April 1999 Bulletin

Leading the way

'In all the different places I've been, I haven't seen anyone who looks like me.'

Mentors help minorities cross barriers to careers

By Carolyn Rogers

A lifelong fascination with bones and joints, combined with a talent for athletics, led Cubyson Oxley toward a career in orthopaedics early on. But after three years of medical school, he'd encountered almost no minority orthopaedists. "In all the different places I've been, I haven't seen anyone who looks like me," he says.

So the Academy's minority mentoring program, initiated last spring, was a welcome opportunity for the fourth-year medical student at Albert Einstein College of Medicine of Yeshiva University in Bronx, NY.

"I decided that instead of speculating," he said, "it would be good to talk to someone within the field who could give me an in-house view of why there aren't many minorities, and who could offer some advice from the minority perspective."

As part of the Diversity Committee's ongoing effort to significantly improve female and minority access to the orthopaedic profession, the Academy established a mentoring program for minority students in spring of 1998. The intent of the program is to change some of the misperceptions that minority medical students may have about orthopaedics, while helping them to overcome some of the unique challenges they may face in getting into the specialty.

The Diversity Committee was created in 1997 after the Academy's Board of Directors received an alarming report on the low number of women and minority group members in orthopaedics. That report showed that in 1994, only 2 percent of all orthopaedists were women, even though women made up 41 percent of all medical school graduates. The report also showed that African-Americans and Hispanics make up about 5 percent of orthopaedic residents while about 12 percent of all medical school graduates were members of minority groups.

More recently, an Association of American Medical Colleges' study of U.S. medical school graduates from 1983-1995 indicated that the diversity of orthopaedic residents, based upon race, ethnicity and gender, has changed minimally over the 12 years of the study. The only dramatic change was the percentage of Asian and Pacific Islander men in the field, which has quadrupled (2.2 percent in 1983 to 9.8 percent in 1995) over the 12 years of the study. The percentage of other minorities and of women in the field remained unchanged.

Given the fact that the number of orthopaedic residency positions is expected to decline over the next 10-15 years, the number of minority and female orthopaedists is also likely to decline, unless steps are taken to increase the percentage of incoming women and minority orthopaedic residents.

"There are barriers, I think, to women and minorities coming into the orthopaedic profession," says Augustus A. White, III, MD, chair of the Academy's Diversity Committee, "and mentors can help them to negotiate those barriers. The 'cultural distancing' that is so often part of the educational experience for many women and minorities bespeaks an even greater need for mentoring on their part than for other students."

Holly J. Duck, MD, chair of the Diversity Committee's subcommittee on mentoring programs for minority medical students, says the program was initiated for two reasons. First, the committee was concerned that the underrepresentation of women and minorities in the field is due in large part to a lack of exposure.

"To this day," Dr. Duck says, "I still hear 'I didn't know there were any women in orthopaedics.'"

The committee also knew they had to reach medical students early in their decision-making process in order to prepare them for a career in orthopaedics. Getting to the students during their first year of medical school is important-or as early as high school, if possible.

"There are certain things you need to do to get into an orthopaedics program, such as being involved in research early on, taking the right electives and knowing what rotations to take in your third year," Dr. Duck explains.

The mentoring program is modeled after the Ruth Jackson Orthopaedic Society (RJOS) mentoring program for women in orthopaedics, which Dr. Duck established three years ago. The RJOS program was initiated because many of the old fallacies about women in orthopaedics seemed to be persisting. The committee thought it was important to expose female medical students to small-statured women who were working successfully in the field.

Another concern, Dr. Duck says, is that "the push of medical schools is toward family practice-whether you're male or female," she said. "They're not getting exposed to orthopaedics in medical school. Almost a third of all medical schools don't even have a musculoskeletal rotation."

The minority mentoring program was announced in brochures and was publicized in the Academy Bulletin in late 1997. Prospective mentors were asked to call the Academy office and to provide their name, address, phone number, ethnic background and the names of nearby medical schools. Once mentors were chosen, they were sent written materials describing their role. Essentially, mentors were asked to talk to minority medical students about orthopaedics and to provide support, encouragement, advice and networking assistance when possible.

Mentors can help in other ways as well. Oxley says, "It's such a competitive profession. And it's not just about having the grades; it's also the little intangibles. It's who is going to get on the horn and make that call for you? Who are your contacts? A lot of minorities just don't have those important connections.

"If some nonminority students don't get into one program, they know 'well, at least I can get into the program my father or grandfather is involved with.' If you don't have those connections to fall back on, it's a different situation."

Oxley was matched with James A. Hill, MD, in Chicago. In spite of the distance, he found the connection to be helpful.

"We talked about the field, what minorities need to do to get into orthopaedics, and how to remain successful within the field," he says. "It was a very positive experience."

Dr. Duck is now mentoring four women actively. The students shadow her at the office, and she also takes them into surgery with her. In addition, she assists them with the application process, helps them to obtain summer positions through contacts and has even conducted mock interviews.

Kirk Dabney, MD, a pediatric orthopaedic surgeon at Alfred duPont Institute in Wilmington, Del., volunteered to be a mentor because he knows how valuable his mentors, both minorities and nonminorities, have been for his career.

"Orthopaedics is a field that, without mentors, is a very closed-knit field. And it's a difficult enough field to begin with. Without pointing any fingers, it can be especially difficult if you don't have people directing you as far as connections and people looking out for your well-being."

In recent years, Dr. Dabney has mentored a few students from Howard University, where he attended medical school, and helped to arrange rotations at the children's hospital. One of those students is now in the last year of a pediatric orthopaedics residency, and another just finished an orthopaedic rotation at duPont and is applying for a residency now.

"I am at a pretty large children's hospital with a lot of people applying from different programs," he continues, "so when I see minorities coming through, I try to take them under my wing."

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