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Why and How to Increase Diversity in the Radiology Trainee Workforce

2022; Radiological Society of North America; Volume: 42; Issue: 3 Linguagem: Inglês

10.1148/rg.220007

1527-1323

Michail E. Klontzas, Jolie Jean, Valery L. Turner, Patricia Balthazar,

Radiology practices and education

HomeRadioGraphicsVol. 42, No. 3 Next Education CornerFree AccessRG TEAMWhy and How to Increase Diversity in the Radiology Trainee WorkforceMichail E. Klontzas , Jolie Jean, Valery L. Turner, Patricia BalthazarMichail E. Klontzas , Jolie Jean, Valery L. Turner, Patricia BalthazarAuthor AffiliationsFrom the Department of Medical Imaging, University Hospital of Heraklion, Voutes, Heraklion 71110, Crete, Greece, and Department of Radiology, School of Medicine, University of Crete, Heraklion, Crete, Greece (M.E.K.); Department of Surgery, Stamford Health/Columbia University College of Physicians and Surgeons, Stamford, Conn (J.J.); Department of Radiology, Stanford University School of Medicine, Stanford, Calif (V.L.T.); and Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Ga (P.B.).Address correspondence to M.E.K. (e-mail: [email protected]; [email protected]).Michail E. Klontzas Jolie JeanValery L. TurnerPatricia BalthazarPublished Online:Mar 18 2022https://doi.org/10.1148/rg.220007MoreSectionsPDF ToolsImage ViewerAdd to favoritesCiteTrack CitationsPermissionsReprints ShareShare onFacebookTwitterLinked In Benefits of a Diverse WorkforceIt is well established that diverse teams are more innovative, adaptable, and effective at problem solving (1). Further, a diverse physician workforce is key to improving patient access and reducing health care disparities (1). Exposing residents to a diverse pool of faculty and colleagues creates an environment that fosters cross-cultural professional and personal relationships, which may improve residents’ communication skills and ability to effectively interact with people from different backgrounds with empathy and cultural competence. It can also create psychologic safety where differences are recognized and respected inside and outside the workplace. In this editorial, we describe the current state of diversity in radiology, potential challenges, and solutions to increase diversity in the field and suggest ways for radiology departments to showcase their commitment to diversity, equity, and inclusion (DEI) to prospective trainee and faculty applicants.Current State of Diversity in RadiologyGender DiversityRadiology remains a male-dominant field. Although women comprise approximately half of the U.S. population (2) and half of all medical school applicants, students, and graduates, women represent only 26% of diagnostic radiology residents and 20% of interventional radiology residents, according to a 2018–2019 Association of American Medical Colleges (AAMC) data report (3). Radiology ranks third among clinical specialties with the smallest proportion of female full-time faculty (30% women), behind only orthopedic surgery (19% women) and surgery (26% women) (3). The gender disparity widens even more with higher academic ranks, with only 16.8% of radiology departments having female chairs (3).Race and EthnicityWhile the proportion of White non-Hispanic U.S. medical school graduates in 2018–2019 was similar to that of the general population (54.6% compared with 60.1% of the general population), there were significant disparities among minorities, including Hispanic or Latino (5.3% of graduates compared with 18.5% of the general population), Black or African American (6.2% compared with 13.6%), and American Indian or Alaskan Native (0.2% compared with 1.3%) (4,5). Some of these racial disparities are even wider in radiology.: 65.6% of practicing radiologists were White, 4.0% were Hispanic or Latino, 2.4% were Black or African American, and 0.2% were American Indian or Alaskan Native (5). An AAMC active resident data report from 2020–2021 showed a similar distribution among trainees: 54.6% of diagnostic radiology (DR) residents and 59.5% of interventional radiology integrated (IRI) residents were White, 26% of DR residents and 29.1% of IRI residents were Asian, 6.9% of DR residents and 6.4% of IRI residents were Hispanic or Latino, 4.3% of DR residents and 2.1% of IRI residents were Black or African American, and 0.7% of DR residents and 0.8% of IRI residents were American Indian or Alaska Native (6). This racial disparity is something to take note of, as the United States is estimated to be majorly constituted by racial minorities by 2045 (4).Other Diversity DimensionsIn addition to gender and racial and ethnic diversity, the field of radiology can also improve in other dimensions of diversity, including physicians with disabilities and international medical graduates (IMGs). Physicians with disabilities, an underreported and understudied population, may suffer from structural barriers that may be mitigated by reasonable accommodations, inclusion of disability training in DEI education efforts, and increased knowledge and awareness of workforce disparities and needs (eg, through surveys of students, residents, fellows, and faculty). IMGs are critical to the U.S. workforce, including the radiology workforce, and represent a progressively increasing proportion of radiology residents (7.31% in 2006 vs 14.46% in 2020) (7). However, IMGs may experience microaggressions and feelings of discrimination because of their accent and cultural differences, the lack of familiarity of program leadership with visa and immigration hurdles, or misperceptions that residency programs with IMGs are of inferior quality or weaker (7).Challenges and Possible SolutionsUnconscious BiasThe diversity gap in radiology is multifactorial (8). Unconscious bias may play an important role in resident and faculty recruitment. Grimm et al (9) previously showed differences in the terms used to describe underrepresented minorities in medicine (URiM) and women in radiology residency letters of recommendation, suggestive of bias. One potential way to minimize the impact of unconscious bias is for members of the selection committee to be aware of their own personal biases. Kallianos et al (8) invited faculty and residents participating in interviews or applicant screenings to undergo the Harvard Implicit Association Test (IAT) and an unconscious bias training session, followed by a survey. Of 11 participants who completed the survey, 91% were surprised by their IAT results, 27% agreed that taking the IAT changed their personal ranking of applicants, and 100% agreed that the IAT or the unconscious bias training before the interview season likely led to a reduction of bias in the evaluation of candidates and was a worthwhile activity for selection committees (8). Blind reviews to the applicant photographs during application screening have also been suggested by radiology program directors to avoid selection bias (1).Applicant Screening Metrics and Financial HardshipBecause objective metrics (eg, U.S. Medical Licensing Examination [USMLE] scores, class rank, Alpha Omega Alpha Honor Medical Society status) fail to capture important predictors of success in radiology residency (eg, resilience, emotional intelligence, curiosity, commitment to service), program directors have started to recognize the importance of a holistic application review (1). For example, many URiM students have a lower number of publications and meeting abstracts, so overreliance on this metric would place these students at a disadvantage (1). Many URiM students come from marginalized communities facing financial hardship, and they do not have the same opportunities as some of their peers. For example, instead of participating in unpaid research summer internships to boost their curriculum vitae and publication records, some URiM students might have to work summer or evening jobs unrelated to medicine to help their families or to pay for their study materials. A holistic application review aims to provide a balanced consideration of applicants’ experiences, attributes, and academic metrics that promotes diversity (1).Another way to promote equitable opportunity for students during residency interview season is to continue the use of virtual interviews after the pandemic. Virtual interviews eliminate the costs associated with travel and accommodation, which previously have caused some students to apply for loans.Lack of Role ModelsThe limited availability of diverse role models and mentors may deter underrepresented medical students from pursuing radiology. Diverse mentors can help recruit talented minority students by increasing their sense of belonging within their institution. A mentor can help navigate and overcome specific hurdles or discrimination pertaining to race, gender orientation, religion, disabilities, and other aspects of one’s identity. Therefore, it is crucial that radiology departments intentionally invest in the career development of their minority faculty and develop realistic objective benchmarks to continuously grow the representation of minorities at all career levels. Further, to increase the pool of diverse medical students who eventually may choose radiology as a specialty, it is important to address the U.S. educational system’s “leaky pipeline” and systemic issues that may deter minorities from pursuing a biomedical science career (eg, racism, food insecurity, housing instability, financial hardship). While social justice is still far from a reality, minority middle school and high school students may benefit from outreach educational programs with diverse physician and medical student speakers, medical career fairs, scholarships, mentorship, and sponsorship.Lack of ExposureLack of exposure is an additional barrier to recruitment of diverse medical students. Exposure to radiology is generally scarce in most medical schools, resulting from the lack of an integrated radiology curriculum in preclinical years, not being part of the core medical school curriculum, limited elective rotations, and limited access to radiology residents and faculty during clinical years. This lack of exposure may result in misperceptions about the specialty (eg, lack of patient interaction and community engagement, which are particularly important factors in breast imaging and interventional radiology). Often, medical students are first exposed to radiology in their late 3rd or 4th year during their electives, and by then they might already have committed to a different specialty. Possible solutions to the lack of or late exposure include having radiology faculty members involved in the preclinical year curriculum (eg, anatomy and pathology) and integrated clinical years (eg, relevant imaging findings for the surgical or emergency medicine clerkships), national and local medical student symposiums intentionally targeting diverse students (by inviting diverse faculty and resident speakers and targeting schools with larger proportions of minorities, such as historically Black colleges and universities), and offering research and scholarship opportunities to students in underrepresented groups.Often perceived by patients and laypersons as “technicians” or by referring providers as a commodity, radiologists can better advertise their role in patient-centered care. These misperceptions can contribute to a medical student’s career decision. National entities such as the American College of Radiology and the American Board of Radiology can continue to work on marketing radiologists’ role as clinicians to the general public, highlighting the key role that we play on the clinical team and the way that this often changes the course of the patient’s management. Locally, radiologists can highlight our role to medical students when we present at multidisciplinary tumor boards, during in-person reading room consultations, or by embedding radiology reading rooms in specialty clinics to decrease the physical distance to other members of the team and patients.Showcasing Departmental DEI CommitmentProspective radiology residency or faculty applicants must be able to gauge the department commitment to DEI. In the Table, we summarize ways to showcase this commitment at the national, institutional, and departmental levels. For example, leaders who are highly engaged in DEI are often invited to talk about it at national meetings, so paying attention to the institution of the speakers can be valuable for prospective recruits. If DEI is a priority at the broader institutional level, it may impact the overall institutional culture and facilitate departmental DEI efforts. Therefore, when interviewing for a residency or faculty position, it is important to also evaluate the institutional commitment (eg, is DEI part of the institutional mission and strategic plan, or are there DEI leaders or champions at a high level, such as a chief DEI officer?). Last, there are many ways for departments to showcase their commitment to diversity and attract more diverse applicants, including the departmental web page (eg, photographs reflecting the diverse staff; diverse resident, faculty, and leadership profiles), social media (eg, a DEI departmental account or main departmental account that covers DEI efforts), and the creation of service opportunities (eg, a DEI committee or task force).Evidence of Commitment to DEI at National, Institutional, and Departmental LevelsConclusionA significant diversity gap still exists in radiology. It is time for residency programs and departmental leaders to prioritize diversity and to implement intentional interventions to move the needle on the recruitment, retention, and career development of diverse trainees and faculty, which will benefit our workforce, patient care, and the field as a whole.Disclosures of conflicts of interest.— P.B. Meeting registration and travel reimbursement from the American College of Radiology.P.B. has provided disclosures (see end of article); all other authors have disclosed no relevant relationships.References1. DeBenedectis CM, Heitkamp DE, England E, et al. A Program Director’s Guide to Cultivating Diversity and Inclusion in Radiology Residency Recruitment. Acad Radiol 2020;27(6):864–867. Crossref, Medline, Google Scholar2. QuickFacts: United States. U.S. Census Bureau. https://www.census.gov/quickfacts/fact/table/US/PST045221. Accessed January 23, 2022. Google Scholar3. 2018-2019 The State of Women in Academic Medicine: Exploring Pathways to Equity. AAMC. https://www.aamc.org/data-reports/data/2018-2019-state-women-academic-medicine-exploring-pathways-equity. Accessed January 23, 2022. Google Scholar4. Demographic Turning Points for the United States: Population Projections for 2020 to 2060. U.S. Census Bureau. https://www.census.gov/content/dam/Census/library/publications/2020/demo/p25-1144.pdf. Revised February 2020. Accessed January 23, 2022. Google Scholar5. Diversity in Medicine: Facts and Figures 2019. AAMC. https://www.aamc.org/data-reports/workforce/report/diversity-medicine-facts-and-figures-2019. Accessed January 23, 2022. Google Scholar6. Table B5: Number of Active MD Residents, by Race/Ethnicity (Alone or In Combination) and GME Specialty. AAMC.https://www.aamc.org/data-reports/students-residents/interactive-data/report-residents/2021/table-b5-md-residents-race-ethnicity-and-specialty. Accessed January 23, 2022. Google Scholar7. Wadhwa V, Vilanilam GK, Chhabra A, et al. A 15-Year Analysis of International Medical Graduates Matching Into Diagnostic Radiology Residency Programs in the United States. Acad Radiol 2022;29(1):137–143. Crossref, Medline, Google Scholar8. Kallianos KG, Webb EM, Hess CP, Talbott J, Bucknor MD. Use of the Implicit Association Test to Improve Diversity in Radiology. J Am Coll Radiol 2019;16(7):976–979. Crossref, Medline, Google Scholar9. Grimm LJ, Redmond RA, Campbell JC, Rosette AS. Gender and Racial Bias in Radiology Residency Letters of Recommendation. J Am Coll Radiol 2020;17(1 Pt A):64–71. Crossref, Medline, Google ScholarArticle HistoryReceived: Jan 26 2022Accepted: Jan 28 2022Published online: Mar 18 2022Published in print: May 2022 FiguresReferencesRelatedDetailsRecommended Articles Invited Commentary: From Unacceptable to IntolerableRadioGraphics2023Volume: 43Issue: 2Grassroots Approach to Forming a Diversity, Equity, and Inclusion Committee in an Academic Radiology DepartmentRadioGraphics2023Volume: 43Issue: 6How We Got Here: The Legacy of Anti-Black Discrimination in RadiologyRadioGraphics2023Volume: 43Issue: 2Addressing Needs of Women Radiologists: Opportunities for Practice Leaders to Facilitate ChangeRadioGraphics2018Volume: 38Issue: 6pp. 1626-1637No Time for Complacency: Near-term Impact of the COVID-19 Pandemic on Author Gender in RadiologyRadiology2021Volume: 300Issue: 1pp. E308-E309See More RSNA Education Exhibits A Grassroots Approach To Forming A Diversity, Equity, And Inclusion Committee In An Academic Radiology Department: Early Successes And Lessons LearnedDigital Posters2021A Review Of Diversity In RadiologyDigital Posters2021How We Got Here: A Review Of Anti-Black Discrimination And Inequities In RadiologyDigital Posters2021 RSNA Case Collection Trans-scaphoid Perilunate DislocationRSNA Case Collection2020Hip Polyethylene Liner DissociationRSNA Case Collection2021Duodenal WebRSNA Case Collection2021 Vol. 42, No. 3 Abbreviations Abbreviation: DEI diversity, equity, and inclusion Metrics Altmetric Score PDF download