Association of Socioeconomic Status, Sex, Racial, and Ethnic Identity with Sustained and Cultivated Careers in Surgery

Abstract

Objective: Examine the association between sex, race, ethnicity, and family income, and the intersectionality between these identities, and sustained or cultivated paths in surgery in medical school. Methods: This retrospective cohort study examines U.S. medical students who matriculated in academic years 2014-2015 and 2015-2016. Data was provided by the Association of American Medical Colleges, including self-reported sex, race, ethnicity, family income, interest in surgery at matriculation, and successful placement into a surgical residency at graduation. This study examined two outcomes: 1) sustained path in surgery between matriculation and graduation for students who entered medical school with an interest in surgery, and 2) cultivated path in surgery for students who entered medical school not initially interested in surgery and who applied to and were successfully placed into a surgical residency at graduation. Results: Among the 5,074 students who reported interest in surgery at matriculation, 2,108 (41.5%) had sustained path in surgery. Compared to male students, female students were significantly less likely to have sustained path in surgery (aRR: 0.92 (0.85-0.98)), while Asian (aRR: 0.82, 95%CI: 0.74-0.91), Hispanic (aRR: 0.70, 95%CI: 0.59-0.83), and low-income (aRR: 0.85, 95%CI: 0.78-0.92) students were less likely to have a sustained path in surgery compared to their peers. Among the 17,586 students who reported an initial interest in a non-surgical specialty, 1,869 (10.6%) were placed into a surgical residency at graduation. Female students, regardless of race/ethnic identity and income, were significantly less likely to have cultivated paths in surgery compared to male students, with URiM female students reporting the lowest rates. Conclusion and Relevance: This study demonstrates significant disparity in sustained and cultivated paths in surgery during undergraduate medical education. Innovative transformation of the surgical learning environment to promote surgical identity development and belonging for female, URiM, and low-income students is essential to diversify the surgical workforce.