Factors Influencing Underrepresented Minority Applicants’ Ranking of General Surgery Residency Programs

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 with median 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-graduate job opportunities higher than were non-URM participants (p<0.05). URM participants also ranked factors such as diversity of residents and faculty and diversity and inclusion statements by programs higher than did non-URM participants (p<0.05). Five URM interns completed semi-structured interviews. Qualitative themes influencing URM interns’ rank list decisions included (1) presence of URM in the program, (2) program support of resident-led goals, (3) active inclusivity initiatives, and (4) direct experiences of current URM residents. All interview participants relied heavily on interactions with current URM residents as a source of information. Detractors from programs included interns concerned with being the only person of color at their prospective program and no concrete initiatives or goals in place to support diversity and inclusion, raising concern 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.