National Survey to Assess Gender, Racial, and Ethnic Differences Among Radiology Residency Applicants Regarding Factors Impacting Program Selection

Rational and Objectives

Radiology has one of the lowest female representation rates in medicine and recruiting female residents is a challenge for some residency programs. There is limited understanding of gender differences among residency applicants during program selection. The study objective is to investigate which program factors were considered most important by radiology residency applicants and to assess for differences by gender, race and ethnicity.

Materials and Methods

An anonymous survey was distributed electronically to diagnostic and interventional radiology residency programs in the US and Canada via the Association of Program Coordinators in Radiology (APCR). Residents were asked to evaluate the importance of 30 factors during evaluation of residency programs using a 5-point Likert scale (1 = not important, 5 = extremely important).

Results

370 residents and 1 fellow completed the survey. Of the respondents, 269 were male (72.5%) and 101 were female (27.2%). The most important factors to respondents during program selection were program culture (4.42), geographic location (4.17), fellowship placement (4.14), and imaging and/or procedure volume (3.98). There was a significant difference between male and female respondents in the importance of program culture (p = 0.002), composition of current residents (p = 0.007), percentage of current female residents (p < 0.0001), program size (p = 0.047), call schedule (p = 0.025), percentage of female faculty (p < 0.0001), faculty ethnic and racial diversity (p < 0.0001), resident ethnic and racial diversity (p < 0.0001), which female respondents ranked more highly.

Conclusion

Applicants consider many factors during residency program selection. Program culture, geographic location, fellowship placement and imaging and/or procedural volume were most important. There were significant differences by gender, race and ethnicity in importance of several factors.

Introduction

The field of radiology has one of the lowest female representation rates in medicine. Overall, 23.1% of all radiologists in the workforce are female, and gender differences in academic radiology advancement persist.^1,2 In the 2018-2019 academic year, 26.9% of diagnostic radiology residents were women, only slightly increased compared to 1980, when 25.5% of radiology residents were women.^3,4 In addition, in the 2018-2019 academic year, 20.0% of integrated interventional radiology residents were women.³ During the last few decades, the percentage of women graduating from medical school has significantly increased, reaching almost 50% in 2007.⁴ In the 1980s, most female residents were in primary care specialties such as medicine, obstetrics, pediatrics, and family medicine. Since then, there has been increasingly more females in previously male dominated fields such as surgery and its subspecialties.⁴ Although there has been an increase in the number of female medical students, there has not been a significant increase in the number of females pursuing radiology as a career in the past several decades.

Radiology also has a low representation of underrepresented in medicine (URM) residents. A study by Chapman et al found that in 2010 4.8% of radiology residents were Hispanic, 3.1% were Black or African American and 0.4% were American Indian, Alaskan Native, Native Hawaiian or Pacific Islanders. All URMs combined composed 8.3% of the radiology resident population, ranking 20^th out of the twenty largest medical specialties during that year. In addition, there was no significant increase in URM representation in radiology training over an 8 year period.⁵

While there is now a robust pipeline of women entering medical school, the small number of women applying for radiology training from medical school is a limiting factor in recruiting women to radiology residency. It has been theorized that inadequate radiology exposure in medical school, perceived less patient contact, perceived less direct community impact compared to other specialties, and lack of role models may contribute to the limited pipeline of female and URM medical students applying for radiology residency.⁶ Some authors have suggested that the pipeline of female medical students and URM students who are interested in radiology may be augmented by increasing student exposure to radiology in medical school including earlier in medical school, since radiology exposure may currently be limited to elective radiology rotations late in medical school, and increasing radiology mentoring and teaching, including by female residents.^4,6 As a result of this limited pipeline of female and URM medical students applying for radiology residency, recruiting female and URM residents continues to be a challenge for many diagnostic and interventional radiology residency programs. To date, there has been limited information about the gender, racial and ethnic differences among applicants to radiology residency programs regarding the factors impacting residency program selection. One study by Campbell et al investigated departmental factors and the gender distribution of residents at 50 residency programs. The study concluded that there was greater representation of female residents at radiology residency programs with a female program director and at programs located in the Northeast or West.⁷

Several studies have investigated what factors are considered by applicants during the residency application process at a limited number of institutions. To our knowledge, there has not been a national study to date on this topic. In 2002, Pretorius and Hrung reported on factors found to be important to students applying to a single institution. The top factors considered by applicants in this study included perceived happiness of current residents, geographic location, and academic prestige. The authors also reported that women valued diversity in the department more than men and that men valued the presence of a strong subspecialty program more than women.⁸ In 2010, Lewis et al wrote about the preferences of applicants interviewing for radiology residency at several academic institutions and of students applying from a single medical school. The study reported that resident and faculty friendliness and approachability, teaching, research opportunities, strength of the interventional radiology department and the call schedule were important to residency applicants.⁹ In 2018, Luk et al surveyed applicants to diagnostic and interventional radiology residency programs at a single academic institution. Overall, the most important factors to applicants included perceived happiness of the residents and faculty, fellowship and job placement of recent graduates, interactions with current program residents, stability of the department and program, and geographic location of the program. They also reported that female applicants valued the opportunity to attend national and international conferences and in-house Core Exam review more than male applicants.¹⁰

Residency applicants consider a number of subjective and objective factors when constructing their program rank lists. Program directors, program coordinators and residents can help address these factors during the application and interview process if they are aware of which elements are most important to applicants. Few prior studies have investigated factors that applicants considered during the residency application and rank process, and the studies that have been conducted included applicants to or from selected programs. Perceived happiness of residents was reported to be the most important factor in prior studies, and fellowship and job placement also ranked highly.^8,10 This study aims to investigate factors considered by a broader population of residency applicants throughout the United States via a national survey and to consider factors in the residency selection process that may vary by gender, race and ethnicity.