“Recent data suggests that women and minority surgery residents differ from their colleagues in perceptions and attitudes surrounding surgical training; therefore, there is a powerful need for novel approaches to improve training for all residents,” says Julie Ann Sosa, MD, MA, FACS.

Dr. Sosa is the Leon Goldman MD Distinguished Professor of Surgery and chair, department of surgery, University of California San Francisco (UCSF), and co-moderator for Identifying and Addressing Inequities in Surgery Residency Training, available at 1:00 pm Central Time on Saturday, October 23. She introduces a panel that identifies ongoing inequities in residency training and discusses current programs to address these issues.

Attrition is a problem for surgical residents, as approximately one-quarter do not complete training, according to speaker Heather Yeo, MD, MHS, associate professor of surgery, Weill Cornell Medical College, New York, NY. Dr. Yeo discusses results from the National Study of Expectations and Attitudes of Residents in Surgery (NEARS) to help inform actions moving forward.

Findings from component studies within NEARS have revealed that personal factors, programmatic factors, and factors from the broader field of surgery affect resident attrition. Additionally, trainee confidence, or lack thereof, in operating independently has a significant influence on whether residents finish training. Minority women are at the highest risk of attrition.

“We need to evaluate [attrition] prospectively; specific groups are at increased risk, but there are areas we can target, including mentorship and support structures,” Dr. Yeo says.

There also are important findings on inequities in surgery residency from two nationwide studies—the FIRST (Flexibility In duty hour Requirements for Surgical Trainees) Trial and the SECOND (Surgical Education Culture Optimization through targeted interventions based on National comparative Data) Trial. Yue-Yung Hu, MD, MPH, assistant professor of surgery and associate program director, general surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL, reviews the results from each in her talk, noting that the FIRST trial and subsequent studies found that women and minorities have considerably higher reports of difficulty with well-being and mistreatment in their training, and that all types of mistreatment (bullying, gender discrimination, and so on) are “underestimated by orders of magnitude” by their program directors.

The SECOND Trial introduced interventions to measure and improve well-being, such as a wellness toolkit, Dr. Hu says. She also discusses the cross-institutional efforts to address inequities that have developed in recent years, including the creation of a national mentorship network.

“We can’t just focus on the educational outcomes,” says Adnan Alseidi, MD, EdM, FACS, professor of clinical surgery and vice-chair of education, department of surgery, UCSF.  “We have to look at [disparities and inequity] in the continuum of care. How does education and teaching about inequities help to start putting a dent in this issue?”

Dr. Alseidi describes the six areas of need that can be addressed in surgical education—the  “educational lift”—including a commitment to a diverse and equitable surgical workforce, cognitive curricula on general and specific disparities, underrepresented minority learner support and mentorship, faculty development, educational teaching and learning modalities research, and diversity in educational societies.

By embedding education on health disparities into medical school, residency, and continuing education, learners will have a greater awareness of the health issues that minority groups face and will be better able to address them in a health care setting, Dr. Alseidi suggests.

Other speakers in this session include Melina R. Kibbe, MD, FACS, the James Carroll Flippin Professor of Medical Science and dean, University of Virginia (UVA) School of Medicine, and chief health affairs officer, UVA Health, Charlottesville, on what surgical leadership understands about inequities; and Erica R. Sutton, MD, FACS, associate dean for academic programs and affiliations, Morehouse School of Medicine, Atlanta, GA, on her insights into inequities from the perspective of an educational leader at a historically black college and university.

This and other Clinical Congress sessions are available to registered attendees for on-demand viewing for a full year following Congress on the virtual meeting platform. Also, be sure to tune into Clinical Congress Daily Highlights for more details about the lecture. Watch Steven Stain, MD, FACS, interview Dr. Sosa and Mallory Williams, MD, FACS.