We will be performing site maintenance on AAOS.org on February 8th from 7:00 PM – 9:00 PM CST which may cause sitewide downtime. We apologize for the inconvenience.


Published 3/1/2019
Cordelia W. Carter, MD

PRiSM and Nth Dimensions Address Diversity, Inclusion, and Representation

Why diversity? Diversity is desirable. Studies in economics and social science support the assertion that, for complex problems, the combination of individual talents and collective diversity leads to improvements in prediction and forecasting, as well as problem-solving and innovation.

In medicine, we know that enhancing diversity within the physician workforce leads to improvements in access to health care: Physicians who are underrepresented minorities (URMs) are more likely to provide care in underserved communities. Additionally, concordance between a patient and his or her physician in terms of gender, race, and ethnicity has been associated with better communication, compliance, patient satisfaction, clinical outcomes, and participation in clinical research.

As a community of medical academicians, we still have work to do. The overall U.S. population is roughly 50 percent men and 50 percent women; our medical school graduates now reflect this ratio. However, only 15 percent of orthopaedic surgery resident and fellow trainees are women, and orthopaedics ranks 41 of 44 medical specialties recently surveyed in percentage of active female trainees. Orthopaedic sports medicine is ranked 43rd.

For Hispanics/Latinos and blacks/African-Americans, the numbers are equally concerning. Although the groups comprise roughly 16.9 percent and 13.1 percent of the U.S. population, respectively, recent data from the American Association of Medical Colleges indicate that the percentage of Hispanics/Latinos enrolled in medical schools is 6.4 percent and the percentage of blacks/African-Americans is 6.9 percent. Furthermore, only an estimated 10 percent of orthopaedic residents are URMs, again placing orthopaedic surgery toward the bottom of the list of medical specialties.

A powerful partnership

The Pediatric Research in Sports Medicine Society (PRiSM) is a multidisciplinary group—orthopaedic surgeons, primary care sports medicine physicians, physical therapists, athletic trainers, radiologists, and research scientists—with a shared interest in pediatric sports medicine. PRiSM’s primary mission is to promote and participate in high-quality, interdisciplinary research in the field of pediatric and adolescent sports medicine to optimize musculoskeletal care for young athletes.

PRiSM understands the critical importance of diversity among healthcare providers for providing accessible, evidence-based, and culturally competent care.

In 2017, under the leadership of Kevin Shea, MD, immediate past-president, and Theodore Ganley, MD, current president, PRiSM created a diversity task force, and I was the lead.

As part of a multifaceted initiative to optimize diversity, inclusion, and representation within PRiSM, a collaborative partnership was formed with Nth Dimensions, a “pipeline-building” program with a mission to eliminate healthcare disparities by diversifying the physician workforce.

Established in 2005 and led by Bonnie Mason, MD, Nth Dimensions recognizes that sustained commitment is key to the successful development of future orthopaedists. It employs a multiphase approach that consists of outreach, clinical and research internships, Board examination preparation, and leadership development throughout each participating student’s medical school experience. Nth Dimensions now boasts 15:1 odds of a URM medical student applying for an orthopaedic surgery residency and 45:1 odds for female medical students. Furthermore, the orthopaedic match rate among Nth Dimensions participants (87 percent) exceeds the overall national match rate (71 percent).

The collaboration between PRiSM and Nth Dimensions has quickly borne fruit. During the Fifth Annual PRiSM Meeting in 2018, five medical student participants in the Nth Dimensions program presented their peer-reviewed research, both at the podium and in e-poster format. They were:

  • Virgenal Owens, MSE (Medical College of Georgia): “Factors Limiting Hip Range of Motion: Bony Versus Soft Tissue Impingement”
  • Dominique Harris, BS (Meharry Medical College): “A Preliminary Study Evaluating Interobserver Reliability of Schöttle’s Technique”
  • Jalea Moses, MS (Frank Netter School of Medicine, Quinnipiac University): “The Prevalence of Klippel-Feil Syndrome in Pediatric Patients: Analysis of 831 CT Scans”
  • Derek Fitzgerald, BA (Meharry Medical College): “An Evaluation of Racial Disparities in the Treatment and Outcomes of Pediatric Patients with Septic Arthritis of the Knee”
  • Taylor Heacock, BA (Morehouse School of Medicine): “Recycling Suture Limbs Technique for Labral Repair Improves Shoulder Stability”

At the conclusion of the meeting, Ms. Moses received the Most Promising Career Award. The award is given each year in honor of one of PRiSM’s founding members and past presidents, Mininder Kocher, MD, to the trainee (student/resident/fellow) with the highest-ranked podium presentation.

The future

There is clearly still work to be done to improve diversity, representation, and inclusion among the ranks of orthopaedic surgeons nationwide. PRiSM and Nth
Dimensions are committed to
continuing to work together to close the gap. For more information, visit www.prismsports.org and www.nthdimensions.org.

Cordelia W. Carter, MD, is an associate professor of orthopaedic surgery at the New York University School of Medicine, a former board member of PRiSM, and chair of the AAOS Women’s Health Advisory Board.


  1. Hong L, Page SE: Groups of diverse problem solvers can outperform groups of high-ability problem solvers. PNAS 2004;101:16385-9.
  2. Hunt V, Layton D, Prince S: Diversity Matters. Available at: https://assets.mckinsey.com/~/media/857F440109AA4D13A54D9C496D86ED58.ashx. Accessed February 19, 2019.
  3. Lyndonna M, Marrast LM, Zallman L, et al: Diversifying the physician workforce may be key in addressing health disparities. JAMA Intern Med 2014;174:289-91.
  4. Cooper-Patrick L, Gallo JJ, Gonzales JJ, et al: Race, gender, and partnership in the patient-physician relationship. JAMA 1999;282:583-9.
  5. Cooper LA, Powe NR: Disparities in patient experiences, health care processes, and outcomes: the role of patient-provider racial, ethnic, and language concordance. Available at: https://www.commonwealthfund.org/publications/fund-reports/2004/jul/disparities-patient-experiences-health-care-processes-and. Accessed February 19, 2019.
  6. Kumar D, Schlundt DG, Wallston KA: Patient-physician race concordance and its relationship to perceived health outcomes. Ethn Dis 2009;19:345-51.
  7. Saha S, Arbelaez JJ, Cooper LA: Patient-physician relationships and racial disparities in the quality of health care. Am J Public Health 2003;93:1713-9.
  8. Saha S, Komaromy M, Koepsell TD, et al: Patient-physician racial concordance and the perceived quality and use of health care. Arch Intern Med 1999;159:997-1004.
  9. Association of American Medical Colleges: 2018 AAMC Physician Specialty Data Report. Available at: https://www.aamc.org/download/493090/data/2018-aamc-physician-specialty-data-report.pdf. Accessed February 15, 2019.
  10. Brotherton SE, Etzel SI: Graduate medical education, 2012-2013. JAMA 2013;310:2328-46.
  11. The Sullivan Commission: Missing Persons: Minorities in the Health Professions. Available at: https://depts.washington.edu/ccph/pdf_files/SullivanReport.pdf. Accessed February 6, 2019.
  12. Herring C: Does diversity pay?: Race, gender, and the business case for diversity. Am Sociol Rev 2009;74:208-24.
  13. Health Resources and Services Administration: The Rationale for Diversity in the Health Professions: A Review of the Evidence. Available at: https://www.hrsa.gov/advisorycommittees/bhpradvisory/cogme/Publications/diversityresourcepaper.pdf. Accessed February 6, 2019.
  14. Mason BS, Ross W, Ortega G, et al: Can a strategic pipeline initiative increase the number of women and underrepresented minorities in orthopaedic surgery? Clin Orthop Relat Res 2016;47:1979-85.