Race and Medicine

Race and Medicine

Disclosures: Kalra is the CEO and creative director of Make a Dent, which funded this study. Please see the study for all other authors’ relevant financial disclosures.
May 27, 2022
2 min read
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CVD program directors attract more fellows of same race; no effect by sex

Disclosures: Kalra is the CEO and creative director of Make a Dent, which funded this study. Please see the study for all other authors’ relevant financial disclosures.
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Directors of CVD fellowship programs were more likely to attract first-year fellows of their same race compared with other races, a finding that was consistent across white, Black, Asian and Hispanic directors, researchers reported.

No association was observed for program director sex and sex of their first-year fellows, according to data published in JACC: Advances.

Graphical depiction of source quote presented in the article
Kalra is associate professor of clinical medicine at Indiana University School of Medicine, director of interventional cardiology quality and innovation at Indiana University Health and CEO of the nonprofit startup Make a Dent

“We should become aware of our unconscious biases. That’s the main takeaway ... and the motivation to do this research. [Based on] the experiences I’ve had when applying for fellowships myself, among my friends and colleagues, it has resonated a lot,” Ankur Kalra, MD, FACP, FACC, FSCAI, associate professor of clinical medicine at Indiana University School of Medicine, director of interventional cardiology quality and innovation at Indiana University Health and CEO of the nonprofit startup Make a Dent, told Healio. “We may consciously think that we’re unbiased, but we have these subconscious biases that come into play when we’re making decisions that we’re not even aware of. The idea is to start becoming more mindful and more aware of subconscious biases.

“[This study has] been welcomed. There hasn’t been any adversarial feedback or an inflammatory comment that I’ve received,” Kalra told Healio. “All has been very complimentary, and several people have thanked me for doing this research and answering this question the way we answered it.”

Kalra and colleagues conducted a cross-sectional study using deidentified data from the Association of American Medical Colleges to assess the association between the race and sex of CVD fellows and that of their corresponding program directors between 2010 and 2019. Data included the sex and race/ethnicity of both fellows and their corresponding program director, and the age, medical school type and citizenship status of the fellows.

Demographic of fellows and program directors

A total of 9,153 first-year fellows and 243 program directors were identified from 243 CVD fellowship programs.

Among first-year fellows (22.8% women), 42.4% were Asian, 41.1% were white, 6.5% were Hispanic, 5.4% were Black and 0.1% were American Indian/Alaska Native.

Between 2010 and 2019, only the number of first-year fellows who identified as Asian decreased (P = .03), while the other races remained consistent.

Among program directors (22.5% women), 50.2% were white, 26.8% were Asian, 2.5% were Black and 4.9% were Hispanic.

Effects of potential unconscious bias

Kalra and colleagues observed a significant association between the race of the program director and the fellow of the same program for all races:

  • white (OR = 1.3; 95% CI, 1.19-1.43; P < .001);
  • Black (OR = 2.03; 95% CI, 1.22-3.39; P = .007);
  • Asian (OR = 1.29; 95% CI, 1.17-1.42; P < .001); and
  • Hispanic (OR = 4.14; 95% CI, 3.18-5.39; P < .001).

Researchers observed no association between the sex of the program director and that of the first-year fellow (OR = 0.99; 95% CI, 0.88-1.11; P = .86).

“The fact that the association would be true for every race was a little surprising to me ... whether you consider Asian, Hispanic, Black or white individuals,” Kalra told Healio. “I’m not trying to paint the picture that program directors are recruiting their own demographic. I mean, that’s what the study has shown, but it may in part also be the other way around, that applicants may see and identify with certain people and program directors who are at the helm the program. If [the applicant] looks like him or her, that person is more likely to come to you compared with going somewhere else. Yes, the program directors are attracting their own demographic, but applicants may want to go to the demographic of the program director. Why I am not surprised is because I’ve seen this in person myself. So have my friends and colleagues.”