April 29, 2022
3 min read
Batnyam U, et al. Abstract PO-627-02. Presented at: Heart Rhythm 2022; April 29-May 1, 2022; San Francisco (hybrid meeting).
Disclosures: Tedrow reports receiving honoraria/speaking/consultant fees from Baylis, Biosense Webster, Boston Scientific, Medtronic, St. Jude Medical and Thermedical.
The rates of women or people from historically underrepresented groups applying for electrophysiology fellowships are low, researchers reported at Heart Rhythm 2022.
Usha B. tedrow
“It is known that cardiac electrophysiology as a specialty has low representation of women and underrepresented minorities at the attending level,” Usha B. tedrowMD, MS, FHRS, director of the clinical cardiac electrophysiology fellowship program and clinical director of the ventricular arrhythmia program at Brigham and Women’s Hospital and associate professor of medicine at Harvard Medical School, told Healio. “We thought it was important to attempt to quantify the representation at the level of the pipeline of trainees entering fellowship training. Prior to clinical cardiac electrophysiology as a specialty participating in the Electronic Residency Application Service (ERAS) and the National Resident Matching Program (NRMP), we had essentially no data on demographics of trainees and applicants seeking electrophysiology training. In the last 3 years, that has changed, and we have for the first time 3 years’ worth of data on applicants to electrophysiology.”
For the 2019 to 2021 academic years, 5% to 6% of CVD fellows chose to subspecialize in clinical cardiac electrophysiology, according to the researchers. Of those, women comprised 13% in 2019, 15% in 2020 and 15% in 2021, an increase that was not statistically significant, and representation of people from historically underrepresented groups was even lower: Black/African American applicants comprised 3% in 2019 , 5% in 2020 and 3% in 2021; Hispanic/Latino/Spanish origin applicants comprised 4% in 2019, 5% in 2020 and 5% in 2021; and there were no applications from people of American Indian/Alaska Native or Hawaiian/Other Pacific Islander in any of the 3 years, according to the researchers.
In 2021, women represented 47.6% of students in medical school and 42.7% of internal medicine residents, but only 23.2% of CVD fellows and 14.6% of clinical cardiac electrophysiology fellows, according to the findings, which were simultaneously published in JACC: Clinical Electrophysiology. Also in 2021, people from historically underrepresented groups comprised 10.4% of those in medical school, 13.6% of residents in internal medicine, 9.1% of CVD fellows and 7.3% of clinical cardiac electrophysiology fellows.
“The problem is multifactorial,” Tedrow told Healio. “For women, we attempted to quantify in our study the degree of attrition occurring between medical school, internal medicine residency, general cardiology and clinical cardiac electrophysiology. The degree of attrition is significant, with a large step down occurring between internal medicine and cardiovascular disease training. However, another major step down in representation of women occurs between cardiovascular disease and electrophysiology, with only 6% of cardiovascular trainees selecting clinical cardiac electrophysiology as a specialty. Others have attempted to quantify with surveys why this may be the case. Factors such as worry about fluoroscopic exposure, not fitting in in an old boys’ network, worry about sexual harassment and difficulty with the prevalence of female role models were all identified (Abdulsalam N, et al. J Am Coll Cardiol. 2021;doi:10.1016/j.jacc.2021.06.033). With underrepresented minorities, our data suggested the story is somewhat different. We found consistent low representation at each stage of training from medical school through clinical cardiac electrophysiology. We do not have data on the preferences of these applicants in the way that we do for women. It is possible and likely that the priorities are different in many areas.”
Improvement in recruitment processes will be important going forward, Tedrow said.
“Survey data (Crowley AL, et al. J Am Heart Assoc. 2020;doi:10.1161/JAHA.120.017916) emphasizes the need for cardiology training programs to ensure that our recruitment process is equitable, and that we also focus on developing a ‘deep pipeline’ of trainees from in our immediate institutions where we all reside and work,” she told Healio. “This means cultivating both women and underrepresented minorities from the level of medical school and internal medicine at our home institutions. Cardiac electrophysiology has a lot to learn from these data.”
Also, she said, “to improve representation, we need to educate trainees about fluoroscopy-free procedures in EP and have zero tolerance for hostile work environments.”
While the numbers appear discouraging, there is hope, Tedrow told Healio.
“The data from our study are not all grim,” she said. “Women are present in a higher proportion among these applicants to electrophysiology specialty training then they are out in practice currently. This suggests that the future is likely to show some improvement in representation.”