Academic Metrics Do Not Explain the Underrepresentation of Women in Orthopaedic Training Programs.

BACKGROUND: Among medical specialties, orthopaedic surgery persistently has one of the lowest representations of women in residency programs. This study examined whether differences exist in the academic metrics of the orthopaedic residency applicants and enrolled candidates by sex, which may be contributing to the persistent underrepresentation of women. Differences in enrollment rate in orthopaedic residency programs also were analyzed. We hypothesized that academic metrics were similar for female and male applicants and thus do not explain the underrepresentation of women in training programs. METHODS: Academic data of first-time applicants (n = 9,133) and candidates who enrolled in an orthopaedic residency (n = 6,381) in the U.S. from 2005 to 2014 were reviewed. The United States Medical Licensing Examination (USMLE) Step-1 and Step-2 Clinical Knowledge (CK) scores, Alpha Omega Alpha (AΩA) Honor Medical Society status, number of publications, and volunteer experiences were compared by sex and were analyzed over time. RESULTS: From 2005 to 2014, representation of female applicants increased from 12.6% to 16.0%, corresponding with an increase in the percentage of enrolled female residents (from 12.9% to 16.1%); 70.3% of male and 67.1% of female applicants to orthopaedic residency enrolled as residents (p = 0.082). Mean academic metrics increased significantly over time for applicants and enrolled candidates, irrespective of sex. Comparing by sex, the mean USMLE Step-1 scores of male applicants and enrolled candidates were approximately 2% higher than those of female applicants (p < 0.0001). Volunteer experiences of female applicants and enrolled candidates were 12% higher compared with male applicants (p < 0.0001). There was no significant difference in USMLE Step-2 CK scores, number of publications, or AΩA status by sex. CONCLUSIONS: The enrollment rate of male and female applicants in orthopaedic residencies was similar and did not change during the 10-year study period. The academic metrics of applicants and enrolled candidates have increased significantly. The academic metrics were found to be comparable by sex; the differences in USMLE Step-1 scores and volunteer experiences were small relative to the magnitude of accomplishments that these values represent. The growth rate of the proportion of women in orthopaedic residencies lags other surgical subspecialties but appears to be independent of academic metrics.

Underrepresented Minority Applicants Are Competitive for Orthopaedic Surgery Residency Programs, but Enter Residency at Lower Rates.

INTRODUCTION: Orthopaedic surgery residency programs have the lowest representation of ethnic/racial minorities compared with other specialties. This study compared orthopaedic residency enrollment rates and academic metrics of applicants and matriculated residents by race/ethnicity. METHODS: Data on applicants from US medical schools for orthopaedic residency and residents were analyzed from 2005 to 2014 and compared between race/ethnic groups (White, Asian, Black, Hispanic, and Other). RESULTS: Minority applicants comprised 29% of applicants and 25% of enrolled candidates. Sixty-one percent of minority applicants were accepted into an orthopaedic residency versus 73% of White applicants (P < 0.0001). White and Asian applicants and residents had higher USMLE Step 1. White applicants and matriculated candidates had higher Step 2 Clinical Knowledge scores and higher odds of Alpha Omega Alpha membership compared with Black, Hispanic, and Other groups. Publication counts were similar in all applicant groups, although Hispanic residents had significantly more publications. Black applicants had more volunteer experiences. CONCLUSIONS: In orthopaedic surgery residency, minority applicants enrolled at a lower rate than White and Asian applicants. The emphasis on USMLE test scores and Alpha Omega Alpha membership may contribute to the lower enrollment rate of minority applicants. Other factors such as conscious or unconscious bias, which may contribute, were not evaluated in this study.