Introduction
In medicine, grand rounds are a formalized medical meeting occurring on a regular basis where professionals with specific expertise present their findings in biomedical research. Over the centuries, grand rounds have developed from bedside teachings to didactic lectures. This progression has become a major part of not only medical education but also prestige. Traditionally, invitations to present at grand rounds/visiting professorships are a sign of national/international expertise, which play a large role in the academic faculty promotion process.
Medical faculty from underrepresented groups, particularly African-American (AA) race, have been historically less likely to receive promotion in academic medicine compared with Caucasian colleagues [1]. This finding combined with the underlying underrepresentation of these groups, as African-Americans comprise 3.3% (172) of radiation oncologists in the U.S., has served to perpetuate limitations in not only representation but in career advancement [1, 2]. These findings raise questions regarding various social and environmental factors limiting potential opportunities for these physicians for recognition and promotion.
Previous studies have conducted qualitative comparison of representation in department academic chairs, which summarizes the discrepancies of AA radiation oncology specialists, and have found that AA radiation oncologists have been overly represented in the topics of diversity, equity, and inclusion (DEI) compared with non-black radiation oncologists [3].
Increasing the diversity of medicine plays a critical role in improving the design and functionality of healthcare. This study was conducted to analyze the proportion of invited African American radiation oncology speakers and their related topic of conversation.
Materials and methods
The study conducted a retrospective observational study of invited speakers from radiation oncology departments across the United States. Several programs were contacted and submitted archived lists of speakers from the date of January 2021 to December 2022. Data was organized based on the speaker’s race, ethnicity and gender. Speaker demographics were confirmed through a previously published methodology of facial recognition and internet investigation [4–6]. Speakers who were not deemed as faculty members (i.e. residents, medical students) were excluded from the analysis. Racial categories included White, Black/African American, Asian, or Other, while ethnicity was defined as Hispanic or non-Hispanic (consistent with the definitions used by the United States census). Individuals who presented on multiple occasions were accounted for only once. Data analysis was performed and statistical significance was assigned at p < 0.05 using the Fisher’s exact test (GraphPad Software, San Diego, California). Baseline parameters were condensed into numerical values of variables, and depicted into several tables and a bar graph.
Results
A total of 252 invited speakers and their associated talk topics were obtained from 51 radiation oncology programs (Tab. 1). Of these speakers, 98 were female (38.9%) and 16 were of African-American race (6.3%). The invited talk topic was DEI-related in 7% of total cases. Among speakers not of African-American race, this was 4.2% (10/236); among African-American speakers, it was 50% (8/16) (Fig. 1). This difference reached statistical significance (p<0.0001).
|
Characteristic |
No. (%) |
|
Race |
|
|
African-American |
16 (6.3) |
|
Non-African-American |
236 (93.7) |
|
Sex |
|
|
Female |
98 (38.9) |
|
Male |
154 (61.1) |
|
Characteristic |
No. (%) |
|
DEI |
18 (7.1) |
|
Non-DEI |
234 (92.9) |
|
Year |
|
|
2021 |
106 (42.1) |
|
2022 |
99 (39.3) |
|
Unknown |
47 (18.7) |
|
|
AA |
Non-AA |
|
DEI |
8 |
10 |
|
non-DEI |
8 |
226 |
|
% DEI |
50.0% |
4.2% |
Discussion
A recent study examining the overall paucity of African-American physicians in academic medicine highlighted three main drivers: 1. Disparities in National Institutes of Health (NIH) grant funding (African-Americans receive only 2% of NIH R01 funding), 2. Absence of mentorship, and 3. Increased activities not resulting in promotion (often referred to as the “minority tax”) [7]. A key barrier contributing to the third component is the limited opportunities African-American physicians receive for national recognition. These opportunities are pivotal for developing a reputation for national expertise essential for promotion from junior faculty (Instructor/Assistant Professor) to senior faculty (Associate Professor) and, ultimately, full professorship. Without these opportunities, African-Americans are often relegated to junior faculty status years and even decades longer than their Caucasian colleagues.
Our study shows that upon review of the Radiation Oncology grand rounds speakers nationwide from 202122022, there is a marked underrepresentation of African-American invited speakers, with only 6.3% of speakers being African-American. Invitations for grand rounds/visiting professor speakership are a sign of national expertise and are used to evaluate faculty promotion and advancement in Radiation Oncology.
Furthermore, our findings suggest that African-American speakers are significantly overrepresented in DEI topics and underrepresented in non-DEI topics (p < 0.0001). While it is crucial to have AA representation on DEI panels, it is equally essential to acknowledge the valuable contributions that AA radiation oncologists make to patient care and the advancement of the field outside of DEI initiatives. Therefore, it remains vital to ensure that appropriate representation accounts for these roles.
There are several limitations of this study, most prominently, our classification of race as African-American versus non-African-American, which inherently limits the scope of this analysis to include other underrepresented minority groups and also limits an analysis by ethnicity. The facial recognition method used in this study may be criticized as race was not based on traditional survey-based self-reporting methodologies. However, the methodology used in this study of facial recognition has been found to be comparable to survey-based methodologies in previous analyses of the Radiation Oncology workforce where both the survey-based [8] and facial recognition based [5] methods revealed the overall proportion of underrepresented minorities in Radiation Oncology faculty to be 5% (47 African-American and Hispanic Radiation Oncology faculty). Another limitation is the relatively poor response rate; although we were able to obtain data involving more than 250 grand rounds speakers, there were a substantial number of radiation oncology programs that failed to provide the requested data, which inherently introduces bias and limits the generalizability of our findings. Finally, given the relatively low numbers of African-Americans in this study, we did not perform an analysis of the intersectionality of gender and race; it is our hope that future investigation with larger sample sizes will be able to adequately address this important topic, particularly, since among African-Americans in Radiation Oncology (and throughout medicine), the minority gender is male.
Conclusion
Only approximately 6% of invited grand rounds/visiting professor talks in radiation oncology departments in the United States involve African-American invitees. Of these invitees, 50% of talks are focused on the topic of diversity, equity, and inclusion (DEI), significantly greater than the 4% of non-African-American invited speakers. Targeted efforts to expand African-American representation in non-DEI topics are needed to ensure and expand diversity in Radiation Oncology. Such efforts will help to ensure that the diverse population of patients is adequately served. Furthermore, increasing overall African-American representation in invited talks should serve to address the disproportionate disparities in delayed/nonexistent promotion from junior faculty regularly experienced by African-American physicians in academic medicine.
Conflict of interest
Authors declare no conflict of interest.
Funding
None declared.