The Current State of Diversity, Equity, and Inclusion (DEI) in Orthopedics at the Medical Student Level: A Systematic Review

INTRODUCTION: Females and individuals underrepresented in medicine currently comprise 50.5% and 23.8% of all medical student matriculates in the United States, respectively. However, orthopedic surgery remains the least diverse specialty with 18.3% female and 17.3% URiM residents. There has been an increasing amount of effort to increase diversity, equity, and inclusion (DEI) and remedy these representation gaps; however, there remains a gap in the literature summarizing the effectiveness of DEI initiatives at the medical student level and their impact on the future diversity of the orthopedic workforce. Thus, the purpose of this systematic review is to analyze the progress and current state of DEI efforts within orthopedics at the medical student level to inform future efforts focused on diversifying this specialty. METHODS: A systematic review of the English literature was performed according to PRISMA guidelines using the following databases: PubMed, Web of Science, Embase, Scopus, Cochrane from inception to October 20, 2023, using a combination of search terms. Eligible full text articles reported on various domains of DEI at the medical student level in the United States such as demographics, initiatives, and perspectives. RESULTS: A total of 3,184 studies were screened and 26 full-text articles met inclusion criteria. Eight articles discussed trends in diversity demographics application, and match with orthopedics (30.8%), 10 articles discussed initiatives detailing methods and results of how to increase DEI in orthopedics (38.4%), and 8 articles discussed perspectives on where to focus future outreach endeavors (30.8%). CONCLUSION: Enhancing DEI in orthopedic surgery at the level of medical students requires a multifaceted approach which fosters early engagement and supports outreach and sustained mentorship. Medical specialties that seek to diversify their field may benefit from similarly structured initiatives. ( J Surg Ed 82:103496. (c) 2025 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights are reserved, including those for text and data mining, AI training, and similar technologies.)