Diversity and Inclusion in Academic Plastic Surgery: the ACAPS National Survey Comparing Attitudes, Knowledge, and Behavior of Medical Students to Faculty and Residents in Plastic Surgery Training Programs
Sara T. Obeid, MD, MPH, Charles Scott Hultman, MD,MBA, FACS.
University of North Carolina-Chapel Hill, Chapel Hill, NC, USA.
Purpose: Academic surgery, including the field of plastic surgery, has lagged behind in efforts to increase diversity in the workforce as a model for delivering more improved, cost effective care to increasingly diverse patient populations. Thus, the American Council of Academic Plastic Surgeons (ACAPS) sought to assess the current knowledge and attitudes towards diversity as a preliminary step to exacting strategies to address the deficit in plastic surgery training programs.
Methods: A national, anonymous, incentivized, 18 question online survey via Qualtrics was administered to all ACAPS members (n=462), integrated and independent plastic surgery residents (n=1029). Medical students from the University of North Carolina at Chapel Hill (n=720) were used as controls and the basis of group comparisons using the chi square test (p<0.05).
Results: The survey response rate was 14.7% (n=339), and included 98 faculty members (48 program directors), 98 residents and 112 medical students. Compared to faculty, medical students had fewer opportunities to engage in diversity/inclusion related endeavors (P=0.004) and felt less confident when addressing diversity/inclusion related concerns compared to faculty (P<0.00) and residents (P <0.000). Medical students were also more likely to feel that their training partially addresses diversity/inclusion as compared to faculty (P=0.002) and residents (P=0.001). Notably, medical students were more likely than faculty to witness discrimination (P=0.003). Discrimination cited most frequently included age, weight/body type, gender, race, medical condition and sexual orientation. Veteran status was cited as the least marker of discrimination by all groups. Lastly, medical students did not differ from faculty and residents in their perception of barriers to diversity and inclusion implementation including inadequate funding, lack of proper training and administrative support. Surprisingly, none of the responders felt that time constraints are a barrier.
Conclusions: Overall, medical students were more similar to residents than faculty with respect to race, parent/guardian educational background, age <40 years, and ability to speak multiple languages. However, medical students were less confident in their training as related to diversity (P<0.00). They were also more likely to advocate for systematic implementation of clinically oriented diversity such as IRB mandated minority representation in research (P=0.042) and required institutional training (P=0.003). It is likely that all groups can benefit from institutionalized, clinically oriented, evidence-based training while providing additional opportunities for residents and medical students to engage in the topic.
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