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Original Investigation
August 12, 2020

Intersectionality of Gender and Visible Minority Status Among General Surgery Residents in Canada

Author Affiliations
  • 1Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta Hospital, Edmonton, Alberta, Canada
  • 2London Health Sciences Centre, Schulich School of Medicine and Dentistry, Division of General Surgery, Department of Surgery, Western University, East London, Ontario, Canada
  • 3Division of General Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
  • 4Division of General Surgery, Department of Surgery, University of Sherbrooke, Sherbrooke, Quebec, Canada
  • 5General Surgery, Department of Surgery, The University of British Columbia, Vancouver, British Columbia, Canada
  • 6Melbourne School of Population and Global Health, University of Melbourne, Victoria, Australia
JAMA Surg. Published online August 12, 2020. doi:10.1001/jamasurg.2020.2828
Key Points

Question  How is diversity associated with resident wellness and resiliency?

Findings  In this survey study of 210 residents enrolled in general surgery training programs in Canada, being a woman and identifying as a visible minority were associated with adverse implications for the training experience during general surgery education.

Meaning  The results of this study serve as a call to training programs, accrediting bodies, and the medical community that new strategies focused on the intersectionality of gender and race/ethnicity are needed to improve the training experience of at-risk residents.


Importance  Within medical specialties, surgical disciplines disproportionately and routinely demonstrate the greatest underrepresentation of women and individuals from racial/ethnic minority groups. Understanding the role that diversity plays in surgical resident training may identify strategies that foster resident resiliency, optimize surgical training, and improve patient outcomes.

Objective  To examine the implication of gender and visible minority (VM [ie, nonaboriginal people who are not White individuals]) status for resiliency and training experiences of general surgery residents in Canada.

Design, Setting, and Participants  In this survey study, a 129-item questionnaire was emailed from May 2018 to July 2018 to all residents enrolled in all Canadian general surgery training programs during the 2017-2018 training year. Survey responses were extracted and categorized into 5 major themes. The survey was designed by the Resident Committee and reviewed by the Governing Board of the Canadian Association of General Surgeons. French and English versions of the survey were created, distributed, and administered using Google Forms.

Main Outcomes and Measures  Survey questions were formulated to characterize resident diversity and training experience. Self-perceptions of diversity, mentorship, and training experience were evaluated using a 5-point Likert scale (1 for strongly disagree, 2 for disagree, 3 for neither agree or disagree, 4 for agree, and 5 for strongly agree) and open-ended responses. The frequency of perceived unprofessional workplace encounters was evaluated using a 5-point scale (1 for daily, 2 for weekly, 3 for monthly, 4 for annually, and 5 for never).

Results  Of the 510 general surgery residents invited, a total of 210 residents (40.5%) completed the survey. Most respondents were younger than 30 years (119 [56.7%]), were women (112 [53.3%]), reported English as their first language (133 [63.3%]), did not identify as a VM (147 [70.0%]), had no dependents (184 [87.6%]), and were Canadian medical graduates (178 [84.8%]). Women residents who identified as VM compared with male residents who did not identify as a VM were less likely to agree or strongly agree that they had a collegial relationship with staff, (21 [63.6%] vs 61 [89.7%]; P = .01), to feel like they fit in with their training programs (21 [63.6%] vs 56 [82.3%]; P = .003), and to feel valued at work (15 [45.4%] vs 47 [69.1%]; P = .03). Both female residents and female residents who identified as VM described significant concerns about receiving fewer training opportunities because of their gender vs their male peers (54 [48.2%] vs 3 [3.0%]; P < .001). Ninety-one of 112 female residents (81.2%) reported feeling that their medical expertise was dismissed because of their gender at least once annually, with 37 women (33.0%) experiencing dismissal of their expertise at least once every week (P < .001). In contrast, 98% of male residents reported never experiencing dismissal of their medical expertise because of their gender. Similarly, residents with VM status vs those without VM status reported at least monthly dismissal of their expertise because of their race/ethnicity (9 of 63 [14.3%] vs 1 of 147 [0.7%]; P < .001).

Conclusions and Relevance  In this study, female sex and VM status appeared to be associated with adverse implications for the training experience of general surgery residents. These findings suggest that new strategies focused on the intersectionality of gender and race/ethnicity are needed to improve the training experience of at-risk residents.

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