Sex and Racial/Ethnic Diversity of US Medical Students and Their Exposure to Dermatology Programs | Dermatology | JAMA Dermatology | JAMA Network
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Figure 1.  Population Comparisons: Program Size
Population Comparisons: Program Size

Sex and racial/ethnic diversity of medical students in cross-referenced dermatology residency program size. SUIM indicates students underrepresented in medicine.

Figure 2.  Population Comparisons: Exposure Opportunities
Population Comparisons: Exposure Opportunities

Sex and racial/ethnic diversity of medical students in additional dermatology exposure opportunities, including fellowship programs and dermatology interest groups. SUIM indicates students underrepresented in medicine.

1.
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
2.
Bae  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(1):92-94. doi:10.1001/jamadermatol.2015.4441PubMedGoogle ScholarCrossref
3.
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
4.
Bernstein  J, Dicaprio  MR, Mehta  S.  The relationship between required medical school instruction in musculoskeletal medicine and application rates to orthopaedic surgery residency programs.  J Bone Joint Surg Am. 2004;86-A(10):2335-2338. doi:10.2106/00004623-200410000-00031PubMedGoogle ScholarCrossref
5.
American Academy of Dermatology. Diversity mentorship program: information for medical students. 2018; https://www.aad.org/members/leadership-institute/mentoring/find-a-mentor/diversity-mentorship-program. Accessed August 19, 2018.
6.
Chen  A, Shinkai  K.  Important considerations for diversity in the selection of dermatology applicants.  JAMA Dermatol. 2017;153(9):949. doi:10.1001/jamadermatol.2017.1812PubMedGoogle ScholarCrossref
Research Letter
January 16, 2019

Sex and Racial/Ethnic Diversity of US Medical Students and Their Exposure to Dermatology Programs

Author Affiliations
  • 1Department of Dermatology, Stanford University School of Medicine, Redwood City, California
  • 2Department of Dermatology, Brigham and Women’s Hospital, Boston, Massachusetts
JAMA Dermatol. 2019;155(4):490-491. doi:10.1001/jamadermatol.2018.5025

Increasing medical workforce diversity improves access to health care in underserved communities.1 Although sex diversity has increased in dermatology, racial/ethnic diversity lags behind other specialties.2,3 We hypothesized that a lack of dermatology exposure during medical school for students underrepresented in medicine (SUIM) may be contributory and characterized sex and racial/ethnic discrepancies in early dermatology exposure opportunities for medical students.

Methods

We obtained medical student sex and race/ethnicity enrollment data from the 2017-2018 academic year from the Association of American Medical Colleges. We defined SUIM as individuals reporting black or African American, Hispanic or Latino, Native American, and/or Native Hawaiian or Pacific Islander race/ethnicity. Institutions were cross-referenced for presence of American College of Graduate Medical Education (ACGME)–accredited dermatology residency programs and residency program size. Programs were stratified as small (≤9 residents), medium (10-14 residents), and large (≥15 residents). Institutional presence of ACGME-accredited micrographic surgery and dermatopathology fellowships, American Board of Dermatology–approved pediatric dermatology fellowships, and Dermatology Interest Group Association–verified interest groups were identified to quantify dermatology exposure opportunities. Data were analyzed from May 17 through August 7, 2018. The institutional review boards of Stanford University School of Medicine, Redwood City, California, and Brigham and Women’s Hospital, Boston, Massachusetts, waived the need for approval.

Results

The ACGME-accredited dermatology residency programs were associated with 102 out of 147 total medical schools, providing potential exposure to 70 954 out of 89 904 US medical students (78.9%). The percentage of female medical students at schools without dermatology residency programs (9109 [48.1%]) was similar to that at schools with small (9656 [49.3%]), medium (13 428 [47.4%]), and large (11 378 [49.4%]) residency programs (Figure 1). The SUIM constituted lower percentages in schools with associated dermatology residencies (9034 [12.7%]) than those without (3180 [16.8%]). The percentages of SUIM were different at schools with small (2665 [13.6%]), medium (3438 [12.1%]), and large (2931 [12.7%]) residency programs. In contrast, Asian medical students constituted 3663 students (19.3%) at institutions without residency programs and steadily increasing percentages at institutions with small (3946 [20.1%]), medium (6040 [21.3%]), and large (5543 [24.1%]) residency programs.

The greatest percentage of SUIM was enrolled at schools without additional dermatology exposure opportunities (3143 [17.6%]), whereas a smaller percentage was enrolled at schools with 1 (3528 [14.5%]), 2 (2512 [10.7%]), 3 (1824 [11.7%]), and 4 (1207 [13.6%]) additional exposure opportunities (Figure 2). The lowest percentage of Asian medical students was enrolled at schools without additional exposure opportunities (3318 [18.6%]), whereas the greatest percentage was enrolled at schools with 4 additional exposure opportunities (2296 [25.9%]). No significant differences were noted for female students.

Discussion

Early exposure and mentorship opportunities are associated with higher rates of students pursuing careers in specific fields.4 We examined associated dermatology residency programs, fellowships, and interest groups as proxies of opportunities for early dermatology exposure. Medical schools without early exposure opportunities correlated with higher proportions of SUIM. Sex diversity did not vary across groups.

Our study is limited because defining dermatology exposure is difficult. The presence of dermatology fellowships may not guarantee significant exposure opportunities; however, we believe that fellowships require institutions to have educational infrastructures supportive of dermatology. Dermatology shadowing programs for students may be better exposure proxies, although more difficult to identify.

Nonetheless, given the correlation between higher proportions of SUIM and institutions with limited dermatology exposure opportunities, such schools might benefit from targeted support. Opportunities for mentorship and funding for clinical rotations such as the American Academy of Dermatology diversity mentorship program5 should be promoted. Dermatology faculty should be encouraged to engage in such mentorship. Partnerships between exposure-rich and exposure-poor schools could be facilitated. Dermatologists should be mindful of continuing mentorship and opportunities for SUIM choosing to pursue dermatology, including programmatic efforts.6 To promote racial and ethnic diversity within dermatology and ensure the delivery of equitable and effective health care for an increasingly diverse population, further research into barriers limiting pursuit of dermatology careers by SUIM and the development of programs to address such barriers is needed.

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Article Information

Accepted for Publication: November 11, 2018.

Published Online: January 16, 2019. doi:10.1001/jamadermatol.2018.5025

Correction: This article was corrected on February 27, 2019, to correct errors in Figures 1 and 2.

Corresponding Author: Vinod E. Nambudiri, MD, MBA, Department of Dermatology, Brigham and Women’s Hospital, 221 Longwood Ave, Boston, MA 02115 (vnambudiri@bwh.harvard.edu).

Author Contributions: Ms Barnes and Dr Nambudiri had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Nambudiri.

Acquisition, analysis, or interpretation of data: All authors.

Drafting of the manuscript: Barnes, Bae.

Critical revision of the manuscript for important intellectual content: All authors.

Statistical analysis: Barnes, Nambudiri.

Administrative, technical, or material support: Barnes, Nambudiri.

Supervision: Nambudiri.

Conflict of Interest Disclosures: None reported.

References
1.
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
2.
Bae  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(1):92-94. doi:10.1001/jamadermatol.2015.4441PubMedGoogle ScholarCrossref
3.
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
4.
Bernstein  J, Dicaprio  MR, Mehta  S.  The relationship between required medical school instruction in musculoskeletal medicine and application rates to orthopaedic surgery residency programs.  J Bone Joint Surg Am. 2004;86-A(10):2335-2338. doi:10.2106/00004623-200410000-00031PubMedGoogle ScholarCrossref
5.
American Academy of Dermatology. Diversity mentorship program: information for medical students. 2018; https://www.aad.org/members/leadership-institute/mentoring/find-a-mentor/diversity-mentorship-program. Accessed August 19, 2018.
6.
Chen  A, Shinkai  K.  Important considerations for diversity in the selection of dermatology applicants.  JAMA Dermatol. 2017;153(9):949. doi:10.1001/jamadermatol.2017.1812PubMedGoogle ScholarCrossref
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