Rationale and Objectives
To investigate whether there is a bias in the residency selection process that influences the proportion of females entering diagnostic radiology residencies.
Materials and Methods
A total of 4117 applications to one diagnostic radiology residency program from 2008 to 2014 were analyzed. Invitations to interview were evaluated by each year, specifically looking at gender. Ranking of applicants, especially those placed in top 25% of the rank, was also assessed. Additional data analyzed included United States Medical Licensing Examination Step 1 board examination score (a proxy for academic performance), interview scores, and final position on rank list.
Results
Female applicants averaged 24% of the total applicant pool during the years studied, yet made up a disproportionately high percentage of applicants invited to interview (30%) and those ranked in top 25% (38%). It was found that female applicants had slightly higher mean interview scores and lower Step 1 scores than male applicants.
Conclusions
Our findings suggest that program directors in one program want to increase gender diversity by making strides to keep the female candidate pool and the proportion of female residents in the program at least stable. The pipeline of female medical students pursuing a career in radiology appears to be a limiting factor rather than a bias against women in the resident selection process. Identifying such trends is important as it provides a better understanding of the etiology for an overall lack of gender diversity within the field. Furthermore, it may lead to closing the gender gap in radiology.
Introduction
Although the percentage of women graduating from medical schools in the United States has increased significantly in the last few decades, reaching almost 50% in 2007, there has not been a parallel increase in gender composition of medical graduates pursuing diagnostic radiology residency programs . The proportion of women starting a career in radiology has remained remarkably stagnant since at least 1980, when 25.5% of all radiology residents were female . As of 2013, women made up just 26.8% of all the radiology residents, demonstrating only a 1.3% increase in more than 30 years . Conversely, the gender landscape in other specialties has changed significantly during this same period of time. In the 1980s and prior, female residents were concentrated in internal medicine, obstetrics and gynecology, pediatrics, and family medicine . Since then, women have redistributed throughout most other specialties, even those that are historically male predominant such as surgery and the various surgical subspecialties . Radiology has not benefitted from this redistribution of women in medicine, as evidenced by the fact that the proportion of women in the specialty has not significantly changed.
The reason women continue to be underrepresented in radiology has been studied at length, including baseline interest of medical students in radiology, factors influencing interest, and whether these factors differ between genders . Lifestyle factors and other characteristics that influence whether medical students choose radiology as a career, such as the amount of patient contact, salary, and competitiveness, have also been described in relationship to gender . The influence of female role models, program directors, and faculty in determining a female medical student’s career path has also been investigated in several articles .
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Methods
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Results
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Table 1
Distribution of Female Applicants as Percentage of Total Applicant Pool, Applicants Invited to Interview, Applicants Ranked, and Applicants Ranked in Top Quartile, 2008–2014
2008 2009 2010 2011 2012 2013 2014 Average All applicants Female 144 152 175 140 144 122 116 142 Male 480 483 485 441 409 409 417 446 % Female of total 23.1% 23.9% 26.5% 24.1% 26.0% 23.0% 21.8% 24.1% Invited to interview Female 38 31 34 38 35 33 41 36 Male 92 73 78 74 72 102 96 84 % Female of total 29.2% 29.8% 30.4% 33.9% 32.7% 24.4% 29.9% 30.1% Ranked Female 32 26 23 23 22 21 29 25 Male 68 45 57 56 54 69 71 60 % Female of total 32.0% 36.6% 28.8% 29.1% 28.9% 23.3% 29.0% 29.7% Ranked in top 25% Female 7 7 6 10 7 7 11 8 Male 12 11 14 10 12 16 15 13 % Female of total 36.8% 38.9% 30.0% 50.0% 36.8% 30.0% 42.3% 37.8%
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Table 2
National ERAS Data: Number of Applicants to ACGME Radiology Residency Programs per Year by Gender
2010 2011 2012 2013 2014 Average All applicants Total 2322 2592 2637 2780 2632 2592 Female 712 830 780 826 758 781 Male 1607 1759 1856 1954 1872 1810 No answer 3 3 1 0 2 2 % Female of total 30.7% 32.1% 29.6% 29.7% 28.8% 30.2%
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Discussion
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Conclusion
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