Resident Race and Operative Experience in General Surgery Residency: A Mixed-Methods Study

Introduction

Recent multi-institutional quantitative work has found that Black general surgery residents perform fewer operations during training. Further mixed-methods research exploring the reasons for this phenomenon is needed to address this inequity for residents who are underrepresented in medicine (URiM).

Material and methods

Data were collected through open response and Likert scale questions that were distributed electronically to residents at 21 accredited US general surgery programs within the US Resident Operative Experience Consortium. Questions focused on what barriers prevent residents from going to the operating room and potential solutions. Free text was analyzed by three qualitative reviewers.

Results

The online survey was completed by 96 general surgery residents representing a 12% overall response rate from the 21 US Resident Operative Experience Consortium programs. Eight (n = 8/13, 62%) of the URiM residents endorsed that they experienced barriers in obtaining case numbers compared to 13% of non-URiM residents (P < 0.05). A similar proportion of both groups agreed that their quality of training was affected by their race or ethnicity (n = 6/13, 46% versus n = 34/49, 41%; P = 0.77). Floor work and clinical tasks were the most common qualitative themes regarding operative barriers (75 responses). Racial bias (n = 22) was frequently referenced as a barrier specifically experienced by URiM residents. Suggestions to improve the operative experience of URiM residents included increasing mentorship at the attending level (n = 25) and setting objective standards for resident operating room participation (n = 30).

Conclusions

Nearly five times as many URiM residents reported experiencing barriers in obtaining case numbers compared to non-URiM residents. Qualitative analysis suggests that clear expectations for resident participation in cases and increasing mentorship at the attending level may be ways to achieve parity.