The IR exposure problem

How present is IR exposure at historically Black colleges and universities?

by Ria Singh, BS, Eric Cyphers, Vishal Kumar, MD, FSIR

October 22, 2024

10:51 AM

Interventional radiology is a patient-facing specialty, and the increasing demand of minimally invasive procedures places it at the forefront of medicine. With growing minority and non-English speaking populations in the United States, there is an inherent need to diversify the IR workforce.

However, a recent review of IR exposure at medical schools with a high proportion of underrepresented minorities (URMs)—particularly focusing on historically Black colleges or universities (HBCUs)—found that no active HBCUs or osteopathic (DO) schools provide students with high-IR exposure.

The need for IR exposure

Diversifying the IR workforce has two-fold benefits. Firstly, racial/ethnic minority providers are more likely to practice in underserved areas, serving about 54% of minority patients and 70% of non-English speaking patients.¹ The patient population is also found to report increased contentment with their treatment when the provider is from the same cultural or ethnic background.² Secondly, the innovative nature of IR needs the intellectual diversity and productivity that comes with a varied workforce. With a large working pool of talent, cooperation between physicians with different lived experiences, perspectives and skillsets leads to well-informed patient care.³

Consistent efforts are being made by the field to diversify its workforce; however, the subjective and unstructured interview format of radiology residency programs disproportionately affects certain populations by introducing implicit bias. The conversational “ice-breaker questions” can be intertwined with unintentional microaggressions targeting certain ethnic or racial minority groups.⁴

In addition, osteopathic medical students have been historically underrepresented in IR. With no structured exposure to the field, students are at a disadvantage in terms of gaining clinical experiences, which precludes them from opportunities necessary for a successful match into integrated IR positions.⁵ As a result, African Americans among URM and DO graduates are referred together as having faced persistent challenges and underrepresentation in healthcare. These groups, with their nontraditional path to medicine, have the potential to enhance creativity and patient communication to ensure better clinical outcomes and patient satisfaction.⁶

Representation of URM and DO physicians in IR is comparable to other competitive specialties like neurosurgery and urology (figure 1). However, in comparison to dermatology and orthopedic surgery, their representation in IR has been low (figure 1). Data from the 2022 AAMC Physician Specialty Report revealed that of the 4,011 active IR physicians, 3% identified themselves as African American and 3.8% are DO graduates. It is crucial to study and address factors contributing to this reduced representation to help diversify the IR work field.

HBCU Figure 1 - 1

How much IR are HBCUs being exposed to?

Data regarding AAMC applicants and DO physicians was gathered, as well as a list of active HBCUs with medical schools. These institutions were then cross-referenced with the presence of an IR interest group; faculty listings within the SIR membership directory; and presence of an integrated IR residency, fellowship or approved Early Specialization in Interventional Radiology curriculum.⁵

Based on the presence or absence of IR resources and opportunities, institutions were classified into three distinct categories. Category I IR exposure was defined as the combination of an IR interest group, IR faculty listed in the SIR directory, and an approved integrated (or independent) IR residency or fellowship. If an institution had one or two out of the three components, it was characterized as Category II and if the institution did not have any of the three components, it was characterized as Category III (table 1).

By cross-referencing the applicant data with the list of schools, it was found that no active HBCUs or DO schools can be classified in high-IR exposure Category I (table 2). Of the total 44 schools studied, 18 (41%) were classified as Category II and the remaining 26 schools (59%) were classified as Category III (table 2).

Table 1. Categorization of HBCUs and DO medical schools
Category	Presence of IR student interest group	IR faculty as listed per SIR directory	Approved Integrated and/or Independent IR residency or fellowship
I^*
II^†	+ /-	+/-	+/-
III^‡

^*Category I: Presence of IR interest group, IR faculty as listed per SIR directory, and approved integrated IR residency or fellowship.

^†Category II: One or two of the three components.

^‡Category III: No IR interest group, no listed IR faculty and no integrated IR residency.

HBCU = Historically Black Colleges and Universities

DO = Doctor of Osteopathy

The path forward

In 2016, the Journal of Vascular and Interventional Radiology published a letter to the editor characterizing the level of IR exposure at schools with high URMs. That letter underscored the disparities in access to IR education and opportunities among URM medical students.⁷ Since then, efforts by the American College of Radiology Pipeline Initiative for the Enrichment of Radiology (PIER) and the SIR Foundation Grants for Education of Medical Students (GEMS) programs have helped address these disparities.

The applicant pool of the GEMS program has seen a 150% increase in the number of African-American applicants and the number of awardees has increased from three to 10 over the last 3 years.⁸ However, their consistent efforts have been affected by existing systemic issues that continue to lead to low URM and DO representation.

In a study by Daye et al. at four institutions with a high percentage of URM students, 59.2% of students indicated they were less likely to understand the work of IR and indicated no awareness of opportunities for IR exposure.⁹ Among the osteopathic medical schools, less than one-third of the schools provide dedicated IR rotations for students.⁵ In addition, as seen from the study results, 59% of the DO schools and HBCUs have no exposure to IR in the form of student interest groups, SIR faculty and approved IR training programs. As a result, students are at disadvantage when it comes to choosing IR as a third-year elective.

Moreover, even with institutions offering an IR elective, the associated cost imposes financial constraints and further limits access.⁵ One way to increase representation is to have more IR physicians from URM backgrounds involved in the medical school faculty. This would provide opportunities for exposure and mentorship in early preclinical years. Stoehr et al. found that after an IR course with an endovascular simulator, fourth-year medical students reported a two-fold increase in IR interest and were 3.2 times more likely to choose IR as a specialty.¹⁰This demonstrates that well-orchestrated outreach efforts at grassroots medical education levels are a potential way to increase awareness about IR among URM.

Through grassroots awareness campaigns, increased diversity in hiring, and programs such as PIERS or GEMS, there is a pathway to increase URM and DO representation and exposure to IR.

Table 2. Categorization of HBCUs and DO medical schools
Category I: Presence of IR student interest group, and IR faculty as listed per SIR directory, and approved Integrated and/or Independent IR residency or fellowship
NONE
Category II: Any one or two of the three components
Howard University	MD
Morehouse School of Medicine	MD
Meharry Medical School	MD
A.T. Still University School of Osteopathic Medicine in Arizona	DO
Western University of Health Sciences College of Osteopathic Medicine of the Pacific	DO
Western University College of Osteopathic Medicine of the Pacific, Northwest	DO
Michigan State University College of Osteopathic Medicine	DO
Ohio University Heritage College of Osteopathic Medicine	DO
Edward Via College of Osteopathic Medicine	DO
Alabama College of Osteopathic Medicine	DO
NYIT College of Osteopathic Medicine -- Jonesboro, AR	DO
Nova Southeastern University College of Osteopathic Medicine	DO
University of Pikeville Kentucky College of Osteopathic Medicine	DO
William Carey University College of Osteopathic Medicine	DO
University of North Texas Health Science Center College of Osteopathic Medicine	DO
Edward Via College of Osteopathic Medicine - Virginia	DO
Touro College of Osteopathic Medicine - Middletown	DO
Rowan University School of Osteopathic Medicine	DO

Category III: none of the three components present
Touro University California College of Osteopathic Medicine	DO
Rocky Vista University College of Osteopathic Medicine	DO
Idaho College of Osteopathic Medicine	DO
Touro University Nevada College of Osteopathic Medicine	DO
Burrell College of Osteopathic Medicine at New Mexico State University	DO
Pacific Northwest University of Health Sciences	DO
Midwestern University Chicago College of Osteopathic Medicine	DO
Marian University College of Osteopathic Medicine	DO
Des Moines University College of Osteopathic Medicine	DO
Oklahoma State University Health Sciences College of Osteopathic Medicine	DO
Arkansas College of Osteopathic Medicine	DO
Lake Erie College of Osteopathic Medicine - Bradenton Campus	DO
Philadelphia College of Osteopathic Medicine - Georgia Campus	DO
Kansas City University of Medicine and Biosciences College of Osteopathic Medicine	DO
A. T. Still University Kirksville College of Osteopathic Medicine	DO
Campbell University School of Osteopathic Medicine	DO
Edward Via College of Osteopathic Medicine - Carolinas Campus	DO
Lincoln Memorial University DeBusk College of Osteopathic Medicine	DO
University of Incarnate Word School of Osteopathic Medicine	DO
Liberty University College of Osteopathic Medicine (LUCOM)	DO
West Virginia School of Osteopathic Medicine	DO
Lake Erie College of Osteopathic Medicine	DO
University of New England College of Osteopathic Medicine	DO
Philadelphia College of Osteopathic Medicine	DO
New York Institute of Technology College of Osteopathic Medicine, Old Westbury	DO
Touro College of Osteopathic Medicine - Harlem	DO

HBCU = Historically Black Colleges and Universities

DO = Doctor of Osteopathy

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