Structural Determinants of Underrepresented in Medicine Residents in Orthopedic Surgery Residency Programs: Impact of Visiting Student Scholarships and Political Policy.

چکیده اصلی

OBJECTIVE: Visiting student scholarships are increasingly offered by orthopedic surgery residency programs to reduce financial barriers to away rotations. We sought to determine the prevalence of these scholarships, characterize programs offering them, and evaluate whether scholarship availability is associated with underrepresented in medicine (URiM) resident representation after accounting for program size and state-level anti-DEI legislation. DESIGN: Cross-sectional observational study using publicly available program-level data from the 2024 to 2025 application cycle. Associations were evaluated using multivariable logistic regression, negative binomial regression, and binomial generalized linear models. SETTING: U.S. Accreditation Council for Graduate Medical Education (ACGME)-accredited orthopedic surgery residency programs. PARTICIPANTS: Of 210 orthopedic surgery residency programs listed on the AAMC Residency Explorer™ tool, 187 programs with complete demographic and program characteristic data were included. RESULTS: Seventy-four programs (39.6%) offered visiting student scholarships, with availability concentrated in larger, university-based programs. After adjustment, scholarship availability was not independently associated with the presence of ≥1 URiM resident (OR 1.01; 95% CI, 0.28-3.62; p = 0.985) or with URiM resident count (IRR 1.13; 95% CI, 0.78-1.64; p = 0.527) or proportion (OR 1.14; 95% CI, 0.95-1.36; p = 0.156). Program size was consistently associated with both scholarship availability and URiM representation across all models. State-level anti-DEI legislation was not independently associated with URiM outcomes. CONCLUSIONS: Although visiting student scholarships may reduce financial barriers to away rotations, they were not independently associated with URiM representation after accounting for structural program characteristics. Program size, used as a proxy for institutional capacity, was the strongest predictor of URiM representation across all models. These findings suggest that scholarships may be a necessary but insufficient component of a comprehensive diversity recruitment strategy, and that surgical educators should consider embedding financial access mechanisms within broader institutional efforts that include mentorship, holistic review, and inclusive training environments.

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