Students lead new study on barriers facing Black medical students pursuing surgical residency

A study led by fourth-year undergraduate medical students at the University of Toronto (U of T) is shedding light on the experiences of Black medical students in applying for a surgical residency in Canada.

In a study published in the Journal of the American College of Surgeons, co-lead authors Edgar Akuffo-Addo and Jaycie Dalson found few Black medical students are pursuing careers as surgeons in Canada due to lack of mentorship, prohibitive admission criteria and unsupportive working environments, among other factors.

The research team comprised a diverse group of Black medical students, along with senior author Dr. Jory Simpson, division head of general surgery at St. Michael's Hospital, a site of Unity Health Toronto.

The study was ongoing for two years and began with Simpson approaching U of T's Black Medical Students Association about the opportunity to do research to understand what was contributing to the low number of Black students pursuing careers in surgery.

"One thing the study showed was that Black medical students don't always have the same opportunity to get early exposure to surgery though things like mentorship, shadowing, and research," says Simpson. "I wanted to encourage them to lead this study and identify how the university can do better."

"All surgical residents get into their program based on merit, but I think it's important to equalize the process to get there—we have to work hard to have equality of opportunity," he adds.

The research team interviewed 27 Black participants in medical schools across Canada, including 18 medical students and nine surgical residents, to explore their experiences in pursuing and completing surgical residency in Canada.

We spoke with Akuffo-Addo and Dalson to learn more about the study findings and what changes they hope to see for the future.

What was it like to have the opportunity to be lead authors on this kind of research as undergraduate students?

EAA: In medical school, it's not uncommon to engage in research, but I think what was unique about this experience was the type of research because this took quite a bit of time—roughly two years. We were involved in getting Research Ethics Board approval and recruiting participants. It wasn't just U of T students that we talked to—we really tried to get that trans-Canadian story.

We know this problem exists, but in a Canadian context there wasn't really documented evidence of the problem. I liked the idea of being involved in the work that would provide evidence and hopefully propose some solutions that future generations would find useful.

JD: The main reason why I signed up to help with this study is because it was not what we would typically get to do and we would have the opportunity to interview these students. As a Black medical student, I felt a personal tie to these experiences.

The fact that there wasn't really any Canadian data, and we would actually be able to propose something and potentially contribute to some change, really made this a very interesting way to contribute.

What were some of your key takeaways from the study and was there anything you heard that surprised you?

JD: I think a big takeaway was really the word 'intersectionality' because all of our participants were Black, but those who are women face different issues or had different considerations for surgery than for the Black men in the study. Another example came from Muslim women who covered their head and had very specific experiences tied to that part of their identity, in addition to being Black.

Each individual participant, although they were all Black, really had a different reason or a different perspective in terms of what happened to them during their clerkship rotations and the type of discrimination they faced.

I think another big thing we looked at was the culture in surgery in general and how it affects everyone. Things like having a positive work environment, feeling comfortable being able to eat or go to the washroom, are pieces of feedback we heard and are things all students can experience. With that information, we were also able to suggest areas for improvement that can help everyone in general.

EAA: For me, one of the big key takeaways was the role mentorship played in the lives of our medical students, and even for young people wanting to pursue a health career and the value of mentorship.

I think something that surprised me a bit was that I had my own idea that finances would come up as more of a barrier because surgery is five years of study, so it's a bit longer deferring an income. It was interesting to learn that wasn't the case—the participants knew they would be adequately compensated in the future and were willing to train as surgeons if the working environments were right.

What do you think are the next steps from this research?

EAA: I think it would be good to start to see some admission reforms. Post-graduate programs tend to emphasize research as part of their admissions criteria, but our analysis found that Black medical students were more likely to have experience with more advocacy work.

Over time, it might be nice to acknowledge that research is important, but perhaps there are other forms of research that equally count and maybe remodeling admission criteria to include these elements.

JD: What's nice to see is that even over the two years of doing this research, we have started to hear of changes and mentorship opportunities that have come up.

I think it's important we continue to extend mentorship programs in smaller communities with an even smaller population of Black students who may feel more isolated in their training environments. It's great to grow mentorship programs in big cities like Toronto, Vancouver, Montreal, but also making sure it extends to the other smaller schools and cities would be good to see going forward.

EAA: To echo what Jaycie said, I think over the two years we have started to see institutions trying to make changes. Even programs like The Next Surgeon program that Unity Health launched—those types of programs are really positive and I'm expecting them to have a really, really big impact in the near term future.