背景:在骨科手术住院医师计划的申请人中通常观察到教育债务;但是,对少数族裔和非少数族裔申请人的债务负担的理解尚不明确。因此,这项研究旨在通过检查骨科手术申请人的教育债务的程度和影响因素来填补这些知识空白。
目标:(1)骨科手术住院医师申请人的教育债务负担是多少?(2)在控制了相关的混杂变量之后,哪些因素与教育债务水平的增加独立相关?(3)在控制相关混杂变量后,被归类为代表性不足的少数群体或那些有教育债务和社会经济劣势的人不太可能在骨科手术中匹配?
方法:对2011年至2021年美国医学院协会骨科手术住院医师申请数据进行了回顾性评估。选择美国医学院协会数据库是因为每个居留申请人都必须通过美国医学院协会注册和申请。因此,这些数据适用于每个居留申请人,样本是全面的。自我报告的数据,包括医疗前,medical,并收集了教育债务负担总额以及社会经济劣势和申请费减免用途的分类。根据自我识别的种族和种族,申请人被分为代表性不足的少数群体或代表性不足的少数群体。货币价值以美元报告,并使用消费者价格指数调整至2021年的通货膨胀。我们对连续变量和分类变量进行了t检验和卡方检验,分别。在p<0.05时考虑显著性。总之,最初的队列中有12,112名申请人,从2011年到2021年,67%(12,112人中的8170人)的完整数据申请人被纳入最终研究队列。其中,18%(8170人中的1510人)是女性,14%(8170人中的1114人)被归类为代表性不足的少数民族,8%(8170人中的643人)被归类为社会经济弱势群体。61%(8170人中的4969人)的申请人报告至少获得了一项奖学金,34%(8170人中的2746人)有医学院前债务,72%(8170人中的5909人)有任何教育债务,包括医学院。在所有申请人中,教育债务中位数(IQR)为197,000美元(25,000至288,000美元)。在那些有奖学金的人中,中位数为25,000美元(9000至86,000美元)。
结果:在控制了性别和社会经济劣势的潜在混杂变量之后,归类为代表性不足的少数群体申请人与较高的奖学金金额独立相关,而不是被定性为代表性不足的少数群体申请人(β=20,908美元[95%置信区间(CI)15,395至26,422];p<0.001),而代表性不足的少数群体分类与总教育债务的差异并不独立相关(β=3719美元[95%CI-6458至13,895];p=0.47)。在控制了性别和分类为代表性不足的少数群体的潜在混杂变量之后,社会经济劣势与较高的奖学金金额(β=20,341美元[95%CI13,300至27,382];p<0.001)和较高的总教育债务(β=66,162美元[95%CI53,318至79,006];p<0.001)独立相关。在控制了性别和分类为代表性不足的少数群体的潜在混杂变量之后,社会经济劣势与匹配率下降独立相关(OR0.62[95%CI0.52~0.74];p<0.001).
结论:这些发现强调了全面的奖学金计划的必要性,以确保所有背景的申请人都能获得公平的财务机会。
结论:在未来,骨科手术可能会受益于比较各种举措的有效性的研究,旨在提高申请人对骨科手术住院医师计划的债务负担的公平性。
BACKGROUND: Educational debt is commonly observed among applicants to orthopaedic surgery residency programs; however, an understanding of the debt burden among minority and nonminority applicants is not well established. Thus, this study aimed to fill these knowledge gaps by examining the extent of and factors shaping educational debt among orthopaedic surgery applicants.
OBJECTIVE: (1) What is the educational debt burden among orthopaedic surgery residency applicants? (2) After controlling for relevant confounding variables, what factors are independently associated with increasing levels of educational debt? (3) After controlling for relevant confounding variables, are individuals classified as an underrepresented minority or those with educational debt and socioeconomic disadvantage less likely to match in orthopaedic surgery?
METHODS: A retrospective evaluation of orthopaedic surgery residency application data from the American Association of Medical Colleges was analyzed from 2011 to 2021. The American Association of Medical Colleges database was selected because every residency applicant must register and apply through the American Association of Medical Colleges. Therefore, these data exist for every residency applicant, and the sample was comprehensive. Self-reported data including premedical, medical, and total educational debt burden as well as classification as socioeconomically disadvantaged and application fee waiver use were collected. Applicants were dichotomously categorized as an underrepresented minority or a not underrepresented minority based upon self-identified race and ethnicity. Monetary values were reported in USD and inflation-adjusted to 2021 using the Consumer Price Index. We performed t-tests and chi-square tests for continuous and categorical variables, respectively. Significance was considered at p < 0.05. In all, 12,112 applicants were available in the initial cohort, and 67% (8170 of 12,112) of applicants with complete data were included from 2011 to 2021 in the final study cohort. Of these, 18% (1510 of 8170) were women, 14% (1114 of 8170) were classified as underrepresented minorities, and 8% (643 of 8170) were classified as socioeconomically disadvantaged. Sixty-one percent (4969 of 8170) of applicants reported receiving at least one scholarship, 34% (2746 of 8170) had premedical school debt, and 72% (5909 of 8170) had any educational debt including medical school. Among all applicants, the median (IQR) educational debt was USD 197,000 (25,000 to 288,000). Among those with scholarships, the median amount was USD 25,000 (9000 to 86,000).
RESULTS: After controlling for the potentially confounding variables of gender and socioeconomic disadvantage, classification as an underrepresented minority applicant was independently associated with higher scholarship amounts than applicants characterized as not underrepresented minorities (β = USD 20,908 [95% confidence interval (CI) 15,395 to 26,422]; p < 0.001), whereas underrepresented minority classification was not independently associated with a difference in total educational debt (β = USD 3719 [95% CI -6458 to 13,895]; p = 0.47). After controlling for the potentially confounding variables of gender and classification as an underrepresented minority, socioeconomic disadvantage was independently associated with higher scholarship amounts (β = USD 20,341 [95% CI 13,300 to 27,382]; p < 0.001) and higher total educational debt (β = USD 66,162 [95% CI 53,318 to 79,006]; p < 0.001) than applicants not classified as socioeconomically disadvantaged. After controlling for the potentially confounding variables of gender and classification as an underrepresented minority, socioeconomic disadvantage was independently associated with decreased match rates (OR 0.62 [95% CI 0.52 to 0.74]; p < 0.001).
CONCLUSIONS: These findings underscore the need for comprehensive scholarship initiatives to ensure equitable financial accessibility for applicants from all backgrounds.
CONCLUSIONS: In the future, orthopaedic surgery may benefit from research comparing the effectiveness of various initiatives aiming to improve fairness in the burden of debt among applicants to orthopaedic surgery residency programs.