دورية أكاديمية
Who Bears the Burden? Understanding the Socioeconomic Patterns of Educational Debt in Orthopaedic Surgery Residency Candidates.
| العنوان: | Who Bears the Burden? Understanding the Socioeconomic Patterns of Educational Debt in Orthopaedic Surgery Residency Candidates. |
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| المؤلفون: | Harris AB; Department of Orthopaedic Surgery, The Johns Hopkins Hospital, Baltimore, MD, USA., Snyder EM; John A. Burns School of Medicine, University of Hawaii, Honolulu, HI, USA., Vankara A; Johns Hopkins School of Medicine, Baltimore, MD, USA., Oni JK; Department of Orthopaedic Surgery, The Johns Hopkins Hospital, Baltimore, MD, USA., LaPorte D; Department of Orthopaedic Surgery, The Johns Hopkins Hospital, Baltimore, MD, USA., Aiyer A; Department of Orthopaedic Surgery, The Johns Hopkins Hospital, Baltimore, MD, USA. |
| المصدر: | Clinical orthopaedics and related research [Clin Orthop Relat Res] 2024 Aug 01; Vol. 482 (8), pp. 1341-1347. Date of Electronic Publication: 2024 Apr 11. |
| نوع المنشور: | Journal Article |
| اللغة: | English |
| بيانات الدورية: | Publisher: Wolters Kluwer Country of Publication: United States NLM ID: 0075674 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1528-1132 (Electronic) Linking ISSN: 0009921X NLM ISO Abbreviation: Clin Orthop Relat Res Subsets: MEDLINE |
| أسماء مطبوعة: | Publication: 2018- : [New York, NY] : Wolters Kluwer Original Publication: Philadelphia : Lippincott, |
| مواضيع طبية MeSH: | Internship and Residency*/economics , Internship and Residency*/statistics & numerical data , Socioeconomic Factors*, Humans ; Retrospective Studies ; Female ; Male ; United States ; Orthopedics/education ; Orthopedics/economics ; Adult ; Minority Groups/statistics & numerical data ; Education, Medical, Graduate/economics ; Education, Medical, Graduate/statistics & numerical data ; Training Support/economics ; Personnel Selection/economics ; Personnel Selection/statistics & numerical data |
| مستخلص: | 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. Questions/purposes: (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). Conclusion: These findings underscore the need for comprehensive scholarship initiatives to ensure equitable financial accessibility for applicants from all backgrounds. Clinical Relevance: 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. Competing Interests: Each author certifies that there are no funding or commercial associations (consultancies, stock ownership, equity interest, patent/licensing arrangements, etc.) that might pose a conflict of interest in connection with the submitted article related to the author or any immediate family members. All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research ® editors and board members are on file with the publication and can be viewed on request. (Copyright © 2024 by the Association of Bone and Joint Surgeons.) |
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| تواريخ الأحداث: | Date Created: 20240720 Date Completed: 20240806 Latest Revision: 20240807 |
| رمز التحديث: | 20240807 |
| مُعرف محوري في PubMed: | PMC11272231 |
| DOI: | 10.1097/CORR.0000000000003068 |
| PMID: | 39031041 |
| قاعدة البيانات: | MEDLINE |
Full Text Finder | تدمد: | 1528-1132 |
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| DOI: | 10.1097/CORR.0000000000003068 |