Disparities in Research during Plastic Surgery Training: How Can We Level the Playing Field?

Abstract

Background: Lack of female and ethnically underrepresented in medicine (UIM) surgeons remains concerning in academic plastic surgery. One barrier to inclusion may be unequal opportunity to publish research. This study evaluates the extent of this challenge for plastic surgery trainees and identifies potential solutions. Methods: Data were collected on academic plastic surgeons' research productivity during training. Bivariate analysis compared publication measures between genders and race/ethnicities at different training stages (pre-residency/residency/ clinical fellowship). Multivariate analysis determined training experiences independently associated with increased research productivity. Results: Overall, women had fewer total publications than men during training (8.89 versus 12.46, P = 0.0394). Total publications were similar between genders before and during residency (P > 0.05 for both) but lower for women during fellowship (1.32 versus 2.48, P = 0.0042). Women had a similar number of first-author publications during training (3.97 versus 5.24, P = 0.1030) but fewer middle-author publications (4.70 versus 6.81, P = 0.0405). UIM and non-UIM individuals had similar productivity at all training stages and authorship positions (P > 0.05 for all). Research fellowship completion was associated with increased total, first-, and middle-author training publications (P < 0.001 for all). Conclusions: Less research productivity for female plastic surgery trainees may reflect a disparity in opportunity to publish. Fewer middle-author publications could indicate challenges with network-building in a predominately male field. Despite comparable research productivity during training relative to non-UIM individuals, UIM individuals remain underrepresented in academic plastic surgery. Creating research fellowships for targeting underrepresented groups could help overcome these challenges.

Discrepancies in Gender Representation Between Integrated and Independent Plastic Surgery Programs

“…With discrepancies in faculty representation, it may be difficult for general surgery residents to complete research in plastic surgery during their initial surgical training. Recent analysis of gender authorship in plastic surgery found a correlation with decreased female first authorship if the senior author was male with higher association for female first authors with female senior authors, a disadvantage that is compounded by low numbers of female faculty in academic plastic surgery 1,6,7 . A recent analysis of academic plastic surgery departments found that only 19% of faculty were female, and examination of fellowship programs in hand surgery found 40% of hand surgery programs had no female faculty at all 1,8 .…”

“…Recent analysis of gender authorship in plastic surgery found a correlation with decreased female first authorship if the senior author was male with higher association for female first authors with female senior authors, a disadvantage that is compounded by low numbers of female faculty in academic plastic surgery. 1,6,7 A recent analysis of academic plastic surgery departments found that only 19% of faculty were female, and examination of fellowship programs in hand surgery found 40% of hand surgery programs had no female faculty at all. 1,8 Analysis of research productivity in hand surgery found that only 3.3% of unique female authors in hand surgery published 5+ articles during the 13-year study period, compared with 7% of unique male authors.…”

“…Gender discrepancies in residency training programs are well-known and acknowledged within plastic and reconstructive surgery 1–7 . There has been much improvement in representation of women among surgical trainees in surgical subspecialities, including plastic surgery, orthopedic surgery, and neurosurgery 2 .…”

Diversity, Equity, and Inclusion in Plastic Surgery

“…147 Many publications advocated minority-focused financial support to underrepresented minorities, in the form of scholarships, clerkships, funded subinternships, funded research fellowships, subsidized travel and lodging, and grants. 37,55,72,78,80,94,101,102,105,113,115,124 Increasing diversity content in patient photographs and Web sites was a frequent theme.…”

“…22,60,78,92,125 Photographs available online were reviewed. 22,47,60,[78][79][80]92,114,120,123,125 A judgment was made regarding gender and race based on these photographs.…”