Minorities on the Interview Trail

I haven't started the interview trail but have heard from previous applicants that ortho tends to lack racial/sex diversity compared to the other fields. You can look at individual websites and figure out which websites have a greater number of minority residents.

Not sure that you can definitively say that about the specialty as a whole. I think saying that orthopaedics lacks diversity implies that the resident matched population is not reflective of the applicant pool, and I am unaware of any statistics that say that is the case. Not saying those numbers aren't out there, I'm just not aware.

What I'm getting at is that I think it's unfair to characterize the specialty as lacking diversity without acknowledging that while the raw numbers or percentages may be lower, it may be instead reflective of the applicant pool from which programs choose rather than a perceived or actual reluctance for programs to take minority candidates.

rwbrhp29

Makes sense. There was something published in the JAAOS where the number of female/minority residents were lower than would be expected based on proportion of med students. I am sure that this is more of a recruitment issue than a 'program director racism' issue. I do understand why females tend to avoid surgical residencies but I don't understand why minorities would avoid surgery (ie not apply).



Women and Minorities in Orthopaedic Residency Programs
Women and underrepresented minorities make up smaller proportions of orthopaedic residency programs than their numbers in medical school would predict, according to our evaluation of self-reported orthopaedic residency data from 1998 and 2001, as well as information on medical students published in 2002. Based on race, ethnicity, and sex, comparisons were made between students entering and graduating from medical school and those in orthopaedic residency programs. With few exceptions, the percentages of women and underrepresented minorities were statistically significantly lower among those training in orthopaedic residency programs compared with those same groups entering and graduating from medical school. The percentage of women and minorities in orthopaedic residency programs remained constant between 1998 and 2001. Further study is necessary to determine whether fewer students of color and women apply to orthopaedic residency programs because of lack of interest, lack of appropriate mentoring and role models, or other factors.

The literature on this topic is growing rapidly as of late, to the point where JAAOS published an entire supplemental issue addressing the need to recruit greater diversity among applicants. The issue addresses a broad variety of explanations for why there is a disparity of females and other minorities in this field, and also addresses how this disparity can compromise the quality of resident training and patient care.

J Am Acad Orthop Surg, Vol 15, No suppl_1, September 2007, S1-S106.

In addition to this issue, an article published recently in Academic Medicine may be interest some of you; it addresses a selection bias in the admission process that may affect the diversity of the orthopaedic workforce at large. The reference is below.

Acad Med. 2009 Oct;84(10):1364-72.
The personal interview: assessing the potential for personality similarity to bias the selection of orthopaedic residents.

Thanks for all the info. I guess I posed the question because I looked through the pictures of the residents for the majority of the programs I was interested in, and there were no minority applicants. In fact, a program ( to me at least), had a higher chance of having a female than a ethnic minority as a resident.

As another interesting side note, at my school we have had 2 program directors in the past 10 years, and both of them are super nice and I wouldn't consider either of them to be racist. But none the less, when the first PD (who was Caucasian) was in charge 95% of the residents that were accepted each year looked like him. Now our PD is Asian, and all of a sudden (when before we had no Asian residents), the majority of residents in each new class is Asian. I don't think this has to do with racism, but an inherent drive for people to gravitate to people that look like them. Of course this is just my n=1 experience, but what I have noticed none the less.

Thanks for the literature ajq2009.

This is an interesting and volitile topic, but one that needs to be addressed. As a pgy 2 now and a african american canidate during my interview trail I never directly felt discrimmination or racisim, but one thing is for sure I was the only brother at 95% of my interviews. One top of that as the orginal poster mentioned I felt very uneasy when I went to programs and in looking at there picture on the wall of past residents there was not one person of color. If people are naive enough to think that race does not matter you are uninformed. That is not to make excuses or to say that unqualified applicants should be given spots. We are all busting our asses to get an ortho spot. But a diverse house staff is not only beneficial to the patients but also to the residents whom you interact. As a black man and a minority I can admit to have intrensic skepticism about some people I have come across because of there apperence, and often times I was wrong and made friends with people I would never expect. I am the only black man in a program of 44 residents. I dont think my program is anti diversity, but exactly the opposite as our chairman is a phenominal man, but it is difficult when i hear people saying there are not minority residents because they are not applying, this is just not true. No one should be given a residency spot because ethinicity, gender, socioeconomics. However as mentioned people gravitate to those like themselves, and being a minority applicant in ortho or any other surgical specialty presents challenges that are hard to understand if you have not faced them, that must be acknowledged.

I don't think it needs to be an issue of racism or volatility, necessarily.

This is a topic that needs to be approached like any other academic topic in medicine or orthopaedics, in that any effective discourse needs to stick to the evidence available in the literature on this topic. Fortunately, there is indeed a lot of literature for such discourse, and after reading through a large portion of these studies, I don't think that any publications have presented evidence of racism. So while this may or may not be a factor affecting diversity in our field, it would suit a discourse on this topic best by sticking to the published evidence.

To that end, i recommend highly that those interested in this topic read the supplemental issue from JAAOS mentioned above. The literature on this topic proposes collectively that a lack of diversity in orthopaedics results from many different factors.

A commonly cited one is that, as noted in a post above, we are unable to recruit a diverse applicant pool among medical students. This results likely from a disparity of role models in this field from those backgrounds that we need to recruit for greater diversity;without such role models, perhaps fewer medical students with diverse backgrounds identify with our field and thereby apply less frequently.

Another study, cited above from academic medicine, indicates that personality similarities between interviewers and interviewees introduce subconsciously a selection bias into the selection of residents. This bias is an important part of discourse on diversity, because personality is strongly linked with cultural and demographic backgrounds (as cited throughout.) Thus, a selection bias where like personalities select like personalities may be introducing indirectly and unintentionally a selection bias for various cultural and demographic groups. While this is not racism, it is a proven mechanism (p<0.05), so to say, that can potentially compromise diversity in our workforce. As a result of this study, programs may want to replace the individual personal interview with group interviews as a way to reduce such bias, and also actively recruit more diversity into their academic faculty and resident selection committee; the former has already occurred at the institution where this study was performed.

So we need to be careful, I think, to ensure that any discourse on this topic stick to the facts. Unless evidence exists to imply racism, we will accomplish more by clarifying that there are other significant barriers to diversity. In the absence of proof that one such barrier is racism, addressing other proven barriers instead will help to engage more effectively in such discourse with the orthopaedic audience at large. The alternative to this is to push away a large majority of participants in this discourse, and it will be more difficult to change the face of our workforce (pun intended.)

If you strongly feel that racism is a factor affecting diversity in the orthopaedic workforce, then I recommend that you conduct a study to prove this. If you can prove this with statistically significant data in a carefully designed study, then you could contribute significantly to a discourse on this topic. If such facts are presented in this fashion, then I think that significantly more orthopaedic surgeons in academic medicine and beyond will go to the drawing board for more related discourse and to seek out more solutions. A word of caution to anyone who is interested in such a study: I would avoid a design where minorities are asked if they feel that racism exists; the perception of racism is not proof of racism. This is just one example of what I mean above when I allude to a well designed study, where your methods need to truly prove what you set out to prove.

Just my 2 cents worth.

If you strongly feel that racism is a factor affecting diversity in the orthopaedic workforce, then I recommend that you conduct a study to prove this.

ajq 2009, wile I understand what you are saying, I think you overlooked one important point. How do you "prove" racism? Anything short of a selection committee saying "yes, we are racist" or unveiling a conspiracy to keep minorities out of the field can not be considered as this "proof" you are looking for. Nonetheless, I understand what you are saying.

It would of course be challenging. But for those who feel it is necessary, the burden of proof is on them. Science is indeed a cruel mistress.

ajq2009 <-- i dont think he is a minority.

Not quite seeing the minority perspective.

Wow, this topic has really taken off... not surprisingly.

I wanted to clarify and restate my original point which I posted before. I agree that the population of orthopaedists in the US does lack racial/ethnic/sexual diversity with respect to other specialties. What I was getting at was the orthopaedic residency selection process, which I believe was what the original question was referring to. The study that was cited above related the ortho resident population to the medical school graduate population. I still have not seen any data that compares the ethnic background of the ortho applicant pool of US graduating seniors to the population of matched applicants. I think this would really get to the root of the problem that I interpreted the original poster to be asking about, which was how his/her ethnicity and color would affect where he/she interviews and their chances of matching. Sorry in advance if I misinterpreted the original two posters.

For me, this issue is important to discuss from the point of view of the applicant. My main bit of advice for any minority applicant is to apply/interview where you want to go and don't let anyone tell you that you shouldn't because the ethnic background doesn't look like you. If you want a specific program, then go for it, and don't let anyone dissuade you on the basis of the program's ethnicity profile. I'm all for being realistic and thinking about all the issues, but bottom line, if you want that program, go for it!

This issue is also particularly frustrating to me because my residency is one that is sometimes labeled as a Southern good ole boy program without racial diversity or female residents. I love my residency, but I hate that that perception is out there and wish I had power to change it. We have graduated 4/16 minority graduates in our last 2 classes, but there is no denying that all but 2 of our 41 residents are white males at this point. That being said, I don't see our program as racist/sexist at all, and would encourage anyone interested to go for it.

Bottom line, I wish this wasn't weighing on the minds of ANY applicants.

rwbrhp29

I think this is a productive forum, and allows people to express how they feel. This is not a personal attack by any means and I think that aqj had some great points however the comment below was mind blowing.

" A word of caution to anyone who is interested in such a study: I would avoid a design where minorities are asked if they feel that racism exists; the perception of racism is not proof of racism".

There is no question that the race card is often played inappropriatly and thus devalues circumstances in which race was a true issue. I cant believe that you stated we should perform a randomized control study as to if racisim affects minority applicants. It does believe me, but as stated it is one of many factors. As mentioned the lack of mentorship, selection bias, ect... can be addressed by minorities whom are in the field pursuing careers in academic medicine. I feel I have a tremdous obligation to strongly consider an academic position to give back to others in my situation. Look man, no one wants a free ride or an excuse to match. The lack of diversity is a problem for our field and our patients, and I can tell you a prospective control study is not the answer. There is no one solution but I do believe forums like these are beneficial.

A very productive forum indeed, if we remain professional and encourage a continued discourse.

Just to clarify what I have been posting, as I am sure a careful reading of my statements above will reflect: I never said that racism doesn't exist. I simply posit that if you wish to make significant changes, then you will be more effective if you can design a carefully crafted study to substantiate any claims of racism. There may or may not be other solutions; but one solution may be to find a way to conduct such a study.

As I mentioned to someone else in reply to a private message, no matter what it is that you are trying to prove or change, you will be more effective if you can substantiate your claims. ONE such way-- but not the only way-- is through a carefully crafted study design that respects the need for a time-proven scientific method, so that any claims of racism are substantiated and thereby all the more effective to the end of eliminating it as much as possible. It is possible that carrying out some thorough background research on how to design such a study may yield creative and effective ways to measure such an outcome; in fact, political scientists, sociologists, and even some epidemiologists devote entire careers to precisely just this. I don't have the answer, but if an easy solution to this issue exists, we probably wouldn't be having this discourse.

So in summary of my posts, I believe that providing concrete and high-quality evidence is the best way to substantiate such claims. Just my opinion, and surely several will disagree and say that this is impossible. Perhaps, and perhaps not; I for one don't like to give up so easily. But it is my opinion that without hard evidence, fewer people will take this type of concern seriously, and ultimately, there will be no or limited progress. I believe that once we meet our burden of proof, the burden of finding solutions will be adopted and met more assertively by the orthopaedic community at large.

Now I'll sugar coat all of my opinions on this forum's thread for those who might be sensitive to the issue by saying that this is simply my opinion, and there is no need to be naughty here. And for the record and in response to a post above, I am indeed a minority with a strong interest in advocating diversity; in fact, I am the lead author of the article sited above from Academic Medicine, which definitely advocates diversity-- read it and you'll see for your self. But whether I am a minority or not is irrelevant; participation in this discourse by non-minority groups is also essential, for anything else would be to censor their opinion and miss an opportunity to stimulate your own thoughts and further develop your philosophies and convictions on this topic.

Finally, I'll have all of you know that the manuscript which I recently authored was rejected before by JBJS, specifically because my discussion on selection bias and demographic (i.e., race) discrimination was not adequantely suppored by hard, concrete evidence. Case in point.

Let the discourse continue, and even controversy if need be, for these are the seeds of progress. Stay professional, and you reveal strength; be a bully, and you'll expose your own weakness.

Be well to all, and stay cool.
Rendering Error in layout BBCode/Image: Layout 'BBCode/Image:default' Not Found. Please enable debug mode for more information.

To add some fuel to this interesting discourse (and not being a minority applicant myself), I noticed something interesting at my away rotation at Georgetown. When looking at their resident class pictures which date back to the 1960s, there was not one picture of a black person. So I would infer from this that either I am terrible at discerning a fair-skinned black person form a white person, or they've never trained one...ever. Now my home program hasn't done too well with training minorities (maybe 5 in their history), but we at least have that. For a program to have none, in a diverse city like DC calls for some deeper inspection.

The issue with this subject is that as others have posted, it would be literally impossible to design a study to really see what's going on. Something that came to mind that could help us determine whether minority apps are screened out initially would be to have 2 dummy applications from 2 Ivy League medical schools with the only real difference being their ERAS picture (i.e.- they have similar Step scores, research projections/pubs, volunteer experiences, AOA status, etc.). Seeing whether there is a difference in which dummy application gets an interview would be one way.

However once you get down to the interview and rank list preparation my dummy project would fall apartment, and you start getting into someone on the admissions committee being honest about their criteria or their biases. Which just won't happen. So now we are back to square one again. Although the interview study might be a good first start.

I am a minority. Graduated from Georgetown SOM a few years ago. Was heavily recruited by the chairman and PD to stay. Your observation is a coincidence, nothing more.

Thanks for your response. I'm curious though, what were you reasons for not matching Gtown high enough to stay there? Also your response leads to another interesting thought..Perhaps, minority applicants are not applying or ranking Gtown high enough because they don't see other minorities, even though G-town is actively recruiting. And in that case, it takes just one minority ranking them high enough and vice versa for more minorities to feel comfortable matching there. Who knows. The match is a cryptic process.

This is just an observation based on my own experience, but I live in what I would consider a diverse city and there are only two african american students in my class. Neither of these students are planning on going into ortho. The fact that there is a minority of black students in medical school as it is may be part of th reason why all races aren't evenly distributed across ortho residencies. On the other hand, I did rotate at a very small program that had two black residents

There are multiple reasons there aren't more minorities (specifically african-americans) in orthopaedics. I am a minority.
1. Not a large percentage in medical school to begin with.
2. They didn't create terms like "good ole boy system" for no reason, "country clubs" also often have fewer minorities than any given population would suggest. (I grew up on a golf course so I speaking from experience here)
3. Its been proven that all standardized test are inherently culturally biased, this didn't stop with the USMLE, and given many programs use those scores to decide who to interview and who not to. They don't have to be racist or biased themselves if they use a biased test to decide who they interview.(Its really a socio-economic bias but that is synonymous with race more often than not)
4. Most importantly I've found that the average program interviews 50-80 people, roughly (go with me here for a second). And I will use the lesser of values to err on the side of overestimating chances. Lets break down why its hard for minorities to get an interview much less match. Of those 50-80, 10-15 will likely come from their own medical school (40-70 interview spots left). They will probably have 4-5 rotators at least over July-0ctober with 1-3 in November and December, and since most places give rotators interviews thats 18-26. (22-52 interview spots left). From that point on these programs are receiving 400-800 applications with 22-52 interview spots. Given USMLE and AOA status are used to offer interviews say at least 25% of interview (13-20) say at least half of those are non-minority youre down to (15-45 inteview spots) for those 400-800 people. If you simply say I'm tired of reading interview applications give the next 15 interviews and waitlist the next 30. Odds are you might hit 2 minorities. Thus, you have 2-6 minorities interviewing for 3-6 spots with 44-74 other applicants all of which look just like the interviewers. Its not racism, thats just life.

5. PHONE CALLS, yes it happens to get guys interviews not just actual residency spots. If you look at the vast majority >95% (I feel I can safely say) of academic ortho faculty making those phone calls, they are not minorities. Their own children and children of friends aren't minorities. They aren't racist individuals they are simply people putting in calls for those that they know. Minorities have the same access to these individuals once in medical school I agree, but many ortho applicants have family members and family friends that are placing calls on their behalf. Naturally an attending can say alot more about a guy he's known 20 years versus 4.

I'm interested to hear how standardized tests are proven to be culturally biased. Would love to have someone educate me on that.

rwbrhp29

I'm assuming you're either an MD or soon to be MD, you've got many tools at your discretion but simply going to and typing in cultural biasis in standardized testing will give more than enough articles and studies. I'd take the time to look for the best one but that sort of looking for an article explaining that the sky really is blue. Never the less the more the test is unbiased and "level" the more racism must be playing a role. Not sure what you're angle is, but if the test aren't biased then the people picking residents must be.