Education Research: Evaluating Racial, Ethnic, and Gender Diversity Trends in Neurology Residency Programs Between...

With increasing efforts to ensure a racially and ethnically diverse physician workforce, it is unclear whether the improved diversity changes in medical schools have been reflected among neurology residents. We aimed to examine the demographic changes of neurology residency applicants and matriculants relative to their medical school graduate counterparts.

This was a population-based repeated cross-sectional study of Association of American Medical Colleges data on self-reported race, ethnicity, and gender of US medical school graduates, neurology residency applicants, and neurology residency matriculants from 2007 to 2020. The representation quotient (RQ) for each applicant and matriculant cohort was calculated from the ratio of the percentage of a racial, ethnic, and gender group in the population to that of those graduating medical school. Median RQs greater than 1 indicated that a cohort is overrepresented compared with their medical school graduate counterparts, whereas RQs less than 1 indicated underrepresentation. Mann-Whitney U tests were used to assess statistical changes in representation between applicants and matriculants within each racial and gender identity. Yearly changes in RQ were assessed using linear regressions for each race by gender.

Asian men (RQ_app = 1.20 [interquartile range (IQR) 1.13-1.28]), Black men (RQ_app = 1.23 [IQR 0.94-1.39]), and Hispanic men (RQ_app = 1.16 [IQR 0.89-1.29]) were overrepresented as applicants. RQ_app for Asian men remained stagnant while all other applicants trended toward increased representation. Hispanic men were the only group to have a significant increase in RQ_mat during the study period. Asian women (RQ_app = 0.98 vs RQ_mat = 1.12; p = 0.006) and White women (RQ_app = 0.40 vs RQ_mat = 0.79; p < 0.001) experienced increases in representation when transitioning to matriculants. Black men (RQ_app = 1.23 vs RQ_mat = 0.64; p < 0.001) experienced the largest reduction in representation, when comparing applicants with matriculants, among all groups. Black women (RQ_app = 0.58 vs RQ_mat = 0.59; p = 0.49) were underrepresented throughout application.

Racially minoritized women were underrepresented among neurology applicants, and most did not show significant increases in representation as matriculants. Black men experienced the largest magnitude reduction in RQ when transitioning from applicants to matriculants. There is a need for greater professional support for applicants from historically underrepresented backgrounds to ensure their equitable recruitment into neurology.