Design: Retrospective cross-sectional study.

Setting: AAMC databases were queried for demographic information between 2011 and 2023.

Patients or Participants: AAGL FMIGS fellows and graduates.

Interventions: The actual-to-expected (AE) ratio of each race, ethnicity, and sex was calculated by dividing the 13-year average actual percentage of FMIGS trainees and graduates by the expected percentage based on ACGME Data Resource Books on OBGYN residents and on national information obtained from the US Census Bureau.

Measurements and Main Results: A total of 477 fellows were in training between 2011-2023. Of those, race and ethnicity information were available in 347 (72.7%) of cases, and sex information was available in 409 (85.7%) of cases. Representation of females ranged from 66.7% in 2017 to 93.3% in 2022. There was a significantly increasing slope for the representation of females (+1.3% per year; 95% CI 0.00-0.03; p=0.027). Compared to their distribution among US OBGYN residents, White fellows’ representation was lower [AE ratio, 95% CI 0.60 (0.44-0.81)] and Asian fellows' was higher [AE ratio, 95% CI 2.17 (1.47-3.21)]. Female fellows’ representation was lower than expected [AE ratio, 95% CI 0.68 (0.48-0.96)] compared to their distribution among US OBGYN residents.

Compared to the general US population, White fellows [AE ratio, 95% CI 0.65 (0.48-0.87)] and Hispanic fellows [AE ratio, 95% CI 0.53 (0.34-0.83)] representation was lower. Asian fellows’ representation was higher compared to the general US population [AE ratio, 95% CI 5.87 (3.48-9.88)].

Conclusion: White fellows’ representation was lower compared to OBGYN residents’ distribution and general US population, while Asian fellows’ representation was higher in AAGL-accredited FMIGS programs. Female representation increased throughout the years, but overall, female fellows representation was lower than expected. These findings may help develop equitable recruitment strategies for FMIGS programs and reduce health disparities within complex gynecology.