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Background: Underrepresented minorities (URM) are disproportionately lacking in academic surgery, yet there is wide variation in URM in residency programs. This mixed methods study aims to describe factors that URM interns identified as important in their rank list of general surgery residency programs. These data will aid institutions in increasing URM representation and creating supportive training environments in academic surgery. Methods: We employed a mixed methods approach using an online survey and semi-structured interviews developed through focus group engagement and literature review. Interviews were audio recorded, transcribed, and coded for themes. We conducted narrative thematic analysis. Results: Sixty-four incoming general surgery interns completed the survey withmedian age 25 to 29. Of respondents, 67% identified as female and 34% as URM.URM general surgery interns were more likely to rate program benefits and finances,revisit opportunities (ie, organized post-interview revisit weekends), and post-graduatejob opportunities higher than were non-URM participants (p0.05). URM participantsalso ranked factors such as diversity of residents and faculty and diversity and inclusionstatements by programs higher than did non-URM participants (p0.05). Five URMinterns completed semi-structured interviews. Qualitative themes influencing URMinterns rank list decisions included (1) presence of URM in the program, (2) programsupport of resident-led goals, (3) active inclusivity initiatives, and (4) direct experiencesof current URM residents. All interview participants relied heavily on interactions withcurrent URM residents as a source of information. Detractors from programs includedinterns concerned with being the only person of color at their prospective programand no concrete initiatives or goals in place to support diversity and inclusion, raisingconcern for performative allyship. Conclusions: When evaluating residency programs, URM weighed current representation and support of URMs, active diversity and inclusion initiatives within a program, and lived experiences of URM residents. Surgery residency programs should take steps to not only intentionally recruit URM applicants but also create a supportive training environment that is diverse, inclusive, and empowering.
Shehiriana et al. (Tue,) studied this question.