Current State of Inclusion and Diversity in Pediatric Urology Fellowship Programs
Jasmine Love, BS, Vinaya Bhatia, MD, Walid Farhat, MD, FACS, GPLLM, Shannon Cannon, MD.
University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
BACKGROUND Increased racial/ethnic diversity of the physician workforce can improve health outcomes for marginalized populations. Currently, the pediatric urology workforce is less racially/ethnically diverse than the pediatric population it serves. We aimed to assess current recruitment efforts and barriers to recruitment in pediatric urology fellowship programs.
METHODS We designed a 20-item survey instrument based on prior similar surveys in other specialties and distributed the survey to 27 program directors (PDs) of ACGME-accredited pediatric urology fellowships, using publicly available email addresses. The survey was designed with iterative input from the study investigators and peers with experience in diversity, equity, and inclusion in medicine. The final survey was distributed using REDCap. We collected data on PD demographics, program characteristics, recruitment efforts, and perceptions of barriers to recruitment. We asked about racial/ethnic diversity of trainees in the programs using the Association of American Medical College's definition of underrepresented in medicine (URM). Descriptive statistical analyses were performed to assess frequencies of responses and medians for Likert-scaled questions containing the parameters: 1 as strongly disagree, 3 neutral, and 5 strongly agree.
RESULTS A total of 20 PDs responded to the survey (74%), including 3 incomplete responses. Most PDs reported being in their role for 5 years or more (68%, 13/19) and were at least 40 years old (89%, 17/19). Respondents were 79% Caucasian/White and 68% male. While 70% reported 5-10 full-time pediatric urologists at their institution, 50% reported no faculty of color. Nearly all (95%) programs recruit 1 fellow per year with 45% of programs identifying no URM or fellows of color in the last 3 years. More than half of PDs (60%) agreed their program reflects the racial/ethnic diversity of the pediatric urology patients cared for at their institution.
While some PDs agreed their program placed value on faculty and trainee diversity (88 and 76% respectively), the median was neutral (median 3, IQR 1) and majority (53%) reported not having methods in place for diversity recruitment (median 2, IQR 1). Of those who reported a recruitment method, mentorship was the most common (35%). The most common barrier to recruitment was an overall limited applicant pool. A minority of participants (N=3) provided ways such barriers were being addressed by their program including hiring a director of diversity, promoting mentorship, and mindfully evaluating the applicant pool.
CONCLUSIONS Although most PDs affirmed the value of diverse faculty and trainees, less than half reported having methods in place to recruit such individuals. A commonly cited barrier was the limited applicant pool, both overall and specifically URM applicants. We recommend focused efforts to increase URM recruitment and mentorship at the medical student and resident level to expand the applicant pool and increase the diversity of the pediatric urology workforce. Future research is needed to identify effective strategies to improve early engagement and exposure to pediatric urology among URM learners.
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