Changing Faces: Match Rates and Demographic Shifts in Cardiothoracic Training Programs.

Background: This study evaluated contemporary trends in the racial and gender compositions of integrated (I6) and traditional fellowship programs, examining associations between demographic shifts and match rates. Methods: Data from the National Residency Matching Program and Accreditation Council for Graduate Medical Education (2011-2022) were analyzed to assess trends in match rates and demographics of I6 and traditional fellowship programs. Time series analyses (Mann-Kendall test, Bayesian trend analysis, autoregressive integrated moving average models) evaluated shifts in racial and gender composition; Dirichlet regression assessed associations between match rate variations and demographic trends. Results: I6 programs showed significant increases in Asian/Pacific Islander (7.5% to 20.7%), Hispanic (0% to 7.8%), and Black trainees (0% to 5.9%) from 2011 to 2022, with White trainees declining from 77.5% to 44.9%. Traditional fellowships had stable racial composition. Women trainees increased significantly in both pathways, with inflection points in 2015 and 2020, and are projected to reach 50% by 2035 (I6) and 2046 (traditional). Match rates fell for traditional fellowships (98% to 63%) with notable declines in 2014 (92% to 73%) and 2021 (72% to 59%) but rose for I6 (25% to 42%). The percentage of women applicants remains lower in traditional fellowships compared with I6. Conclusions: During the last decade, I6 programs have become more racially diverse, whereas traditional fellowships have maintained stable racial compositions. Women are increasingly represented in both. Despite positive trends, ongoing awareness and targeted efforts to enhance access to both integrated and traditional training pathways remain critical for increasing the diversity of the cardiothoracic surgery trainee pool.