Assessment of the Medical Schools Radiation Oncology Residents Come fom Suggests A Reasonable Approach for Diversifying the Workforce

Abstract

The US radiation oncology (RO) workforce has significant underrepresentation of women, African Americans, and Latinos compared to the US population and medical school (MS) graduates. Our hypothesis is that this reflects inadequate RO exposure and mentoring for these students. Our objective was to better understand how MS and RO department demographics correlate with MS-specific residency match rates in RO. The ASTRO directory was used to search all RO physicians that self-identified as a “resident” and listed their MS. This included 507 residents, of which 36 who attended osteopathic or international schools were excluded. Demographic information for all 147 allopathic US medical schools and any on-site affiliated RO department and residency program was also collected from other freely accessible web resources. Spearman’s rank-order and Wilcoxon signed-rank tests were used for correlative analyses. A total of 100 schools (68%) had an affiliated RO department and 81 (55%) had a RO residency program. There was a median of 9 faculty members (interquartile range (IQR) 5 - 15) per RO department, with a median of 2 female faculty (IQR 1 - 5) and 0 African American or Latino faculty per department (IQR 0 - 1). In total, 26.5% of all US RO academic faculty were women and 4.4% African American or Latino. The median percentage of students per MS that matched in a RO residency was 0.4% (IQR 0.2 - 0.7%), and the median percentage of all US RO residents that came from each MS was 0.6% (IQR 0.2 - 1.1%). Both of these percentages were significantly higher when there was an affiliated RO department (p < 0.01) or RO residency program (p < 0.01), and for RO departments with more faculty members (rs = 0.45 and 0.43, p < 0.01), but there was no significant association with any MS factors assessed (percentages of women or underrepresented minority students, or average matriculating student MCAT scores or GPA). RO residents’ ethnicity could not be determined for analysis, however, the number of female RO faculty in a department predicted for significantly more female RO residents graduating from that MS (rs = 0.35, p<0.01), and the top quartile of RO departments with the most female faculty were affiliated with schools that graduated 49% of all female RO residents. Only 57 US RO residents (12%) graduated from the 47 schools without an affiliated RO department, whereas the 25 schools that graduated the highest percentage of US RO residents accounted for 46% of all RO residents. The proportion of students at a given MS that match into RO is strongly associated with affiliation to a larger RO department and residency program. As such, the majority of RO residents come from a select number of schools. Targeted education and mentoring outreach initiatives for schools with fewer affiliated RO faculty should be considered in order to help diversify the workforce.