Impressions of inclusivity within orthopedic surgery: Differences amongst women, minority, and LGBTQIA medical students

Objective: To better understand reasons for the underrepresentation of certain groups in orthopedic surgery, we investigated whether there were differences in medical students’ perceptions of inclusivity in orthopedic surgery between (1) men and women, (2) White, Asian and URiM, and (3) LGBTQIA and non-LGBTQIA students. Design: A one-time survey consisting of validated and/or previously used instruments measuring students' sense of belonging in orthopedics, prospective belonging uncertainty (an individual's worry that they will not fit in), stereotype threat (the effect of negative stereotypes on stereotyped group-members), and pluralistic ignorance (erroneously believing your beliefs are different than “typical” group-members). Setting: The survey was distributed at Loyola University, St. Louis University, University of Michigan, and Washington University in St. Louis. Participants: All medical students at these institutions were offered participation, and 441 medical students completed the survey (∼20% response-rate). Results: There was a lower sense of belonging for each of the following groups when compared to their majority-group peers: women (mean difference ​= ​0.5, 95% CI 0.3–0.7, p ​< ​0.001), Asian students (mean difference ​= ​0.4, 95% CI 0.1–0.7, p ​< ​0.001), URiM students (mean difference ​= ​0.4, 95% CI 0.07–0.7, p ​< ​0.001) and LGBTQIA students (mean difference ​= ​0.4, 95% CI 0.07–0.6, p ​= ​0.003). Medical students perceived that orthopedic faculty, residents, and the general public believe that men are better orthopedic surgeons than women, and that White surgeons are better surgeons than non-White surgeons. Women reported less confidence to succeed in orthopedics compared to “typical” peers (mean −0.5, SD 1.3), whereas men felt similar confidence compared to their peers (mean 0.1, SD 1.3; mean difference 0.6, 95% CI 0.4–0.9, p ​< ​0.001). Conclusions: These differences in belonging, prospective belonging uncertainty, stereotype threat, and pluralistic ignorance provide insight into how medical students perceive the inclusivity of orthopedics, which may ultimately play a role in the underrepresentation of minority groups.