Evaluation of Women and Underrepresented Racial and Ethnic Group Representation in a General Cardiology Fellowship After a Systematic Recruitment Initiative

Abstract

IMPORTANCEThe proportion of women and underrepresented racial and ethnic groups (UREGs) matriculating into general cardiology fellowships remains low. OBJECTIVE To assess a systematic recruitment initiative aimed at ensuring adequate matriculation of women and UREGs in a general cardiology fellowship. DESIGN, SETTING, AND PARTICIPANTSThis quality improvement study took place at a large, tertiary academic medical center and associated Accreditation Council for Graduate Medical Education Cardiovascular Disease fellowship. Participants included cardiology fellowship and divisional leadership and general cardiology fellow applicants to the Duke Cardiovascular Disease Fellowship Program from 2017 to 2019. Data analysis was performed from December 2019 to May 2020. EXPOSURE Multipronged initiative that created an environment committed to ensuring equity of opportunity. This included the creation of a fellowship diversity and inclusivity task force that drafted recommendations, which included reorganization of the fellowship recruitment committee, and changes to the applicant screening process, the interview day, applicant ranking process, and postmatch interventions. MAIN OUTCOMES AND MEASURES The percentage of matriculating and overall women and UREGs before and after the interventions were recorded. RESULTS The fellowship received a mean (SD) of 462 (55) applications annually before the interventions (2006-2016) and 611 (27) applications annually after the interventions (2017-2019).Between the 10-year period before the interventions and the 3-year period during the interventions, there was a significant increase in the annual mean (SD) percentage of women (22.4% [2.9%] vs 26.4% [0.07%]; P < .001) and UREG applicants (10.5% [1.1%] vs 12.5% [1.9%]; P = .01) to the program. Among applicants interviewed, the percentage of women increased from 20.0% to 33.5% (P = .01) and that of and UREGs increased from 14.0% to 20.0% (P = .01). Before the interventions, a mean (SD) of 23.2% (16.2%) women and 9.7% (7.8%) UREGs matriculated as first-year fellows, whereas after the interventions, a mean (SD) of 54.2% (7.2%) women and 33.3% (19.0%) UREGs matriculated as first-year fellows. The proportion of the entire fellowship who were women increased from a 5-year mean (SD) of 27.0% (8.8%) to 54.2% (7.2%) after 3 years of interventions, and that of UREGs increased from 5.6% (4.6%) to 33.3% (19.0%). Overall, the proportion of applicants in the entire population who were either women or from UREGs increased from 27.8% to 66.7%. (continued) Key Points Question Is there an association between implementing a systematic recruitment initiative and improved representation of women and underrepresented racial and ethnic groups (UREGs) in a general cardiology fellowship? Findings In this quality improvement study, a recruitment initiative was associated with an increase in the percentage of matriculating women, from 23.2% in the 10 years before the initiative to 54.2% in the 3 years after the initiative, and UREG fellows, from 9.7% before the init...

National Trends of Gender Disparity in Canadian Cardiovascular Society Guideline Authors, 2001-2020

“…A system-wide quality initiative at Duke Cardiovascular Research Institute to promote representation of women and underrepresented racial and ethnic groups among those receiving cardiology fellowships resulted in improvement from a mean of 23.2% to 54.2% for women and 9.7% to 33.3% for underrepresented racial and ethnic groups within 3 years. 44 A similar quality initiative from other institutions also can help close the leaky pipeline, leading to more women cardiology trainees, which can ultimately lead to increased leadership and authorship among women, and increased numbers of WIC.…”

“…The organization reported that fewer women submitted grant proposals (31.1%) and personal award (44.7%) applications, with women being 14% less likely to be funded when their research focused on circulatory and respiratory health. 44 More importantly, Witteman et al investigated 23,918 Canadian Institute of Health Research grant applications and reported a significant gender gap in grant funding, attributable to a less favorable assessment of women as principal investigators, and not to the quality of the research proposal. 47 Encouraging women during the early career stage through peer mentoring may increase participation in research, grant writing/review, and authoring publications, thereby validating content expertise and increasing opportunities for leadership.…”

Western Journal of Emergency Medicine

“…Success in this regard could encompass not only practicing medicine in these communities, but also serving in other ways, such as health literacy training. 47 Increasing the interest of residents in serving these communities has been the subject of targeted interventions. 48 Establishing programmatic goals and benchmarks for community service in emergency medicine may be an important way to prioritize this metric for certain programs, such as those that have poor retention of physicians in their community post-graduation.…”

“…33,46 Following the interview, all candidates, hires, and committee participants should be asked to assess the overall strategy and provide feedback of the program. 23,47…”

A Call to Action

“…Rymer et al. ( 4 ) recently published the outcomes of a fellowship recruitment initiative that doubled the proportion of women and tripled the proportion of underrepresented racial and ethnic minorities who matriculated to their institution. Our program differs from the aforementioned in that it acts further upstream and targets the recruitment of women internal medicine residents into the field of cardiology by fostering coaching relationships with female faculty members.…”