The Effect of an Orthopedic Clerkship Rotation on Medical Students' Sense of Belonging and Gender Stereotype Threat in Orthopedic Surgery: A Prospective Cohort Study

Objective The field of orthopedics continues to have significant underrepresentation of physicians who identify as women and/or Underrepresented in Medicine (URiM). Clerkship rotations play an important role in increasing medical students' exposure to orthopedics, however it is unknown how clerkships affect students' perceptions of inclusivity within orthopedics. We aimed to identify how student belonging and perceived gender stereotypes (stereotype-threat) (1) differed between students participating in an orthopedic clerkship ("rotators") versus those that did not ("nonrotators"), (2) differed based on student gender/race, and (3) changed after participating in an orthopedic clerkship. Design This was a prospective cohort study in which all surgery clerkship students were invited to participate in a prerotation survey measuring belonging and gender stereotype threat. Differences were measured using t-tests and Chi-square tests, as appropriate. Rotators completed these same scales at the conclusion of their rotations and pre/postrotation differences were measured using paired t-tests. Setting Washington University in St. Louis (St. Louis, MO), a tertiary care academic hospital. Participants Third-year medical students on their surgery clerkship over 2 years. Sixty-five rotators and 73 nonrotators completed the prerotation survey for a response rate of 71% and 57% respectively. Of the orthopedic rotators, 32 students had complete pre- and postrotation data, and therefore were included in the pre- versus postrotation analyses. Results (1) Rotators had a higher sense of belonging in orthopedics than nonrotators (rotators: mean 4.0 +/- 1.1; nonrotators: mean 3.3 +/- 0.8; p < 0.001). Rotators and nonrotators similarly perceived stereotypes favoring men within orthopedics (rotators: mean 2.9 +/- 0.7; nonrotators: mean 2.9 +/- 0.9; p = 0.94). (2) Women had lower belonging than men (women: mean 3.3 +/- 1.0, men: mean 4.0 +/- 1.0; p = 0.002), but there were no differences in belonging between White and minority students (White: mean 3.7 +/- 1.1, minority: mean 3.7 +/- 1.0; p = 0.99). (3) Students' sense of belonging in orthopedics significantly increased after their rotation (mean increase: 0.6 +/- 0.8, p = 0.005, but stereotype threat (mean: 0.2 +/- 0.6, p = 0.14) was unchanged. Discussion/Conclusions Orthopedic clerkships may play an important role in shaping students' sense of belonging. A lack of belonging amongst women and nonrotating students may be a barrier to clerkship participation and subsequent entry into orthopedic careers.