Improving the Radiation Oncology Black Workforce Pipeline: Learning From Early-Stage Career Initiatives

Abstract

Much focus has been placed on describing the serious and disproportionate exclusion of black physicians in radiation oncology. As a result, many programs have recently emerged to introduce historically-excluded minority medical students from radiation oncology. However, according to annual Association of American Medical Colleges data, black applicants, let alone black medical school matriculants, are among the lowest of any racial/ethnic group. With the starting black population in medical school already significantly and concerningly low, the utility of early radiation oncology exposure initiatives are arguably limited in their ultimate objectives. Thus, to improve the exposure and ultimate inclusion of black physicians as part of the healthcare (generally) or radiation oncology (specifically) workforce, the systemic and institutionalized racist barriers to entry into medicine need to be adequately addressed. To this end, we describe and analyze programs designed to help black premedical students in their pursuit for a medical career.We conducted a review of the indexed literature and content analysis in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Studies describing programs and initiatives designed to ultimately increase the volume of black American applicants and matriculants into medical school were included. These studies further analyzed for common themes, successes, and challenges.The search identified 7608 results. Following title, abstract, then full-text review, 10 articles detailing 11 initiatives were included. Programs ranged from three weeks to four years. The primary targets of these initiatives were undergraduate premedical students from underrepresented and economically disadvantaged backgrounds. Themes emerging from these initiatives included mentorship, rigorous academic preparation, test taking strategies, and professional development training. Challenges included sustainable funding, maintaining student interest, and ultimately the need to identify which features specifically lend to programs' success.While programs designed to expose black medical students to radiation oncology are important, they unfortunately do not address the supply/demand problem. Initiatives supporting black premedical students within the larger medical system designed to exclude them and restrict their access offer an opportunity for radiation oncology programs to collaborate with undergraduate institutions to offer practical support of black premedical students. Given the uniqueness and breadth of the clinical components of radiation oncology (e.g., imaging, clinical interactions, procedures, inpatient consults, etc.), we can learn from the successes and challenges of current programs to design and improve future initiatives to introduce and support black undergraduates through the medical career pipeline.