Applying Representation Quotient Methodology to Racial/Ethnic and Gender Trends of Applicants and Matriculants to Neurology Residency Programs from 2007–2021
Elijah Persad-Paisley1, Saba Paracha2, Sanaya Daruvala3, Ali Mahta2, Neishay Ayub4
1Warren Alpert Medical School of Brown University, 2Brown University, 3Rhode Island Hospital, Department of Neurology, 4Brown Neurology
Objective:

To adopt new approaches to evaluating representation trends of racial groups entering neurology.

Background:

Studies examining representation trends of minority groups in neurology residencies do not evaluate diversity patterns in conjunction with the diversity changes occurring in medical schools.

Design/Methods:

Reports on race/ethnicity and gender of U.S. medical school graduates, neurology applicants, and matriculants between 2007–2021 were obtained from the Association of American Medical Colleges. The proportion of each racial/ethnic and gender identity among neurology applicants and matriculants were divided by a denominator of their proportion in the corresponding medical school graduating class year to produce representation quotients among applicants (RQapp) and matriculants (RQmat). Linear regression was performed on yearly RQ values to evaluate for representation changes over time. Non-parametric testing was used to assess differences in average representation within identities among applicants and matriculants. P<0.05 was deemed significant.

Results:

There were 36,383 neurology applicants and 36,196 matriculants. Among applicants, only Asian men had unchanged representation over time (RQapp slope: +2.22´10-3/year); all other groups experienced statistical increases in representation. Asian men (RQapp=1.19), Black men (RQapp=1.16), and Hispanic men (RQapp=1.07) were the only identities to have an average RQapp>1 among applicants. Only Asian men (RQmat slope: –8.04×10-3/year) and Asian women (RQmat slope: –1.54×10-2/year) had declines in matriculant representation during the study period, with all other groups having either positive or unchanged RQmat slopes. White men (RQapp=0.50 vs. RQmat=0.82; p<0.01) and White women (RQapp=0.41 vs. RQmat=0.78; p<0.01) had the largest increases in representation average when comparing applicants to matriculants. Despite having an RQapp>1, Black men experienced the largest decrease in representation average between cohorts (RQapp=1.16 vs. RQmat=0.67; p<0.01).

Conclusions:

Most racial groups experienced increases in representation among neurology applicants and matriculants, but women and Black men were underrepresented as neurology matriculants. Greater support is needed for these groups to ensure their equitable recruitment into neurology.

10.1212/WNL.0000000000202822