Google Scholar 

  37. Heiderscheit EA, et al. Experiences of LGBTQ+ residents in US general surgery training programs. JAMA Surg. 2022;157(1):23–32.

    Article  PubMed  Google Scholar 

  38. 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.

    Article  PubMed  PubMed Central  Google Scholar 

  39. Samuels EA, et al. Association between sexual orientation, mistreatment, and burnout among US medical students. JAMA Netw Open. 2021;4(2): e2036136.

    Article  PubMed  PubMed Central  Google Scholar 

  40. 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.

    Article  PubMed  PubMed Central  Google Scholar 

  41. 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.

    Article  PubMed  Google Scholar 

  42. Westafer LM, et al. Experiences of transgender and gender expansive physicians. JAMA Netw Open. 2022;5(6): e2219791.

    Article  PubMed  PubMed Central  Google Scholar 

  43. 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.).

  44. 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.

    Article  PubMed  Google Scholar 

  45. Zhou AG, et al. Food insecurity in medical students: preliminary data from Yale School of Medicine. Acad Med. 2021;96(6):774–6.

    Article  PubMed  Google Scholar 

  46. Flynn MM, et al. Assessing food insecurity in medical students. Fam Med. 2020;52(7):512–3.

    Article  PubMed  Google Scholar 

  47. Shappell E, Schnapp B. The F word: howfitthreatens the validity of resident recruitment. J Grad Med Educ. 2019;11(6):635–6.

    Article  PubMed  PubMed Central  Google Scholar 

  48. •• 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.

  49. Eastman Kodak Company. Kodak color handbook; materials, processes, techniques. Kodak color data books. Rochester, N.Y. 68, 56, 64, 60 p;1950.

  50. Eastman Kodak Company. [from old catalog], Kodak color dataguide. Rochester, N.Y. 1960;40.

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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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Correspondence to H. Steven Sims.

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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

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