Abstract
The purpose of this scoping review is to determine trends in racial and ethnic representation, identify barriers and facilitators to greater diversity, and assess strategies and interventions to advance diversity among those in the pediatric research workforce in the U.S. We conducted a scoping review of PubMed supplemented with the authors’ personal library of papers published from January 1, 2010, to December 31, 2021. To be eligible, papers had to provide original data, be published in English, report information from a U.S. healthcare institution, and report on outcomes of interest relevant to the child health field. The diversity of faculty has modestly increased over the past decade but reflects a worsening representation compared to overall population trends. This slow increase reflects a loss of diverse faculty and has been referred to as a “leaky pipeline.” Strategies to plug the “leaky pipeline” include greater investments in pipeline programs, implementation of holistic review and implicit bias training, development of mentoring and faculty programs targeted to diverse faculty and trainees, alleviation of burdensome administrative tasks, and creation of more inclusive institutional environments. Modest improvements in the racial and ethnic diversity of the pediatric research workforce were identified. However, this reflects worsening overall representation given changing U.S. population demographics.
Impact
-
Racial and ethnic diversity in the pediatric research workforce has shown modest increases but worsening overall representation.
-
This review identified barriers and facilitators at the intrapersonal, interpersonal, and institutional levels that impact BIPOC trainees and faculty career advancement.
-
Strategies to improve the pathway for BIPOC individuals include greater investments in pipeline and educational programs, implementation of holistic review admissions and bias training, institution of mentoring and sponsorship, alleviation of burdensome administrative responsibilities, and creation of inclusive institutional climates.
-
Future studies should rigorously test the effects of interventions and strategies designed to improve diversity in the pediatric research workforce.
Similar content being viewed by others
Log in or create a free account to read this content
Gain free access to this article, as well as selected content from this journal and more on nature.com
or
References
Stolberg, S. G. Pandemic within a pandemic: coronavirus and police brutality roil black communities. New York Times (2020).
Conrad, S. S., Addams, A. N. & Young, G. H. Holistic review in medical school admission and selection: a strategic, mission-driven response to shifting societal needs. Acad. Med. 91, 1472–1474 (2016).
Witzburg, R. A. & Sondheimer, H. M. Holistic review—shaping the medical profession one applicant at a time. N. Engl. J. Med. 368, 1565 (2013).
Page, S. The Difference: How the Power of Diversity creates Better Groups, Firms, Schools, and Societies (Princeton University Press, Princeton, NJ, 2007).
The compelling need for diversity in higher education. Mich. J. Race Law 5, 241–263 http://www.vpcomm.umich.edu/admissions/research/#um (1999).
Association of American Medical Colleges. Diversity in Medicine (Association of American Medical Colleges, Washington, DC, 2019).
U.S. Census Bureau. Quick facts: United States. 2019 (accessed 1 December 2020); https://www.census.gov/quickfacts/table/PST045215/00.
Walker, L. R. & Stapleton, F. B. Pediatric faculty diversity: a new landscape for academic pediatrics in the 21st century. JAMA Pediatr. 167, 989–990 (2013).
Tricco, A. C. et al. PRISMA extension for scoping reviews (PRISMA-ScR): checklist and explanation. Ann. Intern. Med. 169, 467–473 (2018).
Association of American Medical Colleges. Diversity in Medicine: Facts and Figures 2019. Association of American Medical Colleges. 2019 (accessed 31 December 2021); https://www.aamc.org/data-reports/workforce/report/diversity-medicine-facts-and-figures-2019.
Esparaz, J. R. et al. Trending diversity: reviewing four-decades of graduating fellows and the current leadership in pediatric surgery. J. Pediatr. Surg. 56, 1294–1298 (2021).
Fassiotto, M. et al. Rank Equity Index: measuring parity in the advancement of underrepresented populations in academic medicine. Acad. Med. 95, 1844–1852 (2020).
Guevara, J. P., Adanga, E., Avakame, E. & Brooks Carthon, M. Minority faculty development programs and underrepresented minority faculty representation at U.S. medical schools. JAMA 310, 2297–2304 (2013).
Higgins, M. C. et al. Underrepresentation of women and minorities in the United States IR Academic Physician Workforce. J. Vasc. Inter. Radio. 27, 1837–1844.e1832 (2016).
Kassam, A.-F., Taylor, M., Cortez, A. R., Winer, L. K. & Quillin, R. C. Gender and ethnic diversity in academic general surgery department leadership. Am. J. Surg. 221, 363–368 (2021).
Lett, E., Murdock, H. M., Orji, W. U., Aysola, J. & Sebro, R. Trends in racial/ethnic representation among US medical students. JAMA Netw. Open 2, e1910490 (2019).
Lett, L. A., Orji, W. U. & Sebro, R. Declining racial and ethnic representation in clinical academic medicine: a longitudinal study of 16 U.S. medical specialties. PLoS One 13, e0207274 (2018).
Mehta, L. S. et al. Current demographic status of cardiologists in the United States. JAMA Cardiol. 4, 1029–1033 (2019).
Montez, K. et al. Trends in race/ethnicity of pediatric residents and fellows: 2007-2019. Pediatrics 148, 1 (2021).
Warner, E. T., Carapinha, R., Weber, G. M., Hill, E. V. & Reede, J. Y. Considering context in academic medicine: differences in demographic and professional characteristics and in research productivity and advancement metrics across seven clinical departments. Acad. Med. 90, 1077–1083 (2015).
Xierali, I. M., Nivet, M. A. & Rayburn, W. F. Full-time faculty in clinical and basic science departments by sex and underrepresented in medicine status: a 40-year review. Acad. Med. 96, 568–575 (2021).
Agawu, A. et al. The influence of gender and underrepresented minority status on medical student ranking of residency programs. J. Natl Med. Assoc. 111, 665–673 (2019).
Andriole, D. A. & Jeffe, D. B. Predictors of full-time faculty appointment among MD-PhD program graduates: a national cohort study. Med Educ. Online 21, 30941 (2016).
Aysola, J. et al. Perceptions of factors associated with inclusive work and learning environments in health care organizations: a qualitative narrative analysis. JAMA Netw. Open 1, e181003 (2018).
Campbell, K. M., Corral, I., Infante Linares, J. L. & Tumin, D. Projected estimates of african american medical graduates of closed historically black medical schools. JAMA Netw. Open 3, e2015220 (2020).
Campbell, K. M. & Tumin, D. Mission matters: association between a medical school’s mission and minority student representation. PLoS One 16, e0247154 (2021).
Dixon, G. et al. Factors that influence the choice of academic pediatrics by underrepresented minorities. Pediatrics 144, 2 (2019).
Dixon, G. et al. Factors that influence underrepresented in medicine (UIM) medical students to pursue a career in academic pediatrics. J. Natl Med. Assoc. 113, 95–101 (2021).
Flores, G. et al. Keys to academic success for under-represented minority young investigators: recommendations from the Research in Academic Pediatrics Initiative on Diversity (RAPID) National Advisory Committee. Int. J. Equity Health 18, 93 (2019).
Ginther, D. K. et al. Race, ethnicity, and NIH research awards. Science 333, 1015–1019 (2011).
Hassouneh, D., Lutz, K. F., Beckett, A. K., Junkins, E. P. & Horton, L. L. The experiences of underrepresented minority faculty in schools of medicine. Med. Educ. Online 19, 24768 (2014).
Johnson, T. J. et al. Implicit bias in pediatric academic medicine. J. Natl Med. Assoc. 109, 156–163 (2017).
Kalet, A. et al. Mentoring underrepresented minority physician-scientists to success. Acad. Med. 97, 497–502 (2022).
Kaplan, S. E. et al. Race/ethnicity and success in academic medicine: findings from a longitudinal multi-institutional study. Acad. Med. 93, 616–622 (2018).
Konuthula, D. et al. Perspectives on anti-black racism and mitigation strategies among faculty experts at academic medical centers. JAMA Netw. Open 5, e228534 (2022).
Liu, C. & Hershel, A. Promotion rates for first-time assistant and associate professors appointed from 1967 to 1997. AAMC, The Association of American Medical Colleges. 2010 (accessed 21 July 2022); http://www.lifescitrc.org/resource.cfm?submissionID=3931.
Nfonoyim, B., Martin, A., Ellison, A., Wright, J. L. & Johnson, T. J. Experiences of underrepresented faculty in pediatric emergency medicine. Acad. Emerg. Med. 28, 982–992 (2021).
Rodríguez, J., Campbell, K. & Mouratidis, R. Where are the rest of us? Improving representation of minority faculty in academic medicine. South. Med. J. 107, 739–744 (2014).
Williams, M. et al. The impact of United States Medical Licensing Exam (USMLE) step 1 cutoff scores on recruitment of underrepresented minorities in medicine: a retrospective cross-sectional study. Health Sci. Rep. 3, e2161 (2020).
Xierali, I. M., Nivet, M. A., Syed, Z. A., Shakil, A. & Schneider, F. D. Recent trends in faculty promotion in U.S. medical schools: implications for recruitment, retention, and diversity and inclusion. Acad. Med. 96, 1441–1448 (2021).
Beech, B. M. et al. Mentoring programs for underrepresented minority faculty in academic medical centers: a systematic review of the literature. Acad. Med. 88, 541–549 (2013).
Escalante, E. et al. Increasing pediatric residency class diversity to improve patient outcomes and address structural racism. Acad. Med. 97, 850–854 (2022).
Flores, G., Mendoza, F., Brimacombe, M. B. & Frazier, W. Program Evaluation of the Research in Academic Pediatrics Initiative on Diversity (RAPID): impact on career development and professional society diversity. Acad. Med. 96, 549–556 (2021).
Grbic, D., Morrison, E., Sondheimer, H. M., Conrad, S. S. & Milem, J. F. The association between a holistic review in admissions workshop and the diversity of accepted applicants and students matriculating to medical school. Acad. Med. 94, 396–403 (2019).
Guevara, J. P., Wright, M., Fishman, N. W., Krol, D. M. & Johnson, J. The Harold Amos Medical Faculty Development Program: evaluation of a national program to promote faculty diversity and health equity. Health Equity 2, 7–14 (2018).
Holsti, M. et al. Lessons from the first decade of the native American summer research internship at the University of Utah. Acad. Med. 96, 522–528 (2021).
Lewis, V. et al. A randomized controlled trial of mentoring interventions for underrepresented minorities. Acad. Med. 91, 994–1001 (2016).
Marbin, J. et al. Improving diversity in pediatric residency selection: using an equity framework to implement holistic review. J. Grad. Med. Educ. 13, 195–200 (2021).
Ognibene, F. P., Gallin, J. I., Baum, B. J., Wyatt, R. G. & Gottesman, M. M. Outcomes from the NIH clinical research training program: a mentored research experience to enhance career development of clinician-scientists. Acad. Med. 91, 1684–1690 (2016).
Pachter, L. M. & Kodjo, C. New century scholars: a mentorship program to increase workforce diversity in academic pediatrics. Acad. Med. 90, 881–887 (2015).
Page, K. R., Castillo-Page, L. & Wright, S. M. Faculty diversity programs in U.S. medical schools and characteristics associated with higher faculty diversity. Acad. Med. 86, 1221–1228 (2011).
Rice, T. K. et al. Mentored training to increase diversity among faculty in the biomedical sciences: the NHLBI Summer Institute Programs to Increase Diversity (SIPID) and the Programs to Increase Diversity among Individuals Engaged in Health-related Research (PRIDE). Ethn. Dis. 27, 249–256 (2017).
Tsoh, J. Y. et al. Developing faculty leadership from ‘within’: a 12-year reflection from an internal faculty leadership development program of an academic health sciences center. Med. Educ. Online 24, 1567239 (2019).
Wingard, D., Trejo, J., Gudea, M., Goodman, S. & Reznik, V. Faculty equity, diversity, culture and climate change in academic medicine: a longitudinal study. J. Natl Med. Assoc. 111, 46–53 (2019).
Anonymous. Holistic Review. Association of American Medical Colleges. 2021 (accessed 23 April 2021); https://www.aamc.org/services/member-capacity-building/holistic-review#top.
Gordon, E. K. B. et al. The role of the interview in residency selection: a mixed methods study. Med. Educ. 54, 1029–1039 (2020).
Smedley, B. D., Stith, A. Y., Nelson, A. R. eds. Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care. (Institute of Medicine, National Academy Press, Washington, DC, 2002).
Mendoza, F. S., Fuentes-Afflick, E. & Walker-Harding, L. R. Diversity and inclusion in pediatrics: imperative, not optional. Pediatr. Res. 86, 558–559 (2019).
Lett, L. A., Murdock, H. M., Orji, W. U., Aysola, J. & Sebro, R. Trends in racial/ethnic representaton among U.S. medical students. JAMA Netw. Open 2, e1910490 (2019).
Barr, D. A. et al. The leaky pipeline: factors associated with early decline in interest in premedical studies among underrepresented minority undergraduate students. Acad. Med. 83, 503–511 (2008).
Sackett, P. R., Kuncel, N. R., Ameson, J. J., Cooper, S. R. & Waters, S. D. Socioeconomic Status and the Relationship between the SAT and Freshman GPA: An Analysis of Data from 41 Colleges and Universities. Research Report 2009-1 (The College Board, New York, 2009).
Geiser, S. The Growing Correlation between Race and SAT Scores: New Findings from California (Center for Studies in Higher Education, Berkeley, CA, 2015).
Kids Count Data Center. Children in Poverty by Race and Ethnicity in the United States, 2010-2019. Annie E Casey Foundation (accessed 2020); https://datacenter.kidscount.org/data/tables/44-children-in-poverty-by-race-and-ethnicity#detailed/1/any/false/1729,37,871,870,573,869,36,868,867,133/10,11,9,12,1,185,13/324,323.
Boyd, R. W. The case for desegregation. Lancet 393, 2484–2485 (2019).
Sullivan Commission. Missing Persons: Minorities in the Health Professions—A Report of the Sullivan Commission on Diversity in the Healthcare Workforce (Sullivan Commission, Washington, DC, 2004).
Williams, C. et al. A call to improve conditions for conducting holistic review in graduate medical education recruitment. Mededpublish 8, 6 (2019).
Guh, J., Harris, C. R., Martinez, P., Chen, F. M. & Gianutsos, L. P. Antiracism in residency: a multimethod intervention to increase racial diversity in a community-based residency program. Fam. Med. 51, 37–40 (2019).
Adanga, E., Avakame, E., Brooks Carthon, M. & Guevara, J. P. An environmental scan of faculty diversity programs at U.S. medical schools. Acad. Med. 87, 1540–1547 (2012).
Campbell, K. M. et al. Releasing the net to promote minority faculty success in academic medicine. J. Racial Ethn. Health Disp. 7, 202–206 (2020).
Rodriguez, J. E. et al. Addressing disparities in academic medicine: what of the minority tax? BMC Med. Educ. 15, 6 (2015).
Blackstock, U. Why black doctors like me are leaving academic medicine. STAT (16 January 2020).
Aysola, J., Harris, D., Huo, H., Wright, C. S. & Higginbotham, E. Measuring organizational cultural competence to promote diversity in academic healthcare organizations. Health Equity 2, 316–320 (2018).
Alexis, D. A. et al. Assessment of perceptions of professionalism among faculty, trainees, staff, and students in a large university-based health system. JAMA Netw. Open 3, e2021452 (2020).
Acknowledgements
We would like to thank Michael Luethke for his assistance in pulling the full text of potentially eligible papers.
Author information
Authors and Affiliations
Contributions
J.P.G., J.A., R.W., B.N., and K.N.C. conceptualized the study. M.Q. conducted the literature search. M.R. pulled the full text of the papers and abstracted the data. All authors participated in drafting and editing of the manuscript, and approved the final version submitted.
Corresponding author
Ethics declarations
Competing interests
The authors declare no competing interests.
Additional information
Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Supplementary information
Rights and permissions
Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.
About this article
Cite this article
Guevara, J.P., Aysola, J., Wade, R. et al. Diversity in the pediatric research workforce: a scoping review of the literature. Pediatr Res 94, 904–914 (2023). https://doi.org/10.1038/s41390-023-02603-4
Received:
Revised:
Accepted:
Published:
Version of record:
Issue date:
DOI: https://doi.org/10.1038/s41390-023-02603-4
This article is cited by
-
Hemodynamics assessment in critically ill children with increased intra-abdominal pressure
Egyptian Pediatric Association Gazette (2025)


