Minority Residents Report Discrimination During General Surgery Training

Tarik Yuce, MD, MS

A large proportion of nonwhite residents experienced racial/ethnic discrimination in general surgery training, leading to substantial distress, findings of a new research letter showed.

The findings suggested that efforts should be implemented to improve diversity, equity, and inclusion within surgical training programs.

Tarik Yuce, MD, MS, and a team of US-based investigators had 3 objectives: to determine the national prevalence and sources of discrimination based on race/ethnicity in US general surgery programs, to identify factors associated with discrimination, and to assess its association with resident wellness.

Yuce, from the Surgical Outcomes and Quality Improvement Center at the Feinberg School of Medicine at Northwestern University, and colleagues administered a survey to resident physicians training in Accreditations Council for Graduate Medical Education-accredited general surgery programs. The survey followed the 2019 American Board of Surgery In-Training Examination.

Residents who received the survey were asked about their experiences with various types of behavior based on race/ethnicity or religion within that academic year. The investigators established instruments to assess burnout, thoughts of attrition, and suicidality.

The Association of American Medical Colleges helped the team obtain the proportion of minority faculty members within each program.

The team collected data in January 2019 and analyzed them from June-August 2019.

Overall, 6956 clinically active residents from 301 programs completed the survey, with a response rate of 85.6%. Of 5679 participants who responded to relevant questions, 23.7% reported experiencing discrimination based on their race/ethnicity or religion. Such rates were higher among black respondents (70.7%), Asian respondents (45.9%), Hispanic respondents (25.3%), and other nonwhite respondents (33.3%) compared with white respondents (12.6%).

Being mistaken for another person of the same race was the most common discriminatory behavior, according to 56.3% of black residents, and 37.6% of Asian residents. Nurses and staff were the most common source (43.8%). Black individuals frequently reported being taken for nonphysicians (62.4%), with 73.2% reporting such behavior, along with experiencing different evaluation standards (38.3%, with 63% reporting such behavior).

Nearly 25% of black residents experienced slurs or hurtful comments, most commonly from patients or families (35.5%).

Female residents were more likely to report discrimination (OR, 1.48; 95% CI, 1.27-1.74; P <.001), along with those who were nonwhite (black: OR, 20.91; 95% CI, 14.39-30.38; P <.001; Hispanic: OR, 2.62; 95% CI, 1.99-3.47; P <.001; Asian: OR, 6.29; 95% CI, 5.18-7.63; P <.001), and more senior (program year 2 or 3: OR, 1.30; 95% CI, 1.08-1.57; P=.005; program year 4 or 5: OR, 1.57; 95% CI, 1.28-1.92]; P <.001; compared with program year 1).

The team stratified for sex and revealed higher odds in women for every nonwhite race/ethnicity (black men: OR, 18.6; 95% CI, 11.44-30.32 vs black women: OR, 23.93; 95% CI, 13.93-41.12; Hispanic men: OR, 2.32; 95% CI, 1.57-3.42 vs Hispanic women: 3.09; 95% CI, 2.06-4.64; Asian men: OR, 5.66; 95% CI, 4.36-7.34 vs Asian women: 7.35; 95% CI, 5.57-9.72).

There was no association between geographic location, program type, and the racial ethnic compositions of the faculty and residency members and the association of likelihood of experiencing discrimination.

Among those who experienced discrimination, there were higher reported rates of burnout (51.6% vs 40.0%; P <.001), thoughts of attrition (16.2% vs 10.1%; P <.001), and suicidal thoughts (6.5% vs 3.8%; P <.001).

The findings highlighted the need for an improvement in diversity, equity, and inclusion within such residency programs.

The study, “National Evaluation of Racial/Ethnic Discrimination in US Surgical Residency Programs,” was published online in JAMA Network Open.