Diversity of Pediatric Residents, Fellows Continues to Lag

Jaleesa Baulkman

June 28, 2021

The proportion of underrepresented groups in pediatric fellowships decreased between 2007 and 2019, while those in pediatric residencies remained stagnant, new research revealed.

Researchers acknowledged that some of the factors contributing to the low proportion of minorities in the pediatric workforce may include educational disparities starting in primary or secondary school, such as underfunded schools and lack of educational resources.

"Something I really appreciated about the paper is that this goes beyond a student stepping into medical school, finding a mentor in pediatrics, and then eventually matriculating into a pediatric residency," said Christle Nwora, MD, an internal medicine–pediatrics resident physician at Johns Hopkins Urban Health Residency Program in Baltimore, who was not involved in the study. "I like the idea of knowing that people aren’t going into the field and being very critical as to why."

Prior studies, including a 2019 study published in JAMA Network Open, has found that minority students remain underrepresented in medical schools. However, this most recent study, published in Pediatrics, is one of the first to report trends in the race or ethnicity of pediatric residents and fellows.

"It’s been pretty well documented throughout the medical literature that the representation of underrepresented [groups] in medicine is low among all specialties," study author Kimberly Montez, MD, MPH, FAAP, said in an interview. "This is one of the first studies that [show this trend] in pediatrics, [but] we were kind of expecting [these findings] knowing the rest of the literature out there."

Montez and colleagues examined self-reported race and ethnicity data from 2007 to 2019 for pediatric residents and fellows from the GME Census reports. The annual number of pediatric trainees increased from 7,964 to 8,950 between 2007 and 2019. For pediatric subspecialty fellows, that number increased from 2,684 to 3,966.

The number of underrepresented pediatric trainees also increased over time, from 1,277 to 1,478 residents and 382 to 532 subspecialty fellows. However, researchers found that the trend in proportion of underrepresented in medicine (URiM) trainees was unchanged in pediatric residencies – 16% in 2007 to 16.5% in 2019 – and, overall, decreased for URiM subspecialty fellows from 14.2% in 2007 to 13.5% in 2019.

"I was shocked at the fact that there has been no significant increase either over the last 12 years," said Joan Park, MD, a pediatric resident at Johns Hopkins Hospital, Baltimore, who was not involved in the study. "In the news, we’re seeing way more discussions in regards to racism and representation and the fact that that hasn’t really fueled or caught fire yet in medicine at all to really move that arrow is definitely really shocking."

The recent study also pointed out that the percentage of underrepresented groups in pediatric residencies and fellowships is considerably lower in comparison with those groups’ representations in the U.S. population. For example, Black or African American people make up 13.4% of the U.S. population but just 5.6% of pediatric trainees. Meanwhile, American Indian or Alaskan Native people make up 1.3% of the U.S. population but make up 0.2% of pediatric trainees.

Montez hypothesized that the lack of underrepresented groups as pediatric trainees — or in the medical field, in general — may have to do with systemic barriers that span the entire educational continuum and affects them even before they reach medical school, including attendance at underfunded primary and secondary schools.

"Just think about all the barriers that exist for underrepresented minorities in medicine," said Montez, assistant professor of pediatrics at Wake Forest University, Winston-Salem, N.C. "We know that underrepresented minorities are accepted and matriculate at lower rates than [those of] their nonminority counterparts. All of this occurs even just before getting into the field of pediatrics. So multiple barriers exist."

Those barriers may also include racism, bias, and discrimination, which may play out unconsciously when members of an underrepresented group are applying for residencies or med school, such as "recognizing a name that may be from a different ethnic or racial background and then unconsciously biasing yourself against that applicant, for example," Montez explained.

Montez said that although there has been progress, there is still a long way to go. She hopes the study will help academic institutions and professional organizations recognize the importance of diversity in pediatrics. She noted that pediatric trainees are more likely to experience microaggressions, which could potentially cause them to leave a program.

"I hope this will galvanize pediatric programs to really think a lot about the environment that they create for underrepresented minority trainees and also about their recruitment process in terms of making sure it’s standardized, using a holistic review," Montez explained.

In 2016, the Association of American Medical Colleges published a diversity and inclusion strategic planning guide to improve training programs. Furthermore, in 2019, the Accreditation Council for Graduate Medical Education instituted a new common program requirement on diversity that requires programs to focus on systematic recruitment and retention of a diverse and inclusive workforce of residents and fellows.

"The same way pediatricians are aware of how the environment will shape the way a child grows up, we have to be mindful of the way an environment that surrounds the medical student will shape where they eventually end up as well," said Nwora.

The experts disclosed no conflicts of interest.

This article originally appeared on MDedge.com, part of the Medscape Professional Network.


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