Shaking Up the Status Quo
As with most medical specialties, there is a lack of diversity in ophthalmology. Black History Month is an opportunity to celebrate efforts underway at Wilmer Eye Institute, Johns Hopkins Medicine, to change the status quo.
Fasika Woreta, the Eugene de Juan, M.D., Professor of Ophthalmic Education at Wilmer, points out that a lack of diversity affects more than just diversity of thought — it can also contribute to health disparities and affect patient outcomes. Sharon Solomon, the Katharine M. Graham Professor of Ophthalmology and the first African American promoted to full professor at Wilmer, agrees. “For some patients, their level of trust, confidence and adherence to medical recommendations are clearly bolstered by interacting with a physician with whom they identify,” Solomon says.
That can be challenging in the U.S., where under-represented minority groups comprise over 30% of the population, yet make up only 6% of practicing ophthalmologists. Woreta, director of Wilmer’s residency program and a graduate of Wilmer class of 2011, says efforts to increase the number of underrepresented in medicine (URM) students entering ophthalmology must start with creating opportunities to be exposed to the field.
Learning by Example
Now in its fifth year, Wilmer’s Diversity Scholars Program exposes rising second-year URM students to ophthalmology and provides them with opportunities for mentored research — research that often centers around issues of under-representation in medicine. Last year, Woreta mentored student Ugochi Aguwa, and together they published an editorial in the American Journal of Ophthalmology calling for greater racial diversity in the ophthalmology workforce. Aguwa also produced a paper with Wilmer’s vice chair of education, Divya Srikumaran, on barriers to implementation of residency program diversity recruitment. That paper was published in the Journal of Surgical Education.
Aguwa shadowed Solomon, a retina specialist, and, noting Aguwa’s track record of publication and her interest in ophthalmology, Solomon invited her to serve on a committee she co-chairs as part of an American Academy of Ophthalmology (AAO) task force on disparities in eye care. Solomon also recruited Ann Margret Ervin, a young epidemiologist at the Johns Hopkins Bloomberg School of Public Health, to serve on the committee.
“Both Dr. Ervin and student-doctor Aguwa are incredibly talented and accomplished women of African descent,” Solomon says, adding that their expertise, fresh perspectives and steadfast work ethic benefit the committee’s work. But Solomon also saw the moves as opportunities to support the women. “I hoped to put on the academy’s radar two incredibly talented colleagues, one in the early part of her academic career and the other just about to apply for training in ophthalmology,” Solomon says. “I recognized existing talent and offered it a chance to thrive. That is how one increases diversity in the ranks.”
Woreta says programs such as Diversity Scholars are especially important because some medical schools, including most that are historically Black, don’t have home ophthalmology programs. Students without exposure to ophthalmology during medical school are less likely to choose the profession, and if they do pursue ophthalmology, says Woreta, they face barriers while trying to find mentors in the absence of a home ophthalmology program.
URM students planning to enter ophthalmology may not have encountered a single URM role model in the field. Leangelo Hall was attending the National Medical Association annual meeting’s ophthalmology section when he heard a talk by Adrienne Scott, an associate professor of ophthalmology and co-chair of Wilmer’s Diversity Council. “It was really inspiring to see somebody that looks like me,” Hall says. “Just to see somebody that was a Black ophthalmologist, and successful and smart and kind, were all things that were new to me.”
Afterward, Scott spoke with Hall and another prospective applicant about Wilmer’s residency program. “She told me that Dr. Woreta was a huge advocate for diversity,” says Hall. “That was really appealing to me. Not only was Wilmer a top ophthalmology center, but they were targeting diversity.” Hall, who hails from Miami and attended Harvard University, had been considering staying in Boston or going to Miami for his residency, but the talk with Scott led him to take a closer look at Wilmer, where he is now a third-year resident.
As a medical student at Yale University, Anuoluwapo Sopeyin, who is from Nigeria, found an accepting and diverse culture, but as a research assistant in New York City, she was the only Black person in the laboratory. “Some of my colleagues couldn’t understand the challenges I faced with being a woman of color and navigating the academic landscape,” says Sopeyin, adding that the experience helped her appreciate what it means to value diversity in academia and science and to have programs in which people from diverse backgrounds are encouraged and mentored. Today, she too is a Wilmer resident.
Making a Difference
Additional efforts to expose URM students to the ophthalmology field are underway through a variety of programs offered by organizations including the AAO, the Association of University Professors of Ophthalmology (AUPO) and Johns Hopkins Medicine.
Wilmer faculty members have mentored students through the Minority Ophthalmology Mentoring (MOM) program, a partnership between the AAO and the AUPO. The program accepts URM college students through the second year of medical school and assigns them a mentor who guides them through the process of becoming an ophthalmologist. Woreta, a member of the MOM metrics subcommittee, says it’s exciting to see that programs such as MOM and Rabb-Venable Excellence in Ophthalmology are making a difference.*
Woreta also co-chairs an AAO subcommittee on diversity and inclusion education that provides resources for program directors, including a toolkit to enhance diversity initiatives and raise awareness of factors that lead to under-representation in the ophthalmology field. In addition, she serves on a Graduate Medical Education (GME) diversity recruitment subcommittee with other program directors from Johns Hopkins Medicine. “Some of our residency programs are doing well with regard to diversity in recruitment, whereas other programs have room for improvement, so we try to share ideas and best practices that we can implement in our own programs,” she says.
The Office of Graduate Medical Education at Johns Hopkins organizes a virtual elective in equitable health care for visiting fourth-year medical students interested in its residency programs. Students taking the elective study specialty-specific content and participate in group sessions that focus on achieving health equity. Elise Mike took the elective during her last year of medical school and attended interactive lectures by Wilmer faculty. “Although many programs highlight diversity as a feature, Wilmer was one of the few programs that demonstrated representation of those systematically excluded and marginalized in the residents and faculty,” she says.
Mike subsequently published a commentary in JAMA Ophthalmology about the need for more direct action to increase the number of minority ophthalmology residents nationwide. She also worked with two residents to create the interactive Normalizing Antiracism in Ophthalmology lecture series. The trio has led sessions at two academic medical centers, and another is scheduled to take place next month at Johns Hopkins, where Mike is a first-year ophthalmology resident.
Woreta says she’s grateful for the support provided by the Eugene de Juan professorship, which gives her time to focus on her diversity outreach work. “That they dedicated the professorship to the residency program director in the name of education is unique to Wilmer and reflects Wilmer’s history of teaching and mentorship,” Woreta says. The efforts appear to be paying off: Wilmer Eye Institute’s residency program is more diverse today than it has ever been.
* Knight, O. R. J., Padovani-Claudio, D. A., Croteau-Chonka, C. C., Olivier, M. M. G., & Miller-Ellis, E. G. (2021, December 31). Rabb–Venable Excellence in Ophthalmology Research Program: Contributions to Ophthalmology Workforce Diversity. Journal of Academic Ophthalmology. Retrieved February 3, 2022, from https://www.thieme-connect.com/products/ejournals/abstract/10.1055/s-0041-1736215