Characterization of Educational and Executive Leadership in University-Based General Surgery Programs: Demographics, Training Backgrounds, and Institutional Ties

Introduction: Despite longstanding homogeneity in surgical leadership at academic institutions, promoting diversity in leadership positions is increasingly recognized as critical to fostering inclusion, mentorship, and improved patient outcomes. This study aims to further characterize and compare educational and executive leaders within academic general surgery (GS) programs. Methods: A cross-sectional study was conducted using publicly accessible online resources to collect program characteristics and leadership demographics for Accreditation Council for Graduate Medical Education–accredited, university-based GS residency programs for the 2024-25 academic year. Leadership roles included Program Directors (PDs), Associate Program Directors (APDs), Clerkship Directors (CDs), Vice Chairs of Education (VCE), and Department Chairs (DCs). Roles were categorized as educational (CD, PD, APD, VCE) and executive (DC). Demographics assessed included gender through program website photographs and pronouns, and race through an online facial recognition tool. Training history was defined as completing a medical degree, residency, or fellowship training at the current institution of practice. Univariate logistic regression assessed predictors of educational versus executive roles. Results: Among 119 GS programs, we identified 119 DCs (86.6% male), 119 PDs (60.5% male), 229 APDs (47.6% male), 129 CDs (58.9% male), and 51 VCEs (66.7% male), of which the majority were White (74%-83%). Educational leaders were more likely to have completed residency or fellowship training at their current institution (51.5% versus 26.1%, P < 0.001). Fellowship training in colorectal, pediatric, and trauma/critical care surgery was more commonly associated with educational leadership; surgical oncology and endocrine surgery were more common among executive leaders. A univariate logistic regression model demonstrated that females and individuals with institutional training history had higher odds of being in an educational role. Conclusions: This cross-sectional study characterized current educational and executive leaders in university-based GS programs. Educational leadership positions, particularly PD, APD, and CD roles, demonstrated higher proportions of females compared to the executive role of DC. These roles were also more commonly associated with certain fellowship training and institutional training ties. These findings underscore the critical need for ongoing efforts to improve equitable pathways for academic promotion.