will be Dr. Selina Poon. She is a pediatric orthopedic surgeon, and she's located in Southern California at the Shriners Children's Hospital. She's an esteemed colleague, writing quite a few articles in regards to diversity, equity, inclusion. She spends a lot of time looking particularly at gender itself. So I'll let Selina go ahead and give kind of an overview as we go forward here. Thank you. So here are my disclosures. I will be speaking about one study in this talk that is funded by an OREF research grant. Otherwise, everything else is listed. So how are we doing in the orthopedic diversity in our residencies? And this picture kind of gives you a little brief introduction. But if we look at the data, we've been the lowest in terms of diversity since 2009. And compared to all the other surgical subspecialties. And what is more concerning is that if you look at that thick blue line, it is a downward trend. So in those 10 years, we've actually become less diverse. How about for gender diversity? So the picture is slightly different. Every single surgical subspecialty has been increasing in their gender diversity. However, ever since 2011, we've been the lowest once again. How did that happen? Is because we are increasing in a slower rate than everybody else. So why are we having such problems increasing our diversity? Is this because of a pipeline problem? And the answer is partially yes, because for some reason we are lacking, we seem to be unable to inspire minorities to apply in the same proportion that they are available in medical school. And the problem is amplified for women. For those 10 years in this study, we've been around 12.6 to 16%. That is way lower than the 40, 50% of women, medical students that are available in the medical schools. And how much of the applications matter? Once we've inspired these students to at least think about orthopedic surgery, are we letting them in? And so we looked at this, and we looked at all the application characteristics of a medical student, and we looked at what influences their likelihood of being accepted. Those of us who do residency review know that these, everything mattered except for work experience. But we know that AOA is important. We know step one is really important as well. What we did then was that we put in gender and race. I'm really happy to report that gender didn't make a difference. So for all the ladies in the room, you were right. It was not easier for us to get into orthopedic surgery. But what was really surprising was when we put race into the model. Every single category of minorities had a lower odds of getting into orthopedic surgery, even if we held all the application characteristics the same. And this chart actually surprised me and opened up my eyes a lot more. So in those 10 years, we've matched 238 black residents and only 110 Hispanic residents. That's in 10 years. And if we look at black women and Hispanic women, the number is even more staggering. So once we have matched them into orthopedic surgery, should we just pat ourselves on the back and that's it? I would have to say we have to look at our attrition rate. Are we keeping them and letting them graduate residency and become orthopedic surgeons? So we took 20-year data, and I'm really happy to report as orthopedic surgeons, we have one of the lowest attrition rate compared to all the other surgeons. But our attrition is still driven by women and minorities. So women make up about 13% of our residents, but 22.8% of them leave our residency. 10% of our residents are underrepresented minorities, but they make up almost 30% of those who leave. The relative risk of female attrition is 2.5 compared to male, and dismissal where we fire them is 3.6. The number is even more staggering for black and African-Americans. Their relative risk of attrition is 3.6, and the relative risk of being fired is seven times their white colleagues. So not only are we not letting them in, they're leaving our residencies at a higher rate. And so how do we do better? I don't know. I'm sorry, I don't have all the answers, but I do have a few thoughts because I've been thinking about this for a few years now. Every year during residency selection time, this is how we feel, right? We get a stack of applications and we just want to get through it, but we can no longer do what is easy. We can't just use step one and maybe now step two cutoffs because all the steps have shown differences by gender and by race. Even AOA, something that we say, oh, here are the best medical students available, have shown to have racial bias. We need to reconsider what we're looking for. So holistic review have been shown to increase diversity in medical graduate education. And it probably gives us a better idea of who these medical students are, but it does take a significantly more time. We should figure out what we want in the resident or even an orthopedic surgeon. We shouldn't be looking at a number on a piece of paper. So are we looking for grit? Are we looking for a growth mindset? Or are we looking for somebody who's learned from their failures or compassion? Whatever it is that we want in an orthopedic surgeon. The other thing we need to do is turn the mirror back on ourselves. We need to look at our own implicit biases. We all have them. It affects everything we do, including how we select residents and how we treat our residents. And so here's the website for those of you out there who are interested. And I will tell you a few years ago, when I did this test, I learned a lot about myself. And once we have matched residents, we need to nurture them. They are our talent pool. And our old paradigm of one size fit all is no longer appropriate because research have shown us that these residents do not have the same experiences. So even though there's a lot of bullying and discrimination that's shown on this paper, women are more likely than men to have experienced these behaviors. And Dr. O'Day, who's gonna speak next, have shown us that racial discrimination is still something that we experience today. 97% of your colleagues experience racial discrimination in the workplace. And if you're a black and a woman, it is much harder for you because of the intersectionalities of your two different identities. So my final thoughts on how we can do better, we need to be intentional. We can no longer just passively wait. We need to prioritize early recruitment and every single one of us can actually encourage a medical student to at least look at orthopedic surgery. We need to acknowledge that we all have the potential for unconscious bias and non-underrepresented minorities need to get involved because you guys are the majority. And then we also need to ask, listen, and really learn. Thank you.

diversity in orthopedic residencies

lack of diversity

gender diversity

pipeline problem

race and acceptance in orthopedic surgery