Shaking Up the Status Quo
Expanding the ophthalmology pipeline for those who are underrepresented in medicine is critical, say Wilmer faculty and trainees, who are focused on doing just that.
As with most medical specialties, ophthalmology suffers from a lack of diversity. While underrepresented minority groups comprise over 30% of the United States, physicians who are underrepresented in medicine (URM) make up only 6% of practicing ophthalmologists. Research shows this lack of diversity can contribute to health disparities and affect patient outcomes, notes Fasika Woreta, M.D., M.P.H., the Eugene de Juan, M.D. Professor of Ophthalmic Education at Wilmer.
Sharon Solomon, M.D., 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.
Woreta, director of Wilmer’s residency program and a graduate of its class
of 2011, says efforts to increase the number of URM trainees entering ophthalmology must start with creating opportunities for exposure to the field.
Now in its fourth year, Wilmer’s Diversity Scholars Program exposes rising second-year URM medical students to ophthalmology and provides them with opportunities for mentored research, which often focuses on issues of underrepresentation in medicine. Last year, Woreta mentored medical student Ugochi Aguwa. 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, M.D., on barriers to residency program diversity recruitment. That paper — which advised creating diversity education resource toolkits that could be shared to provide programs with needed support — was published in the Journal of Surgical Education.
In addition, Aguwa shadowed Solomon, a retina specialist who, noting Aguwa’s record of publication and interest in ophthalmology, 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, Ph.D., M.P.H., a young epidemiologist at the Johns Hopkins Bloomberg School of Public Health, to serve.
“Dr. Ervin and student-doctor Aguwa are incredibly talented and accomplished women of African descent,” Solomon says, noting that their expertise, fresh perspectives and steadfast work ethic benefit the committee’s efforts. Solomon also saw the move as an opportunity 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 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 since some medical schools, including most historically Black ones, lack home ophthalmology programs. She points out that students without exposure to ophthalmology are less likely to choose the profession, and if they do, they face barriers to finding mentors in the absence of a home ophthalmology program.
In fact, URM students entering ophthalmology may not have encountered a single URM role model in the field. Leangelo Hall, M.D., was attending the National Medical Association annual meeting’s ophthalmology section when he heard a talk by Adrienne Scott, M.D., 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.”
Hall, who hails from Miami and attended Harvard University, was considering staying in Boston or going to Miami for his residency, but after talking with Scott about Wilmer’s diversity efforts, he took a closer look at its program, where he is now a fourth-year resident.
As a medical student at Yale University, Anuoluwapo Sopeyin, M.D., 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 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.
Additional efforts to expose URM medical students to the field are underway through programs offered by AAO, the Association of University Professors of Ophthalmology (AUPO) and Johns Hopkins Medicine. Wilmer faculty have mentored students through the Minority Ophthalmology Mentoring (MOM) program, a partnership between AAO and AUPO. The program assigns mentors to URM college students through the second year of medical school, who guide them through the process of becoming an ophthalmologist. A member of the MOM metrics subcommittee, Woreta says it’s exciting to see that programs such as MOM and the Rabb-Venable Program are making a difference.
(The Rabb-Venable Excellence in Ophthalmology Program supports medical students, residents and fellows in ophthalmology who are underrepresented in medicine or who desire to work in underserved communities.)
Woreta also co-chairs an AAO subcommittee on diversity and inclusion education that provides resources for program directors, including a toolkit to raise awareness of factors that lead to underrepresentation in ophthalmology, such as unconscious bias and lack of mentorship.
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 others have room for improvement. We share ideas and best practices that we can implement in our own programs,” she says.
The Johns Hopkins GME office organizes a virtual elective in equitable health care for visiting fourth-year medical students, who study specialty-specific content and attend group sessions on achieving health equity. Elise Mike, M.D., Ph.D., took the elective, which included interactive lectures by Wilmer faculty. “Although many programs highlight diversity as a feature, Wilmer was one of the few that demonstrated representation of those systematically excluded and marginalized among 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 an interactive lecture series called “Normalizing Antiracism in Ophthalmology.” The trio led sessions at several academic medical centers, including Wilmer, where Mike is a second-year resident. Plans for additional sessions are in the works.
Woreta is grateful for the support provided by the Eugene de Juan, M.D. Professorship in Ophthalmic Education, including the gift of time to focus on teaching and research. “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,” she says.