Background: Women and racial and ethnic minorities remain underrepresented in orthopedic surgery. Exploring factors that draw individuals from these demographics to pursue orthopedic surgery and their experiences during training can provide valuable insights into this disparity. We aimed to quantify the current state of diversity in terms of race, ethnicity, gender, and sexual orientation among orthopedic surgery residents and fellows, and to identify factors that influenced their decision to pursue orthopedic surgery. Methods: An institutionally validated survey was delivered via Qualtrics to national orthopedic surgery residency programs from January to April 2023. Topics addressed included gender identity, sexual orientation, racial and ethnic background, reasons for pursuing orthopedic surgery, and medical training experiences. Differences between gender and racial discrimination were assessed via Chi-square test. Results: A total of 119 orthopedic surgery residents and fellows responded. Of these, 62.2% (n = 74) identified as non-Hispanic White, 60.5% (n = 72) were male, and 86.6% (n = 103) identified as straight or heterosexual. Mentorship was cited by 79.9% (n = 95) of respondents as a critical factor in their decision to pursue orthopedic surgery. Additionally, 23% of female respondents and 4.2% of male respondents highlighted the presence of women and diverse faculty as very important. Gender identity negatively impacted the decision to pursue orthopedic surgery in 15.4% of female and 1.4% of male respondents (p = 0.004). Among underrepresented minorities (URMs), 24.4% reported negative experiences during training compared to 4.1% of non-Hispanic White participants (p = 0.002). Discrimination experiences ranged from 2.6% due to sexual orientation, 20.7% due to race and ethnicity, and 26.3% due to gender and gender identity. Conclusions: Discrimination based on race, ethnicity, and gender continues to pose significant challenges for orthopedic surgery trainees. The presence of mentors, particularly women and individuals from diverse backgrounds, remains crucial in fostering interest in orthopedic surgery among underrepresented groups. Sustained efforts are needed to create a more inclusive and supportive environment all trainees.
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