The Diversity of Surgical Trainees Index Identifies Racial and Ethnic Disparities Among Surgical Specialties

Background Racial and ethnic disparities have been well-described among surgical specialties, however, variations in underrepresented minority (URiM) representation between these specialties have not previously been quantified. Methods Data collected from Accreditation Council for Graduate Medical Education (ACGME) annual reports were used to derive the Diversity of Surgical Trainee Index (DoSTI) metric, which was calculated as the proportion of URiM resident and fellow physicians within a given surgical specialty, relative to the overall proportion of URiM trainees within all surgical and non-surgical ACGME-accredited programs in the same academic year. Results From 2013 to 2022, a total of 108,193 ACGME-accredited residency programs trained 1,296,204 residents and fellows in the United States. Of these, 14.1% (n=182,680) of trainees self-identified as URiM over the study period. The mean DoSTI among all surgical specialties was 0.80 (standard error, 0.01) compared with all ACGME-accredited programs. High DoSTI specialties incorporated significantly higher proportions of Hispanic (8.7% vs 6.3%) and Black (5.2% vs 2.5%) trainees compared with low DoSTI specialties (p<0.0001 each). General surgery (1.06±0.01), plastic surgery (traditional) (1.12±0.06), vascular surgery (integrated) (0.96±0.03), and vascular surgery (traditional) (0.94±0.06) had the highest DoSTI indices (p<0.05 each vs composite). On linear regression analysis, only ophthalmology (+0.01/year, R2=0.41, p=0.019), orthopedic surgery (+0.01/year, R2=0.33, p=0.047), otolaryngology (+0.02/year, R2=0.86, p<0.001), and pediatric surgery (+0.06/year, R2=0.33, p=0.048) demonstrated an annual increase in DoSTI. Conclusion The Diversity of Surgical Trainees Index is a novel metric used to quantify the degree of URiM representation among surgical specialties. DoSTI has revealed specialty-specific variations in racial/ethnic minority representation among surgical training programs. This metric may be used to improve provider awareness, identify high performing DoSTI specialties to highlight their best practices, and ultimately, recruit a more diverse surgical workforce.