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Table 1.  Survey Participant Demographic Information
Survey Participant Demographic Information
Table 2.  Survey Results by Race, Ethnicity, and Household Income Using a Likert Scalea
Survey Results by Race, Ethnicity, and Household Income Using a Likert Scalea
1.
Pandya  AG, Alexis  AF, Berger  TG, Wintroub  BU.  Increasing racial and ethnic diversity in dermatology: a call to action.  J Am Acad Dermatol. 2016;74(3):584-587. doi:10.1016/j.jaad.2015.10.044PubMedGoogle ScholarCrossref
2.
Smart  DR.  Physician Characteristics and Distribution in the US. Chicago, IL: American Medical Association; 2009.
3.
Cooper  LA, Roter  DL, Johnson  RL, Ford  DE, Steinwachs  DM, Powe  NR.  Patient-centered communication, ratings of care, and concordance of patient and physician race.  Ann Intern Med. 2003;139(11):907-915. doi:10.7326/0003-4819-139-11-200312020-00009PubMedGoogle ScholarCrossref
4.
Jiménez  RL.  Barriers to minorities in the orthopaedic profession.  Clin Orthop Relat Res. 1999;(362):44-50.PubMedGoogle Scholar
5.
Oyesanya  T, Grossberg  AL, Okoye  GA.  Increasing minority representation in the dermatology department: the Johns Hopkins experience.  JAMA Dermatol. 2018;154(10):1133-1134. doi:10.1001/jamadermatol.2018.2018PubMedGoogle ScholarCrossref
6.
Pritchett  EN, Pandya  AG, Ferguson  NN, Hu  S, Ortega-Loayza  AG, Lim  HW.  Diversity in dermatology: roadmap for improvement.  J Am Acad Dermatol. 2018;79(2):337-341. doi:10.1016/j.jaad.2018.04.003PubMedGoogle ScholarCrossref
Research Letter
January 9, 2019

Understanding Perceived Barriers of Minority Medical Students Pursuing a Career in Dermatology

Author Affiliations
  • 1Division of Dermatology, Department of Internal Medicine, Albert Einstein College of Medicine, Bronx, New York
  • 2Department of Dermatology, University of Michigan Medical School, Ann Arbor
JAMA Dermatol. 2019;155(2):252-254. doi:10.1001/jamadermatol.2018.4813

As the US population becomes increasingly diverse, the specialty of dermatology has not followed this trend; it is the least diverse medical field, after orthopedics.1 Although African Americans and Hispanics compose 12.8% and 16.3% of the American population, respectively, each group represents less than 5% of dermatologists (https://www.census.gov/prod/cen2010/cph-1-1.pdf).2 The representation of minorities improves patient care because race-concordant visits are associated with longer visits and greater patient satisfaction.3,4 Recently, several calls to action have endorsed evidence-based research to understand barriers to minority students pursuing dermatology.1,5,6

Methods

All research activities for this study were deemed exempt from ethical review by the institutional review board of Albert Einstein College of Medicine (IRB 2017-8705); nonetheless, all survey respondents provided written informed consent before completing the survey. A survey was conducted between January and April 2018 to investigate the lack of diversity and barriers to applying for a dermatology residency. The survey was electronically sent to 35 medical schools. Demographic information was collected, and participants were asked to rate survey items on a Likert scale (1, not important to 5, very important). Minorities were defined as nonwhite persons, and lower-income students were defined as those with annual household incomes below $40 000. Analysis was performed with SPSS Version 24.0 (IBM Corp).

Results

The survey was completed by respondents from 28 of 35 medical schools (school response rate, 80%). It was accessed by 242 medical students and completed by 155 of them (student response rate, 64%). Demographic characteristics are detailed in Table 1. Of the participants 43.2% (n = 67) expressed an interest in applying for a dermatology residency. Overall, participants cited the following factors as the most important (mean [SD] Likert score) to applying for a dermatology residency: US Medical Licensing Examination Step 1, 4.91 (0.35); clinical grades, 4.70 (0.59); and risk of not matching, 4.53 (0.76) (Table 2).

Students with lower incomes and ethnic minorities cited the lack of diversity in dermatology as a significant factor; the highest scores were among Hispanic/Spanish/Latino students (4.50 [0.65]) and those with household incomes between $20 000 and $40 000 (4.41 [0.87]) (Table 2). Students reported negative perceptions of minority students by residency programs, such as expecting lower performance, to be important; the highest scores were among those identifying as “other” race (4.17 [1.17]), African Americans (3.96 [1.16]), Hispanic/Spanish/Latinos (4.00 [1.08]), and those with household incomes between $20 000 and $40 0000 (4.19 [1.17]). Racial minorities and low-income students were more likely to cite socioeconomic barriers, such as lack of loan forgiveness. The highest values were reported by those identifying as other races (4.50 [0.84]) and those with household incomes less than $20 000 (4.78 [0.44]). Hispanic/Spanish/Latino students (4.79 [0.43]) and those with household incomes less than $20 000 (4.89 [0.33]) reported the highest scores for poor accessibility to mentors, especially with which students can identify.

Study limitations included calculating accurate response rates (medical student respondents/number of medical students who received survey); participants may not represent all US medical students; and not all minority groups are underrepresented in medicine. Asians were included as minorities because 50.0% of respondents were born outside of the United States (n = 21), and 37.5% (n = 15) had a first language other than English. These participants are likely to have an “additional distance traveled,” a higher likelihood of addressing health care disparities, and may demonstrate “grit” compared with their peers.6 Study strengths include a diverse cohort representing many medical schools.

Discussion

Overall, participants cited US Medical Licensing Examination Step 1, clinical grades, and the risk of not matching as the most important barriers to applying for a dermatology residency. However, minority students reported the lack of diversity, perceived negative perceptions of minority students by residencies, socioeconomic factors, and lack of mentors as major barriers. The perceived barriers differ by the racial, ethnic, and socioeconomic backgrounds of students and highlight the need to actively recruit and mentor students of all backgrounds. Furthermore, efforts should be made to increase minority students’ exposure to dermatology by incorporating it into the curriculum, providing research opportunities, and reducing the cost of “visiting electives” by providing stipends.

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Article Information

Accepted for Publication: October 27, 2018.

Corresponding Author: Yssra S. Soliman, BA, Division of Dermatology, Department of Internal Medicine, Albert Einstein College of Medicine, 3411 Wayne Ave, Second Floor, Ste D, Bronx, NY 10467 (ysoliman@mail.einstein.yu.edu).

Published Online: January 9, 2019. doi:10.1001/jamadermatol.2018.4813

Author Contributions: Dr Halverstam was the principal investigator, had full access to all of the data in the study, and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Study concept and design: Soliman, Rzepecki, Guzman, Williams, Cohen.

Acquisition, analysis, or interpretation of data: Soliman, Rzepecki, Guzman, Cohen, Ciocon, Halverstam.

Drafting of the manuscript: Soliman, Guzman, Williams, Cohen.

Critical revision of the manuscript for important intellectual content: Soliman, Rzepecki, Guzman, Cohen, Ciocon, Halverstam.

Statistical analysis: Soliman.

Administrative, technical, or material support: Soliman, Rzepecki, Williams, Cohen.

Study supervision: Williams, Cohen, Ciocon, Halverstam.

Conflict of Interest Disclosures: None reported.

Additional Contributions: We are indebted to Mondana Ghias, BA, Albert Einstein College of Medicine, for her assistance with the manuscript and Juan Lin, PhD, Albert Einstein College of Medicine, for her assistance with the statistical analysis of our data. They received no compensation for their contributions.

References
1.
Pandya  AG, Alexis  AF, Berger  TG, Wintroub  BU.  Increasing racial and ethnic diversity in dermatology: a call to action.  J Am Acad Dermatol. 2016;74(3):584-587. doi:10.1016/j.jaad.2015.10.044PubMedGoogle ScholarCrossref
2.
Smart  DR.  Physician Characteristics and Distribution in the US. Chicago, IL: American Medical Association; 2009.
3.
Cooper  LA, Roter  DL, Johnson  RL, Ford  DE, Steinwachs  DM, Powe  NR.  Patient-centered communication, ratings of care, and concordance of patient and physician race.  Ann Intern Med. 2003;139(11):907-915. doi:10.7326/0003-4819-139-11-200312020-00009PubMedGoogle ScholarCrossref
4.
Jiménez  RL.  Barriers to minorities in the orthopaedic profession.  Clin Orthop Relat Res. 1999;(362):44-50.PubMedGoogle Scholar
5.
Oyesanya  T, Grossberg  AL, Okoye  GA.  Increasing minority representation in the dermatology department: the Johns Hopkins experience.  JAMA Dermatol. 2018;154(10):1133-1134. doi:10.1001/jamadermatol.2018.2018PubMedGoogle ScholarCrossref
6.
Pritchett  EN, Pandya  AG, Ferguson  NN, Hu  S, Ortega-Loayza  AG, Lim  HW.  Diversity in dermatology: roadmap for improvement.  J Am Acad Dermatol. 2018;79(2):337-341. doi:10.1016/j.jaad.2018.04.003PubMedGoogle ScholarCrossref
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