Barriers to Black Medical Students and Residents Pursuing and Completing Surgical Residency in Canada: A Qualitative Analysis

Edgar Akuffo-Addo; Jaycie Dalson; Kwame Agyei; Samiha Mohsen; Safia Yusuf; Clara Juando-Prats; Jory S Simpson

doi:10.1097/XCS.0000000000001067

Barriers to Black Medical Students and Residents Pursuing and Completing Surgical Residency in Canada: A Qualitative Analysis

J Am Coll Surg. 2024 Mar 12. doi: 10.1097/XCS.0000000000001067. Online ahead of print.

Authors

Edgar Akuffo-Addo¹, Jaycie Dalson¹, Kwame Agyei¹, Samiha Mohsen¹, Safia Yusuf¹, Clara Juando-Prats^{2

3}, Jory S Simpson^{1

3}

Affiliations

¹ Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
² Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
³ St. Michael's Hospital, Toronto, ON, Canada.

PMID: 38470049
DOI: 10.1097/XCS.0000000000001067

Abstract

Background: The limited available data suggest that the Canadian surgical workforce does not reflect the racial diversity of the patient population it serves, despite the well-established benefits of patient-provider race concordance. There have been no studies to date that characterize the systemic and individual challenges faced by Black medical students in matching to and successfully finishing training in a surgical specialty within a Canadian context that can explain this underrepresentation.

Study design: Using critical qualitative inquiry and purposive sampling to ensure gender, geographical, and student/trainee year heterogeneity, we recruited self-identifying Black medical students and surgical residents across Canada. Online in-depth semi-structured interviews were conducted and transcribed verbatim. Transcripts were analyzed through an inductive reflexive narrative thematic process by four analysts.

Results: 27 participants including 18 medical students and 9 residents, were interviewed. The results showed three major themes that characterized their experiences: journey to and through medicine, perceptions of the surgical culture, and recommendations to improve the student experience. Medical students identified lack of mentorship and representation, as well as experiences with racism as the main barriers to pursuing surgical training. Surgical trainees cited systemic racism, lack of representation and insufficient safe spaces as the key deterrents to program completion. The intersection with gender exponentially increased these identified barriers.

Conclusions: Except for a few surgical programs, medical schools across Canada do not offer a safe space for Black students and trainees to access and complete surgical training. An urgent change is needed to provide diverse mentorship that is transparent, acknowledges the real challenges related to systemic racism and biases, and is inclusive of different racial and ethnic backgrounds.