Plastic Surgery Research Council

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Underrepresentation in Plastic Surgery: Examining the Influence of Specialty Factors on Career Choice
Jason L. Green, BS1, Kate B. Krucoff, MD2, Krisen Rezak, MD2, Suhail K. Mithani, MD2.
1Duke University School of Medicine, Durham, NC, USA, 2Duke University Medical Center, Durham, NC, USA.

Purpose: Racial/ethnic representation among health providers can enhance patient communication and understanding of health care disparities, leading to improved health outcomes in minority populations. This is of particular importance in plastic surgery where appropriate communication, including understanding of procedures and clarifying expectations, is essential to optimal treatment outcomes. Unfortunately, Black/African-American and Hispanic/Latino populations are traditionally underrepresented in plastic surgery, which may contribute to health disparities among these populations. The purpose of this study was to understand how career, lifestyle, and educational factors affect specialty decision-making by underrepresented minority medical students and their consideration of plastic surgery as a career.
Methods: An online survey was designed to collect information on the importance of selected specialty factors for medical students and the influence of important specialty factors on specialty choice and their consideration of plastic surgery. Following pilot testing among medical students and IRB-approval, the survey was distributed to the medical student membership of the American Medical Women's Association (AMWA), the Association of Women Surgeons (AWS), and the Student National Medical Association (SNMA). The importance of specialty factors was measured using a Likert scale (1=not important, 5=very important). Respondents then rated the influence of important specialty factors on specialty choice and plastic surgery interest using a Likert scale (1=negative influence, 5=positive influence). The influence of specialty factors, including mentorship, was compared between specialty choice & plastic surgery using an unpaired t-test.
Results: The survey was completed by 266 medical students of which 134 (50.2%) participants identified as Black/African-American and 23 (8.6%) participants identified as Hispanic/Latino. Thirty-two (20.5%) participants reported an interest in plastic surgery. The most important specialty factors were career opportunities (4.430.72), lifestyle after residency (4.400.82), and interest in specialty content (4.320.81). Each of these specialty factors had a positive influence on their choice of specialty (career opportunities-4.340.81, lifestyle after residency-4.241.04, interest in specialty content-4.420.76). When applied to plastic surgery interest, these factors had a significantly more negative influence: career opportunities (3.601.07, -0.84), lifestyle after residency (3.521.31, -0.72), and interest in specialty content (3.261.27, -1.07) (P <0.05). The influence of mentorship on plastic surgery interest was similar in medical students interested in plastic surgery vs. uninterested students (3.171.09 vs. 3.101.04) (P >0.05). The influence of having a mentor of the same race/ethnicity on plastic surgery interest was also similar in medical students interested in plastic surgery vs. uninterested students (2.930.14 vs. 2.980.15) (P >0.05).
Conclusions: The factors identified as most important to underrepresented minority medical students -career opportunities, lifestyle after residency, and interest in specialty content- had a more negative influence on their interest in plastic surgery in comparison to their specialty interests. Additionally, mentorship and mentor racial/ethnic concordance may have a limited influence on plastic surgery interest. This information can be applied to efforts to increase underrepresented minority interest in plastic surgery.


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