Etiology of Black Exclusion in Radiation Oncology and Beyond: A Systematic Analysis of Early-Stage Career Barriers

Abstract

Recent studies and commentaries have highlighted the systemic and sustained exclusion of black physicians from the radiation oncology workforce and beyond. Moreover, the importance of black physicians in yielding better clinical and oncological outcomes for patients of color is well documented. Unfortunately, the disproportionate exclusion of black providers is also apparent among trainees and medical students, which would suggest barriers to entry at earlier stages in the workforce pipeline. Thus, a better understanding of the etiology of the systemic exclusion of black physicians and workforce pipeline problem is warranted to identify adequate solutions and interventions. To this end, we conducted a review of the literature and content analysis to describe and highlight barriers of entry into medicine, and describe a way forward to improving early exposure of radiation oncology as a field to black premedical students.In accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses, we conducted a review of studies and commentaries in the indexable literature of barriers experienced by black, American undergraduate/college students interested in medicine. These studies were further analyzed and grouped by frequency of barrier reporting. Grounded theory-based content-analysis was performed on commentaries/perspective articles.Our initial query generated 3924 results. Following title, abstract, then full-text review, 88 papers were selected for inclusion. While the majority of included papers discussed multiple barriers to entry (33%), the single most discussed topic was educational (18%). Educational barriers included lower grade-point averages, access to science courses, as well as the impact of individual courses on motivation. Other barriers included socioeconomic (15%), standardized testing (10%), interview preparation (7%), lack of mentorship/exposure (7%), discrimination (3%), lack of research experience (3%) 6burnout (2%), financial (2%).In addition to technical barriers to entry (e.g., admissions test scores, grade point averages), black premedical students face social barriers and racial abuse during their premedical journey that impact confidence, self-esteem, and motivation. With the recent prioritization of racial justice in radiation oncology, addressing systemic barriers that limit black inclusion in medicine should serve as an early starting place and a mentoring opportunity for earlier exposure to oncology as a profession.