American Council of Academic Plastic Surgeons
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Barriers and facilitators for under-represented in medicine (URiM) students interested in surgical sub-specialties: a pilot study
Edgar Soto, MSPH1, Marshall Lewis, BS1, Carlos Estrada, MD, MS1, Britney Corey MD2, Colin Martin MD2, Jorge de la Torre MD,MHSA3
1School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA, 2Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, USA, 3Department of Surgery, Division of Plastics, University of Alabama at Birmingham, Birmingham, AL, USA

Background: As the racial and ethnic make-up of the US population increases it is important to recruit a health care workforce that mirrors the diversity of the general population. Despite support for diversification from the American Medical Colleges recent studies suggest that there have been no changes in the percentages of under-represented in medicine (URiM) matriculants to surgical subspecialties like plastic surgery in the last 10 years. There are a variety of advantages to a diverse surgical workforce including but not limited to recent research noting that URiM physicians are more likely to treat Medicaid patients and work in underserved communities compared to their non-URiM counterparts. The goal of this study is to examine perceived barriers and facilitators to pursuing a career in surgery among URiM medical students using a consensus development nominal group technique (NGT)
Methods: 5 NGT sessions were conducted with groups of 3rd and 4th year medical students. Questions were designed to characterize the range of experiences in terms of barriers and facilitators that URiM students encounter in their training path. Responses were weighted and ranked. The main outcome was the top five responses to three questions that were obtained at each session
Results: 38 students generated 300 responses to 3 questions. The top responses from each session resulted in experiences that provide structural barriers to a career in surgery such as: lack of information in pre-clinical years of surgery as a career (weighted sum 45%); minority experience (23%); financial pressures (20%); and other (10%) The top responses resulted in experiences that strengthen enthusiasm: role models(43%), peer mentors (28%), student groups (20%), and learning a craft (9%)
Conclusion: Medical students highlighted unique relationships with mentors and student groups that facilitated their interest in surgical subspecialties like plastic surgery. Understanding how URiM medical students overcome perceptual and structural barriers may be critical to informing national strategies that enhance the recruitment and retention of a more diverse surgical workforce.

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