Diversity in Neurosurgical Recruitment and Training in the United States: A Systematic Review

Abstract

Objective: The benefits of diversity are particularly salient in neurosurgical training because of treatment of varied patient populations and the importance of close collaboration between trainees and attending neurosurgeons of different backgrounds. However, there is a paucity of literature that comprehensively examines diversity in neurosurgical recruitment and training. The aim of this study is to systematically review the scope of diversity in neurosurgical recruitment and training.

Methods: PudMed, Embase, and Scopus were searched since inception to October 31, 2021. Inclusion consisted of 1) on neurosurgery training; 2) sample was medical student, resident, fellows or attending; 3) discussed diversity variable(s). This study followed PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines.

Results: Of 1578 articles, 15 studies were included. Studies largely reported gender (n = 14) underrepresentation in neurosurgery compared with racial/ethnic diversity (n = 2) and socioeconomic status (n = 1). From studies focusing on residency match (n = 4), women medical students placed greater emphasis on mentorship, earlier clinical exposure, and program camaraderie and reputation as most important. From studies (n = 4) reporting retention and attrition, although women residents and attendings representation has increased, black, indigenous and people of color groups continue to represent <15% of studies on neurosurgical training. Studies (n = 4) discussing research suggested that women residents were more likely to have lower h-indices with fewer research grants. Studies (n = 4) describing workforce employment further showed that women and racial/ethnic minority groups were less likely to hold high academic and leadership positions. In studies (n = 4) on work-life balance, 18.5% women attendings found less career fulfillment and 20.4% would not choose to pursue neurosurgery again because of lack of protected personal time.

Conclusions: This systematic review shows the scope of studies of diversity within neurosurgery and provides impetus for efforts to expand our understanding of diversity within the field.

Keywords: Career choice; Diversity and representation; Internship and residency; Neurosurgery training.