Representation Of Underrepresented Minorities Research Articles

Female and underrepresented minority representation in radiology

Rational and objectiveDiversity, equity, inclusion, and representation in various sectors have garnered increasing attention in the past two decades, including healthcare. In this report we investigate representation of females and underrepresented minorities (URM) in the field of radiology and asses for significant growth trends in representation in residency training programs in the United States. Materials and methodsDe-identified trainee demographic information for active radiology trainees from 2016 to 2021 was queried using the Accreditation Council for Graduate Medical Education (ACGME), and new radiology trainees using the National Resident Matching Program (NRMP)’s Main Residency Match Data and Reports databooks. ResultsIn 2021 females represented 26.7% of DR residency trainees and 22% of IR integrated trainees. In the same year URM trainees represented 11.3% of trainees and 8.7% of IR integrated trainees. From 2017 to 2021, diagnostic radiology had a compound average growth rate (CAGR) 1% (p <0.01) of female representation and 1.12% (p<0.01) of URM representation. ConclusionThis study quantifies female and underrepresented minority representation among radiology trainees for diagnostic radiology and radiology subspecialities, identifying modest uptrends in representation within both demographics.

Factors Influencing Underrepresented Minority Applicants’ Ranking of General Surgery Residency Programs

Background: Underrepresented minorities (URM) are disproportionately lacking in academic surgery, yet there is wide variation in URM in residency programs. This mixed methods study aims to describe factors that URM interns identified as important in their rank list of general surgery residency programs. These data will aid institutions in increasing URM representation and creating supportive training environments in academic surgery. Methods: We employed a mixed methods approach using an online survey and semi-structured interviews developed through focus group engagement and literature review. Interviews were audio recorded, transcribed, and coded for themes. We conducted narrative thematic analysis. Results: Sixty-four incoming general surgery interns completed the survey with&amp;nbsp;median age 25 to 29. Of respondents, 67% identified as female and 34% as URM.&amp;nbsp;URM general surgery interns were more likely to rate program benefits and finances,&amp;nbsp;revisit opportunities (ie, organized post-interview revisit weekends), and post-graduate&amp;nbsp;job opportunities higher than were non-URM participants (p&amp;lt;0.05). URM participants&amp;nbsp;also ranked factors such as diversity of residents and faculty and diversity and inclusion&amp;nbsp;statements by programs higher than did non-URM participants (p&amp;lt;0.05). Five URM&amp;nbsp;interns completed semi-structured interviews. Qualitative themes influencing URM&amp;nbsp;interns&amp;rsquo; rank list decisions included (1) presence of URM in the program, (2) program&amp;nbsp;support of resident-led goals, (3) active inclusivity initiatives, and (4) direct experiences&amp;nbsp;of current URM residents. All interview participants relied heavily on interactions with&amp;nbsp;current URM residents as a source of information. Detractors from programs included&amp;nbsp;interns concerned with being the only person of color at their prospective program&amp;nbsp;and no concrete initiatives or goals in place to support diversity and inclusion, raising&amp;nbsp;concern for performative allyship. Conclusions: When evaluating residency programs, URM weighed current representation and support of URMs, active diversity and inclusion initiatives within a program, and lived experiences of URM residents. Surgery residency programs should take steps to not only intentionally recruit URM applicants but also create a supportive training environment that is diverse, inclusive, and empowering.

The Effect of Underrepresented Minority Mentorship on Orthopaedic Spine Surgery Recruitment and Diversity: A 20-Year Analysis at a Single Institution.

Despite national efforts to increase diversity and inclusion, underrepresented minority (URM) representation among orthopaedic spine surgery faculty remains low. Research has shown that URM trainees are more likely to pursue surgical careers when they have access to URM mentors. The purpose of this study was to explore the influence of URM representation among spine faculty on the rate of URM orthopaedic residents pursuing spine surgery fellowships. From 2004 to 2023, data were collected from each residency class at our academic institution: residency year, number of residents per class (total and URM), and number of residents applying to spine surgery fellowships. These ethnicities were considered URM: Black or African American, Hispanic or Latino, and Native American. In 2018, two African American spine faculty were hired. Data were compared between Before and After their arrival. A subanalysis was done to include a period of increasing URM recruitment (2012 to 2018). Binary logistic regression analysis evaluated associations between appointment of URM faculty and fellowship choice of URM residents. Two hundred fifty-six residents were included. Thirty-one total URM residents were in the program during the study period (12.1%). Overall, URM representation in the program increased over time [OR: 1.1, 95% CI: 1.1 to 1.2], whereas residents applying to spine surgery fellowships did not change [OR: 1.0, 95% CI: 1.0 to 1.1]. Comparing Before-2012 and 2012 to 2018 groups with the After-2018 group demonstrated a significant difference in the proportion of URM residents applying to spine surgery fellowships after the hiring of URM spine faculty (0.0% versus 23.1% versus 74.1%; P = 0.001). This retrospective study provides empirical evidence of the importance of URM representation among orthopaedic spine surgery faculty and the potential effect on URMs pursuing orthopaedic fellowships. Institutions should consider prioritizing the representation of URM faculty in spine surgery to address the lack of current and future diversity in the field. III.

Race and Gender Shift among Academic Glaucoma Specialists in the Last 5 Decades.

To evaluate the demographic composition of academic glaucoma specialists currently practicing in the United States. Retrospective and observational study. Academic glaucoma specialists identified from ophthalmology residency programs listed on the Doximity database. The American Board of Ophthalmology (ABO) membership directory, Doximity database, publicly available data, and direct communications were used to identify academic glaucoma specialists and their demographics. Information collected included-name, gender, race/ethnicity, geographic location, board certification date, academic affiliation, and academic rank. Ophthalmic age was defined as the number of years since ophthalmology board certification. Underrepresented minority (URM) groups were defined as Hispanics, Black or African Americans, Latinos, American Indians, or Alaskan Natives as defined by San Francisco match. In addition, the temporal, geographic, and academic rank distributions among females and URMs were explored. Women and URMs representations among academic glaucoma specialists across academic ranks, geographic regions, as well as ophthalmic age. There were 457 active academic glaucoma specialists identified from 110 institutions in 38 states. Among them, 185 (40.5%) were women and 42 (9.2%) were URM. The proportion of women glaucoma specialists in academia had increased significantly with a rate of 1.049 in odds ratio (OR) per year (p < 0.001). However, there were no significant changes in the proportion of URMs over time. The earliest year of certification was 1,964 for males and 1,974 for females. When controlled for ophthalmic age, there were no significant differences in the distribution of women or URMs between the different academic ranks (p = 0.572 and p = 0.762, respectively). Among assistant professors, women had a significantly higher ophthalmic age compared to men (p < 0.001), but there was no significant difference in ophthalmic age in both the associate and full professor groups. There were no significant differences in the geographic distribution of gender (p = 0.516) and URM across United States regions (p = 0.238). The proportion of women among academic glaucoma specialists has significantly increased over the past 5 decades; however, the proportion of URMs has been stagnant in the same period. Enhancing URM representation among academic glaucoma specialists deserves to be a future priority. Afzali K, Fujimoto DK, Mohammadi SO, et al. Race and Gender Shift among Academic Glaucoma Specialists in the Last 5 Decades. J Curr Glaucoma Pract 2023;17(2):98-103.

A quantitative synthesis of disparities in the inclusion of racial/ethnic minorities and older women in breast cancer trials.

6557 Background: Trials that inadequately include underrepresented minority (URM) populations widen inequities in cancer care. We assessed reporting patterns, representation, and trends of URM representation in breast cancer (BC) trials. Methods: We analyzed all phase 2/3 trials for age disparity and trials recruiting from the US for racial/ethnic disparity amongst BC RCTs (1990-2021). Enrollment-incidence ratios (EIR), which compare trial proportions (TP) from age subgroups against global estimates of incidence in the corresponding age group (from Global Burden of Disease) and racial/ethnic subgroups against US-population-based incidence in the corresponding racial/ethnic group (from SEER 22), were calculated. Individual-trial EIRs were pooled using random-effects meta-analyses. EIRs of &lt;0.80 indicated meaningful underrepresentation, while EIRs &gt;1.20 indicated meaningful overrepresentation. Meta-regression was used to explore associations between key trial characteristics and EIR, and trends in EIR over the last three decades. Results: Of 842 global trials with 490,657 participants, 232 (27.6%) reported the number of participants in specific age strata and 144 (17.1%) reported outcomes by age. Only 60 trials recruited exclusively from the US. Of these, 41 (68.3%) reported race and 24 (40.0%) reported ethnicity, and 2 (3.3%) analyzed outcomes by race. Older adults aged ≥65 years (TP: 24.3%; EIR: 0.53 [95% CI: 0.47-0.60]) and Hispanic women (TP: 5.3%; 0.54; 0.40-0.75) were underrepresented across global trials and US-only trials respectively. Black women were significantly underrepresented in trials that led to FDA approval (0.38; 0.25-0.58) but not in US-only trials. Stratified analysis by BC subtype (with subtype-specific population incidence) showed underrepresentation of Black women in US-only trials for HER2+ BC (0.66; 0.47-0.93), Hispanic women in ER+ BC (0.42; 0.20-0.90), Asians in triple-negative BC (0.24; 0.11-0.53), and older women in HER2+ BC (0.35; 0.31-0.40) and triple-negative BC (0.36; 0.29-0.45). From 1990-2021, the representation of older women declined significantly (meta-regression coefficient for EIR: -0.4 per 10 years), while Black and Hispanic representation showed no significant change. Black (p = 0.02) and Hispanic representation (p = 0.05) worsened significantly in larger trials. Conclusions: Published reports of BC trials do not consistently report the inclusion of URM. Older and Hispanic women were consistently underrepresented, whereas Black women were underrepresented in large, practice-changing trials. [Table: see text]

Asserting Accountability to Address Diversity: Report Card as a System of Measurement.

To the best of our knowledge, there are no standard accountability measures for diversity efforts at the departmental level. Therefore, the purpose of this study is to evaluate a multiprong report card as a structure for evaluation, tracking, and reporting as well as to examine any relationships between expenditures and outcomes. We instituted an intervention that offered leadership a report card of metrics related to diversity efforts. Included are diversity expenditures, benchmark demographic and departmental data, applications to support faculty salaries, participation in clerkship programs focused on attracting diverse candidates, and requests for candidate lists. The purpose of this analysis is to demonstrate the impact of the intervention. A significant relationship was found between faculty funding applications and under-represented minority (URM) representation in a department (0.19; confidence interval [95% CI] 0.17-0.21; p<0.001). An association was also found between total expenditures and URM representation in a department (0.002; 95% CI 0.002-0.003; p<0.001). Other outcomes include the following: (1) women, URM, and minority faculty have all increased in representation since tracking began; (2) diversity expenditures and faculty opportunity fund and presidential professorship applications have increased over time; and (3) a steady decline in departments with zero URM representation after the tracking of diversity expenditures in both clinical and basic science departments. Our findings suggest that standardized metrics for inclusion and diversity initiatives promote accountability and buy-in from executive leadership. Departmental detail enables tracking of progress longitudinally. Future work will continue to evaluate the downstream effects of diversity expenditures.

Representation of minorities in European neurosurgical leadership

IntroductionEthnic diversity has significantly increased within European countries since World War II for several reasons. However, there continues to be a contrasting lag in leadership positions within healthcare circles, and neurosurgery is no exception. Under-representation of minorities is a contributory factor to recurring problems of healthcare inequality. Research questionThe European Association of Neurosurgical Societies (EANS) Diversity Committee (DC) set out to examine trends in underrepresented minority (URM) representation in leadership positions across Europe. Material and methodsData on the race and ethnicity of departmental heads across the units in the European nations was collated. We defined the term ‘ethnic minority’ in line with the criteria set by the European Commission against Racism and Intolerance (ECRI). The percentage of URM among the European neurosurgical units was analysed against the demographics of the respective countries to assess whether there was a corresponding association. ResultsThe percentage of URM representation was low across most European countries. Countries with the highest immigration rates e.g. Great Britain and Germany had the highest rates of representation within the neurosurgical leadership in comparison to other countries. The Balkan states had zero rates of URM representation within the neurosurgical leadership. Discussion and conclusionOur findings demonstrate that URM representation in neurosurgical leadership across European countries is significantly low. Selection policies, training curricula and recruitment processes aimed at improving health inequality are necessary. Further studies are needed to elucidate the factors contributing to the low participation of URM in neurosurgical leadership.

Gender and Racial Representation Trends Among Internal Medicine Department Chairs from 2010–2020

BackgroundQuality medical education, reduction in health disparities, and healthcare research that includes all members of society are enhanced by diversity in departments of internal medicine (IM). Research on increasing diversity within the academic medicine student body or faculty notes the important role of leadership. Yet, there is a scarcity in research into diversity in leadership.ObjectiveThe purpose of this study is to go beyond aggregate numbers and answer the question: What is the level of parity representation, by gender and race, at department chair positions in academic IM departments?DesignA cross-sectional analysis of race/ethnicity and gender in IM medical school departments from 2010 to 2020 was conducted using data from the American Association of Medical College’s (AAMC) Faculty Roster. The proportion of IM department chairs to IM faculty by race/ethnicity for each year (2010–2020) was used to calculate the Leadership Parity Index (LPI) in this study. LPI by gender and by gender and race/ethnicity were also calculated for each year.ResultsIn aggregate numbers, Black or African American and Hispanic, Latino, or of Spanish Origin faculty remain under-represented in academic IM each making up, on average, approximately 4% of the total IM faculty. The LPI calculations revealed that faculty who identified as White were consistently over-represented as department chairs while Asian faculty were consistently under-represented in leadership and ranked lowest in leadership parity among the ethnic groups studied. The leadership parity index also showed that women faculty across all races were under-represented.ConclusionWomen and Asian faculty encounter a ceiling effect that may be at play in IM departments. While significant progress still needs to be made in the representation of under-represented minorities, the findings of this study show that aggregate data does not provide a true picture of equity and parity in Internal Medicine faculties.

Workforce Trends of Underrepresented Minority Nurses in the United States Over the Last Decade: Progress Towards Equal Representation?

A healthcare workforce representative of the race/ethnicity composition of the population it serves is central to addressing systemic health inequities. The aim of this study was to assess workforce trends of underrepresented minority (URM) nurses using the National Sample Survey of Registered Nurses years 2008 and 2018 and the American Community Survey years 2010 and 2019. We examined changes over time in URM composition (Black/African American (B/AA), Latine, American Indian/Alaskan Native (AI/AN), Native Hawaiian/Pacific Islander (NH/PI)) for registered nurses (RN), nurse practitioners (NPs), educational attainment (diploma/associate, BSN, MS(N)/PhD), job type (patient care, research, administration/supervision, teaching, other), and rural/urban location using descriptive statistics and bivariate regressions. While the proportion of the URM RN workforce grew significantly, the only URM group demonstrating proportional gains in the APRN workforce were Latine nurses. URM representation in educational attainment grew across all degree types. By 2018/2019, Latine nurses have their largest representation in the Dipl./ASN degree group and saw a proportional decline for PhD educated nurses. B/AA nurses have their largest representation at the MS(N)/PhD level. However, smaller proportions of B/AA nurses were working as APRNs compared to their non-URM colleagues. At the PhD level, few B/AA nurses were represented in research and teaching positions. A subgroup analysis of unemployed nurses seeking work revealed that B/AA and AI/AN nurses were overrepresented among unemployed nurses. While today's nursing workforce is more representative of the nation than ever before, results show unequal representation of URM and non-URM nurses across the ranks of the nursing professions that suggest unequal career and labor market opportunities.

Search committee diversity and applicant pool representation of women and underrepresented minorities: A quasi-experimental field study.

The diversification of applicant pools constitutes an important step for broadening the participation of women and underrepresented minorities (URMs) in the workforce. The current study focuses on recruiting diverse applicant pools in an academic setting. We test strategies grounded in homophily theory to attract a diverse set of applicants for open faculty positions. Analysis of recruitment data (13,750 job applications) showed that women search committee chairs and greater percentages of women on search committees related to more women applicants and that URMs search chairs and a greater percentage of URM members on search committees related to more URM applicants, resulting in 23% more women applicant pools with a woman chair and over 100% more URM applicants for a URM chair. Furthermore, women and URMs actively engage in ways to reach out to a more diverse set of applicants, whereas men and non-URMs' behavior maintains the status quo. We discuss the implications and advancement of homophily theory that can ultimately increase the representation of women and URM in the workforce. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

An intensive summer pipeline program for pre-pharmacy students to increase underrepresented minority matriculation to pharmacy school

Background and purposeTo describe the Summer Academic Enrichment Program (SAEP) for underrepresented minority (URM) matriculants at Virginia Commonwealth University (VCU) School of Pharmacy. Educational activity and settingThe SAEP is a six-week summer pipeline program at VCU for undergraduate and post-baccalaureate students interested in applying to medical, dental, physical therapy, or pharmacy school, divided into school tracks. Demographic and matriculation information about the pharmacy track program participants was obtained from the program and school administration from inception in 2012 through 2019. A retrospective analysis of the impact of SAEP on URM matriculation at VCU School of Pharmacy was conducted. FindingsOf the 80 pharmacy track participants, 56.3% (n = 45) have enrolled at VCU School of Pharmacy. Among those 45 that matriculated, 33.3% (n = 15) identified as one or more of the following URM populations: Black or African American 28.9% (n = 13), Hispanic or Latinx 4.4% (n = 2), and American Indian 2.2% (n = 1). In comparison, the same URM classifications for students enrolled at VCU School of Pharmacy over the last nine years ranged from 5% to 11% Black or African American, 0% to 5% Hispanic or Latinx, and 0% to 2% American Indian with a total URM representation range of 7% to 25% during this timeframe. SummarySAEP is a program utilized to increase matriculation of students from diverse backgrounds, including URM populations. This type of pipeline program is described as one way to improve URM representation.

Trends in racial diversity of dermatology residency applicants from 2016 to 2020: a retrospective review study.

Disparities in racial diversity in the field of dermatology continue to persist given that dermatology has the second lowest percentage of underrepresented minorities (URM), only second to orthopedic surgery. This study aims to investigate any trends in racial representation of dermatology residency applicants over a 5-year period from 2016 to 2020. Dermatology residency applicant race data were extracted from the Electronic Residency Application Service (ERAS) of the Association of American Medical Colleges (AAMC) for application seasons 2016-2020 for a retrospective review study. There was an overall increase in the number of dermatology residency applicants during the 5-year study period. Prior to 2018 (midpoint of the study), 14.1% of applicants identified as URM compared to 16.2% after 2018, although this difference was not statistically significant (p = 0.25). Our findings suggest that in the study period analyzed, racial representation remained relatively similar, with a non-statistically significant increase in URM applicants. Outlining the current trends in dermatology residency applicants may be helpful in identifying factors affecting the disparity in racial representation within the field. There is hope that dermatology residency applicants are becoming more racially diverse with improved representation of URMs.

AUTHOR'S REPLY

The editors note there exists a bottleneck at the level of recruiting underrepresented minority (URM) students into medical school. We made reference to this phenomenon citing the prevalence of URM students in medical school in 2019 was 14%, with a similar lag in URM (including Asian trainees) representation in urology trainees at 17.7% (30.8%) behind surgery at 20.4% (33.6%) and all fields at 25.6% (42.3%). While this bottleneck is evident at the beginning of medical education, these straggling numbers continue at every juncture of becoming a physician resulting in a further silo effect in competitive surgical subspecialties like urology.

Effect of Application Screening Methods on Racial and Ethnic Diversity in Otolaryngology.

Otolaryngology-head and neck surgery (OHNS) lags behind other surgical subspecialties in the representation of underrepresented minorities in medicine (URMs). Given the recently announced changes to Step 1 scoring, we aimed to assess the effect of alternative application screening methods-Step 2 Clinical Knowledge scores and Alpha Omega Alpha membership-on the racial/ethnic diversity of the OHNS applicant pool. After reviewing OHNS residency applications submitted to our institution for the 2015-2020 matches (N = 2177), we determined that a significantly greater proportion of URM vs non-URM applicants would be screened out from interview consideration if any the following were used as an initial screening method: Step 2 cutoff score of 240, Step 2 cutoff score of 253 or non-Alpha Omega Alpha membership (P < .01 for each). Given that using these metrics to screen applications disproportionately affects URMs, programs should consider implementing alternative application review methods, such as holistic evaluation, which may promote more equitable distribution of interviews.

Abstract IA-51: If not now, then when? Tackling barriers to clinical trials to ensure inclusion of underrepresented minorities

Abstract The low representation of underrepresented minorities in clinical trials is well known. Unfortunately, there appears to be modest progress in the inclusion of these groups in the nearly 30 years since the NIH Revitalization Act of 1993. Racial and ethnic diversity in clinical trials is imperative for ensuring that novel cancer therapies, behavioral interventions and other types of scientific advances reach and are relevant to all population segments. It will be impossible to eliminate disparities and achieve health equity without diversity and inclusion in clinical research. Many barriers exist to clinical trials and some may be exacerbated among racial/ethnic minorities. This presentation will discuss multilevel barriers to participation in clinical research, share engagement principles related to partnerships with African American/Black and Latino/Latinx populations, and provide lessons learned from institutional and investigator led-initiatives. Data sources include chart reviews, patient interviews and surveys. Selected clinical studies will be discussed along with qualitative and quantitative data. The overall goal is to identify actionable steps towards a collective path of improving minority participation in clinical trials. Strategies that optimize opportunities for system change may have greater impact than strategies that focus solely on patient and/or community attitudes or behaviors. Given the COVID-19 pandemic, public awareness about clinical trials may be at a record high. Thus, community conversations about science and the clarion call for social justice may be the energy needed for cancer scientists to collaborate and change the narrative regarding participation of underrepresented minorities in research. Citation Format: Vanessa B. Sheppard. If not now, then when? Tackling barriers to clinical trials to ensure inclusion of underrepresented minorities [abstract]. In: Proceedings of the AACR Virtual Conference: 14th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2021 Oct 6-8. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr IA-51.

A multi-pronged, antiracist approach to optimize equity in medical school admissions.

Increasing the number of physicians who identify as an underrepresented minority (URM) has been a focus for decades. Despite the US Department of Health and Human Services establishing The Council on Graduate Medical Education focussing on the underrepresentation of minorities in medicine in 1990, US medical students in 1998-1999 were15.2% URM and twenty years later, URM students comprise only 14.6% of matriculants. This reflected our experience at University of Maryland School of Medicine despite our diverse community where over 60% of the population identify as Black or African-American. We share our strategies to mitigate bias in the admissions process and our resulting outcomes. We implemented multiple interventions including interviewer training, recruitment strategies, holistic screening, changes in the interview process and increased racial, ethnic and gender diversity on our admissions committee. These changes were made over a two-year period initially focussing on the committee, followed by focussed interventions for interviewers. With these interventions, we demonstrated an improvement in the number of URM applicants that matriculated. In 2019, we had the first class that was in which no one ethnicity or race comprised the majority of the class, with 54% of matriculants identifying as students of colour. In 2020, in addition to sustaining a majority of the class identifying as students of colour, the proportion of URM students increased from 10%-13% for the preceding 3years, to 24% of the entering class. The number of physicians who identify as URM must be increased for the benefit of our patients and health care system. Unconscious bias training for interviewers, focused recruitment strategies, holistic screening deemphasising the MCAT, blinding interviewers to MCAT scores and GPA, and increasing admissions committee diversity are five concrete steps that yielded the desired outcome of increasing URM representation among our medical school matriculants.

Racial and ethnic representation trends in United States oncology training programs.

6519 Background: Utilizing race and ethnicity data from the Accreditation Council for Graduate Medical Education (ACGME), this study aims to assess representation trends across American Society of Clinical Oncology (ASCO) participant specialties from the past five academic years in order to characterize current needs and effectively address these needs moving forward. Methods: Self-reported ethnicity/race data from the ACGME database books were collected from academic years 2015-16 to 2019-2020 for the following oncologic training programs: hematology and medical oncology, medical oncology, gynecologic oncology, pediatric hematology and oncology, radiation oncology, complex general surgical oncology. Summary statistics and chi-square analysis were conducted to compare underrepresented minority (URM) trends across programs. URM groups were cross-referenced with definitions provided by the AAMC and included those who identify as Hispanic, Latino or of Spanish origin, Black or African American, and Native American or Alaskan. Results: Over the study period, only 1,250 (9.0%) of 13,853 oncology trainees identified as URM. Chi-square analysis demonstrated no significant change in URM representation in all oncology specialties combined between 2015-16 and 2019-20 (8.9% [95% CI, 7.8%-10.0%] vs. 9.7% [95% CI, 8.7%-10.8%]; P=.31). Between 2015-16 and 2019-20, Hematology and oncology (+1.3%), pediatric hematology and oncology (+0.3%) all demonstrated insignificant increasing trends in representation while radiation oncology (-0.3%), complex general surgical oncology (-4.0%) had statistically insignificant decreasing trends in representation. Gynecologic oncology (+6.0%) demonstrated a significant increasing trend in representation. Conclusions: This is the first study to characterize the vast disparities in representation in oncologic training programs in the United States. There is a demonstrated lack of representation across all oncology training programs and a lack of significant improvement over the study period. A multiprong approach is needed to improve diversity and representation across the spectrum of the oncology workforce in the United States.

National trends in gender and ethnicity in dermatology training: 2006 to 2018

To the Editor: Sex and race concordance between physicians and patients is associated with improved perceptions of clinical care.1Street R.L. O'Malley K.J. Cooper L.A. Haidet P. Understanding concordance in patient-physician relationships: personal and ethnic dimensions of shared identity.Ann Fam Med. 2008; 6: 198-205Crossref PubMed Scopus (341) Google Scholar In 2017, 48.9% and 64.5% of dermatology attendings and residents, respectively, were female.2Bae G. Qiu M. Reese E. Nambudiri V. Huang S. Changes in sex and ethnic diversity in dermatology residents over multiple decades.JAMA Dermatol. 2016; 152: 92-94Crossref PubMed Scopus (41) Google Scholar Academic dermatology leadership positions are underrepresented in sex and ethnic diversity.3Jayakumar K.L. Lipoff J.B. Trends in the dermatology residency match from 2007 to 2018: implications for the dermatology workforce.J Am Acad Dermatol. 2019; 80: 788-790Abstract Full Text Full Text PDF PubMed Scopus (4) Google Scholar,4McDonald T.C. Drake L.C. Replogle W.H. Graves M.L. Brooks J.T. Barriers to increasing diversity in orthopaedics: the residency program perspective.JB JS Open Access. 2020; 5: e0007PubMed Google Scholar We examined sex and ethnicity trends of dermatology residents and fellows compared to other medical and surgical trainees. Demographics of dermatology residents and fellows and other of medical/surgical trainees were obtained from the Accreditation Council for Graduate Medical Education annual census, 2006 to 2018. Underrepresented minority (URM) was defined as Black/African American, Hispanic, or Native American. A 2-sample z-test was used to compare sex and ethnicity proportions in 2006 and 2018 (α level, <.05). Female representation in dermatology residency was stable at approximately 60% (Supplemental Table I; available via Mendeley at https://doi.org/10.17632/m3hs3dyr2n.1), and the overall residency census national average increased from 44% to 46% (P < .01) during the study period. Proportions of women in procedural dermatology and dermatopathology increased from 27% to 44% and from 46% to 54%, respectively (P > .05) (Fig 1). Female representation increased in all fellowship comparator groups; however, proportions of female fellows were consistently less than those of corresponding residencies in internal medicine, plastic surgery, and general surgery (Supplemental Table II; available via Mendeley at https://doi.org/10.17632/m3hs3dyr2n.1). All fields trended toward a narrowing of residency-fellowship gender gaps. Average URM representation in the overall residency national census increased from 12.5% in 2006 to 13.6% in 2018 (P < .05) (Supplemental Table I). URM representation in dermatology residency and fellowship increased from 8.2% to 9.3% and decreased from 9.5% to 3.1% (P > .05), respectively. URM representation in dermatology residency was consistently below the national average (Fig 2). URM residency-fellowship disparities persist in other fields (Supplemental Table II); however, only dermatology experienced a downward trend of URM fellowship representation over time. This study is limited by use of self-reported data and unknown rates of fellowship application by candidates of differing gender/ethnicity. We did not have access to pediatric dermatology fellowship data or total number of dermatology residency/fellowship positions. Our study showed significant narrowing of female residency-fellowship gaps and persistent URM dermatology residency underrepresentation and residency-fellowship gaps compared to the national average. Physician diversity is essential in addressing health care disparities.5Pritchett E.N. Pandya A.G. Ferguson N.N. Hu S. Ortega-Loayza A.G. Lim H.W. Diversity in dermatology: roadmap for improvement.J Am Acad Dermatol. 2018; 79: 337-341Abstract Full Text Full Text PDF PubMed Scopus (50) Google Scholar Lack of URMs in leadership positions, mentorship, racism, and implicit bias have been cited as barriers for URMs pursuing subspecialties. Female and URM residents should be encouraged to seek mentorship from leaders of concordant and discordant gender and ethnicity. Mentorship programs, through the American Academy of Dermatology and Women's Dermatologic Society, which support URM medical students interested in pursuing dermatology and female resident dermatologists pursuing subspecialties, likely contributed to some of the upward trends observed. The Perry and student to resident institutional vehicle for excellence initiatives, Nth Dimension programs, and near-peer mentors have been successful in encouraging URMs to apply for competitive fields, subspecialties, and academic faculty positions. Similar initiatives should be adopted for dermatology. Early exposure of URMs to dermatology, updated curricula including skin of color topics, and rethinking residency selection criteria are also essential.5Pritchett E.N. Pandya A.G. Ferguson N.N. Hu S. Ortega-Loayza A.G. Lim H.W. Diversity in dermatology: roadmap for improvement.J Am Acad Dermatol. 2018; 79: 337-341Abstract Full Text Full Text PDF PubMed Scopus (50) Google Scholar Our study highlights positive trends for women in dermatology residency/fellowships and significant deficiencies in URM representation in dermatology residency/fellowships. Increased efforts are needed to understand barriers to pursuing subspecialties and initiatives taken to promote mentorship and guidance to underrepresented groups. None disclosed.

Underrepresented minority representation trends in gynecologic oncology fellowships in the United States

ObjectiveTo evaluate representation trends of historically underrepresented minority (URM) groups in gynecologic oncology fellowships in the United States using a nationwide database collected by the Accreditation Council for Graduate Medical Education (ACGME). MethodsData on self-reported ethnicity/race of filled residency positions was collected from ACGME Database Books across three academic years from 2016 to 2019. Primary chi-square analysis compared URM representation in gynecologic oncology to obstetrics and gynecology, other surgical specialties, and other medical specialties. Secondary analysis examined representation of two URM subgroups: 1) Asian/Pacific Islander, and 2) Hispanic, Black, Native American, Other (HBNO), across specialty groups. ResultsA total of 528 gynecologic oncology positions, 12,559 obstetrics and gynecology positions, 52,733 other surgical positions, and 240,690 other medical positions from ACGME accredited medical specialties were included in analysis. Primary comparative analysis showed a statistically significant lower proportion (P < 0.05) of URM trainees in gynecologic oncology in comparison to each of obstetrics and gynecology, other surgical fields, and other medical fields. Secondary analysis also demonstrated a significantly lower proportion (P < 0.05) of HBNO physicians in gynecologic oncology in comparison to obstetrics and gynecology, as well as all other medical and surgical specialties. ConclusionsThis study illustrates the disparities in URM representation, especially those who identify as HBNO, in gynecologic oncology fellowship training in comparison to obstetrics and gynecology as well as other medical and surgical fields. Improvements to the current recruitment and selection practices in gynecologic oncology fellowships in the United States are necessary in order to ensure a diverse and representative workforce.

Current and Historical Trends in Diversity by Race, Ethnicity, and Sex Within the US Pathology Physician Workforce.

This study assessed historical and current gender, racial, and ethnic diversity trends within US pathology graduate medical education (GME) and the pathologist workforce. Data from online, publicly available sources were assessed for significant differences in racial, ethnic, and sex distribution in pathology trainees, as well as pathologists in practice or on faculty, separately compared with the US population and then each other using binomial tests. Since 1995, female pathology resident representation has been increasing at a rate of 0.45% per year (95% confidence interval [CI], 0.29-0.61; P < .01), with pathology now having significantly more females (49.8%) compared to the total GME pool (45.4%; P < .0001). In contrast, there was no significant trend in the rate of change per year in black or American Indian, Alaskan Native, Native Hawaiian, and Pacific Islander (AI/AN/NH/PI) resident representation (P = .04 and .02). Since 1995, underrepresented minority (URM) faculty representation has increased by 0.03% per year (95% CI, 0.024-0.036; P < .01), with 7.6% URM faculty in 2018 (5.2% Hispanic, 2.2% black, 0.2% AI/AN/NH/PI). This assessment of pathology trainee and physician workforce diversity highlights significant improvements in achieving trainee gender parity. However, there are persistent disparities in URM representation, with significant underrepresentation of URM pathologists compared with residents.