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Differences in Underrepresented in Medicine Applicant Backgrounds and Outcomes in the 2020-2021 Dermatology Residency Match

In Partnership With The Association Of Professors Of Dermatology Residency Program Directors Section
Cutis. 2022 August;110(2):76-79,E1 | doi:10.12788/cutis.0587
August 9, 2022|Cutis
Fatuma-Ayaan Rinderknecht, MS;Caitlin M. Brumfiel, MD;Itisha S. Jefferson, BS;Scott Worswick, MD;Ilana S. Rosman, MD
Author and Disclosure Information

Ms. Rinderknecht is from the University of California San Francisco School of Medicine. Dr. Brumfiel is from Georgetown University School of Medicine, Washington, DC. Ms. Jefferson is from Loyola University Stritch School of Medicine, Maywood, Illinois. Dr. Worswick is from the Department of Dermatology, University of Southern California, Los Angeles. Dr. Rosman is from the Division of Dermatology, Washington University School of Medicine, St. Louis, Missouri.

Ms. Rinderknecht reports no conflict of interest. Dr. Brumfiel and Ms. Jefferson held leadership roles in the Dermatology Interest Group Association while work was being done on this study. Drs. Worswick and Rosman are dermatology residency program directors at their respective institutions and serve on the Association of Professors of Dermatology Residency Program Directors Section steering committee. Dr. Rosman also is the chair of the committee. These are elected positions without financial compensation. This article was not sponsored by any of the aforementioned organizations.

The eTable is available in the Appendix online at www.mdedge.com/dermatology.

Correspondence: Ilana S. Rosman, MD, 660 S Euclid Ave, CB 8118, St. Louis, MO 63110 (irosman@wustl.edu).

Dermatology is one of the least diverse medical specialties. Although there have been studies addressing barriers faced by underrepresented in medicine (UIM) applicants to dermatology, there is little information about how UIM applicants approach and fare in the dermatology residency match process. This study aimed to assess differences between UIM and non-UIM applicants in the dermatology match process. A survey was administered to 2020-2021 dermatology applicants (N=232) to evaluate applicant characteristics, approaches, and outcomes in the match process. Survey responses were analyzed to determine if differences between variables were statistically significant. An additional survey was administered to dermatology residency program directors to evaluate their approach to the 2020-2021 application process. Our findings are important in identifying interventions to improve equity in the dermatology application process and to improve diversity in the dermatology workforce.

Practice Points

  • Underrepresented in medicine (UIM) dermatology residency applicants (Black and Latinx) are more likely to come from disadvantaged backgrounds and to have financial concerns about the residency application process.
  • When choosing a dermatology residency program, diversity of patients and faculty are more important to UIM dermatology residency applicants than to their non-UIM counterparts.
  • Increased awareness of and focus on a holistic review process by dermatology residency programs may contribute to higher rates of matching among Black applicants in our study.

Underrepresented in medicine applicants were more likely to complete a research gap year (eTable). Most applicants who took research years did so to improve their chances of matching, regardless of their race/ethnicity. For those who did not complete a research year, Black applicants (46.7%) were more likely to base that decision on financial limitations compared to non-UIMs (18.6%, P<.0001). Interestingly, in the PD survey, only 4.5% of respondents considered completion of a research year extremely or very important when compiling rank lists.

Applicant Characteristics

Application Process and Match Outcomes—The Table highlights differences in how UIM applicants approached the application process. Black but not Latinx applicants were less likely to be first-time applicants to dermatology compared to non-UIM applicants. Black applicants (8.3%) were significantly less likely to apply to more than 100 programs compared to non-UIM applicants (29.5%, P=.0002). Underrepresented in medicine applicants received greater numbers of interviews despite applying to fewer programs overall.

Match Outcomes

There also were differences in how UIM candidates approached their rank lists, with Black and Latinx applicants prioritizing diversity of patient populations and program faculty as well as program missions and values (Figure).

Factors dermatology residency applicants considered when compiling rank lists
Factors dermatology residency applicants considered when compiling rank lists (non-UIM applicants, n=156; Latinx applicants, n=16; Black applicants, n=23). UIM indicates underrepresented in medicine.

In our cohort, UIM candidates were more likely than non-UIM to match, and Black applicants were most likely to match at one of their top 3 choices (Table). In the PD survey, 77.6% of PDs considered contribution to diversity an important factor when compiling their rank lists.

Comment

Applicant Background—Dermatology is a competitive specialty with a challenging application process2 that has been further complicated by the COVID-19 pandemic. Our study elucidated how the 2020-2021 application cycle affected UIM dermatology applicants. Prior studies have found that UIM medical students were more likely to come from lower socioeconomic backgrounds; financial constraints pose a major barrier for UIM and low-income students interested in dermatology.4-6 We found this to be true in our cohort, as Black and Latinx applicants were significantly more likely to come from disadvantaged backgrounds (P<.000008 and P=.006, respectively). Additionally, we found that Black applicants were more likely than any other group to indicate financial concerns as their primary reason for not taking a research gap year. 

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