IMPORTANCE The lack of underrepresented in medicine physicians within US academic surgery continues, with Black surgeons representing a disproportionately low number. OBJECTIVE To evaluate the trend of general surgery residency application, matriculation, and graduation rates for Black trainees compared with their racial and ethnic counterparts over time. DESIGN, SETTING, AND PARTICIPANTS In this nationwide multicenter study, data from the Electronic Residency Application Service (ERAS) for the general surgery residency match and Graduate Medical Education (GME) surveys of graduating general surgery residents were retrospectively reviewed and stratified by race, ethnicity, and sex. Analyses consisted of descriptive statistics, time series plots, and simple linear regression for the rate of change over time. Medical students and general surgery residency trainees of Asian, Black, Hispanic or Latino of Spanish origin, White, and other races were included. Data for non-US citizens or nonpermanent residents were excluded. Data were collected from 2005 to 2018, and data were analyzed in March 2021. MAIN OUTCOMES AND MEASURES Primary outcomes included the rates of application, matriculation, and graduation from general surgery residency programs. RESULTS Over the study period, there were 71 687 applicants, 26 237 first-year matriculants, and 24 893 graduates. Of 71 687 applicants, 24 618 (34.3%) were women, 16 602 (23.2%) were Asian, 5968 (8.3%) were Black, 2455 (3.4%) were Latino, and 31 197 (43.5%) were White. Women applicants and graduates increased from 29.4% (1178 of 4003) to 37.1% (2293 of 6181) and 23.5% (463 of 1967) to 33.5% (719 of 2147), respectively. When stratified by race and ethnicity, applications from Black women increased from 2.2% (87 of 4003) to 3.5% (215 of 6181) (P < .001) while applications from Black men remained unchanged (3.7% [150 of 4003] to 4.6% [284 of 6181]). While the matriculation rate for Black women remained unchanged (2.4% [46 of 1919] to 2.3% [52 of 2264]), the matriculation rate for Black men significantly decreased (3.0% [57 of 1919] to 2.4% [54 of 2264]; P = .04). Among Black graduates, there was a significant decline in graduation for men (4.3% [85 of 1967] to 2.7% [57 of 2147]; P = .03) with the rate among women remaining unchanged (1.7% [33 of 1967] to 2.2% [47 of 2147]). CONCLUSIONS AND RELEVANCE Findings of this study show that the underrepresentation of Black physicians at every stage in surgical training pipeline persists. Black men are especially affected. Identifying factors that address intersectionality and contribute to the successful recruitment and retention of Black trainees in general surgery residency is critical for achieving racial and ethnic as well as gender equity.

中文翻译：

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黑人学术外科医生的交叉性和管道检查。

重要性 在美国学术外科手术中，内科医师的代表性不足的情况仍在继续，黑人外科医生所占比例低得不成比例。目的 评估随着时间的推移，与其他种族和族裔同行相比，黑人实习生的普通外科住院医师申请、入学率和毕业率的趋势。设计、地点和参与者 在这项全国性的多中心研究中，对普外科住院医师匹配电子住院医师申请服务 (ERAS) 和普外科住院医师研究生医学教育 (GME) 调查的数据进行了回顾性审查，并按种族、族裔进行分层, 和性。分析包括描述性统计、时间序列图和随时间变化率的简单线性回归。包括亚裔、黑人、西班牙裔或西班牙血统的拉丁裔、白人和其他种族的医学生和普通外科住院医师。非美国公民或非永久居民的数据被排除在外。收集了 2005 年至 2018 年的数据，并于 2021 年 3 月对数据进行了分析。主要结果和测量指标主要结果包括普通外科住院医师项目的申请率、入学率和毕业率。结果 在研究期间，共有 71 687 名申请人、26 237 名一年级预科生和 24 893 名毕业生。在 71 687 名申请人中，24 618 名（34.3%）为女性，16 602 名（23.2%）为亚裔，5968 名（8.3%）为黑人，2455 名（3.4%）为拉丁裔，31 197 名（43.5%）为白人。女性申请人和毕业生从 29.4%（4003 人中的 1178 人）增加到 37.1%（6181 人中的 2293 人）和 23.5%（1967 人中的 463 人）增加到 33.5%（2147 人中的 719 人），分别。当按种族和民族分层时，黑人女性的申请从 2.2%（4003 人中的 87 人）增加到 3.5%（6181 人中的 215 人）（P < .001），而黑人男性的申请保持不变（3.7% [4003 人中的 150 人] 到4.6% [6181 人中的 284 人])。虽然黑人女性的入学率保持不变（2.4% [1919 年的 46 人] 至 2.3% [2264 人中的 52 人]），但黑人男性的入学率显着下降（3.0% [1919 年的 57 人] 至 2.4% [2264 人中的 54 人] ]；P = .04）。在黑人毕业生中，男性的毕业率显着下降（4.3% [1967 年的 85 人] 到 2.7% [2147 人中的 57 人]；P = .03），女性的毕业率保持不变（1.7% [1967 年的 33 人]）到 2.2% [2147 中的 47]）。结论和相关性 本研究的结果表明，在外科培训管道的每个阶段，黑人医生的代表性不足仍然存在。黑人尤其受到影响。确定解决交叉性问题并有助于在普通外科住院医师中成功招募和保留黑人实习生的因素对于实现种族和民族以及性别平等至关重要。