Perceptions on Diversity in Cardiology: A Survey of Cardiology Fellowship Training Program Directors

Abstract

Background The lack of diversity in the cardiovascular physician workforce is thought to be an important driver of racial and sex disparities in cardiac care. Cardiology fellowship program directors play a critical role in shaping the cardiology workforce. Methods and Results To assess program directors’ perceptions about diversity and barriers to enhancing diversity, the authors conducted a survey of 513 fellowship program directors or associate directors from 193 unique adult cardiology fellowship training programs. The response rate was 21% of all individuals (110/513) representing 57% of US general adult cardiology training programs (110/193). While 69% of respondents endorsed the belief that diversity is a driver of excellence in health care, only 26% could quote 1 to 2 references to support this statement. Sixty‐three percent of respondents agreed that “our program is diverse already so diversity does not need to be increased.” Only 6% of respondents listed diversity as a top 3 priority when creating the cardiovascular fellowship rank list. Conclusions These findings suggest that while program directors generally believe that diversity enhances quality, they are less familiar with the literature that supports that contention and they may not share a unified definition of "diversity." This may result in diversity enhancement having a low priority. The authors propose several strategies to engage fellowship training program directors in efforts to diversify cardiology fellowship training programs.

Increasing Diversity in Cardiology: A Fellowship Director’s Perspective

“…These findings suggest that program directors believe that they have the means to employ methods that meaningfully increase diversity within their programs. As in previous studies, most fellowship directors claimed to support diversity, although a previous study found that less than half of directors reported having a formalized plan to achieve this goal [11][12]. Achieving meaningful increases in diversity in the field of cardiology may require fellowship program directors to identify and implement such strategies.…”

“…However, PDs remain unsure how to implement the desire for diversity in the process of selecting candidates and creating a rank list [ 12 ]. In fact, a previous survey of fellowship directors showed that only 6% of respondents considered diversity to be a top-three priority when forming the rank list [ 11 ].…”

“…These responses suggest that directors of cardiology fellowship programs believe that increasing representation in cardiology requires the cooperation of administrators in undergraduate medical education as well as post-graduate training. Crowley et al takes this argument a step further and encourages program directors to diversify the field through the development of a “deep pipeline” recruitment model through a partnership with local universities, high schools, and even elementary schools to recruit URMs to cardiology through early exposure to the field as a potential future career option [ 11 ]. Furthermore, the role of department chairs in promoting a culture of inclusion and representation amongst fellows and faculty and the responsibility to hire a diverse group of faculty is seen as important to achieving these goals by fellowship directors.…”

“…The final questionnaire consisted of 15 items. Within the questionnaire, an underrepresented minority (URM) was defined as any individual whose racial or ethnic identity is: Hispanic, Black, American Indian, Native Alaskan, Native Hawaiian, or Native Pacific Islander [ 11 ]. Items one through five and item nine assessed fellowship program demographic data (region, location, length of program, number of fellowship positions, and number of applicants interviewed).…”

“…Given that fellowships constitute the entryway into the field of cardiology, the role of the fellowship program director (PD) in increasing diversity in the cardiologist workforce cannot be overstated. A 2016 survey by Crowley et al reported that 63% of fellowship program directors believed that diversity in their program was adequate and did not require further intervention; this study also reported that 69% of the same respondents agreed with the statement, “diversity is a driver of excellence in healthcare delivery” [ 11 ]. Another survey of program directors by Damp et al described cardiology program culture, lack of support for URM trainees, and lack of diversity among current fellows as major barriers to increasing diversity [ 12 ].…”