Podium IC DEI
(S022) HOW CAN WE MITIGATE IMPOSTER SYNDROME? IDENTIFYING DAY-TO-DAY INTERACTIONS THAT PROMPT FEELINGS OF IMPOSTERISM IN RESIDENT TRAINEES
Tasha Posid, MA, PhD1, Rebecca Brown, MD2, Sarah Lund, MD3, Amanda Cooper, MD4, Joseph L’Hullier, MD, MSHPEd5, Olabisi Ololade Sheppard, MD6, Esther Wu, MD7, Jeanette Zhang, MD8, Sophia McKinley, MD, EdM9, Theofano Zompou, MD10, Minna Wieck, MD11, Christie Bialowas, MD12, Deborah Jacobson, MD13, Kimberly Hendershot, MD14; 1The Ohio State University Wexner Medical Center, 2University of Maryland School of Medicine, 3Mayo Clinic, 4Penn State Milton S. Hershey Medical Center, 5University of Buffalo, 6University of Nebraska Medical Center, 7Loma Linda University Health, 8Tulane University School of Medicine, 9Massachusetts General Hospital, 10Rutgers New Jersey Medical School, 11University of California Davis Children’s Hospital, 12Albany Medical Center, 13University of Utah, 14University of Alabama at Birmingham
Introduction:
Imposter Syndrome involves self-doubt of intellect, skills, or accomplishments, significantly affecting mental health, well-being, career retention, and job performance. Although Imposter Syndrome has been documented in the healthcare literature and is prevalent particularly amongst trainees. Little work has been conducted investigating methods to mitigate imposterism. The purpose of this study was to identify and describe what specific day-to-day interactions that prompt feelings of imposterism in surgical residents.
Methods:
An anonymous, cross-sectional, electronic survey was developed by members of the ASE Graduate Surgical Education Committee and distributed via listserv to surgical residents across specialties at collaborating institutions. A qualitative sub-analysis was conducted identifying specific day-to-day interactions (examples) that prompted feelings of imposterism. Across 155 survey respondents, free responses from residents were coded for interactions involving patients (n=28), residents (n=34), and faculty (n=25). See Figure 1.
Results:
Residents were asked whether they had experienced imposterism during interactions with patients, other residents, and/or faculty attendings. 34.8% of respondents said they had not experienced imposterism during these encounters, 15.5% said they had for one type, 25.8% across two, and 23.9% across all three. Linear regression modeling indicated that women (p=0.031) had a higher number of these encounters than men. Qualitative coding of free responses indicated that patient experiences that triggered the most feelings of imposterism were patients thinking the resident was not qualified to be their doctor or not their doctor (42.9%), typically due to demographic factors such as age, gender, size, or race. 21.4% of residents also felt imposterism when they were unable to answer patient questions. Resident-resident feelings of imposterism primarily came from observing other residents ‘succeed’ (47.1%), such as receiving a higher ABSITE score, having a better skillset, or appearing more knowledgeable. Feelings of imposterism from faculty interactions typically came when residents felt unsure of something or made a mistake (40.0%).
Conclusion:
Results from this qualitative analysis identify behaviors and perceptions of patients, peers (residents), and faculty attendings that are associated with feelings of imposterism during residency training. Targeted education and interventions should account for these interactions that are encountered on a day-to-day basis.
(S023) BALANCING SCALPEL AND STROLLER: THE UNIQUE STRUGGLES OF SURGEON MOTHERS ON MATERNITY LEAVE
Madison Dusick1, Claire Wilson2, Jacob Davidson2, Danielle Vucenovic1, Jennifer Shaw3, Fiona Webster3, M. Elise Graham3, Natashia M Seemann3; 1Schulich School of Medicine, Western University, 2London Health Sciences Centre, 3Western University
Background: Ideal family building years inevitably coincide with training and early career for surgeons. Maternity leave for surgeon mothers can be a significant source of stress and indecision. Quantitative studies have demonstrated that surgeons and surgical trainees take significantly shorter maternity leaves than both non-surgeon physicians and the general population. Various reasons for this discrepancy include financial and academic pressures and the logistics of medical training and practice. This study sought to qualitatively explore the experience of navigating maternity leave as a surgeon mother.
Methods: Surgeons and surgical trainees were recruited via social media to complete virtual semi-structured interviews that explored their experience of motherhood. Audio-recorded interviews were transcribed and de-identified. Constructivist grounded theory was used to analyze transcripts. Open coding was conducted by the entire research team to establish familiarity with the data, followed by refined coding by two authors. Themes that emerged were discussed with the entire research team and key themes were finalized.
Results: Sixteen surgeons across a variety of surgical specialties participated, including three residents and one fellow. An equal number had their first child in residency compared to in early career. Three major themes emerged from the data regarding maternity leave: (1) productivity, (2) pressure and (3) policies. Productivity encapsulated the incredible amount of work that surgeon mothers continued to complete throughout their maternity leaves. This included completing advanced degrees, exam preparation, academic and research work. Pressure was evident both through external sources demanding productivity and early return to work as well as internal pressures and guilt to prove oneself as not lesser than colleagues once embodying the roles of both mother and surgeon. Policies were not in place to protect surgeon mothers during their maternity leaves, and this included policies to protect surgeons financially or temporally. Despite the different challenges, surgeons invariably felt that becoming a mother made them a better doctor.
Conclusion: Surgeon mothers face unique challenges to navigating early motherhood and maternity leave. Surgical careers are generally not supportive or conducive to true maternity leaves, often resulting in feelings of pressure, guilt and regrets from both a career and motherhood perspective.
(S024) ADVANCING STUDENT PREPAREDNESS AND INVOLVEMENT FOR REPRESENTATION AND EQUITY IN SURGERY (ASPIRES): A PIPELINE FOR INCREASING DIVERSITY IN SURGERY
Michael K Mensah-Mamfo, BS1, Paula V Gomes, BS1, Rebecca Zasloff, BS1, Giussepe Yanez, MS1, Alexandria Soto, MA1, Akosua Odei, BA1, Cathlyn K Medina, BA1, Camryn Thompson, BS1, Ioana Antonescu, MD2, Cory J Vatsaas, MD2; 1Duke University School of Medicine, 2Duke Department of Surgery
Background: The American College of Surgeons has underscored the importance of recruiting underrepresented groups into surgery to enhance patient care by creating a more diverse and representative workforce. However, the number of Black academic surgeons has remained relatively unchanged, and there has been a decline in Latino surgeons in academic surgery. In 2020, a novel mentorship program, Advancing Student Preparedness and Involvement for Representation and Equity in Surgery (ASPIRES), was created to provide early recruitment and mentorship of URiM students within the field of surgery. Pipeline programs like ASPIRES exist, but little is known about their utility in increasing the number of URiM students in surgery. Herein, we describe the early results of the ASPIRES program as a pipeline for URiM medical students applying into surgical residencies.
Design: Medical Students from the Student National Medical Association (SNMA) and Latino Medical Student Association (LMSA) were paired with surgical faculty. The mentorship pairs completed a 7-month curriculum with monthly meetings to increase their understanding of surgical training, prepare students for the surgery clerkship, and provide students with opportunities to strengthen their residency applications. Surveys were administered to the ASPIRES alumni class of 2020 to collect information regarding research experience, specialty choice, and match outcomes.
Results: Survey data from our first cohort of 19 URiM students were compiled. Of the 9 students who applied to the 2024 Residency Match, 5 (56%) applied to and successfully matched into surgical specialties. The other 10 students pursued an additional year of scholarly activity, and 8 (80%) of those students applied to a surgical specialty (Figure 1).
Conclusions: ASPIRES offers a model mentorship program that has successfully guided URiM students to match into a surgical specialty. ASPIRES aims to address the persistent lack of diversity in surgery by strengthening the pipeline of students applying to the surgical specialties through exposure and one-on-one mentorship. With over two-thirds of our inaugural ASPIRES cohort applying or matriculating into surgical residencies, we demonstrate the potential of this pipeline program to aid in the diversification of the surgical field.
Figure 1: Residency Applications and Match Results of the Inaugural ASPIRES Program Cohort of 2020.
(S026) THE DEVELOPMENT OF CONFIDENCE IN SURGERY RESIDENTS: DEFINING THE QUALITIES OF A SUCCESSFUL SURGEON
A. Reema Kar, MD1, Tracy Andrews, PhD2, Nell Maloney-Patel, MD1; 1Rutgers/Robert Wood Johnson Medical School, 2Rutgers School of Public Health
Title: The Development of Confidence in Surgery Residents: Defining the Qualities of a Successful Surgeon
Background:
Academic faculty generally accept that confidence is an essential quality in successful surgeons, but there is little consensus on the definition of confidence, and, importantly, no standardized way to quantify it. Known disparities in medical education suggest that male and female surgical trainees have different experiences that cause variable growth of confidence, which contribute to attrition, fellowship choices, and board pass rates. The same psychosocial and political factors play a significant role in a young surgeon’s confidence development. This multi-stage study aims to better characterize how surgery residents develop confidence by qualitatively analyzing resident metrics for success in surgery.
Methods:
A mixed methods approach was used to determine how surgery residents of all levels of training characterize successful careers and evaluate confidence. A focus group collected general ideas of success and confidence. Next, an anonymous online survey asked residents to rate their impressions on the discussed features of success and confidence using a Likert scale. Survey responses were statistically analyzed to compile a resident-generated list of the most important qualities of a successful surgeon.
Results:
41 responses were collected from the anonymous survey. Resident attitudes on confidence were analyzed on a 5-point Likert scale. 59% of residents strongly agreed that confidence is important for a surgeon’s career, and 37% strongly disagreed that competence and confidence were equivalent. Similarly, 52% of residents felt that confidence is equal parts situational and absolute. Residents reported 58 different qualities that characterize a successful surgeon. The most common traits were confidence, technical skill, competence, efficiency, and empathy.
Conclusions:
This data sets the stage for a deeper analysis of the development of confidence in surgery residents, and their attitudes surrounding success in surgery. All residents agree that a combination of intrinsic traits and learned behaviors constitute confidence. The subsequent phases of this study will assess resident’s self-assessment on the identified qualities of a successful surgeon, and determine trends in the development of confidence in residents of different genders, ages, races, and levels of training.
(S027) A DIFFERENT STUDENT: UNIVARIATE COMPARISON OF DEMOGRAPHIC AND SOCIOECONOMIC CHARACTERISTICS OF FIRST TIME MATRICULANTS (FTM) TO ALLOPATHIC MEDICAL SCHOOL VS REAPPLICANT MATRICULANTS
Colleen E McDermott, MD, MPH, Laura Lambert, MD, FACS, FSSO; University of Utah
Introduction/Background: Nearly two-thirds of applicants to MD-granting programs are unsuccessful each year, including many with high MCAT scores and GPAs. Many students who reapply are ultimately successful and while improved applications may partly drive their eventual success, there is a paucity of research on the differences between reapplicant matriculants (RM) and first-time matriculants (FTM). For applicants weighing the significant opportunity cost of reapplying, insights into these differences could provide essential guidance in making well-informed decisions.
Methods: A retrospective analysis of data obtained by the Association of American Medical Colleges (AAMC) on students entering medical school between 2015-2019 was conducted. Students were identified as reapplicants by the AAMC, and only the final year of application was assessed. Univariate comparison between RM and FTM was conducted in STATA, with Chi2 analysis of categorical variables and unpaired T test comparison of continuous variables.
Results: Results are described in Figure 1. Overall, FTM had higher GPA as described in prior studies (3.746 vs 3.599, p <0.001). They also had higher average MCAT percentile scores (80.5 vs 75.7, p <0.001). RM were older (25 vs 23, <0.001), and more likely to have an advanced degree (29% vs 7%, p <0.001). However, RM were more likely to be socieconomically disadvantaged (26% vs 22%, p<0.001), first generation college students (9% vs 7%, p <0.001), and be underrepresented in medicine (URiM). 20% vs 18% p <0.001).
Conclusions/Future Directions:
Socioeconomically disadvantaged and underrepresented in medicine students are less likely to secure acceptance as first-time applicants to medical school. Further analysis is needed to control for MCAT and GPA and identify additional factors that could inform strategies to reduce inequities in medical school admissions.
Figure 1: Differences Between FTM and RM:
(S028) A NOVEL HOLISTIC REVIEW METHOD FOR RECRUITMENT OF INTERNATIONAL MEDICAL GRADUATES IN AN ACADEMIC SURGICAL RESIDENCY PROGRAM
Ioannis A Ziogas, MD, MPH, Alejandro Suarez-Pierre, MD, Brittney Reyes, MEd, MHA, Mark Nehler, MD, Nicole Christian, MD, MSCS; University of Colorado
Introduction: Nearly 20% of active general surgeons practicing in the USA are international medical graduates (IMGs). However, given the competitiveness of the general surgery residency match, most IMG applicants begin with a non-designated preliminary intern year before transitioning to a categorical position. To overcome potential selection bias that may limit the recruitment of strong applicants from diverse backgrounds, we sought to develop a more objective method for evaluating IMGs applying to our academic categorical general surgery residency program.
Methods: A novel holistic review method for evaluating IMGs was created by IMG surgery residents and the educational leadership of the residency program. The evaluation process involved five categories: A) involvement in volunteerism and leadership, B) research aptitude, C) letters of recommendation (LOR), D) familiarity with US residency training (including year of graduation and US clinical experience), and E) background and adversity experienced. Each category was scored from 0 (lowest) to 4 (highest), except for adversity, which was scored from 0 to 2. Applicant demographics, USMLE scores, and immigration status were excluded from consideration during the selection process.
Results: A total of 179 unique applications from IMGs were reviewed. The median and mean total scores were both 11 (interquartile range [IQR]: 9-13). The median scores for the five categories were as follows: volunteerism/leadership, 2 (IQR: 1-3); research, 2 (IQR: 1-3); LOR, 3 (IQR: 2-3); dedication, 4 (IQR: 3-4); adversity, 1 (IQR: 0-1). Histograms of the five evaluation categories are shown in Figure 1. Twelve (6.7%) IMG applicants with a total score above 15 were invited for interviews and two (1.1%) were matched as categorical surgery residents.
Conclusion: The implementation of a novel holistic review method for evaluating IMG candidates for categorical general surgery residency positions successfully facilitated a structured and objective evaluation process. By focusing on non-quantitative attributes such as leadership, research, and adversity specific to IMG candidates, and excluding traditional parameters in line with our US allopathic holistic review, we were able to identify strong candidates for interview and facilitate the selection of IMG applicants for categorical surgery positions.
(S029) THE EARLY BIRD GETS THE WORM: OUTCOMES OF A MENTORSHIP AND EARLY EXPOSURE SURGERY PROGRAM FOR PRECLINICAL UNDERREPRESENTED MINORITY MEDICAL STUDENTS
Rebecca A Zasloff, BS1, Akosua D Odei, BA1, Alexandria L Soto, MA1, Giussepe Yanez, BS1, Michael Mensah-Mamfo, BS1, Paula Viza Gomes, BS1, Cathlyn K Mendina, BA1, Camryn Thompson, BS1, Cory J Vatsaas, MD2; 1Duke University School of Medicine, 2Department of Surgery, Duke University Medical Center
Introduction:
While diversity within the physician workforce has consistently been demonstrated to enhance patient outcomes, minority representation in surgical fields remains disproportionately low in comparison to the general population. Studies demonstrate that only 11.8% of all applicants to general surgery residency identify as underrepresented in medicine (URiM). Initiatives to increase early exposure and mentorship for URiM medical students are integral to the formation of a diverse surgical workforce. To aid in this mission, our institution developed a mentorship program with the goal of facilitating early exposure to surgery and fostering interest in a surgical career among URiM medical students.
Methods:
This mentorship program involved a 7-month curriculum for first-year URiM medical students where students were paired with surgeon mentors. Mentor-mentee pairs met for monthly educational discussions and completed at least two experiences in the operating room (OR). Student participants engaged in monthly large group interactive sessions including OR tours, research panels, subspecialty career panels, and surgical skills workshops. A survey was distributed to fourth-year students to assess post-program engagement in surgical activities, mentorship, and career interest.
Results:
Twenty-two fourth-year students who completed the program responded to the survey (64.7%). The majority engaged in surgical research (72.7%), participated in a surgical elective (68.2%) and completed a surgical sub-internship rotation (63.6%). Over one-third (36%) received an award during the surgical clerkship. More than half (59.1%) remained in contact with their mentors after the program. Most (63.9%) felt that the program influenced their decision to pursue a surgical specialty, with 72.7% intending to pursue a surgical career (Figure 1.).
Conclusion:
Our results demonstrate that this short-term program for first-year students has longitudinal impact on surgical career trajectory with the vast majority of students engaging in surgical research, surgery electives, and surgical sub-internships. Among program graduates, the majority of respondents reported their participation influenced their decision to consider and ultimately pursue a surgical career. This structured mentorship model pioneered at our institution provides an accessible, easily-implemented framework to facilitate early surgical exposure and foster long-term engagement with the Department of Surgery while positively influencing URiM students' decisions to pursue a career in surgery.
