Strategies to Enhance Diversity, Equity, and Inclusion in Pathology Training Programs: A Comprehensive Review of the Literature

Abstract

Context.— Like many medical specialties, pathology faces the ongoing challenge of effectively enriching diversity, equity, and inclusion within training programs and the field as a whole. This issue is furthered by a decline in US medical student interest in the field of pathology, possibly attributable to increasingly limited pathology exposure during medical school and medical student perceptions about careers in pathology. Objective.— To review the literature to identify the challenges to diversity, equity, and inclusion in pathology, with an emphasis on the pathology trainee pipeline. To evaluate the medical education literature from other medical specialties for diversity and inclusion–focused studies and initiatives, and determine the outcomes and/or approaches relevant for pathology training programs. Data Sources.— A literature review was completed by a search of the PubMed database, as well as a similar general Google search. Additional resources, including the Web sites of the Association of American Medical Colleges, the Electronic Residency Application Service, and the National Resident Matching Program, were used. Conclusions.— Many strategies exist to increase diversity and encourage an inclusive and equitable training environment, and many of these strategies may be applied to the field of pathology. Interventions such as increasing exposure to the field, using a holistic application review process, and addressing implicit biases have been shown to promote diversity, equity, and inclusion in many medical specialties. In addition, increasing access to elective and pipeline programs may help to bolster medical student interest in careers in pathology.

How Do Academic Medicine Pathways Differ for Underrepresented Trainees and Physicians? A Critical Scoping Review

“…• Creating diverse search/admissions committees 76,[78][79][80][81][82] • Implicit bias training for reviewers and interviewers [78][79][80][81][83][84][85][86] • Implementing minimum numbers of URiM candidates to interview 79,87 • Adopting holistic review strategies 71,73,77,78,[81][82][83][85][86][87][88][89][90][91]110 • Standardized interview protocols and scoring systems 79,81,83,87,89,91 • Making voting on selection committees anonymous 78 • Outreach with URiM student groups such as SNMA and LMSA and associated conferences [74][75][76]82,83,86,89 • Community outreach, 96,97 partnerships between HBCUs and PWIs 74,…”

“…79 Particularly in medical school and residency application review, many programs incorporated or recommended holistic review strategies that minimized the role that standardized test scores and grades play when considering applicants for limited interview slots. 56,71,73,77,78,[81][82][83][85][86][87][88][89][90][91] Because this strategy can be more time-consuming than using standardized test score or grade minimums, programs recommended recruiting more faculty to review applications and buying out faculty time so that they can properly consider applications. 73,79,81,82,89 Additionally, several programs incorporated standardized interview protocols and scoring systems.…”

“…For instance, some residency programs partnered with their local Student National Medical Association and Latino Medical Student Association chapters and participated in local, regional, and national conferences creating mentorship and networking opportunities for each specialty. [74][75][76]82,83,86,89 Other strategies included creating clinical rotations and mentorship programs for URiM trainees and faculty members. 73,74,76,82,90,92,93 In particular, historically Black colleges and universities partnered with predominantly White institutions (PWIs) to create clinical rotations in specialties that did not have residency programs at their institutions, and they also leveraged these partnerships to improve faculty networking, particularly for URiM faculty at PWIs who had few URiM mentors at their own institutions.…”

Recruiting the future of pathology

“…4 • Groups underrepresented in medicine are even less represented in pathology. 5 • The amount of pathology teaching in medical school may have little impact on the number choosing the specialty. 2 This year, seven medical students from the University of Virginia (UVA) applied for pathology residency; this is an exciting blip on the graph of national trends.…”

“…There are twice as many pathology postgraduate year 1 positions as graduating US and Canadian medical school applicants 4 Groups underrepresented in medicine are even less represented in pathology 5 The amount of pathology teaching in medical school may have little impact on the number choosing the specialty 2 …”