Improving the Retina Fellowship Applicant Pool
How can we prioritize diversity and inclusion in retina from the very beginning?
Kirsten Simmons, MD, MHSc, and Nita Valikodath, MD, MS
Retina Today
AT A GLANCE Women comprise about half of the medical student population yet make up 22% to 54% of surgical residents and fellows across subspecialties. Residency program directors and selection committee members should implement a holistic application review and selection process to improve the match for underrepresented-in-medicine applicants into our field. Mentorship programs create mentor-mentee partnerships and support opportunities for junior residents to present at national conferences. Ophthalmic advancement, patient-centered care, and outreach are contingent on sustained efforts that recruit and retain a diverse workforce within our dynamic specialty. WHERE WE STAND The Association of American Medical Colleges (AAMC) defines underrepresented in medicine (URiM) as “those racial and ethnic populations that are underrepresented in the medical profession relative to their numbers in the general population.”1 While this definition allows for routine accommodations based on changing ethnic populations within our country, the groups to whom this definition most commonly applies to are Blacks, Hispanics, Native Americans (American Indian/Alaska Native/Native Hawaiian), and mainland Puerto Ricans.1,2 Decades of ophthalmic research has demonstrated vast examples of disease-specific disparities in treatment and outcomes based on race/ethnicity, socioeconomic status, and other factors.3 Importantly, physician-patient concordance in demographic factors (eg, race/ethnicity, culture, and gender) increases patient satisfaction, medical adherence, and health outcomes.4-6 However, women comprise approximately half of the medical student population yet make up 22% to 54% of surgical residents and fellows across subspecialties.7 Similarly, URiMs comprise 7.7% of resident trainees, 6% of practicing ophthalmologists, and 5.7% of ophthalmology faculty, despite making up 30.7% of the US population.8 By lacking in diversity, ophthalmology misses out on the wealth of knowledge and experiences embodied within women and URiM trainees that can help tackle complex research and clinical challenges, coined the diversity bonus by social scientist Scott E. Page, PhD.9 AN UNEQUAL EDUCATION SYSTEM Nearly 70 years after the landmark 1954 Brown vs. Board of Education Supreme Court ruling, our country’s education system continues to perpetuate unequal learning opportunities. There is a stark opportunity gap between Black and White students (known as the achievement gap).10,11 Black students are more likely to attend schools with less funding per student, have less access to advanced placement courses, have lower rates of acceptance into gifted programs, experience lower expectations from teachers, and receive greater suspensions and discipline.12-14 Although we cannot uproot decades of inequitable education, we can acknowledge its existence. Ophthalmologists in a position of influence must examine each step of the student-to-physician pipeline to develop sustainable programs and policies that will increase awareness of our specialty, offer academic and research support, promote holistic evaluations, and prioritize longitudinal career development and retention. Undergraduate and Graduate Training It is imperative that URiM students establish an ophthalmology mentor early in their educational training.